Rethinking the Science of Skin

欧洲杯买彩票What is all the scrubbing, soaping, moisturizing, and deodorizing really doing for the body’s largest organ?

Buttocks and arm.
Skin, long seen as a barrier that should be sterile and pristine, is increasingly seen as a “complex, diverse ecosystem.”Photograph by Maisie Cousins for The New Yorker

When my sister and I were young, we liked to come home from school and turn on “Guiding Light,” a soap opera on CBS. We only ever caught the last fifteen minutes of the hour-long show, but, because it wasn’t particularly subtle, this was plenty of time to follow even its most involved plotlines—such as when Reva Shayne, a nine-times-married character who had arcs as a talk-show host, a psychic, the princess of a fictional island, and a time traveller to the Civil War and Nazi Germany, had to fight Dolly, a devious clone that her most recent husband had made of her in order to spare her children from grief during the most recent of her presumed deaths.

“Guiding Light” began, in 1937, as a radio show to promote a soap called Duz. (“Duz does everything.”) When it went off the air, in 2009, it was the longest-running show in broadcast history. It was owned, until the end, not by CBS but by Procter & Gamble, which began as a soap company and has been credited with inventing modern advertising in America. In addition to promoting its brands with paintings on trolley cars and billboards, the company developed more than twenty radio and television dramas. The first, “Oxydol’s Own Ma Perkins,” premièred in 1933; the last, “As The World Turns,” left the airwaves in 2010, by which time the term “soap opera” had become freestanding. You could even watch them, as I did, without ever knowing they had anything to do with a soap company.

It was easy, until the COVID-19 outbreak, not to think very often or very deeply about soap. Early in the pandemic, this began to change. We learned which pop songs had choruses that we could sing to keep us scrubbing for a full twenty seconds; we learned that, at least during the pre-lockdown period, the lines outside men’s rooms grew suddenly longer—likely because (according to one study) only thirty-one per cent of men had previously been in the habit of washing their hands after using the bathroom. As distilleries and breweries pivoted to producing hand sanitizer, the Times ran a piece explaining why old-fashioned soap was actually better at destroying the coronavirus: the hydrophobic tails of soap molecules bond with the lipid membrane that protects the virus, literally ripping it apart, while their hydrophilic heads bond with the water that washes the dead virus away. Like many people, I developed a new appreciation for soap, imagining with grim satisfaction a scene of microscopic destruction each time I scrubbed my hands.

欧洲杯买彩票So this has been a strange time to be reading a book by a medical doctor which takes a critical view of the soap industry and begins with the sentence “Five years ago, I stopped showering.”

Let me clarify at once that James Hamblin, a staff writer at The Atlantic and the author of “” (Riverhead), is still an advocate of regular handwashing, indisputably a world-changing innovation in public health, and of especially crucial importance at this moment in history. (Hamblin also writes that he “would never wear a white coat two days in a row without cleaning it.”) But he’s doubtful about all the scrubbing and soaping—not to mention moisturizing and deodorizing and serum-and-acid application—to which we subject the rest of our body’s largest organ, and about the companies that spend a lot of money to convince us that we must do so to be clean.

Soap is an ancient invention, so old that we can only assume it was the lucky result of animal fat spilling into fire ash and some people being alert enough to notice the cleaning power of the resulting lather. Still, early versions, made with lye, could burn skin, and were used more often for laundry than for people. Bathing more commonly involved water, sand, pumice, scrapers, and oils or perfumes—though in certain places the whole notion was seen as dangerous. Some historical records suggest that washing was comparatively rare in the Western world: Marco Polo wrote of his surprise at how frequently people in India and China bathed, and Ahmad ibn Fadlan, who travelled from the court of Baghdad to the Volga River in the early tenth century, wrote that the people he met on his journey did not wash after eating, shitting, peeing, or having sex, and were “the filthiest of Allah’s creatures.” The French historian Jules Michelet described the European Middle Ages as “a thousand years without a bath.”

欧洲杯买彩票In America, soap made for skin became commonly sold only in the nineteenth century, largely as a way to make money from the leftovers of the meatpacking industry, which produced large quantities of unused animal fat. Entrepreneurs added potash and made soap, for which they then needed to create public demand. These early “soapers” included William Procter and James Gamble, who began working together after marrying a pair of sisters; another familial pair, whose company name eventually changed from Lever Brothers to Unilever; and a man named William Wrigley, Jr., who gave away chewing gum as a promotion for his soap, but found that the gum was in higher demand.

