Both residents and visitors of the high altitude of Colorado are faced with the frustration of applying lotion and Chapstick frequently throughout the day and yet continuing to experience dry, irritated skin and chapped lips. Although this can be contributed to by uncontrollable factors such as dry climate and cold temperatures, there are daily modifications that can be made to help treat and prevent persistent dry skin. It is important to recognize that varying factors including environment, chemical exposure, diet, and genetics have a role in the progression and persistence of dry skin and other related skin conditions. To discuss some of these different common skin problems and the multitude of “therapies” and “myths” that surround them I had the opportunity to meet with Kelly Ballou PA-C from Renew Dermatology
A recent study performed in Vail, CO revealed that at higher altitudes, SPF 100+ sunscreen was more effective at protecting against sunburn compared to SPF 50+. The information found in this study differs from the American Academy of Dermatology recommendations of using water resistant SPF 30 or higher. Kelly expressed her wishes for more dermatologic studies to be performed at higher altitude communities like Summit County, Colorado in the future as there is known increased UV exposure risk with higher elevations. Whether it is snowy, sunny, rainy, or cloudy, it is important to be compliant with frequent sunscreen application as recommended on the bottle and barrier repair lotions to achieve the greatest benefit with sun damage prevention (which can develop as brown spots, fine lines, loose skin or precancers) and hydrated skin. Kelly stated how “Even when it is a blizzard in Summit County, the UV exposure is still 80-90% compared to the UV exposure at sea level.” She recommended “setting an alarm while hiking, fishing, or skiing as a reminder to re-apply sunscreen frequently during outdoor activities.” Recognizing and modifying factors such as frequent hand washing and bathing, forced air heating, chemical exposure, and overuse of soaps can help to reduce dry skin.
There are a multitude of moisturizers available over-the-counter which can be overwhelming to choose from. It is recommended to choose moisturizers that are plain “no scents or oils added” such as Eucerin, Aquaphor, Cetaphil, or CeraVe. It is encouraged to apply moisturizers 2-3 times daily as needed to avoid dry, cracked or painful skin. For irritable dry skin, scratching and itching are highly discouraged as this can result in increased risk of infection or scarring. Trimming of nails and applying bandaging over dry areas can help to reduce these tendencies and associated risks. If there is a severe urge to itch, over-the-counter antihistamines such as Zyrtec and Claritin can provide some relief. To avoid daytime “tiredness”, Claritin (less-sedating) is recommended during the morning and afternoon hours, while Zyrtec (possibly more-sedating) can provide relief at night.
Kelly and I discussed how Epionce has a medical grade product called Renewal Calming Cream which has shown incredible results with treating not only eczema, but many other conditions associated with dry and irritated skin. It is a product which utilizes multiple natural ingredients that is able to be sold at medical practices but does not require a prescription. Kelly described how, in her experience, it “works on most anything red, can reduce itching and dryness quickly over damaged skin exposed to the outdoors, and is one of the best moisturizers – much more effective than any over-the-counter moisturizers or other products.”
As parents may well know, kids can present with odd skin conditions that are persistent despite efforts of frequent moisturizing. For conditions such as Keratosis Pilaris, Cradle Cap, and Atopic Dermatitis (Eczema), there are additional recommendations other than just applying frequent lotion and sunscreen throughout the day.
Keratosis Pilaris is a chronic condition that can present as dry skin that appears on upper arms, thighs, and buttocks. It is commonly described as “rough sandpaper with tiny bumps”. It is often made worse by soaps that remove the skin’s natural oils, thus disabling the skin from holding onto necessary moisture. Avoiding bubble baths, strong soaps, and creams with fragrances can help to improve Keratosis Pilaris. Dr. Ebert-Santos recommends room humidifiers and applying moisturizing cream within 3 minutes after bathing at least 2 times throughout the day for optimal results.
Cradle Cap is best described as red patches on the scalp covered with oily, yellow scales or “crusts”. It is the result of hormones causing over production of oil and can be linked with an overgrowth of yeast. Eventually, cradle cap will go away on its own within 6 to 12 months of age, however, best treatment can include antidandruff shampoo twice per week or nonprescription Hydrocortisone 1% cream for resistant cases. Kelly often informs her patients that “oil treatments are not effective for resolving cradle cap” in her experience, but rather she recommends prescription antifungal shampoo which can be applied for at least 20 minutes and then rinsing shampoo off for optimal results. If not resolved with just the shampoo, a combination of Ketoconazole cream and Epionce Calming Cream has additionally shown positive results.”
Atopic Dermatitis (Eczema):
Eczema is a red, itchy rash that can appear as early as birth or can start at any time throughout life. The rash can be found anywhere on the body. The overall treatment for eczema may involve steroid creams, moisturization, as well as avoiding frequent use of bathing soaps and anything with fragrance. To prevent further aggravation of eczema, keep shampoo off the rash and try to use non-drying soaps such as Dove, CeraVe or Cetaphil. It may take trialing different therapy regimens to find what works best for each individual. However, if the rash weren’t to improve after a few days of treatment, or the rash were to become raw and appear infected it is recommended to follow up with your doctor.
Breeann Backer is a second-year physician assistant student at Red Rocks Community College. She graduated from Colorado State University in Fort Collins, CO with a Bachelor’s in Health and Exercise Science. Before PA school she completed an internship at Cardiovascular and Pulmonary Rehabilitation and thereafter worked as a medical assistant in outpatient cardiology for 2 years in Denver, CO. She enjoys any excuse to stay active outside and loves calling Colorado home. Her hobbies include photography, exploring, and trying new foods.
Keratosis Pilaris: Schmitt BD. My Child Is Sick!: Expert Advice for Managing Common Illnesses and Injuries. Elk Grove Village, IL: American Academy of Pediatrics; 2017.
Cradle Cap: Schmitt BD. My Child Is Sick!: Expert Advice for Managing Common Illnesses and Injuries. (2018). Cradle Cap Patient Education. Change Healthcare.
Atopic Dermatitis: Schmitt BD. My Child Is Sick!: Expert Advice for Managing Common Illnesses and Injuries. Elk Grove Village, IL: American Academy of Pediatrics; 2017.
Eske, J. (2019, April 10). Top 6 Remedies for Dry Skin on the Face . Medical News Today. Retrieved from Medicalnewstoday.com
Confused about sunscreen? Get the facts. (2019, May 21). https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/best-sunscreen