Clean: The New Science of Skin

View in Browser   Key insights from Clean: The New Science of Skin By James Hamblin

What you’ll learn It might sound counterintuitive to take a sabbatical from showering to refresh your skin, but recent studies prove that a bathroom full of skincare products might not improve your bodily health at all—in fact, all of those moisturizers, conditioners, and wrinkle creams might be feeding the problems you’ve been trying to eliminate. Despite the health and skincare industry’s advertisement of various products as wellness necessities, their claims aren’t always scientifically sound and their creations may be corrupting the skin’s “microbiome”—a crucial layer of microbial organisms partly responsible for one’s overall wellness. Writer and physician James Hamblin deconstructs society’s increasingly expensive reliance upon skincare products to reveal a more nuanced understanding of hygiene, skin, and overall human wellbeing.   Read on for key insights from Clean: The New Science of Skin.

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1. You are made of microbes. But you still might want to hold off on that second shower. A quick glance at your skin might not reveal anything even remotely interesting—some hair here, a mole there, and maybe even a few freckles—in short, nothing spectacular. But if you were to peer just a bit closer (presumably with a little help from a microscope), you would see something remarkable: layers upon layers of different cells, nerves, and glands intermingling and ultimately creating the miracle that is your skin. Despite the common and highly advertised belief that a cabinet of skincare products keeps the body’s 20 square feet of skin in pristine, magazine-glowing condition, that may not be the case—and humans may actually have bacteria to thank for that healthy glow, and other benefits. The body’s most plentiful organ, (which the average person spends a tranquil two years cleaning in the shower), contains three layers: the top is the epidermis, the middle portion is the dermis, and the bottom layer is simply a collection of fat and tissue. The epidermis is home to “strata,” or tiny layers of cells which are in a constant state of shedding, a process in which stem cells from the basal layer of the epidermis create new cells to eventually replace the older ones. Entwined within the epidermis and the remaining two layers of skin are nerves, follicles, and glands, each playing an integral role in the self-sustaining nature of skin. Particularly fascinating, the apocrine sweat glands near the armpits and groin area are the unlikely homes of whole microbial worlds. These spaces are populated by creatures with cells that are more numerous than the body’s very own. Don’t freak out, but right now, your face is crawling with tiny arachnids called Demodex. These creatures, looking as if they scurried straight out of a Sci-Fi movie, squirm throughout your pores with various other microbes, most of which are too tiny for the human eye to see. While this certainly isn’t a pleasant image to conjure, it leads to a much more complete (though slightly terrifying) understanding of skin and the ways we might learn to enrich its health. According to dermatologist Sandy Skotnicki, too much washing and exposure to water is damaging not only to one’s skin but also to one’s overall wellness. Because water cleanses oils from glands and sucks moisture from the skin, the surface becomes prone to host particles that provoke frustrating skin conditions like eczema. The world of skin requires balance, and by doing too much to its surface, people inevitably tamper with its composition and resilience.  In an experiment with mice, the dermatologist Richard Gallo proved that the microbes found on human skin, such as Staphylococcus epidermidis, may also contribute to the body’s ability to combat the threat of cancerous cells. When researchers split a set of mice into two groups, administering to one Staphylococcus epidermidis and subjecting both to potentially harmful UV rays, they found that the mice in the former set fared much better than the control group. Sadly, the mice without the bacterium experienced a larger number of skin cancers, leading Gallo to posit that there’s something within Staphylococcus epidermidis that fights malignant cells. So, skipping your next shower might not be such a bad thing after all. The microbiome and all of its seemingly unsanitary creatures are essential to the wellbeing of skin and to the body as a whole—no matter how gross those bugs may look beneath the microscope.