Last year, the beauty-and-personal-care market in the U.S. was valued at nearly a hundred billion dollars, which makes it hard to imagine a time when people had to be persuaded to use soap. But the soap industry, Hamblin argues, serves as an effective introduction to the history of American marketing. Early soap companies pioneered many techniques that we still see today: a single company owning lots of competing brands with nearly identical products, in order to foster feelings of consumer choice and loyalty; the use of “sponsored content,” such as the soap operas or Procter & Gamble’s “How to Bring Up a Baby,” which was part health pamphlet and part advertisement. The ad campaigns created a sense of lurking danger in the competition by claiming that their own products were safer and purer, or they promoted, as product virtues, obscure, jargony terms (“triple milled”) that consumers assumed to be important simply because they were touted on a package. The companies leaned, not at all subtly, on racism and classism to sell their products. They even used people who would now be called influencers, such as the film stars who appeared in “9 out of 10 screen stars use Lux Toilet Soap” ads. “Lever never even paid them,” Hamblin writes, “and the practice being so new, the stars apparently didn’t think to ask.”

The other innovation was to create, and then meet, needs that people didn’t know they had. Hamblin notes that “B.O.” began as a marketing term, and that many soaps advertised as “antimicrobial” and “antibacterial” were less safe than standard soap, leaving behind dangerous compounds. (Many products that we now think of as soaps are actually detergents, made from synthetic compounds.)

Meanwhile, soap companies, in order to expand their product lines, “had to sell the idea that soap was insufficient on its own—or that its effects had to be undone by yet more products,” Hamblin writes. You needed separate soaps for your hair, your body, your face, and even for different members of a family. (Albert Einstein, asked why he didn’t use shaving cream, then newly invented, is reported to have replied, “Two soaps? That is too complicated!”) To offset the drying effects of soap, you then needed other products—conditioners, moisturizers, toners. Hamblin identifies the 1957 introduction of Dove, whose cleaning power is reduced because it’s mixed with moisturizer, as the moment when the industry started moving toward selling a product that would do nothing at all.

” (Atlantic Monthly Press), Lyman’s goal is to push back: to teach readers to appreciate an organ that is often “invisible in plain sight. ”

Skin is a strange little miracle. Were it removed, you would quickly lose the water in your body and die of dehydration. It protects you from deadly radiation and pathogens and helps you stay within the narrow temperature spectrum your body can tolerate, yet it is, at its thinnest, half the width of a penny. And the cells with which it faces the world are already effectively dead, and will, in general, last no longer than a month—a million or so are shed each day, filling your house with dust. As these skin cells are lost, they are replaced with new ones, taking their own self-sacrificial turn at the barricades to protect the trillions of other cells of which you are made. “Never was so much owed by so many to so few, ” Lyman writes.

欧洲杯买彩票As is often true in medicine, the importance of skin is made most clear when its workings go awry. Lyman tells us about pellagra, a painful rash that was widespread in South Carolina in the early twentieth century, leading to “unstoppable diarrhea” and eventually psychosis, until it was finally cured by the introduction of a balanced diet; it is the reason that packaged bread now includes niacin. We’re introduced to children with xeroderma pigmentosum, a genetic condition that sabotages the natural repair system that searches for U.V. damage to DNA; they are sometimes known as “midnight children,” because of their need to avoid the sun, and develop skin cancer at horrifying rates. In epidermolysis bullosa, another genetic condition, no proteins connect the epidermis to the dermis, which means skin can be ripped off by “a shearing force as light as twisting a door handle.” A young patient with the condition, Hassan, had barely any skin remaining when he received a pioneering treatment: doctors harvested some of his skin cells, exposed them to a virus that carried a healthy version of the mutated gene, then used them to grow nine square feet of new skin in a lab, which they successfully grafted onto Hassan’s body.

欧洲杯买彩票While Hamblin focusses on cleanliness, Lyman attempts a comprehensive look at skin, speeding through sections on touch, pain, the history of tattoos, the science of melanin, how different religions view nudity, and how our skin’s exposure to the sun affects our broader health. (Did you know that dogs and cats, perhaps because their fur blocks their skin’s ability to absorb sunlight and produce Vitamin D, secrete an oil that converts to Vitamin D when exposed to sunlight? It then has to be ingested orally, which is one reason that pets are always licking themselves.) The sun can affect the aging of skin even more profoundly than time itself does, Lyman notes. He writes about working in a clinic and wrongly assuming that a sixtysomething woman was the daughter, rather than the mother, of a fortysomething, sun-worshipping patient.

