In the COVID-19 era, is it possible to take cleanliness too far? | Expert Opinion

Cleanliness is next to godliness, they say, and also keeps the COVID-19 far away, right? Like most doctors, I’ve always prioritized hand washing in my work and my daily life, but now in a pandemic age, keeping clean has taken on greater weight. If I don’t wash my hands well enough, could I accidentally get infected, or perhaps even worse, could I unwittingly spread a virus that takes someone’s life?

And yet, as a dermatologist, I also know how complex the balance is between bacteria and our bodies. In a pandemic more than ever, we are extra conscious about the need to cleanse ourselves from any possible source of infection. Yet, many microbes live in our bodies and play an essential role in its functioning. How do we strike the right balance in fending off the bad infections, yet preserving what we call the good microbiome, the life-sustaining bacteria covering our skin and filling our guts?

Recently I read a new book, Clean: The New Science of Skin, about our quests for purity, by James Hamblin, a preventive medicine doctor at Yale and writer for The Atlantic. In this deep dive into skin care, Hamblin playfully explores how as a culture we’ve become so obsessed with cleanliness and wellness. He asks questions such as, are showers even necessary? Hamblin even goes without showers to see how, if at all, it affects his life. And indeed, he is just fine.

To be clear, not showering doesn’t mean not rinsing, it just means not over-washing. I tell my patients, especially those prone to dry skin and eczema, to keep showers short and under 10 minutes with warm not scalding hot water, to avoid washcloths and scrubbing, and to only use fragrance-free bar soap limited to the target areas: the armpits, buttocks, and groin, the only areas with the specialized apocrine sweat glands that make odor. If you only quickly soap in those areas, you won’t smell, I promise! No need for body wash that most overuse anyway.

As a practicing dermatologist, I have these conversations every day with patients, and I witness first-hand our oftentimes unhealthy obsession with practices done in the name of hygiene, that in fact, may do more harm than good.

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As repellent as body odor may seem in our society, it does not cause any harm aside from difficulty getting a date. People laboriously over-wash and scrub themselves to little benefit, and then top it off with complicated, expensive, and borderline scam regimens of skin care products. There is an incredible amount of fakery and marketing posing as science in this field (peptides, anyone?). And yet, as Hamblin notes, a face mask can make you feel like you’re experiencing a refreshing rebirth. As a consumer luxury good, is it fair to critique skin care if for some people, it does add value?

Novelist Toni Morrison said that beauty was an absolute necessity and not an indulgence. I agree that pursuit of self-care and good appearance is not all about vanity – indeed, research affirms the value of many cosmetic procedures in improving quality of life. But we must be vigilant since the mostly unregulated beauty industry does manipulate, and dare I say scams the public out of billions of dollars, all while co-opting the name of health and wellness. Non-medication products (herbal supplements and vitamins) do not require FDA approval even as they are touted as the latest panaceas (here’s looking at you, CBD), so take them (or rather don’t take them) with a grain of salt.

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We’re all looking for what else we can be doing to keep clean, but my main advice: keep it simple. Wear a mask whenever you’re in public, and wash your hands. If your skin gets dry, apply moisturizer (I love Vaseline/petroleum jelly) on your wet skin, and if your fingers crack this winter, a little super glue can fix you right up (just don’t glue your fingers together!).

In this time of COVID-19, the balance between natural and clean will remain challenging, but you don’t need to overdo it.

Jules Lipoff is an assistant professor of dermatology at the University of Pennsylvania Perelman School of Medicine.