Very sensitive and dry skin. How to handle!

Hi Dr. Irwin, I've had a problem for many years now. I'm currently 24 and have severely dehydrated and sensitive skin. It started with acne when I was a teenager that I didn't know was linked to diet and I handled it too harshly and wound up damaging my skin with overexfoliation and skin peels for a few years. I've since switched to natural oils for moisturizers and am a lot more gentle with my skin. Full on creams and lotions don't really work anymore and will just make my face feel bone dry. The issue is that every few months or so with a change in the humidity and weather my skin with start to feel very tight and sensitive and won't absorb the oils I put onto it, so my face simultaneously feels oily and dry. I have to find a new type of oil or toner to "unlock" it and make it feel normal again. My face gets agitated with sweat and will dry out if it gets wet, so I try to live a fairly undemanding life. I got in touch with a skin specialist who recommended a lot of great products and informed me this was all linked to a damaged lipid barrier, but even though my skin will feel great for a few months, it still goes back to feeling tight and dry when the weather changes and it feels like I'm back to square one trying to figure it out. If you think you have any ideas why this happens they'd be great to hear. Thank you.

You all ask such great questions.   Thank you!  Was the "skin specialist" you saw a board certified dermatologist?  I'm asking because board certified derms are trained to look for both internal and external causes of skin problems.  For example, you may need labs like a thyroid panel, or testing for celiac sprue.  Or you could have a genetic defect in your barrier layer like atopic dermatitis that may need to be addressed. Let's start with the inside of you.  It may be that you're doing all these things below, but I'd like to make sure.

In my opinion, toners are largely useless.  They just add chemicals and are often drying without providing any real benefit, especially to dry skin.

Have you had a thorough evaluation including:

1. Laboratory tests for internal causes of skin disease, including celiac sprue (a blood test) which can cause you to not absorb the healthy fats you may be eating.
2. A reasonable amount of healthy fats each day contributes to skin health.  For example, olive oil, other vegetable oils, avocados are good examples.  Your skin won't be healthy without these.
3. Are you eating fish like salmon or black cod several times a week, or taking a fish oil supplement.  I like the wild Alaskan salmon ones.
4. A probiotic and a prebiotic may be helpful for your gut.  We know that the skin and the gut are linked.  If you're not sure how to do this, consider talking to a good nutritionist.  Be wary of providers who want to sell you lots of supplements.

For topicals, here are some thoughts:

• Propylene glycol is a low level irritant in many skin care products.  Consequently, it's a good idea to check for that ingredient in everything you are using.  Things like hexylene or butylene glycol are fine.  The MadisonMD products in our SHOP are all propylene glycol free.
• Look at your cleanser especially.  Could you switch to just using a gentle washcloth and plain water for a month or two?
• Most importantly, skin has a natural biome that may be not doing well.  This is where a good gut helps too.  Consider switching to all organic products for a month or two.

It sounds like this problem is really affecting your life in a negative way.  Especially during Covid, many of our patients and staff have needed extra psychological support.  Counseling may be a good option for you too, as you work your way through this tough problem.

Good luck and wishes to you!

Dr. Brandith Irwin