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Though he takes readers on a tour of fad skin treatments, from the “vampire facials” once favored by Kim Kardashian to Cleopatra’s daily bath in donkey milk, his only fully endorsed beauty treatments are sun protection, a healthy diet, and the avoidance of smoking, excessive drinking, and long-term stress. “It is no surprise that the 2008 financial crisis saw a record peak in psoriasis and eczema consultations,” Lyman writes. Disorders such as celiac disease, Crohn’s disease, rosacea, and eczema—all of which involve the skin, the immune system, and the gut—reveal just how intertwined these systems are. Eczema, for example, is a predictor of whether an infant will develop food allergies, and acne has been found to increase when a person’s diet becomes Westernized.

Skin care, whose market value grew by some twenty billion dollars between 2014 and 2019, has become the most profitable sector of the cosmetics industry. Products can be wildly expensive, especially when combined with others into elaborate regimens. But the science of skin health, as described by Hamblin and Lyman, suggests that we err when we think of skin as static or as separate, to be ministered to by surface applications of various cleansers and moisturizers, goops and goos. (Hamblin scoffs at the idea of trying to promote skin’s internal collagen production by rubbing on, or ingesting, collagen: “It’s like if you needed new tires and you put rubber in your gas tank.”) Skin is, literally, an ecosystem, in constant connection with the health of the rest of our body, as well as with the world beyond.

In a chapter called “Skin Safari,” Lyman gives a tour of the denizens of our skin. They range from the microscopic mites that wander around our faces at night, copulating, to the highly stable communities of microorganisms that live on the different regions of our bodies, each with its own unique environmental conditions. “At first glance, our skin looks like a bare, inhospitable landscape,” Lyman writes. In fact, for critters that are small enough, it’s full of ridges and canyons and deserts and swamps: “Habitats filled with wildlife worthy of a nature documentary. ” These habitats are affected, in turn, by our own environmental conditions. In one study, scientists could tell, just by examining people’s skin microbiome, what city they lived in and with whom they cohabitated.

If reading this makes you want to use more soap, not less, I can certainly relate. (It probably won’t help to learn that all those tiny face mites, because they have no anuses, eventually die from the backup of all the skin and oil they have consumed on your face.) But bear in mind that the skin microbiome has always been with us, and includes at least as many microorganisms as you have cells in your entire body—maybe three times as many. It is you, in a very real way, and it serves purposes we’re only beginning to understand. For example, microbes called archaea, discovered on skin in 2017, may be caretakers of our skin, helping it turn over nitrogen and keep pathogens at bay; smelly microbes on our feet may discourage fungal infections; and even those face mites could be thought of as natural exfoliants. One person’s skin is home to “a thousand species of bacterium, not to mention fungi, viruses, and mites,” Lyman writes—a diversity of characters and story lines that would put any soap opera to shame, and that have real outcomes for our health and our well-being. He tells of a smelly person who, after being swabbed with microbes taken from the armpits of his sweet-smelling twin, stopped stinking, and another who used dietary changes to combat a socially crippling genetic condition known, evocatively, as “fish-odor syndrome.” Lyman expects that science will soon be able to alter our unique microbial selves in ways that are far more sophisticated than using, or giving up, soap: “Manipulating and adjusting these populations has the potential to revolutionize medicine.”

Hamblin, too, learns that soap is a small player compared with other things that affect the microbiome: use of antibiotics, say, or the early life experiences that affect its initial development. Rethinking soap, he decides, may be most important as a symbol of the way that we think about cleanliness: Is it a war or a balancing act? He concludes his book with an ode to public parks as a key part of urban hygiene, wishing that we spent more of the money that we’ve shelled out for soaps and skin care on improving our own habitats—both those that we live in and those that we are. “As we change our worlds, we change our bodies,” he writes. “The old duality between environmental health and human health is obsolete.”

Still, he decides that his personal experiment is a success. After a period of transition, which his microbial populations presumably spent getting themselves reorganized, the girlfriend who rejected the van idea embraces the non-showering. She declares that Hamblin smells neither good nor bad, exactly, but “like a person.” ♦