Cleansing, Hydration and Skin Protection

Skin cleansing

Daily skin cleansing, at any age is an important and essential procedure for our own care, since it not only removes dirt or any bacteria from the skin, but also the dead surface skin cells, preparing the skin to better absorb the topical treatments (drugs/creams).
Common problems such as irritation, xerosis, dermatitis, eczema, psoriasis, acne, rosacea, and photodamage, leave the skin vulnerable to external insults mainly due to an alteration of the stratum corneum (SC) skin barrier.
In the daily skin cleansing is therefore important to minimize any further weakening of the stratum corneum barrier, using mild and emollients cleansers, with neutral or acid pH (about pH 5.5) that do not attack or alter this barrier causing dryness, irritation and itching.

Intimate cleansing

Intimate cleansing includes all those practices that are designed to maintain a good state of health of the genitals and their functions in good working order. The habit of a good hygiene is a very healthy practice that should be taught from an early age. In fact it is important not only to establish the simple mode of washing and cleaning, but also and above all to adopt a series of useful behaviors for preventing various kinds of disorders (discharge, irritation, inflammation, cystitis, etc.). It is important to perform the intimate by washing and rinsing always from the top to bottom, so as not to drag the intestinal bacteria of the anal area to the vagina and urethra. It is recommended to cleanse intimate areas with specific products as this area is covered with a mucous layer, does not have a corneum stratum with a protective function, then it is a very delicate, vulnerable and permeable area. In addition in the inner genital area of the woman, the pH is more acidic than the rest of the skin, and this for a very precise purpose. In fact he acidic environment, favors the presence of specific useful and not harmful microorganisms, and inhibits, both directly and indirectly, the colonization of other harmful microorganisms. So too alkaline soaps are not good for the intimate areas cleansing, as this would cause a change in pH and this, in turn, would encourage the indiscriminate growth of Candida and other pathogenic bacteria. Therefore, a proper hygiene must always respect the natural defenses present on the genitals, especially the vagina, because it constitutes the link between the outside and the interior system and it acts as a barrier against any “aggressor.” Numerous studies confirm that many young people have irritation, redness and infection of the genitals, caused simply by poor or improper hygiene. A proper and careful hygiene is therefore an important first step to intervene and prevent of a variety of disorders affecting the reproductive system of male and female. A proper hygiene is essential both for women than for men because is essential to avoid stagnation of secretions that can easily cause alkalinity and irritation of the genital mucosa. Being particularly sensitive areas, are provided with numerous sebaceous glands which ensure a constant lubrication. It is this sebum which, once deposited in the folds of the genital mucosa, it oxidizes and is attacked by bacteria. Furthermore the female reproductive system is regulated by a hormonal mechanism that changes in the course of life, from adolescence to mature period and the menopause. It is important to keep in balance this natural mechanism having care and respecting certain rules of hygiene. This can result in inflammation and infectious states of the vagina and cervix, which may expand and cause problems to the partner. There are also allergic irritative and traumatic diseases, for reaction to chemicals, or for the use of synthetic underwear or for the rubber latex of condoms. Even too frequent sex, rubbing of tight clothing, some sports (like horse riding or cycling) can cause irritation to the genitals. Therefore a proper hygiene, in the presence of all these causes, can prevent the spread of germs and more serious consequences. For a proper hygiene should be used detergents able to avoid compromising the natural acidity of the environment. The ideal products are the specific acidic cleaners formulated for this area of the body. In women during the menstrual period personal hygiene must be particularly accurate and frequently, especially during the days of menstruation using acidic cleaners with a pH around 4. During the period of menopause, characterized by the cessation of reproductive activity and of the production of estrogen (hormones that are also used to maintain vital and elastic tissues of the genitals), there is a marked decrease of major structural defenses, so it is extremely important to follow a scrupulous hygiene, in order to prevent the onset of irritating disorders. The period of pregnancy ultimately requires a thorough cleansing and a special hygienic care, especially because of those white discharge resulting from increased production of mucus, which could enhance the colonization of pathogens. Cleaning should be done at least twice a day with a adequate cleaning agent. The choice of intimate cleanser is very important for a proper genital hygiene and the maintenance of their health. A good cleanser in fact, must respect the physiological pH and bacterial flora naturally present in the vagina. In woman the pH changes with the age: it has values ​​between 3.5-4.5 during the childbearing years then should be used detergents with a pH around 3.5-5.5, while it is more high in menopause and in pre-pubertal. So the cleanser must always be adapted to the specific needs and different events which occur naturally in the course of life. The cleaner also does not contain harsh surfactants, which do not respect the vaginal flora and thin the vulvar mucosa, or perfumes that are responsible for frequent allergic reactions. It should have an antiseptic, deodorant and significant refreshing action for the well being of women and men, and possibly should contain herbal extracts that play a soothing, moisturizing and emollient action.

