Medical myths: All about skin

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Our skin plays multiple roles. For instance, it helps keep our insides inside and blocks the path of pathogens. It also helps us stay warm when it is cold and cool down when it is hot.
multiple roles
Importantly, the skin provides a home for sensory neurons, which let us sense the world around us.
Despite the wide range of physiological functions this organ plays, it is arguably most famous for being the largest organ of the body, although some scientists disagree. The skin is also our most visible organ.
largest organ
disagree
And because it is so visible, skin has also become the target organ for a wide range of products, many of which promise clearer, healthier, more youthful skin.
Medical Myths
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coronavirus hub
Because the skin, for many of us, is the poster child of our face, it is no wonder that scientists, doctors, and charlatans have paid it a great deal of attention over the years.
With this heady cocktail of high visibility and multiple physiological roles, it is no wonder that public dermatological perceptions are a mixed bag of myths and misunderstandings.
In this article, we will address 12 common confusions. To help us wrestle fact from fiction, we enlisted the help of three experts:
Prof. Hywel C. Williams, OBE, D.Sc.: a Fellow of the Academy of Medical Sciences and a National Institute for Health Research Senior Investigator Emeritus. Prof. Williams is also a professor of dermato-epidemiology and co-director of the Center of Evidence-Based Dermatology at Queen’s Medical Centre at Nottingham University Hospitals National Health Service (NHS) Trust.
Prof. Hywel C. Williams, OBE, D.Sc.
Dr. Derrick Phillips: a dermatologist and spokesperson for the British Skin Foundation.
Dr. Derrick Phillips
British Skin Foundation
Dr. Beth G. Goldstein: Founder at Get Mr. and Central Dermatology Center.
Dr. Beth G. Goldstein
Get Mr.
1. Expensive skin cream can keep your skin ‘young’ forever
The skin cream industry is huge. For instance, in the United States in 2020, “prestige skin care” sales totaled $1.1 billion from April to June. And that marked an 18% drop from 2019 sales.
$1.1 billion
However, despite their lucrative popularity and regardless of cost, no skin creams can protect skin against aging indefinitely. “This is a marketing ploy and is certainly not true,” said Dr. Phillips.
As Prof. Williams explained to Medical News Today, “Simple moisturizers can achieve quite a lot. Creams containing topical retinoids can improve photoaging effects.” He dryly notes, however, that he is “not aware of any cream that keeps skin young forever.”
Dr. Goldstein informed us that “90% of skin aging is from photodamage. So all of the creams that state they can prevent wrinkles and aging are missing the mark.”
In agreement, Dr. Phillips wrote: “The most important intervention in slowing down the process is using a sunscreen with broadband UV cover.” Notably, he also notes that “these needn’t be expensive.”
2. Drinking water keeps your skin hydrated 
This is a half-truth. According to Prof. Williams, drinking water only keeps your skin hydrated “in the sense that water keeps the body hydrated and skin is the largest organ of the body.”
It is only at certain, rare times when this might be the case. “There is no evidence that drinking water directly impacts your skin unless in extremes, such as heat stroke or severe dehydration,” said Dr. Goldstein.
3. Antibacterial soap is best for the skin 
This is a myth. The skin’s natural microbiome is vital for maintaining healthy skin. “Using antibacterial soaps can upset that natural balance,” explained Prof. Williams. “They can also be harsher on the skin than pH neutral soaps.”
microbiome
“Removing both the good and bad bacteria on a regular basis is not always the best idea,” added Dr. Goldstein, “unless you are in a situation where this is important, for instance, if you work in healthcare, food handling, or of course, during a pandemic.”
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4. Having a dirty face causes acne
In Prof. Williams’s professional opinion, this is “nonsense.” Unless, he explained, the dirt “is contamination with oily substances such as hair pomade, oily make-up, or occupational oil exposure.”
Standard dirt will not produce acne.
“Acne is caused by a complex interaction of hormones and the skin, not dirt. People will use scrubs, toners, and many products to clean their faces to address or prevent acne, but often this can just result in irritation. The pores are plugged by keratin, a protein produced by the skin cells, not dirt.”– Dr. Goldstein
Diving into the details, Dr. Phillips told MNT that, although the skin’s microbiome may differ in people who have acne compared with those who do not, this is not due to cleanliness.
He also adds an interesting note about a rather modern dermatological condition:
“In the past year, there has been a rise in ‘cell phone’ acne, where people get acne spots on the side of their face that presses against their mobile phones. It is thought to be related to a combination of short-wavelength visible light from smartphones, sweat, dust, heat, friction, and bacteria on the surface of the phones. Flares may be prevented by regularly cleaning phone screens.”
‘cell phone’ acne
5. Chocolate causes acne 
Simply put, Prof. Williams writes that this is “another myth.” For the reasons outlined above, this has no basis in fact.
6. All sun exposure is bad for the skin
“All sun exposure causes some degree of photodamage,” explained Prof. Williams, “but some sun exposure is essential for boosting vitamin D synthesis,” especially for people in regions that are further from the equator and those with darker skin who receive lower sun exposure.
