Medical myths: All about skin

Our skin plays multiple roles. For instance, it helps keep our insides inside and blocks the path of pathogens. It also helps us stay warm when it is cold and cool down when it is hot.

Importantly, the skin provides a home for sensory neurons, which let us sense the world around us.

Despite the wide range of physiological functions this organ plays, it is arguably most famous for being the largest organ of the body, although some scientists disagree. The skin is also our most visible organ.

And because it is so visible, skin has also become the target organ for a wide range of products, many of which promise clearer, healthier, more youthful skin.

Because the skin, for many of us, is the poster child of our face, it is no wonder that scientists, doctors, and charlatans have paid it a great deal of attention over the years.

With this heady cocktail of high visibility and multiple physiological roles, it is no wonder that public dermatological perceptions are a mixed bag of myths and misunderstandings.

In this article, we will address 12 common confusions. To help us wrestle fact from fiction, we enlisted the help of three experts:

  • Prof. Hywel C. Williams, OBE, D.Sc.: a Fellow of the Academy of Medical Sciences and a National Institute for Health Research Senior Investigator Emeritus. Prof. Williams is also a professor of dermato-epidemiology and co-director of the Center of Evidence-Based Dermatology at Queen’s Medical Centre at Nottingham University Hospitals National Health Service (NHS) Trust.
  • Dr. Derrick Phillips: a dermatologist and spokesperson for the British Skin Foundation.
  • Dr. Beth G. Goldstein: Founder at Get Mr. and Central Dermatology Center.

1. Expensive skin cream can keep your skin ‘young’ forever

The skin cream industry is huge. For instance, in the United States in 2020, “prestige skin care” sales totaled $1.1 billion from April to June. And that marked an 18% drop from 2019 sales.

However, despite their lucrative popularity and regardless of cost, no skin creams can protect skin against aging indefinitely. “This is a marketing ploy and is certainly not true,” said Dr. Phillips.

As Prof. Williams explained to Medical News Today, “Simple moisturizers can achieve quite a lot. Creams containing topical retinoids can improve photoaging effects.” He dryly notes, however, that he is “not aware of any cream that keeps skin young forever.”

Dr. Goldstein informed us that “90% of skin aging is from photodamage. So all of the creams that state they can prevent wrinkles and aging are missing the mark.”

In agreement, Dr. Phillips wrote: “The most important intervention in slowing down the process is using a sunscreen with broadband UV cover.” Notably, he also notes that “these needn’t be expensive.”

2. Drinking water keeps your skin hydrated 

This is a half-truth. According to Prof. Williams, drinking water only keeps your skin hydrated “in the sense that water keeps the body hydrated and skin is the largest organ of the body.”

It is only at certain, rare times when this might be the case. “There is no evidence that drinking water directly impacts your skin unless in extremes, such as heat stroke or severe dehydration,” said Dr. Goldstein.

3. Antibacterial soap is best for the skin 

This is a myth. The skin’s natural microbiome is vital for maintaining healthy skin. “Using antibacterial soaps can upset that natural balance,” explained Prof. Williams. “They can also be harsher on the skin than pH neutral soaps.”

“Removing both the good and bad bacteria on a regular basis is not always the best idea,” added Dr. Goldstein, “unless you are in a situation where this is important, for instance, if you work in healthcare, food handling, or of course, during a pandemic.”

4. Having a dirty face causes acne

In Prof. Williams’s professional opinion, this is “nonsense.” Unless, he explained, the dirt “is contamination with oily substances such as hair pomade, oily make-up, or occupational oil exposure.”

Standard dirt will not produce acne.

“Acne is caused by a complex interaction of hormones and the skin, not dirt. People will use scrubs, toners, and many products to clean their faces to address or prevent acne, but often this can just result in irritation. The pores are plugged by keratin, a protein produced by the skin cells, not dirt.”

– Dr. Goldstein

Diving into the details, Dr. Phillips told MNT that, although the skin’s microbiome may differ in people who have acne compared with those who do not, this is not due to cleanliness.

He also adds an interesting note about a rather modern dermatological condition:

“In the past year, there has been a rise in ‘cell phone’ acne, where people get acne spots on the side of their face that presses against their mobile phones. It is thought to be related to a combination of short-wavelength visible light from smartphones, sweat, dust, heat, friction, and bacteria on the surface of the phones. Flares may be prevented by regularly cleaning phone screens.”