Hydration and skin protection

The skin is the outermost structure of our body and therefore it has the function to preserve an essential element for our survival: water.
Water is the primary source of hydration of the body and in particular is the most important parameter for the functional balance and skin health, that contain a total of approximately 67% water, which is distributed very differently in the various tissues. The water from the deeper tissues of the skin, follows a well-defined pathway within the different layers of the skin: from the bloodstream it reaches the dermis, then it spreads regularly and consistently up to the upper layers of the epidermis reaching the outermost surface consists of the stratum corneum, where it is responsible for preserving skin hydration.
The natural moisture of the skin is the result of several biological mechanisms with specific functions, which take place in the dermis, epidermis and stratum corneum. This movement of the water depends mainly on the secretion of the sweat glands, an active process under the control of the nervous system, and of sebaceous glands, which together with the aggregated polypeptide from the dacay of the corneocytes, substances of purine and carbohydrate nature, derived from the loss of nucleus of keratinocytes, and from lipids of epidermis, are a mixture of lipophilic and water-soluble substances, whose task is to protect the skin and, in particular, in maintaining the hydration of the stratum corneum. Then the free water in the stratum corneum, evaporates through a process called “perspiratio insensibilis” or trans epidermal water loss (TEWL – Trans Epidermal Water Loss), which consists in the evaporation constant and passive of water in vapor form in the outermost layer of epidermis. Its size is very variable and depends on the degree of environmental humidity, temperature and ventilation. The movement of water between cells in different layers of the epidermis also depends on proteins called aquaporins, which are present in the epidermis where they form appropriate channels to convey water and water-soluble ingredients, transporting them to the surface. A right hydration of the epidermis and stratum corneum, is only possible if the water supply from the dermis is sufficient to balance the small losses and if the water retention capacity in the upper compartments of the skin is efficient and consistent.

In the dermis, the water is retained thanks to the presence of glycosaminoglycans (GAGs), hydrophilic polymers able to retain large amounts of water of the extracellular matrix. The dermis is particularly rich in water: it contains about 70% of the water supply of the entire skin, and this concentration is hardly to be changed by external events but mainly depends on the hydration state of the whole organism, and on the efficiency of protein synthesis by fibroblasts. In case of systemic dehydration, the dermal water supply becomes the primary source from which to draw to compensate for the lack of water. Another cause of depletion of dermal water supply is the qualitative and quantitative alteration of the molecules able to bind water, as in the case of photodamage in which the dermal structures are altered by UV radiation and lose their ability to retain water.

Defenses against dehydration

The structure of the skin acts as a barrier essential to maintain hydration of the skin within physiological values. The main factors of this barrier responsible for maintaining hydration are:

  • The Stratum corneum
  • The Epidermal lipids
  • The Natural moisturizing factor (NMF)
  • The hydro-lipid film surface

These components are subjected to a continuous renewal process determined by the ability of the epidermal keratinocytes to reproduce and differentiate continuously, thus giving rise to the various layers of the epidermis.
Different factors, both exogenous and endogenous, may affect these fragile defense mechanisms, causing lower or higher skin dehydration. The extent of skin hydration depends on the humidity, the hygroscopic properties of the stratum corneum and the presence of naturally moisturizing factors, without which you have dry skin. In addition to age and genetic predisposition to skin aging, many external factors can lead to lower or higher skin dehydration. The main factors of dehydration are chemical (eg, the solvent action and loss of skin lipids caused by the continuous use of surfactants) or due to unfavorable climatic or environmental conditions: wind, cold, and humidity, separately or in combination, cause dehydration of the stratum corneum leading to dry, rough, scaly and cracked skin, redness, itching and irritation. Even prolonged contact with water, despite the protection of the sebaceous-sweating film, causes a depletion in NMF. Indeed, a topical application of water alone causes a stress on all the stratum corneum that causes an alteration of its barrier function. The more exposed areas, such as face and hands, are the most affected; however also other areas of the skin are particularly prepared to excessive dryness often associated with a more or less evident flaking skin.

