The Beauty about Dirt – To Wash or Not Wash?

This week, I was contacted by a Swedish radio station asking of my opinion in the “shower debate” of Ashton Kutcher and Mila Kunis. I have to admit, I had totally missed this news. The journalist told me that there has been a “Huge Debate About How Often They Bathe Their Children”. 

“Are they right or wrong?”

Before answering this question, I read a CNN interview with the couple (CNN 21/7 2021). The interview goes like this:

I didn’t have hot water growing up as a child so I didn’t shower very much anyway,” Kunis said.

That has apparently continued with her and Kutcher’s two kids, Wyatt, 6, and Dimitri, 4.

“I wasn’t that parent that bathed my newborns, ever,” Kunis said.

And now that they are older, Kutcher said they have a system.

“If you can see the dirt on them, clean them,” he said. “Otherwise, there’s no point.”

Kutcher said he does wash his “armpits and my crotch daily and nothing else ever,” and has a tendency to “throw some water on my face after a workout to get all the salts out.”

So, what is right and wrong when it comes to washing our skin, or our kid’s skin?

The Head of infectious diseases and international medicine at Beaumont Hospital in Royal Oak, Michigan, Dr. Christopher Carpenter says in an interview with US News:

“I’m a sound believer that we’re too clean of a society. Our fear of germs has pushed us too far into trying to keep everything safe and sterile. That extreme is harming us more than it’s helping us.” 

In the same article adds Kiran Krishnan, a microbiologist and chief scientific officer for Microbiome Labs, based in St. Augustine, Florida:

“We are getting far too sterile. Exposure to microbes is an essential part of being human. Most of our immune system is comprised of tissue that requires activation by the microbes we’re exposed to. The immune system requires the presence of friendly bacteria to regulate its functions. Think of the immune system as an army, with tanks and missiles but no general to lead them. That’s the role friendly microbes play in your body; they’re the general. The vast majority of microbes, 97% to 99%, are benign or beneficial, and they are the best protection to fight pathogenic microorganisms.”

What do I believe?

Well, since the discovery of antibiotics, antiseptics and disinfectant we have been very focused on staying clean and getting rid of bacteria. However, since the discovery of the gut flora (gut microbiome) we have started to understand that the tiny bugs we have in our gut is really truly vital for our health. Without micro-organisms, we human couldn’t survive. They cooperate with our cells and play an essential role in all aspects of our health. In fact, they control most of what goes on, including our daily lives. Do you think you’ve got a weak character if you can’t resist eating sweets in the evening, or that you’re unlucky if you constantly feel off-colour?

That’s not the way it is.

Micro-organisms regulate your sweet tooth, they break down the food in your digestive tract, they protect you against the unwelcome microbial guests you encounter daily, they cooperate with your immune system — and they even interact with your brain and even affect your personality.

Akvarell av: Ina Schuppe Koistinen

What about the skin flora (the skin microbiome), what do we know about it?

Well, ever since we managed to sequence the microbiome, something that has only been done in the last ten years, we have learned tremendously much about the skin microbiome. We know that most bacteria on the skin are helping us, for example they help us to fight bad bacteria, so called pathogens. We also know that the skin bacteria are of unique importance for our immune defense in the skin. Some scientist even says that this is essentially a newly discovered layer of the skin called “stratum microbiome”, which function is to be our outermost protective layer.

If we go back to the first question- how about washing the skin and are Kunis and Kutcher right or wrong in the (non)washing procedure of their kids?

First of all, there is no intrinsic value regarding washing the skin. However, if there is a risk of getting pathogens into the body such as prior a surgery and in certain environments such as hospitals, it is obviously vital to wash and disinfect the skin to reduce the risk of infections. 

But if you have an intact, healthy skin, there is no need to excessively wash the skin. In contrast, there are more and more evidence  that our skin can benefit from less washing. For example, recently a large study was carried out in China on how cleansing habits influence the onset and development of rosacea. The study was in the form of a retrospective case-control survey of 999 rosacea cases and 1010 skin-healthy controls. So, what was the results of the study? Well, the study showed that cleansing the facial skin more than once daily with a cleansing product actually increased the risk of getting rosacea. Also using a large amount of cleanser (more than 500 gram a year), using a cleansing tool and interestingly also using masks and exfoliants increased the risk of getting rosacea (Li et al., 2020).  

When it comes to children, a recently published Dutch study showed that bathing frequency increased TEWL (transdermal water loss), leading to dryer skin but also very surprisingly that start of use of moisturizers on infants (at the age of 3 months) increased the risk of food allergy and aeroallergen sensitization at the age of 3 years old (Perkin et al., 2021). The moisturizers used frequently was olive oil based but also other natural oils.

So, in summary, the approach of Kunis and Kutcher might be worth taking on. There is at least no evidence that a heavy cleansing procedure would be beneficial for our skin nor will it promote skin health. 

When developing skincare formulations at Skinome Project, we are focusing on microbiome support, since more and more evidence speaks for the benefit of a microbiome in balance for a healthier skin. For example, we only recommend that you wash your face with a cleanser in the evening since the skin is producing a lot of beneficial substances during the night that are skin friendly. 

Earlier this year, we finalized an interesting study together with Linköping University and Gut feeling labs. In this study we wanted to understand the difference between conventional skincare products, that contain ingredients such as preservatives that can disturb our good bacteria compared to microbiome supporting skincare.

For 3 weeks, 16 people used a microbiome supporting face cream (Rich Emulsion) on one side of the face and a conventional face cream on the other side of the face (so called split face design). They were only using a cleanser in the evening – one microbiome friendly (Mineral Cleanser) and one conventional. The results showed that the side where the Skinome project formulations was used, the microbiome diversity increased which also correlated to a reduction in redness and irritation which led to a more even skin tone. 

So in terms of my recommendations regarding to wash or not wash I would say that “lagom” or “less is more” is a good principle😊.

Figure above shows reduction of redness after 3 weeks use of microbiome supporting skincare products which was correlated with increased skin microbiome diversity.

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References:

Li, G., Wang, B., Zhao, Z., Shi, W., Jian, D., Xie, H., Huang, Y., & Li, J. (2020). Excessive cleansing: an underestimating risk factor of rosacea in Chinese population. Archives of Dermatological Research. https://doi.org/10.1007/s00403-020-02095-w

Perkin, M. R., Logan, K., Marrs, T., Radulovic, S., Craven, J., Boyle, R. J., Chalmers, J. R., Williams, H. C., Versteeg, S. A., van Ree, R., Lack, G., Flohr, C., Young, L., Offord, V., DeSousa, M., Cullen, J., Taylor, K., Tseng, A., Raji, B., … Turcanu, V. (2021). Association of frequent moisturizer use in early infancy with the development of food allergy. Journal of Allergy and Clinical Immunology. https://doi.org/10.1016/j.jaci.2020.10.044