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Q&A with Canadian Dermatologist Dr. Sandy Skotnicki

Sandy Skotnicki
Sandy Skotnicki

We chatted with Dr. Sandy Skotnicki, Founding Director of the Bay Dermatology Centre and Assistant Professor at the University of Toronto, Department of Medicine in the Divisions of Dermatology and Occupational and Environmental Health


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What are the biggest stressors on an individual’s skin health?

Our outermost skin, the stratum corner, acts as a permeable layer. It’s really an amazing feature of evolution, as it keeps water in, bacteria and chemicals out and is less than the diameter of a human hair. Our skin’s total diameter is around 1-4 mm depending on the location on our bodies, with eyelids and groin having the thinnest. This thin organ has tensile strength and also has its own immune system, which, along with the skin microbiome, helps train out the immune system from birth to identify what is good and bad.

It’s important to clean your hands, but contrary to popular belief, alcohol hand sanitizer is less damaging to your skin’s barrier than washing with a cleanser or soap, and water.

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If we consider the function of our skin — essentially its permeability, strength and immune systems, what stressors can disrupt these functions?

Our skin’s outermost layer is similar in structure to that of a brick wall — with the cells being the bricks and the mortar our natural lipids/oils. Water and detergents break down our skin’s barrier function. Our skin has developed a mechanism to replace these bricks and mortar but excessive washing and scrubbing exhaust these mechanisms leading to a disrupted skin barrier or crumbled brick wall. This will allow bacteria and chemicals more ready access.

High pH (9-10) old-fashioned soap bars and liquid soaps also damage our skin microbiome, which functions at a normal skin pH of 4-6. A healthy functioning skin microbiome is integral in the first years of life to help train our immune system.

Cold weather or wind, resulting in low humidity, is also a stress on the skin as it depletes the skin’s natural lipids. Antiseptics and antibiotics used when not necessary also likely affect our skin microbiome. However, research has shown that in adults the skin microbiome is quite stable with repeat insults and it recovers. Research in this area is still evolving.

Pollution and UVL rays damage our skin through oxidative stress — breaking down collagen and elastin and potentially causing damage to genetic material that can lead to skin cancer years later.

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How has COVID been a burden to patients in relation to their skin health?

One of the biggest stressors to our skin health is washing and cleaning. As dermatologists, the number of patients with hand eczema has skyrocketed. We also saw this after SARS. Health care workers are especially affected, and it has led to problems. It’s important to clean your hands, but contrary to popular belief, alcohol hand sanitizer is less damaging to your skin’s barrier than washing with a cleanser or soap, and water. Furthermore, using a cleanser (Dove, Cetaphil or Aveeno bars) over a true soap bar, is better for your skin barrier and is sufficient for hygiene purposes.

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Is technology changing the game for dermatological treatments?

Telehealth has finally advanced in Canada and has been helpful for doctors to see patients virtually, but this still doesn’t replace examining patients when necessary. I think we need, as doctors, to come to a happy medium where telemedicine will allow us to be more effective as physicians while helping our patients with availability. As far as other technologies, Dermatology screening apps are now available and, if used properly, they could help triage patients who need to be seen more urgently.

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