5. Chocolate causes acne 

Simply put, Prof. Williams writes that this is “another myth.” For the reasons outlined above, this has no basis in fact.

6. All sun exposure is bad for the skin

“All sun exposure causes some degree of photodamage,” explained Prof. Williams, “but some sun exposure is essential for boosting vitamin D synthesis,” especially for people in regions that are further from the equator and those with darker skin who receive lower sun exposure.

Similarly, Dr. Philips told MNT that “The sun is a major source of vitamin D, which is important for bone health and may play a role in the immune system. We also know that UV exposure from the sun has anti-inflammatory properties that can be beneficial in some skin conditions, such as psoriasis, eczema, and pruritus.”

However, he also explained that “these benefits must be counterbalanced against the risk of skin cancer, which we know in white populations is directly related to UV exposure.” He recommends using high-factor sunscreen, wearing appropriate clothing, and staying in the shade between 11 a.m. and 3 p.m. on sunny days.

As someone who focuses on skin cancer surgery, Dr. Goldstein took a firmer line:

“There is a skin cancer epidemic with at least five million new cancers treated each year in the U.S. The majority of these cancers are due to sun exposure.”

Although vitamin D is essential, she explained that we can also derive it from foods and supplements,“1 in 5 Americans will get skin cancer, and melanoma is set to be the most common cancer among men, and only second to breast cancer in women by 2040.”

7. A spray tan protects against UV rays 

A spray tan will not protect against sun damage unless it contains added UV protectants. “Just spraying color onto the skin does not protect against UV rays,” said Prof. Williams.

Dr. Phillips reiterates the message: “They do not provide any protection against UV radiation and should not be used as an alternative to sunscreen.”

8. Vitamin E helps get rid of scars 

Over the years, many scientists have investigated whether vitamin E reduces the appearance of scars, but our experts were unanimous in their responses. To date, Prof Williams says, the evidence is “unconvincing.”

Dr. Goldstein agreed that “current data do not support the use of vitamin E to help get rid of scars.”

Dr. Phillips goes one step further, writing that “in some instances, it can be detrimental.” However, as an alternative approach, he told us that “silicone gel products have been consistently shown to prevent scar overgrowth and improve the appearance of mature scars.”

9. ’Natural’ products are better for the skin 

Products that are marketed as “natural” are popular among consumers. However, the term “natural” says nothing about a product’s effectiveness or safety.

“Arsenic is natural after all,” Prof. Williams reminded us. “Many natural products, such as moisturizers, are very expensive and have no additional benefit over cheaper, refined products.”

He also noted that “natural products can have just as many side effects as well-tested medical products — they may not be as effective, and they may suffer from stability issues. But it is a personal choice — if people like the sound of the word ‘natural’ as a euphemism for ‘gentle’ or ‘safe’ and want to pay for the product, that is up to them.”

“Poison ivy is all-natural,” said Dr. Goldstein, “but you would not rub it all over your skin.” She also explained that all-natural products can still have “serious environmental impacts.” Importantly, according to Dr. Phillips, natural ingredients, especially in high quantities, can trigger allergies and irritate the skin.

10. Wounds need air to heal

This is a long-standing and pervasive myth, but, as Prof. Williams explained succinctly, it is “not true — wounds heal better with a clean, moist environment.”

In agreement, Dr. Goldstein said, “Research has shown that cells migrate better to initiate and continue healing in a moist environment in the early stages of healing in particular. Keeping a wound covered with Aquaphor or similar ointment and a bandage is ideal [if there is no infection].”

She also noted that, toward the end of the healing process, once new connective tissue and microscopic blood vessels have formed, air can aid the healing process.

11. Exfoliating daily is essential for healthy skin

Skin exfoliation is the process of removing dead cells from the surface of the skin. This can be achieved by using an exfoliation tool, a granular surface, or chemicals.

Although popular, exfoliation is not essential. As Prof. Williams explained to MNT, “the skin feels smoother after exfoliating, but repeated exfoliation is damaging the natural skin barrier.”

12. Black salve is a safe treatment for skin cancer 

Over recent years, so-called black salve, a derivative of the bloodroot plant, has entered the marketplace. Unscrupulous companies market it as a way to treat skin cancer. In reality, black salve can be dangerous.

Prof. Williams told us that “sanguinarine — the active ingredient in black salve — can cause severe tissue necrosis and may not kill all skin cancer cells. Always see a dermatologist to get suspected skin cancer diagnosed properly first and discuss treatment options if then confirmed.”

