Hygiene Practices, Cleanliness, and Lupus

Good hygiene, the practice of keeping yourself and your living space clean, is an important part of remaining healthy. These days, it’s absolutely essential for everyone, including Lupus Warriors.

Hygiene comes from the Greek word “Hygieninos” which translates roughly as “healthful.” The word also is related to Hygia, the ancient Greek goddess of cleanliness. This means that the relationship between staying clean and staying healthy has been well-known for hundreds of years. (Though it wasn’t until the mid-19th century that hand washing between patients became standard practice for doctors and nurses.)

This holds true for Lupus Warriors. But, even the basic actions of personal hygiene can be out of reach during a flare

• Pain limits movement
• Fatigue limits energy available to do it
• Depression drains what energy remains

Still, it is important. The CDC states that:

“Many diseases and conditions can be prevented or controlled through appropriate personal hygiene
and by frequently washing parts of the body and hair with soap and clean, running water (if available).”

Key hygiene practices include handwashing, showering, and toothbrushing. Because people with lupus are more vulnerable to disease, it is very important to spend some “spoons” on these tasks – or get help to do them. Even just the self esteem boost from being clean is enough to be worth the trouble.

Read on to see the best practices for personal hygiene – and how you can put them into practice in your
own life.

Washing Your Hands

Washing your hands is, hands down (pun intended), one of the best ways to prevent sickness. The CDC advises people to wash hands before and after eating, after using the bathroom, after coughing or sneezing, or after handling dirty or sticky things.

We use our hands for so many things, touching everything around us, and also our faces. This means
that our hands pick up a lot of germs (bacteria, viruses and other microbes, as well as pollutants and dirt) and carry it right to our mouths, noses, and eyes where they can enter the body.

Our hands can also pass these things on to others as we touch food, objects, and even other people’s hands. Washing your hands and avoiding touching your face helps prevent this from happening.

The WHO (World Health Organization) has a very in-depth (and catchy!) video on how to properly wash your hands, and you can view it here.

• Run your hands under clean, running water.
  • It can be warm or cold, whatever is most comfortable for you.
  • Using hot water may feel clean (and it does kill some bacteria) but it also damages your skin.
  • After wetting your hands, you may turn off the tap to conserve water
• Lather your hands with soap for ~20 seconds
  • Both liquid and solid soap will work, but it should lather.
  • Scrub the backs of your hands, between your fingers, and under your nails
  • To remind yourself to wash long enough, sing the chorus of your favorite song twice
• Rinse your hands well under running water until no soap bubbles remain
• Dry your hands with a clean towel or air dry them.
  • If you are using a paper towel, use it to turn off the tap and open the door.

You can also use hand sanitizer that has at least a 60% ethanol base if you don’t have access to a sink or
to soap. But, soap and water is very effective at preventing both infection and transmission of disease.

Should I use antibacterial soap?

Antibacterial soap is no better than normal soap for preventing diseases. In fact, most of the disease-
prevention action from soap is from how it removes germs and dust, not from killing them.

Soap molecules separate dirt and potential pathogens from our skin by taking advantage of the fact that most of these gross particles stick to our natural skin oils. Soap molecules are a surfactant – one side of their molecules is attracted to oils, and the other side is attracted to water. These molecules go between the water on the hands and the oils on the skin, lifting them off. Then, the water rinse is able to remove all of it. This rinse is what cleans the hands, not the antibacterial activity of the soap.

Antibacterial soaps are not better. Hand sanitizers work because of their ethanol content. 60% ethanol (or even higher) dries out and breaks apart the membrane or skin that surrounds many microbes, killing them off. However, this does not work against norovirus or cryptosporidiosis, both of which cause diarrheal diseases. Hand sanitizers also don’t remove pesticides, heavy metals, or other pollutants and do not work very well on dirty or greasy hands.

Ethanol (or rubbing alcohol) can also dry out the skin and may make cutaneous lupus symptoms worse,
so be careful.

