Exfoliation involves using either abrasive products or chemical masks to remove dead skin cells from the outermost layer of skin. It can provide what seems to be an immediate glow-up, leaving skin looking brighter and feeling softer. For this reason, it has enjoyed an enduring popularity. 

Social media, TikTok in particular, has driven a new enthusiasm for exfoliation. Some influencers claim that exfoliation should be done every day. Others advocate skin “cycling,” where the skin is exfoliated every four days, as a gentler alternative to daily exfoliation. 

The viability of these claims is an even greater concern to eczema sufferers. Eczema flares often leave patches of dry, scaly skin behind, making exfoliation look very appealing. At the same time, exfoliation can be hard on sensitive skin. 

There’s a lot of conflicting information about exfoliation and eczema. Here’s a quick run-down on different exfoliation methods and their safety for eczema-prone skin.

How is exfoliation done?

Exfoliation is nothing more than the removal of dead skin cells from the stratum corneum, the outermost layer of skin. When left alone, the skin (under average circumstances) handles this task on its own.

New skin cells are generated in the skin’s basal layer, the innermost layer of the epidermis. As they migrate through the other layers of the epidermis, these new cells push older cells up and out. This creates a natural rhythm; old skin cells are sloughed away by the new cells that take their place, a process called desquamation that takes around 28-30 days on average. 

One part of that process–the desquamation of dead skin cells–can be hastened along with chemical or mechanical exfoliants. Exfoliating products have evolved over time, from the rough scrubs popular in the 80s (still available today), to chemical peels, to at-home chemical exfoliation creams and masques. 

 

Chemical exfoliants

Chemical exfoliants are, surprise, surprise, chemicals that remove the outermost layer of skin. Most chemical exfoliants are acids that work by loosening the bonds between dead skin cells so that they can be shed. 

Acids marketed as exfoliants mostly fall into three main categories: beta hydroxy acids (BHAs), alpha hydroxy acids (AHAs), and poly hydroxy acids (PHAs). They can be found in cleansers, toners, and creams. Creams are usually used overnight for maximum results, and also to prevent them from combining with wind or sun to irritate the skin. 

• Beta hydroxy acids (BHAs) are derived from the bark or leaves of woody plants. They include salicylic acid, beta hydroxybutanoic acid, tropic acid, and trethocanic acid. These are some of the strongest exfoliating acids available without a physician’s oversight. 

Because they penetrate the skin deeply and inhibit the production of sebum, BHAs are popularly used for treating acne, seborrheic dermatitis and psoriasis. They tend to be far too harsh for people with eczema, especially during flares. 

• Alpha hydroxy acids (AHAs) are found in milk, fruits, and sugar cane. They include glycolic, lactic, citric, malic, and tartaric acids, and they range in acidity; glycolic is one of the most acidic AHAs, lactic acid one of the least acidic. 

Each AHA works a little differently; glycolic acid stimulates the production of collagen, for example, and lightens areas of hyperpigmentation. It’s useful for treating melasma, because it helps regulate the production of melanocytes. 

Lactic acid is one of the gentler AHAs. It is actually one of the key components of natural moisturizing factor (NMF), a substance produced by the epidermis that is vital to the maintenance of the skin barrier. It has humectant properties, drawing water into the skin, which assists with desquamation (the shedding of dead skin cells). It also helps the skin preserve its plasticity and maintain its barrier function. 

All AHAs are humectants. This is a desirable trait for folks with eczema. However, they can be irritating, especially the stronger AHAs such as glycolic acid. They should be used with caution and should not be used on skin that is actively flaring. They should be used cautiously when the skin is not flaring. 

• Poly hydroxy acids (PHAs) are the gentlest of exfoliating acids. Derived from AHAs, they include gluconolactone, galactose, and mandelic acid. Because their molecular structure is larger than those of AHAs and BHAs, they cannot penetrate as deeply into the skin, and their effect is mostly seen on the surface layer. They have some of the same humectant and skin evening properties as AHAs. 

Mandelic acid is regarded as the gentlest of PHAs, and is often recommended for sensitive skin. As gentle as these products are, they can aggravate extremely sensitive skin. They should not be used during flares. 