He also sent us a link to a recent article discussing black salve. The authors explain that “clinical data concerning the efficacy of bloodroot primarily come from case studies with unfavorable outcomes involving patients who self-treated with bloodroot-containing black salves.”

Dr. Goldstein mirrors these findings, explaining that “I have seen sad outcomes of people trying this treatment.” She also reiterated that black salve damages healthy tissue without effectively curing cancer.

Dr. Phillips confirms the negative consequences of black salve: “The Food and Drug Administration (FDA) has listed black salve as a fake cancer cure, and it should be avoided!”

Female face close-up, showing skin problems. Dry skin, acne, wrinkles and other imperfections. Rejuvenation, hydration and skin treatment

How can we prevent the spread of SARS-CoV-2 in children?

Children are being hospitalized with COVID-19 in record numbers across the United States. As most children are not old enough to get vaccinated, hospitalizations could further increase as schools reopen. Doctors and epidemiologists are thus calling for the use of safety precautions, such as masks and ventilation, during class.

The rise in cases of COVID-19 among children in the U.S. is primarily linked to the Delta variant. Cases are rising especially quickly in communities with low rates of COVID-19 vaccinations.

Although the Centers for Disease Control and Prevention (CDC) recommend universal indoor masking and physical distancing in schools, mask-wearing is optional in North Dakota and Ohio.

Rapidly increasing infection rates among children and teachers have forced many schools in the U.S. to halt in-person learning and turn to hybrid models of education. This comes despite 175 pediatric disease experts agreeing earlier this year that elementary schools could open full-time for in-person instruction.

Although children generally have milder COVID-19 symptoms than adults, the fact that few studies have investigated how the disease affects children means that many questions remain unanswered. For example, why are so many children being hospitalized with COVID-19? Which children are most at risk? And what can parents and authorities do so that children can return to school safely?

To answer these questions and more, we spoke with seven doctors and researchers who specialize in pediatrics and infectious diseases and have worked directly with children with COVID-19.

Why are COVID-19 hospitalizations among children increasing?

The Delta variant of COVID-19 is more than two times as contagious as previous variants. Alongside school reopenings, this may partially explain the increase in pediatric hospitalizations due to COVID-19.

The Delta variant that is circulating widely is more contagious, and children are getting infected more often than previously during the pandemic.

Now, you have a more contagious variant with fewer mitigation measures in place. With the rising number of cases, unfortunately, you will see more hospitalizations. As an example, if 2% of children need hospitalization, then it’s a big difference between 2% of 10,000 cases vs. 2% of 100,000 cases.

Another reason for rising COVID-19 hospitalizations among children may be that those under the age of 12 years cannot get the vaccination yet.

Vaccines remain effective at preventing severe illness, hospitalization, and death from [SARS-CoV-2] infection, even Delta strain infection,” Kristin Moffitt, M.D., an infectious disease expert at Boston Children’s Hospital, MA. “This is consistent with reports that the overwhelming majority of hospitalizations and deaths during the recent surge are occurring in unvaccinated individuals.

“Since children under 12 aren’t yet able to be vaccinated, and many adolescents and young adults remain unvaccinated relative to older individuals, this age group is making up a bigger proportion of those at risk for severe illness based on their unvaccinated status,” she added.

Dr. Karen Ravin, M.D., chief of infectious diseases at Nemours Children’s Hospital in Delaware, agreed. “Children under 12 years of age make up a substantial proportion of the unvaccinated population in the U.S., so they are the population at highest risk,” she said. “Early in the pandemic, schools were closed, and children had a lower risk of exposure in the community. Contrast this to now, schools are open for in-person instruction so children are at greater risk for being exposed, becoming infected, and, unfortunately, being hospitalized.”

“Overall, children are at lower risk for severe illness, hospitalization, and death due to COVID-19, but they are not at no risk.”

– Dr. Karen Ravin

“Early in the pandemic, those over 65 accounted for more severe disease and hospitalization. Now that this age group has a higher percentage of vaccinated persons, the disease burden will be seen in the younger, unvaccinated population,” noted Dr. Adriana Cadilla, an infectious diseases pediatric specialist at Nemours Children’s Hospital in Orlando, FL. “[In Florida,] there has been over a four-fold increase in child [SARS-CoV-2] infections in the past month,” Dr. Cadilla added.

