In October, when the Canadian air starts drying out , the men flock to Sandy Skotnicki’s office. The men are itchy. Skotnicki studied micro biology before becoming an assistant professor of dermatology at the University of Toronto. She has been practicing for 23 years, always with an eye to how the environment— including the microbial one on our skin—affects health. “I say to them, ‘How do you shower?’ ” she told me. “They take the squeegee thing and wash their whole body with some sort of men’s body wash. They’re showering twice a day because they’re working out. As soon as I get them to stop doing that and just wash their bits, they’re totally fine.”
Bits? “Bits would be underarms, groin, feet,” she said. “So when you’re in the shower or the bath, do you need to wash here?” She pointed to her forearm. “No.” Even water alone, especially hot water, slowly strips away the oils in the outer layers of skin that help preserve moisture— and the drier and more porous someone’s skin, the more susceptible it is to irritants and allergens.
Skotnicki believes that this is one way overwashing prompts eczema to flare in people with a genetic pre disposition to the disease. While eczema itself can be debilitating, it often does not travel alone. It seems to be part of a constellation of conditions caused by immune-system misfires. Infants with eczema have an increased risk of developing allergic rhinitis or asthma in childhood, part of a cascade of immune-system overreactions known as the “atopic march.”
“And so what if,” Skotnicki speculated, “as a society, you actually triggered eczema by overwashing?”
Now couldn’t be a weirder time to question washing. I’ve spent the past three years reporting on how our notions of what it means to be “clean” have evolved over time—from basic hygiene practices to elaborate rituals that involve dozens of products targeted at each of us by gender and age and “skin type.” At the same time, the incidence of immune-related skin conditions such as eczema and psoriasis has risen in the developed world, while acne is as pernicious as ever, despite the constant stream of expensive new medications and unguents sold to address it.
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July - August 2020