Mechanical exfoliants

Unlike chemical exfoliants, mechanical exfoliants rely upon friction to remove dead skin cells. They have a characteristic “rough” texture. Mechanical exfoliants include: 

• Loofahs 
• Complexion brushes/cleansing brushes
• Scrubs (including salt and sugar scrubs)
• Microdermabrasion
• Exfoliating gloves

Mechanical exfoliants require a gentle hand and should not be used regularly. This is true, especially for facial skin, which is thinner and more delicate than skin on the body. Mechanical exfoliation treatments should be infrequent, and they should be followed with thorough moisturization. 

Mechanical exfoliants can leave skin raw and red. They can also cause small abrasions, which can worsen eczema flares. People with eczema should be wary of mechanical exfoliation when they are not flaring; these exfoliants are an absolute no-go during flares. 

Eczema and exfoliation

Most dermatologists agree that exfoliating once a day is excessive for anyone. Most people fare better exfoliating 3-4 times a week at a maximum. Those with sensitive skin should exfoliate far less frequently–once a week or once every week and a half. 

People with eczema should be even more conservative about exfoliation. When your skin is not flaring, harsh mechanical exfoliants should be avoided, as they can cause small injuries to the skin and trigger flares (and infections). Chemical exfoliants should be used cautiously. 

If you have eczema and would like to try exfoliation, try starting with a mild PHA (mandelic acid is the gentlest) on a conservative, once-weekly schedule–mandelic acid. If using an AHA, consider using lactic acid, as glycolic acid can be hard on sensitive skin. Monitor your skin’s reaction to these treatments carefully. Always moisturize after exfoliating. 

You should never exfoliate flaring skin. It can worsen inflammation, and mechanical exfoliation in particular can damage your suffering skin even more. Mechanical exfoliation during flares can also invite infection, a complication nobody needs. 

 Some dermatologists advise that exfoliating during a flare overstimulates the basal layer, leading to disorganized, abnormal production of skin cells. The result, they say, is lichenification, patches of thickened skin that is prone to cracking and oozing. 

 

The long and short of it

Should you exfoliate if you have eczema? Only if you are not flaring, and conservatively when you are not. Avoid brushes, loofahs, scrubs, and other mechanical exfoliants, flaring or not. Choose a gentle chemical exfoliant that is made for sensitive skin; try a mild PHA like lactic acid first, and exfoliate once weekly at a maximum. 

Always moisturize after exfoliating. Moisturization is one of the most important parts of eczema management. You should be moisturizing twice a day as a rule; more frequent moisturization is better during flares.

Speaking of moisturizing…

A new product from HarlanMD–makers of the eczema cream SmartLotionⓇ–offers exceptional moisturization for those with dry, sensitive, or damaged skin. 

Perfect Repair™ moisturizing cream is packed with ceramides that help restore the skin’s barrier function. It uses coconut oil, well-known for its healing properties, to prevent moisture loss. Its prebiotic formula encourages a healthy microbiome, defending against the overgrowth of harmful bacteria such as staph. 

Fragrance-free Perfect Repair™ offers unparalleled protection and healing for skin affected by eczema. It’s an ideal follow-up to a gentle exfoliation treatment. 

 

 

When eczema flares

Your skin deserves–and needs–more TLC during and immediately after an eczema flare. Don’t exfoliate during flares, and steer clear of scrubs and brushes, especially. Use Perfect Repair™ at least twice a day (more is better) to infuse the skin with needed moisture. 

Don’t forget your SmartLotionⓇ. Used at the first signs of a flare, it decreases the severity and the duration of eczema symptoms. Like Perfect Repair™, SmartLotionⓇ uses a prebiotic formula to promote skin health. Containing 0.75% hydrocortisone, it reduces redness and itching with no risk of skin atrophy or topical steroid withdrawal. In fact, SmartLotionⓇ has few reported adverse effects at all. 

SmartLotionⓇ is safe even for treating long-term symptoms. Under a physician’s supervision, it can be added to most other treatments without risk. 

With SmartLotionⓇ and Perfect Repair™, you have greater control than ever before over your eczema symptoms. Combined with your dermatologist’s treatments and a healthy skincare regimen, they can help your skin regain its natural radiance and softness–no harsh exfoliants needed. 

 

 

  Cee Van

  Medical Writer

  HarlanMD.com