Is the Delta variant more severe than earlier strains? 

Although the number of COVID-19 cases among children is increasing more quickly now than at any other time in the pandemic, it is unclear whether the Delta variant of SARS-CoV-2 is more severe for children than previous variants.

“We don’t know if the Delta variant causes more severe disease for kids than previous variants, but it’s definitely more contagious,” said Dr. Chang.

Due to low testing and hospital admissions among children from previous variants, the data to compare the outcome of COVID-19 strains are sparse. As schools reopen, however, and safety precautions such as mask-wearing wane, more children are becoming infected with SARS-CoV-2 at the same time, leading to higher numbers of children developing severe COVID-19.

There are some indications to suggest that COVID-19 from the Delta variant is more severe in children than with earlier strains,” Dr. Allison Ross Eckard, M.D., professor of pediatrics and medicine at the Medical University of South Carolina.

“We are seeing a greater number of children, particularly unvaccinated adolescents, with more severe COVID-19 resulting in respiratory failure that is requiring intubation and sometimes ECMO (heart-lung bypass machine), ARDS (a very serious lung condition that develops as a result of the inflammation associated with COVID-19), and other COVID-related problems — all complications we more commonly see in adults,” she continued.

“It may be that the increased number of hospitalizations among children is a result of both of these factors — more cases combined with a higher chance of severe disease. More data is needed to determine the exact reason(s) behind what we are seeing,” she added.

Which children are at higher risk of adverse outcomes from COVID-19?

The CDC says that children with underlying medical conditions, such as congenital heart disease or genetic, neurologic, or metabolic conditions, could have an increased risk of severe outcomes from COVID-19.

The CDC states that this higher risk also applies to children with obesity, diabetes, asthma, chronic lung disease, sickle cell disease, or immunosuppression.

“Children who are at higher risk of adverse outcomes from COVID-19 are those under 1 year of age, those with underlying conditions, and those with immunocompromising conditions, including those on immunocompromising medications,” Dr. Tina Q. Tan, M.D., medical director at Ann & Robert H. Lurie Children’s Hospital of Chicago.

“Other children may also develop more severe disease, resulting in the need for hospitalization, but at a lower rate than those with underlying or immunocompromising conditions,” she added.

“Anecdotally, most of our hospitalized patients with COVID-19 are unvaccinated teenagers. Many of these teens are quite ill, and their only risk factors are obesity and/or asthma,” Dr. Danielle Zerr, M.D., M.P.H., professor and division chief of pediatric infectious disease and adjunct professor of epidemiology, University of Washington.

Dr. Chang echoed these statements, saying that teenagers with a body mass index of 25 or above and infants under the age of 1 year have a higher risk of hospitalization.

“Many families think their children are healthy and, therefore, not at risk of severe COVID-19,” said Dr. Eckard. “While that is true statistically, we cannot always predict which children will develop severe disease, and children [without underlying conditions] sometimes do develop severe disease.”

“In addition, some children are healthy but perhaps require an inhaler a couple of times per year, or some children’s families don’t even realize they are overweight. So, there is sometimes a misconception about a child’s risk. Therefore, it is very important for every family to discuss their child’s health with their primary care physicians to ensure that all children are appropriately protected.”

– Dr. Allison Eckard

“We are still learning what causes some children to develop more severe COVID-19 than others, but it is important to know that perfectly healthy children can develop severe COVID-19,” Elizabeth Mack, M.D., M.S., medical director of pediatric critical care medicine at the Medical University of South Carolina, told MNT.

Dr. Mack also noted that the risk of death from severe COVID-19 remains a possibility even for children without underlying conditions.

Race, ethnicity, and socioeconomic conditions may also play a role in adverse outcomes from COVID-19 among children. Dr. Cadilla noted, “Hospitalization rates are higher among Hispanic [and] Latino children and non-Hispanic Black children, mirroring adult data.”

While more data are necessary to confirm why this is the case among children, among adults, research highlights deep-seated inequities that put these populations at higher risk.

For example, Hispanic, Latinx, and non-Hispanic Black populations are more likely to be uninsured, working in jobs that do not offer remote working, and living in conditions that make it difficult to practice physical distancing and self-isolation. These populations also have higher rates of underlying health conditions, such as diabetes and obesity.

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All data and statistics are based on publicly available data at the time of publication. Some information may be out of date. Visit our coronavirus hub and follow our live updates page for the most recent information on the COVID-19 pandemic.