Similarly, Dr. Philips told MNT that “The sun is a major source of vitamin D, which is important for bone health and may play a role in the immune system. We also know that UV exposure from the sun has anti-inflammatory properties that can be beneficial in some skin conditions, such as psoriasis, eczema, and pruritus.”
anti-inflammatory
However, he also explained that “[t]hese benefits must be counterbalanced against the risk of skin cancer, which we know in white populations is directly related to UV exposure.” He recommends using high-factor sunscreen, wearing appropriate clothing, and staying in the shade between 11 a.m. and 3 p.m. on sunny days.
As someone who focuses on skin cancer surgery, Dr. Goldstein took a firmer line:
“There is a skin cancer epidemic with at least five million new cancers treated each year in the U.S. The majority of these cancers are due to sun exposure.”
Although vitamin D is essential, she explained that we can also derive it from foods and supplements,“1 in 5 Americans will get skin cancer, and melanoma is set to be the most common cancer among men, and only second to breast cancer in women by 2040.”
7. A spray tan protects against UV rays 
A spray tan will not protect against sun damage unless it contains added UV protectants. “Just spraying color onto the skin does not protect against UV rays,” said Prof. Williams.
Dr. Phillips reiterates the message: “They do not provide any protection against UV radiation and should not be used as an alternative to sunscreen.”
8. Vitamin E helps get rid of scars 
Over the years, many scientists have investigated whether vitamin E reduces the appearance of scars, but our experts were unanimous in their responses. To date, Prof Williams says, the evidence is “unconvincing.”
evidence
Dr. Goldstein agreed that “current data do not support the use of vitamin E to help get rid of scars.”
Dr. Phillips goes one step further, writing that “in some instances, it can be detrimental.” However, as an alternative approach, he told us that “silicone gel products have been consistently shown to prevent scar overgrowth and improve the appearance of mature scars.”
9. ’Natural’ products are better for the skin 
Products that are marketed as “natural” are popular among consumers. However, the term “natural” says nothing about a product’s effectiveness or safety.
popular
“Arsenic is natural after all,” Prof. Williams reminded us. “Many natural products, such as moisturizers, are very expensive and have no additional benefit over cheaper, refined products.”
He also noted that “natural products can have just as many side effects as well-tested medical products — they may not be as effective, and they may suffer from stability issues. But it is a personal choice — if people like the sound of the word ‘natural’ as a euphemism for ‘gentle’ or ‘safe’ and want to pay for the product, that is up to them.”
“Poison ivy is all-natural,” said Dr. Goldstein, “but you would not rub it all over your skin.” She also explained that all-natural products can still have “serious environmental impacts.” Importantly, according to Dr. Phillips, natural ingredients, especially in high quantities, can trigger allergies and irritate the skin.
10. Wounds need air to heal
This is a long-standing and pervasive myth, but, as Prof. Williams explained succinctly, it is “not true — wounds heal better with a clean, moist environment.”
better
In agreement, Dr. Goldstein said, “Research has shown that cells migrate better to initiate and continue healing in a moist environment in the early stages of healing in particular. Keeping a wound covered with Aquaphor or similar ointment and a bandage is ideal [if there is no infection].”
She also noted that, toward the end of the healing process, once new connective tissue and microscopic blood vessels have formed, air can aid the healing process.
11. Exfoliating daily is essential for healthy skin
Skin exfoliation is the process of removing dead cells from the surface of the skin. This can be achieved by using an exfoliation tool, a granular surface, or chemicals.
exfoliation
Although popular, exfoliation is not essential. As Prof. Williams explained to MNT, “the skin feels smoother after exfoliating, but repeated exfoliation is damaging the natural skin barrier.”
12. Black salve is a safe treatment for skin cancer 
Over recent years, so-called black salve, a derivative of the bloodroot plant, has entered the marketplace. Unscrupulous companies market it as a way to treat skin cancer. In reality, black salve can be dangerous.
Prof. Williams told us that “sanguinarine — the active ingredient in black salve — can cause severe tissue necrosis and may not kill all skin cancer cells. Always see a dermatologist to get suspected skin cancer diagnosed properly first and discuss treatment options if then confirmed.”
He also sent us a link to a recent article discussing black salve. The authors explain that “[c]linical data concerning the efficacy of bloodroot primarily come from case studies with unfavorable outcomes involving patients who self-treated with bloodroot-containing black salves.”
article
Dr. Goldstein mirrors these findings, explaining that “I have seen sad outcomes of people trying this treatment.” She also reiterated that black salve damages healthy tissue without effectively curing cancer.
Dr. Phillips confirms the negative consequences of black salve: “The Food and Drug Administration (FDA) has listed black salve as a fake cancer cure, and it should be avoided!”
listed
Summary
Although we have only scratched the surface of skin myths, we hope that this goes some way in redressing the balance between myths and truth in dermatology.
Because the cosmetics industry is a veritable behemoth, trained dermatologists struggle to match their penetration into the public psyche. This, unfortunately, makes skin-based myths difficult to shake.