Showering, Baths, and Lupus

There are no strict CDC guidelines about showering or bathing, but it is important to wash the body periodically if possible. Removing dead skin and built-up oils prevents irritation, inflammation, and can even prevent disease. Warm water may help with joint pain and appropriately cleaning skin can sooth some symptoms of lupus (including sores or itchy areas) and help them heal. Showering and bathing can also help with mental health, as feeling clean is worth a lot.

However, these actions can be beyond the energy or ability of severely affected lupus warriors. Fortunately, a wipe down with a washcloth can be enough for most instances.

Cutaneous Lupus and Hygiene

Speaking of skin symptoms of lupus, cutaneous lupus erythematosus (CLE) is a form of lupus that affects the skin. You can read more about it here.

CLE can cause the skin to be more sensitive to both sun and chemicals, making some cleaning supplies not a good idea. CLE also is treated with topical medications, making some degree of cleaning – to remove old medications – necessary. But, not too much cleaning such that it irritates the skin or removes the medication.

People with lupus can also have more reactions to hygiene due to both sensitive skin and a sensitive immune system. These reactions can come from the act of washing itself including:

• dryness
• irritation
• itching
• cracking and bleeding

This can be managed with moisturizers, gloves to protect the hands from dirty surfaces and prevent the need for additional washing (and protect the hands from water-related tasks such as dishwashing,) and non-irritating soaps.

These reactions happen as the detergent in the soap strips away the protective lipids of the skin, allowing it to dry it out and become more easily damaged. It also changes the bacteria on the skin in ways that might be dangerous – the skin is much like the gut in this way, and you can learn more about the relationship between gut bacteria and lupus here. Moisturizers can help, and are often added to soaps to help protect the skin – however, that raises another issue: allergic reactions to the ingredients of hygiene products.

Allergic reactions to hygiene practices can range in severity, and you can read more about allergies and lupus here. Usually, a person with lupus will be allergic to something in a hand hygiene product, which is a reason why using simple soaps (no fragrances or antibacterial ingredients) might be a very good idea.

Toothbrushing and Flossing and Lupus

Brushing your teeth does more than protect your teeth – for people with lupus, it can prevent flares and even protect your heart.

How does this work?

Well, people with lupus are more likely to get mouth ulcers and sores, which link the mouth to the bloodstream. In fact, the symptom of mouth ulcers are very common.

When the mouth is not regularly cleaned through brushing and mouthwash, bacteria levels grow in the mouth. These bacteria encourage cavity formation, impacting the ability to eat, but also create a risk of these bacteria, along with particles of food, passing into the bloodstream. Much like in leaky gut, this increases inflammation in the body and can potentially lead to flares. However, mouth bacteria entering the bloodstream can also lead to infection and sickness. Both of these factors can influence heart and lung health.

You can read more about the relationship between lupus and the mouth here.

So, how do you properly brush your teeth?

Colgate’s website has a very in-depth article about toothbrushing techniques that you should definitely check out. In general, there are a few basic recommendations:

• Brush your teeth at least twice a day. Brushing after every meal is recommended but not
  necessary.
• Use fluorinated tooth paste (which helps shore up your teeth against normal wear and tear)
• Brush for at least 2 minutes, using circular motions to really scrub off the plaque. An electric
  toothbrush does this part for you.
• Floss daily, making sure to get into the gums and the bottoms of the teeth, if possible.
• Rinse the mouth thoroughly with water.

Avoiding sugar and using mouthwash can also help a lot.

Clean Up and Lupus

So that takes care of you – what about your space, where you and your family lives and where germs enter your environment? Keeping your home and work clean can protect you against disease and sickness and potential flare inducers. Getting help with cleaning your space is sometimes easier to articulate then getting help to clean your body, and having a clean home keeps morale up.

However, be careful – many harsher home cleaners may provide a spotless space, but have chemicals that damage the body and trigger an immune response. Gentler cleaners with natural ingredients work well and it is easier to know what is in them and control what ends up in your body.