Winter or postwinter exfoliation may seem counterintuitive to some patients because skin is often more dry because of cold weather and dry heat from heaters in the home, car, and workplace. Some patients even admit to using emollients less frequently in the winter because they are too cold to do it after bathing or are covering more of their body. But winter exfoliation can be an important method for improving skin hydration by aiding skin cell turnover, removing surface flaky skin, and enhancing penetration of moisturizers and active ingredients applied afterward. Here we explore exfoliation techniques used in various cultures around the world.
Ancient Egypt:
Egyptians are credited with the first exfoliation techniques. Mechanical exfoliation was practiced in ancient Egypt via pumice stones, as well as alabaster particles, and scrubs made from sand or plants, such as aloe vera. (Although the subject is beyond the scope of this article, the first use of chemical exfoliation, using sour milk, which contains lactic acid, has been credited to ancient Egypt.)
Iran:
Most traditional Iranian households are familiar with kiseh and sefidab, used for exfoliation as often as once a week. Kiseh is a special loofah-like exfoliating mitt, often hand woven. Sefidab is a whitish ball that looks like a dense piece of chalk made from animal fats and natural minerals that is rubbed on the kiseh, which is then rubbed on the skin. Exfoliation results as the sefidab and top layers of skin come off in gray white rolls, which are then rinsed off. The dead skin left on the mitt is known as “chairk.” Archaeological excavations have provided evidence that sefidab may have been used in Persian cosmetics as long ago as 2000 BC–4500 BC, as part of Zoroastrian traditions.
Korea:
Koreans have long been known for practicing skin exfoliation. Here in Los Angeles, especially in Koreatown, many Korean spas or bathhouses, known as jjimjilbang, can be found; these provide various therapies, particularly “detoxification” in hot tubs, saunas (many with different stones and crystal minerals for healing properties), computer rooms, restaurants, theater rooms. They also provide body scrubs, or seshin: A soak in the hot tub for at least 30 minutes is recommended, followed by a hot water rinse and a scrub by a “ddemiri” (a scrub practitioner), who intensely scrubs the skin from head to toe using a roughened cloth. Going into a hot room or sauna is recommended after the scrub for relaxation, with the belief that the sweat won’t be blocked by dirty or clogged pores. Scrubs in jjimjilbang are recommended as often as once per week.
Indigenous people of the Americas and Caribbean:
Sea salt is used commonly as an exfoliant among people from Caribbean countries and those of indigenous ancestry in the Americas (North America, including Hawaii, and Central and South America). Finer-grained sea salt is commonly found in the showers of my friends of Afro-Caribbean and indigenous American descent. While sugar is less coarse and easy to wash off in warm water, finer-grained sea salt provides more friction but is not as rough as coarse sea salt. Fine sea salt, because it is less coarse, can also be used on the face, if used carefully. While the effect of topical salt on skin microbes is unknown, cutaneous sodium storage has been found to strengthen the antimicrobial barrier function and boost macrophage host defense (Cell Metab. 2015 Mar 3;21[3]:493-501). Additionally, it has been noted that some Native Americans used dried corncobs for exfoliation. The people of the Comanche tribe would use sand from the bottom of a river bed to scrub the skin (similarly, Polynesian people have been known to use crushed sea shells for this purpose).
India (Ayurveda):
Garshana is a dry brushing technique performed in Ayurvedic medicine. Dry brushing may be performed with a bristle brush or with slightly roughened silk gloves. The motion of dry brushing is intended to stimulate lymphatic drainage for elimination of toxins from the body. Circular strokes are used on the stomach and joints (shoulders, elbows, knees, wrists, hips, and ankles), and long sweeping strokes are used on the arms and legs. It is recommended for the morning, upon awakening and before a shower, because it is a stimulating practice. Sometimes oils, specific to an individual’s “dosha” (constitutional type or energy as defined by Ayurveda) – are applied afterward in a similar head-to-toe motion as a self-massage called Abhyanga.
Japan:
Shaving, particularly facial shaving, is frequently done not just among men in Japan, but also among women who have shaved their faces and skin for years as a method of exfoliation for skin rejuvenation. In the United States, facial shaving among women has evolved to a method of exfoliation called “dermaplaning,” which involves dry shaving hairs (including facial vellus hairs) as well as top layers of stratum corneum. The procedure uses of a 25-centimeter (10-inch) scalpel, which curves into a sharp point. Potential risks include irritation from friction, as well as folliculitis.
France:
It is not certain whether “gommage” originated in France, but in French, it means “to erase” because the rubbing action is similar to erasing a word. In gommage, a paste is applied to the skin and allowed to dry slightly while gentle enzymes digest dead skin cells on the surface; then it is rubbed off, taking skin cells with it. Most of what comes off is the product itself, but this may include some skin cells. One commonly used enzyme in gommage is papain, derived from the papaya fruit. Gommage was popular with facials before stronger chemical exfoliants like alpha-hydroxy acids became widely available commercially.
West Africa (Ghana, Nigeria):
A long mesh body exfoliator, much like a tightly woven fishing net made of nylon, is common in Ghanaian and Nigerian households. The textured washcloth typically stretches up to 3 times the size of a regular washcloth, making it easy to scrub hard-to-reach places like the back.
Worldwide:
Around the world in places where coffee beans are native, including Kenya and other parts of Africa, the Middle East, South America, Australia, and Hawaii, coffee beans are used as a skin exfoliant. Coffee grounds can however, should be used cautiously in showers as they can coagulate in water and clog drains and pipes. One tradition in Kenya is to crush and rub coffee beans on the skin with a piece of sugarcane to remove top layers of skin. Often too harsh to use directly, coffee grounds in cosmetic formulations are often mixed with oils or shea butter to create a smoother texture.
May this list grow as we continue to learn from the skin care techniques practiced in different cultures around the world.
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