2. As disease spread throughout the 19th century, the notion of “hygiene” expanded, too. How did we become a society of the soap-obsessed, boasting more exfoliators, sanitizers, and moisturizers than we can count on both spotlessly sparkling hands? The tale of our modern romance with skincare boutiques and the cleaning aisle at the grocery store is a bit more complicated than a simple desire to be healthy. According to “disgutologist” Val Curtis and her study of the human tendency to flinch at innocuous images of scars or blood that ignite “disgust,” our drive to sanitize is born from a common fear of getting sick. Human bodies revolt in the presence of substances that might present “pathological microbes” or lead to illness, which is a doubtlessly beneficial and potentially exploitable facet of human nature. Despite the fact that scientific literature defines hygiene simply as “disease-avoidance behaviors,” practiced by creatures as diverse as bees and badgers, nematodes and humans, our contemporary conception of the word surpasses its initial connotations. In the early 1800s, the Industrial Revolution brought swarms of people to popular cities like London, Paris, and New York. It didn’t take long before these unequipped environments began to burst at the seams. With a deluge of people trudging through polluted air and living their days in the closely confined, unsanitary spaces of slums, typhoid, typhus, and cholera took root and spread throughout the cities. In the face of these depraved conditions, various physicians investigated the cause and possible preventions for these transferable diseases, ushering in the highly necessary “hygiene revolution.” Marking the beginnings of the study of “epidemiology” in 1854, the unique investigative findings of British physician John Snow were cast aside by government officials who were loath to restructure their cities as Snow’s evidence encouraged. In 1883 though, Robert Koch took up Snow’s cause with the aid of a microscope, proving that cholera was polluting the city’s drinking water and invading the whole population. This demonstration of “germ theory,” or the idea that invaders trickle into ecosystems or organisms and disrupt one’s health, was hugely beneficial to cities and led to many necessary systemic developments, including the creation of the public health industry. But this development also fueled two increasingly pervasive misunderstandings. As people began to prize their polished appearances, equating them with sanitation, the less-kept lower classes were deemed the “Great Unwashed” and crowned infectious pariahs. As a result, people falsely thought that proper sanitation meant constant washing, fueling a lifestyle of cleaning that would corrupt overall health.  Hygiene grew much more complicated as it became saturated with social meaning and shortsighted science. As the 19th century came to a close, products created with the seemingly pure intentions of sustaining health overwhelmed the market, creating a misguided system that engages the public’s desire to be clean while catering to their more hidden wish for social prestige. Our dreams of clean unraveled into a highly profitable nightmare, and our acne-spotted skin is just now beginning to make the truth clear.

3. The modern face cream might be a money-making mask—many skincare products are more about prestige than wellness. Prior to the late 19th century, soap was a product reserved for the wealthy and the privileged. Those who weren’t able to afford the “real deal” made their own soaps from simple ingredients that created an effective though often incredibly harsh cleaner that most people didn’t use too often. With the discovery of a gentler ingredient for soap, called potash, and an efficient way to procure it (a method that earned the first patent in the United States), commercial soap production took off, making showers a welcome reality for everyone in the Western world. Out of the sudsy history of soap, contemporary skincare burst into view. Industry giants of today, like Unilever, Procter and Gamble, and Palmolive got their start in the soap industry and quickly consumed the growing field. Through highly crafted advertising, they pitched an increasing number of their products as medicines or increasingly specific remedies to remain relevant to a public overwhelmed by so many new soap brands. In the process, though, they strategically marketed soap as a product it simply (and scientifically) was not, causing it to morph (at least in the public eye) into something much more powerful than a mere combination of fats and an alkali. With Palmolive’s use of the Egyptian beauty Cleopatra as their cover girl, bandying the 1924 campaign to “keep that schoolgirl complexion,” and Procter and Gamble’s precedent-setting 1928 advertisement that tethered their skincare soap to dermatology, the slight beginnings of an industry mingling good looks and social position with good health solidified. Now, many products on the skincare and personal health market parade as propellants of wellness and self-care, but do little to actually improve a person’s skin or microbiome. Rather, they simply appeal to an individual’s sense of social stature. The new wave of “clean beauty” exemplifies this concept, invading the fields of personal health and cosmetics with advertising that speaks to buyers’ interests in “clean” products. The only problem is that these products often don’t deliver on their promises. The University of Miami’s Cosmetic Dermatology Research Institute studies the claims of this growing field of skincare, and its leader Leslie Baumann states that many sought-after products such as collagen and peptides aren’t proven to do anything beneficial to people’s skin. Despite lack of proof and experimental tests, many skincare companies take after their early 20th century ancestors touting their products as miraculous cure-alls they most probably are not. While culture’s understanding of hygiene has improved rapidly since the smog-coated days of the Industrial Revolution, people continue to fall for many of the industry's most popular marketing traps. Whether these schemes are intentional or not, the seemingly endless line of products they promote are not always conducive to skincare and may stimulate issues that are even more unfortunate than a bad bout of acne.

