(CNN) — Our skin is considered our largest organ, with a surface area of approximately 15 to 20 square feet (1.4 to 1.9 square meters) — and some put the estimate at least 10 times greater, if the nooks and crannies created by hair follicles and sweat ducts are taken into consideration. It is our body’s first line of defense, charged with (among other things) keeping the outside out and our insides in.
And we like to keep our skin squeaky clean, especially in the United States. The beauty and personal care products market (which includes skin, hair, mouth, shower and bath, cosmetics, and fragrance products) in the US amounted to more than $100 billion in 2024, and it’s projected to keep growing.
“You walk into any pharmacy and next to cold and flu medications, there are aisles of shampoos and soaps. It just got me thinking: what is this all for?” Dr. James Hamblin told CNN Chief Medical Correspondent Dr. Sanjay Gupta on his podcast Chasing Life recently.
“How much of it is necessary for health? And how much of this is just a personal preference? And am I wasting time and money? Would I be better off if I did less?”
Those were all questions Hamblin, a preventive medicine and public health doctor and then a writer for The Atlantic, wanted to explore. So he stopped showering — in the traditional sense of the word — for about five years. (Before you click out of the story in horror, please read on.)
Hamblin’s 2020 book “Clean, The New Science of Skin” documents his experiment and traces the history of cleanliness and hygiene.
“I carefully wrote (in the book) that five years ago I stopped — and I did,” he explained, noting that those years were dedicated to trial and error. “In that time …. I tried all kinds of different products. This was a course of experimentation of all different sorts of regimens. So, I didn’t spend five entire years never showering — no. But people really wanted to hear that.”
But, he said, “I certainly was very minimalist for a very long time.”
You can listen to the full episode here.
Hamblin, who is now a lecturer at the Yale School of Public Health, said there is “a large health halo” around personal care products. We think of them as hygiene-promoting because many make medical-sounding claims, which amount only to clever marketing.
“If you look at the actual way in which many of those products are actually doing anything to prevent disease transmission (besides) making sure you don’t have bodily fluids on you … that might transmit disease, the rest of it is making you look and feel and smell good.”
Soap is a valuable tool, he said, mainly to help break up sticky, oily substances. “But usually, it’s more the mechanical force that’s doing most of the washing,” he said. “When you rub your hands together … under water, you’re getting a lot of that off.” (To be clear, we are talking about in most situations, and not in the case of food workers or surgeons trying to get sterile for surgery, for example.)
Hamblin said he was inspired to write his book in part because of a fairly new health trend at the time.
“People were suddenly taking probiotics and wanting to have optimal gut flora,” he said. “And I saw the same thing potentially happening in skin health because you have these trillions of microbes all over you. The skin microbiome is smaller than the gut microbiome, but it’s a similar principle.”
An abundant and diverse microbial community lives on our skin, just like in our gut. The skin microbiome is a go-between, interacting with both our body’s internal world and the external world. The results of these interactions impact our individual health in ways we are only just beginning to understand. Constantly washing it away can create issues.
“There is a harmony between the oils and chemicals that your skin secretes naturally and the skin microbiome that lives on that skin,” he explained. “You temporarily disrupt the microbiome when you take a hot shower, and you use (soap). But you’re also disrupting essentially the soil on which those microbes live, by drying out your skin and removing all the oils.”
It’s not necessarily bad, he said, “but it changes the dynamic. And if you are prone to an inflammatory cascade like (what) happens with eczema or acne, you can be exacerbating (that problem).” He likened it to clear-cutting of a forest, which isn’t always good for the land.
“We don’t know any more than we really do with the gut microbiome,” he said. “It’s not so simple as saying, ‘Well, you have taken out this one microbe; we’re going to put this one microbe back in, or we’re going to replace it with this other one, and you will feel all better.’ It’s much more of a holistic ecosystem that is difficult to understand.”
If you’re interested in nurturing a more natural (and possibly healthier) skin microbiome by changing your showering habits, Hamblin — who does not want to tell people what kind of personal care regimen they should follow — has five things to keep in mind.
Bathing is not the same as hygiene
Hygiene is done to prevent the transmission of infectious disease, said Hamblin, while cleansing is more personal and ritualistic.
Hygiene would be things “like washing your hands after you use the bathroom so you’re not spreading any kind of bodily fluids — you’re not sneezing into your hand and then shaking someone’s hand — the very basics of what you would do specifically so you do not get other people sick,” Hamblin said.
“Cleanliness would be a much broader category of feeling like you are refreshed and renewed and your best self,” he said. “And it’s certainly not purely cosmetic: There (are) psychological components to it.”
Lathering up from head to toe every day is “purely a cosmetic and recreational choice,” and it’s not necessary for your health, he added.
Someone could walk around smelling very bad and looking very disheveled and pose zero risk to anyone, Hamblin noted. “But there’s a long history of conflating those … even in pre-germ theory times.”
There’s no agreed-upon definition of a proper shower
For some people, rinsing off is good enough, others want the whole soup-to-nuts pampering experience. And there is an entire range in between those two options.
“For some people it’s important to feel like they’ve woken up and begun the day and they just feel refreshed — and it’s sort of a ritual,” said Hamblin. “If they don’t wash their hair and barely use any soap and it takes two minutes to do, that still counts.
“Other people would say, ‘No, you really need to lather up and go through the full routine and … scrub head to toe in order (for it) to be a shower.’”
While it’s true that people who are in and out in 30 seconds are not having the same experience as someone who takes 15 minutes, the choice is extremely personal.
Maybe you learned “how you’re ‘supposed’ to do it when you were a kid,” and then adapted your own routine as you grew into an adult, he said.
But what influenced those changes?
Marketing colors our perception
After we learn the basics and are left to our own devices, what we read and see in traditional and social media, and what we encounter in society, impacts our ideas of what is collectively acceptable.
“You’re inundated with a bunch of marketing — some of which you internalize, some of which you don’t, as necessary and good, or disgusting if you don’t do,” he said.
“You have plenty of people who feel like they need to shower every day, even twice a day, or every time they sweat, they need to shower. And other people who (shower) much less frequently but don’t like to talk about it,” he said.
It’s one of the few areas where people are still stigmatized and called “gross” or “disgusting” openly, to their face, Hamblin said. “I know because I’ve been called it quite a bit.”
Products are pretty much the same
What you choose to slather on your hair and body is a personal preference, and it comes down to aesthetics: what you find works for you, what feel and smell you prefer, said Hamblin.
“I wouldn’t do things based on medical claims that are made on packages,” he added.
“If it’s all the same to you, and you don’t particularly care about nice-looking bottles or smell, and you feel like your skin looks and feels similar no matter what you use, then I would go with the cheapest thing because chemically there’s very little difference,” he said.
“Soaps and detergents can only vary so much. And everything else is just additives that are made to either make you smell a certain way, so fragrances, or they have emollients that are meant to undo the drying effects of the detergent that you’re putting on your skin.”
The pandemic set back interest in the microbiome
When Covid-19 became a pandemic in 2020, we followed the guidance to kill all the germs.
“There was a real pause in people’s interest in the skin microbiome, in the industry, in the science,” he said. “And we went far back toward … ‘Just obliterate everything on my skin. I don’t want any exposure to anything,’” he said, adding that it was good and necessary during an emergency.
But that may be changing. “Now we’re easing our way back toward where we were pre-pandemic,” he said. I’ve even seen some marketing around healthy microbes on the skin in products and people becoming more open to that as an idea.”
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