Dr. Schadlow Responds:

Dear Joanna:

First off, I’m very glad to hear that you’re otherwise healthy, but I’m sorry to hear about the pain and unhappiness you’re experiencing from these changes in your complexion. I am sure that any woman would be self-conscious if her skin were in this state. Although this is not an unusual problem, treating it can be challenging; I hope that what I am about to share will be helpful.

There are likely a few contributing factors that are making your skin extra-sensitive at this time of year. First, there is genetic predisposition. Certain ethnic groups, including people of Irish descent, may have a propensity for sensitive, dry skin that can become easily irritated and red. Second, as you probably know, our skin changes as we age, becoming less supple and less able to retain moisture. Third, you mentioned menopause. It is clear that estrogens play a role in maintaining skin elasticity. Not only do we start to lose this elasticity once these estrogens decrease, but the skin also thins as well. This decrease of estrogens may also be responsible for increasingly dry skin, thanks to less sebaceous oil production. Together, your genetic makeup and the change in hormones after menopause are a setup for easily irritated skin. Add a retinoid and cold, dry weather and you have a perfect storm of factors leading to the condition you describe. I’m afraid that not all of those underlying causes can be corrected, but don’t give up. There are certainly ways to improve this condition.

So, with those factors in mind, we can work on changing what we can to make you more comfortable this winter. Many women, even those without particularly sensitive skin, need to change their regimens in the colder months.
I usually tell my patients in a similar situation the following:

1. Stop everything. First, let me say that I love retinoids, but I do recognize that there are times to call it quits. For some women, it may mean decreasing the strength of the retinoid during the dry winters, and for others it may simply mean to use extra moisturizer, but there is a group that simply can’t tolerate prescription topical retinoids, or even over-the-counter retinols. You may be able to return to your Retin-A eventually, but first we need to repair your irritated skin. Stopping everything also means stopping vitamin C serums, glycolic acid products, “anti-aging” moisturizers, and traditional soap cleansers that can irritate sensitive skin.

2. Start over. Put aside all the moisturizers that are not helping—but don’t worry, you will likely be able to use them again once the weather improves. For both dry facial skin and all-over dry skin, avoid the temptation to take long, hot baths or showers to combat the cold weather. This actually just dries the skin further.

3. Consider cleansers. You probably already know that traditional soap cleansers with sodium lauryl sulfate should not be used on the face if you have sensitive skin. Many people find that even water can be irritating if their skin is dry and cracked. In fact, washing your face with water only makes matters worse, because as the water evaporates it can leave your skin tight and dry. I recommend non-foaming, creamy cleansers like Cetaphil. One trick is to use Cetaphil gentle cleanser without any water at all. It is applied to the face and then gently wiped off with a cotton ball. A thin layer is left in place; this actually helps to protect the skin. Similarly, Pond’s Cold Cream Cleanser, an old classic, works the same way. It does not need to be washed off. This extra layer of protection without rinsing can be very soothing.

4. Use moisturizers. In the morning, pat your skin dry with a cotton towel after your shower and immediately apply a very bland, fragrance-free moisturizer. A few brands I like for this are Vanicream, CeraVe Moisturizing Cream, Pond’s Dry Skin Cream, and Cetaphil Moisturizing Cream. They are all a little on the thicker side, but as your skin improves you can switch to a lighter lotion. For now, thicker creams will help your skin to retain moisture. On your lips, a thin layer of Vaseline is best. Vaseline is also terrific for around the eyes at night. The same cleansing technique followed by a moisturizer can be repeated at night.

5. Add protection. Simple measures like protecting your skin from harsh winds and freezing temperatures are also useful. Wrapping up in a soft scarf is a must, but be careful of harsh fabrics. A silk scarf or soft pashmina is better tolerated than traditional wool scarves. Wear sunglasses that wrap around the eyes as much as possible to prevent the cold wind from causing tearing that adds to under eye damage.

I hope that these five simple steps will help you survive the winter in more comfort. Of course, if the problem persists, please return to your doctor. There are some prescription creams available to help both restore the barrier function of the skin and to decrease irritation.

Dr. Monica Schadlow

Dr. Monica Schadlow is a board certified dermatologist in private practice in New York at Sutton Place Dermatology. She is a voluntary attending physician in the Department of Dermatology at New York–Presbyterian Hospital and a diplomat of the American Academy of Dermatology. She is also an officer of the Dermatologic Society of Greater New York.