Skin dehydration: Interventions

A dehydrated skin favors the entry of foreign substances, the onset of inflammation and causes loss of elasticity and tone. The application of topical cosmetic formulations on the dehydrated skin is able to restore smoothness, softness and distensibility. Therefore it is necessary to intervene with moisturizing treatments that prevent skin dehydration, and at the same time restoring the optimal content of water and other substances, which may be impaired as a result of multiple factors. Topical treatments are able to intervene on the hydration of the stratum corneum and also to convey compounds able to bring water, and to restructure the skin barrier which is essential to effectively replenish and restore the water and lipid content of the skin (collagen, hyaluronic acid, urea, ceramides, plants lipids and fatty acids treatments). The moisturizing efficacy of a formulation is due not only to the presence of specifically moisturizing ingredients, but also to the choice of vehicle and cosmetic form that contributes to the transfer of such property.

RSS Obstetrics & Gynecology News

  • Adjuvant Human Papillomavirus Vaccine to Reduce Recurrent Cervical Dysplasia in Unvaccinated Women: A Systematic Review and Meta-analysis May 1, 2020
    OBJECTIVE: To perform a systematic review and meta-analysis evaluating the efficacy of adjuvant human papillomavirus (HPV) vaccination in preventing recurrent cervical intraepithelial neoplasia (CIN) 2 or greater after surgical excision. DATA SOURCES: Electronic databases (Cochrane, PubMed, EMBASE, MEDLINE, Scopus, and ClinicalTrials.gov) were searched for studies comparing surgical excision alone to surgical excision with adjuvant HPV […]
  • Coronavirus Disease 2019 (COVID-19) and Pregnancy: Responding to a Rapidly Evolving Situation May 1, 2020
    As the world confronts coronavirus disease 2019 (COVID-19), an illness caused by yet another emerging pathogen (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]), obstetric care providers are asking what this means for pregnant women. The global spread has been swift, and many key questions remain. The case-fatality rate for persons cared for in the United […]
  • Placenta Accreta Spectrum Disorder: Uterine Dehiscence, Not Placental Invasion May 1, 2020
    For decades, placenta accreta spectrum disorder has been classified, staged, and described as a disorder of placental invasion. In this commentary, we argue that placenta accreta spectrum exists as a disorder of defective decidua and uterine scar dehiscence, not as a disorder of destructive trophoblast invasion. Adopting this understanding of placenta accreta spectrum will help […]
  • Fetal Sex Results of Noninvasive Prenatal Testing and Differences With Ultrasonography May 1, 2020
    OBJECTIVE: To assess the causes of reported discordance between noninvasive prenatal testing (NIPT) and ultrasound or other clinical information. METHODS: In this retrospective, observational study, all cases in which single-nucleotide polymorphism (SNP)–based NIPT reported normal sex chromosomes and the laboratory was notified by the patient or health care provider of discordance between NIPT and observed […]
  • The Imperative for Transgender and Gender Nonbinary Inclusion: Beyond Women's Health May 1, 2020
    We aim to make evident that solely referencing cisgender women in the context of sexual and reproductive health—particularly pregnancy planning and care—excludes a diverse group of transgender and gender nonbinary people who have sexual and reproductive health needs and experiences that can be similar to but also unique from those of cisgender women. We call […]
  • First Twin in Breech Presentation and Neonatal Mortality and Morbidity According to Planned Mode of Delivery May 1, 2020
    OBJECTIVE: To compare neonatal mortality and morbidity of first twins according to the planned mode of delivery when the first twin is in breech presentation, in a country where planned vaginal delivery is an option. METHODS: This is a planned secondary analysis of the JUMODA (JUmeaux MODe d'Accouchement) cohort, a national prospective population-based study of […]
  • Internal Iliac Artery Balloon Occlusion for Placenta Previa and Suspected Placenta Accreta: A Randomized Controlled Trial May 1, 2020
    OBJECTIVE: To investigate the effect of intraoperative balloon occlusion of the internal iliac arteries in women with placenta previa and antenatally diagnosed placenta accreta. METHODS: In this single-center, randomized controlled trial, women with placenta previa and antenatally suspected placenta accreta were randomly assigned to either the balloon occlusion group or to the control group. The […]
  • Syphilis in Pregnancy May 1, 2020
    Despite a national plan to eliminate syphilis by 2005, recent trends have reversed previously achieved progress in the United States. After a nadir between 2000 and 2013, rates of primary and secondary syphilis among women and congenital syphilis rose by 172% and 185% between 2014 and 2018, respectively. Screening early in pregnancy, repeat screening in […]