A Primer on Moisturizing in the Cold Winter Months

Winter is upon us, which means it’s high time that we protect our stratum corneum—the outermost layer of the skin which serves as a barrier between the body and the environment—from the cold and dry winds.

The benefits of protecting your skin go far beyond having skin that merely feels and looks healthy; it means ensuring the health of the largest organ in your body, which is responsible for resisting chafing and subsequent blisters. And for prosthetic users, having healthy skin means a more comfortable experience with your prosthesis, allowing discomfort-free movement and overall better days.

The Skin’s Moisture Requirements

To answer the question of why we need to use moisturizers, let's go back to our skin's composition; it is composed of 64 percent water, which makes water an essential component to healthy skin. This means that if the stratum corneum becomes too dry, the skin can become itchy, scaly, inflamed, leathery, and generally uncomfortable. And for most people—whether their skin is dry or oily and if they live in areas where the climate is cold, dry, or windy—protecting the skin’s moisture means using the right moisturizer.

Considering the variety of options available in your local drug store, how do you know which moisturizer is compatible with your skin type and safe to use with your prosthetic supplies, therefore unlikely to cause an unwanted reaction? Should you choose a lotion over a cream? Should you look for one labeled “dermatologist-recommended,” “fragrance-free,” “designed for prosthetics,” “organic,” “clinically proven,” or “hypoallergenic?” Or do you make a selection based on brand name, price, or your prosthetist’s and friend’s recommendations?

Allergens in Your Moisturizer

Those are all excellent questions, but admittedly hard-to-answer. You see, moisturizers and their advertised claims—like all other cosmetic and personal care products—are loosely regulated. The industry is dependent almost entirely on the integrity of manufacturers to market a safe and effective product. However, when a particular product is neither safe nor effective, the onus to inform other consumers seems to fall solely on those who have bought and tried the product. This is why consumer reviews hold a lot of weight when deciding to buy a product.

One of the most frequent complaints about skin care products, like moisturizers, is their all-too-common ability to trigger an allergic reaction, which results in itchy, red, inflamed skin. Inside a closed environment, like a prosthetic socket, the wrong moisturizer can make walking difficult at best.

In a study published in the National Center for Biotechnology Information (NCBI), Dr. Xu and colleagues evaluated 174 best-selling moisturizers of different types across a price range of 10 cents an ounce to $9.51 an ounce. Particular attention was given to the presence of allergenic ingredients in these products.

The study found that lotions were the most popular among consumers, accounting for 59 percent of moisturizers sold. Creams were the second most popular at 13 percent, oils at 12 percent, butter at 8 percent, and ointments at 2 percent. Based on the North American Contact Dermatitis Group’s list, only 12 percent of the best-selling moisturizers were free of allergens. The study found that 3 of the most common allergens found in moisturizers were fragrances, parabens (preservatives), and tocopherol.

Product Labels: The Real Score

Among products labeled “fragrance-free,” 45 percent had at least one fragrance-related ingredient, the study found. Most companies get away with using this claim if they use an ingredient that is both a preservative and a fragrance, especially if the ingredient's primary purpose is preservation.

Furthermore, the study found that products that claim to be “fragrance-free” or “unscented” could contain a masking agent (a fragrance that counters a chemical odor), a cross-reactive chemical that acts like a fragrance, or a botanical ingredient that is an allergen.

Among the 15 products that claim to be “hypoallergenic,” 83 percent had at least one ingredient on the allergen list, and the remaining 24 percent contained 5 or more such ingredients. Interestingly, products that lacked any allergenic ingredients, costing on average 83 cents an ounce, were not statistically more expensive per ounce (median, 60 cents) than products with one or more allergens, the team found.

“Much of the labeling of products as hypoallergenic is somewhat nonsense. If you use a product long or often enough, you can become vulnerable to an allergic reaction. It’s not that the product is mislabeled—it’s that you can become allergic to almost anything, especially if you have a predisposition,” said Dr. Jonathan I. Silverberg, director at Northwestern’s Contact Dermatitis Clinic and Eczema Center.

An initial mild allergic reaction of itching and redness can progress to stinging, burning, swelling, and pain. “With each exposure, the reaction gets stronger,” Dr. Silverberg said. Therefore, if you have an allergic tendency, you might want to consider switching periodically to a different product. If any moisturizer caused an adverse reaction, stop using it immediately.

Understanding Ingredients

The American Academy of Dermatology suggests picking a product that is free of additives, fragrances, and perfumes to avoid common allergic sensitizers. While this might seem like a straightforward task, the study proved that it could be a challenge.

According to the study's findings, the price of a product is no guarantee of safety or effectiveness, even though most moisturizers that claim to be “dermatologist-recommended” are typically more expensive. Dr. Xu’s team analyzed the most expensive moisturizer in the sample size and found that it contained the most number of allergens—a total of 8 on the North American Contact Dermatitis Group’s list. 

Meanwhile, health-conscious consumers turn to products labeled “organic” or “all-natural,” hoping to avoid synthetic chemicals. But, according to Dr. Xu, these "are not necessarily unlikely to cause a reaction and may not be very effective."

For example, a more natural and organic olive oil might seem like a good moisturizer. On the contrary, it cannot seal moisture in the skin; it only increases water evaporation and moisture loss.

If you're interested in oils, you might want to look into sunflower oil, coconut oil, and shea butter. These three are not only the most protective, but they are also free of allergens.

Types of Moisturizers

Most people prefer using moisturizing lotions, which typically contain more water than creams or ointments. This is because lotions generally are more effective and the least expensive. Quality lotions designed for prosthetic users will contain a higher silicone content and a greater percentage of nourishing vitamins and essential oils to reduce the damaging effects from friction. Prosthetic moisturizers also have a thinner consistency to avoid clogging your skin's pores.

Nonetheless, people with dehydrated skin might do well to invest in a cream or salve, both of which seem more expensive up front, but they tend to last longer than lotions. You only need a small amount of product to moisturize large areas of your skin. Meanwhile, creams contain more water than salves, but they do not offer the same targeted treatment as balms and salves.

However, most prosthetists would say that the type of moisturizer isn't as important as the prosthetic user's willingness to regularly use a moisturizer.

Once you've decided on the type of moisturizer you want to use, always remember that these products are best applied on damp skin. So, slather on your preferred moisturizer within minutes of bathing and after patting the skin dry. This allows the product to lock in as moisture as possible. You can also prevent skin dryness by bathing or showering in warm—not hot—water.

The Bottomline

There is a wide variety of moisturizers available on the market, and all make convincing claims on being the best. Choose the best moisturizer by understanding the ingredients and knowing your allergic triggers and needs.  Consider using a prosthetic moisturizer or salve because their ingredient list is formulated for prosthetic users' needs.

What is your favorite prosthetic moisturizer and why? Please leave your comments in the section below.