Can skin become dependent on moisturizers?

Dear Dried Up,

You're not the only person on the quest for highly hydrated skin. Although they can be very helpful, finding the right one isn't a simple task. Lathering on the confusion is the large number of available moisturizer brands, formulations, and ingredients. Still, dry skin affects about 40 percent of the population courtesy of factors such as urbanization, pollution, and increased life span. However, dryness isn’t usually attributed to a single cause, rather it’s characterized by changes in the epidermis (top layer of skin) depending on the internal and external environment. In terms of whether it's possible to become dependent on moisturizers, that may depend. If you're not using the moisturizer that is most appropriate for your skin, it may not prevent the skin from losing moisture, which may be the feeling you're experiencing. Read on for more specifics on the types of moisturizers and which ones are recommended based on skin type.

Dry skin occurs when there isn’t enough moisture available or when there’s a break in the barrier (epidermis) that keeps the water in the skin. Historically, moisturizers were designed to reduce transepidermal water loss (TEWL) by creating a barrier to stop water loss from the skin. It turns out that many moisturizers on the market just hydrate the skin by providing moisture for it to absorb without actually changing the TEWL levels, so skin may not feel more moisturized. So, it seems choosing whether to moisturize and with what isn’t so simple. In order to maintain hydration and create a barrier for water to stay in and thereby reduce TEWL levels, most moisturizers contain water and oil. There are four main types of moisturizers that can be classified based on what they contain and how they work.

• Emollients: These moisturizers mainly contain lipids (fats) and oils that are used to improve skin softness, flexibility, and smoothness but don’t affect water content. Some examples of ingredients include cholesterol and fatty acids.
• Humectants: These moisturizers attract water. They actually pull water from the dermis (a deep layer of skin) and the environment (especially when it’s humid) into the epidermis. This process may expose more of the skin’s water, resulting in more water loss so it’s often combined with an occlusive.  
• Occlusives: Unlike humectants, these moisturizers don’t help increase the water content in the skin, but rather help maintain it. Occlusives create a hydrophobic (water repelling) barrier over the skin, which helps keep water from being lost to the environment. Although greasy, this type of moisturizer can reduce the water loss by up to 98 percent depending on the ingredients.
• Protein rejuvenators: As the category name alludes to, these moisturizers are thought to help with skin rejuvenation by replenishing essential proteins needed for healthy skin.

It’s critical to note that the appropriate moisturizer for you depends on many factors, including your skin type, your age, and whether you have specific conditions, such as acne or eczema. In general, skin can be described as:

• Normal skin: This would be skin that’s neither oily nor dry. Individuals with this skin type often use a light, water-based moisturizer for a non-greasy feel.
• Dry skin: This is the type that needs help keeping moisture locked in on the skin. Individuals with dry skin may choose to use an oil-based moisturizer such as an emollient or occlusive that contains petrolatum to reduce those TEWL levels. 
• Oily skin: Individuals with this skin type may have more natural body oils, so a light, water-based moisturizer may be recommended, as to avoid additional oils that may clog the pores.
• Sensitive skin: This skin type may be more prone to itchiness, rashes, or redness. In this case, a moisturizer with aloe or menthol and doesn’t contain any allergens (such as fragrances, dyes, or acids) may be the way to go.
• Mature skin: As individuals age, their skin becomes drier due to decreased oil production (commonly referred to as sebum). Using a combination of a humectant and occlusive moisturizer can help bring more moisture to the skin and make sure it’s there to stay.

Despite the variety in moisturizers, they essentially function by supplying water for the skin to absorb and an oily substance that hinders water loss from the skin. Therefore, the choice of what moisturizer to use often comes down to the subjective experience. It may warrant some experimentation to determine the best combination of soap, bathing duration, moisturizer, time of application, among other variables, that works for you. If after trying lots of combinations, there’s still no improvement, you may want to consult a dermatologist. This type of specialist may be able to help you determine if something more serious is going on such as eczema, dermatitis, or psoriasis, all of which can benefit from medical treatment.

Best of luck figuring out what works best for finding your highly hydrated skin!