4. Allergies aren’t simply natural phenomena—they’re often complicated consequences of unnatural environments and products. Set apart from the modern pull of the skincare industry, the Amish community is a cultural anomaly—from shirking modern technology to cultivating self-sustained lifestyles, the Amish inhabit a more natural way of acting within their environments than contemporary Americans do. As such, the Amish live as cultural foreigners compared to those in developed countries who wile away 90% of their days within air-conditioned, Lysol-ridden homes, offices, or buildings. As cases of hay fever, asthma, type 1 diabetes, and allergic reactions to food increased exponentially since the 1950s, the Amish community’s relatively unchanged portrait of health enables us to see the consequences of our modern lifestyles and how we might stand to improve them.  After witnessing several cases of Amish patients with glowing faces and few allergy conditions, allergist Mark Holbreich decided to peer a bit closer into their seemingly poreless skin. Along with pediatrician Erika von Mutius, Holbreich discovered that the Amish community’s agricultural lifestyle gave their immune systems a considerable edge. A 2016 study that weighed Amish health against that of their genetic cousins the Hutterites found that cases of asthma and allergies were four to six times less prominent in Amish communities due to their uniquely close relationship to farms. Amish children and even wily newborns (on the backs of farming parents), experience an onslaught of seemingly harmful microbes as their immune systems and microbiomes grow. This process is primarily active throughout youth and concludes when a child turns three or four. While this way of rearing one’s child might frighten many modern helicopter parents, it reduces the odds that their kids will develop eczema, gluten allergies, or other health conditions in the future. Suffice it to say, most American children aren’t spending their free time on farms or helping their parents milk the cows. By the time many children are adults, their immune systems aren’t fluent in the many languages of “antigens,” or anything (both safe and dangerous) entering the body from outside, and often fail to differentiate friends from foes. For adults with immune systems already conditioned to the overly sanitized atmosphere of modern life, it may be too late to ditch cleaners and disinfectants completely. But easing away from one’s chemical dependency may improve overall health in more long-term ways. Proponents of the “old friends” or “biodiversity hypothesis,” microbiologist Graham Rook and ecologist Jenni Lehtimäki encourage people to recognize the necessity of seemingly “dirty” microbes to one’s bodily health by going beyond one’s comfort zone of “cleanliness”—exercising outside, living with roommates or family members, owning animal companions, and even just spending time outdoors lead to greater “microbial diversity” and with that, greater immune system resilience as well. Complete withdrawal from the modern world and skincare products isn’t always desirable or even possible for most people, and adopting an Amish lifestyle may not be necessary to cultivating a more stable immune system. Consider adopting a dog, taking regular trips to the park, or having some family over for dinner—your microbial dwellers will appreciate your effort and reward you with internal health and perhaps even gleaming skin, too.

5. A little bacteria won’t kill you—the world of probiotics shows great medical promise. No matter how vigorously (and harmfully) we shower, our skin is covered in bacteria—a billion for every square centimeter of the human body. As recent studies prove, we shouldn’t be ridding ourselves of these bacterial companions too soon. In fact, we may even want to add a few to our microbial collection. The increasingly popular use of probiotics in the health and skincare industry marks a departure from traditional thinking about what people need to do to maintain their health. Often found in products like yogurt or kombucha, probiotics consist of living bacteria which positively impact the existing bacteria in a person’s stomach or her skin’s microbiome. While the effectiveness of many skin probiotics is still unproven, many new studies display the beneficial potential of introducing new microbes to one’s existing microbiome. Commercial companies and federally funded programs are discovering the vast potential of embracing the human microbiome and actively contributing to its flourishing. Trending skin products like those of David Whitlock’s AOBiome employ natural bacteria to treat prevailing skin imbalances. The company also develops studies to test its products’ effectiveness in eliminating afflictions like acne and eczema. Meanwhile, in 2018, scientists at the National Institute of Allergy and Infectious Diseases made history and developed a way to treat eczema with the aid of particular bacteria. In countless experiments, the scientists found that when they added a particular kind of bacteria to participants’ inner elbows, Roseomonas mucosa in this case, participants experienced better results than when they simply stripped the skin of the excessive, eczema-stimulating bacteria. The benefits of these kinds of treatments are more than just skin deep—a growing number of probiotic remedies achieve sustainable success by addressing underlying issues within participants’ microbiomes and provoke a more nuanced understanding of human skin. While this field of wellness and skin health research is young, its insights are already beginning to improve the personal wellness and skincare industry. You don’t have to seek out the latest, trendiest facial treatment or the shiniest anti-aging cream to sustain your skin’s wellbeing; more often than not, the products we spend increasingly exorbitant amounts of money on are more than just useless. They are actually detrimental to overall health. If you’re uncomfortable with the idea of skipping your morning shower, infesting your skin with microscopic bacteria, or ditching your nightly face wash routine, you don’t have to abandon the skincare ship altogether. Simply pause to consider the soap, shampoo, or facial serum you place on your skin to realize that you might not need a pantry full of treatments—a little goes a long way and a lot can do more than just a little bit of damage.