Wash-out effect, or dryness from the cream?

Svetlana Tkachenko , candidate of medical sciences, dermatovenerologist, associate professor of the department of dermatology, venereology and medical cosmetology of KhNMU, doctor of the medical center "European Dermatology" (Kharkov)

The washout effect is more often encountered by women who complain of tingling and burning sensations upon contact with water. In this case, the complaint usually looks like this: “I can’t wash my face with water at all. After washing, there is a feeling of tightness, the face bakes and tingles.” Typically, the skin of such patients is generously lubricated with rich cream and looks healthy. The important thing in this case is that water intolerance was not always present; in childhood and youth the patient washed his face well with water and used little cosmetics. The problem developed against the background of regular care, which included a lot of moisturizing, protective and nourishing products, day and night creams, serums, which were sometimes applied as a “sandwich” and were on the skin almost constantly.

What will the dermatologist say? There are no rashes, your skin is healthy, just very dry.

What will the cosmetologist say? Apparently tap water is not suitable for you, use cleansing without water.

What will I say? This is a washout effect caused by the use of emulsion cosmetics, and we can correct this.

Emulsion products are now very popular in the cosmetology industry. Technologically, these are heterogeneous systems consisting of water and a water-insoluble part, conventionally called oil. Surely, most of every person’s cosmetic arsenal consists of emulsion creams: cleansing (cosmetic milk), moisturizing (light day creams), nourishing (thick night and protective creams), etc. The more water in the cream, the more liquid, fluid, easy. The predominance of butter in the cream gives it greater fat content and density.

Emulsion creams allow technologists to introduce any biologically active substances (both water-soluble and fat-soluble) and deliver them not only to the most superficial, but also to the deeper layers of the epidermis. Creams easily spread on the skin, improve its surface, and allow you to beautifully apply decorative cosmetics.

But in order to combine the incompatible things in the cream - water and oil, technologists use emulsifiers. And it is emulsifiers that can cause the leaching effect.

An emulsifier (or the more familiar name of a surfactant - a surfactant), placed at the interface between water and oil, reduces surface tension and thereby stabilizes the emulsion system.

As you can see, the emulsifier molecule in this picture has a water-soluble part in the form of a ball and a fat-soluble part in the form of a tail, lining up in the desired position, it connects the water and fat parts of the cream, making it homogeneous and thick. It is easy to see that a lot of emulsifier is needed, since it is necessary to “stick” to the particle from all sides, holding it in the opposite environment. Studying technological literature, I discovered that if you use one type of emulsifier, the cream will be obtained only by adding a high concentration of emulsifier (30-50%). From the point of view of a technologist, this is not rational, and from my point of view as a dermatologist, it is also dangerous. Therefore, to create a cream, two emulsifiers of different types are usually used, which makes it possible to reduce the total dose of such a surfactant mixture to 10%. However, this is enough.

Imagine that the cream was applied to the skin for several hours. The water part of the product quickly evaporates, and the fatty part slowly seeps deeper, gradually breaking down and fermenting. And now the time has come for the long-awaited wash: sensing water, the water-soluble part of the emulsifier will immediately contact water, and its fat-soluble residue will grab some fatty particle. And all this will be carried away by the flow of water. If the components of the cream remain on the surface, a person will feel freshness and a sense of cleanliness: after all, sebum lipids, fragments of the cream itself and oily decorative cosmetics have been washed away. And that's exactly what it should be.

But what if the emulsifier penetrated deeper? If he reached the level of the epidermal barrier, which controls transepidermal water loss, regulates skin permeability, if he took with him fragments of ceramides? Is it possible? Maybe. And then, after drying the skin, a person will feel a burning sensation, a feeling of tightness, a feeling of dryness. This is the Wash-out effect.

What would any sane person do? Of course, she will apply the cream again. And he will go to bed with cream on his face. And then he’ll buy himself a cleansing milk, which is essentially the same liquid cream with an emulsifier to prevent any contact with water. But is it possible to exclude water from hygiene? Of course not. A person takes a bath, shower, and sometimes is forced to wash his face with water in order to wash off the huge amount of applied cosmetic fat. And the symptoms of the washout effect are growing and growing. And so every day, layer by layer, our sufferer drives more and more emulsifiers into his skin, which, penetrating deeper and deeper, erode the natural lipids of the skin more and more.

I will say right away that this problem does not always arise and not for everyone. There are contributing factors both on the part of the patient (impaired skin barrier of any origin) and on the part of the cream (very active deep-penetrating cream, too frequent or voluminous use of it, increased skin penetration before applying the cream).

Is there a way out? What to do if a person has become a hostage to the cream?

Unfortunately, neither dermatology nor aesthetic medicine provides any protocol or ready-made clinical recommendations. Moreover, in dermatology there is not even such a nosology, because no rash means no dermatosis. As for cosmetology, there is the condition “subjective dermatitis, or irritated skin” as a variant of sensitive skin. This is a feeling of heat, tingling, tightness of the skin in the absence of rashes. The symptoms of the washout effect fit well into this definition. But it is important to understand that this condition easily turns into allergic or contact dermatitis with the appearance of pronounced rashes and a very specific clinical picture, and this is already a dermatological disease. And if there are any rashes - spots, papules, pustules, vesicles, the right tactic is to contact a dermatologist.

For cases of “pure” Wash-out effect I am ready to share my thoughts and my own developments, which allowed me to save many of the cream’s hostages.

1. It is necessary to reduce the time of wearing emulsions. It is best to avoid night cream. The patient must understand that the constant application of cosmetic fat blocks its own synthesis of both epidermal lipids and sebum components. To minimally restore this synthesis, you need at least 6-8 hours of clean skin.

How to do this technically? After all, a person cannot live without cream?

Of course, it will bake, burn and pull together. We'll have to be patient.

As an alternative, I recommend applying a thick, non-emulsifying cream (ointment) for a couple of hours and then rinsing off with a cleanser. This makes it easier to endure the period without cream.

The second alternative is lamellar emulsion. This is a cream that is made using a completely different technology - by crushing it into layers under high pressure. The result is a structure reminiscent of our epidermal barrier, and such a cream contains a very minimal amount of emulsifier. And the emulsifier is phosphatidylcholine, known to us as lecithin, which is physiological for the skin and promotes the repair of epidermal structures. Lamellar emulsions are sold in pharmacies and are available on the professional cosmetics market. It is the lamellar emulsion that I suggest using as a day cream, temporarily putting aside your usual cosmetics.

2. Washing. It is better to wash with gel or foam for sensitive skin, wash quickly, leave the cleanser on for 10-20 seconds, then rinse with water.

3. Replenishment of deficiencies: it is necessary to provide building material for the synthesis of epidermal lipids. Orally, strictly with food, lecithin (1-2 g per day) or essential phospholipids (Essentiale) 2 capsules 3 times a day - 10 days, then 1 capsule 3 times a day, evening primrose oil (0.5-1 g per day ), omega-3 (1 g per day), for adherents of nutrition, you can add PEA 300 mg 2 times a day or a complex of skin ceramides. Give not all at once, but sequentially one drug at a time for a month. The recovery process takes months, but improvement is observed quite quickly. Patients with calculous cholecystitis must consult a gastroenterologist and agree on taking these medications.

It is important to correct vitamin D deficiency; it is necessary to check the initial level and calculate the dose accordingly. Usually it is 1-5 thousand. IU per day.

Pay special attention to patients who have problems with the gallbladder: dyskinesia of the duodenum, bending of the gallbladder, cholecystopathy. Artichoke preparations before meals and Allahol after meals, enzymes are usually well known to this category of patients, and I recommend resuming the usual course for 1 month. I often recommend consulting a gastroenterologist, especially if there are typical complaints from the gallbladder. For patients with calculous cholecystitis, consultation with a gastroenterologist is mandatory. It is very important to establish bile kinetics, otherwise all attempts to compensate for deficiencies will be futile, and precious substances will pass through in transit in the absence of lipases.

Wash-out effect is not a death sentence at all. Improvement occurs within a couple of weeks, and after a couple of months the patient can return to his usual favorite creams. Often patients consciously switch to lamellar emulsions - they are indeed very light and comfortable. And in the future, cosmetics with emulsifiers are used more rationally, taking the necessary night breaks and replenishing deficiencies.