Should You Shower Every Day? with Shilpi Khetarpal, MD

Podcast Transcript

John Horton:

Hey there, and welcome to another Health Essentials Podcast. I'm John Horton, your host.

When it comes to showering, I'm at least a once-a-day guy. Of course, if I run late in the afternoon, it's two trips in to shampoo and soap up. On a hot summer day, I might be looking at three showers. That's a lot, but is it too much? After all, there's a school of thought that says skipping a daily shower here and there might actually be good for you and your skin. We're going to scrub the data today with dermatologist Shilpi Khetarpal to get a squeaky-clean answer. Dr. Khetarpal is one of the many experts at Cleveland Clinic who pop into our weekly podcast to answer health-related questions. So with that, let's warm up the water and step into the daily shower debate. Welcome back to the podcast, Dr. Khetarpal. It has been way too long since your last visit.

Dr. Shilpi Khetarpal:

Thanks so much for having me.

John Horton:

So showering is something that we all do, but it seems like folks have different ideas as to how often we need to rub-a-dub-dub. There's a surprising amount of debate on the topic when you start looking it up.

Dr. Shilpi Khetarpal:

Yes. It comes up a lot. I feel like it's something that my patients ask on a daily basis. I think it's something we all think about, and there's a lot of information out there, so I'm glad we're talking about this today.

John Horton:

Yeah. Well, let's kind of start diving in and looking at the overall issue. And let's start by going over some factors that might dictate shower frequency. I'm guessing the obvious starting point is just kind of general stinkiness.

Dr. Shilpi Khetarpal:

Yeah. So I think there's a lot of different reasons, different considerations, when we look at how often one should shower and what you're using to shower with. So I think a few important points…

Just culturally, we have bacteria on our skin. In the hot, humid, wet weather, we have sweat, bacteria, all sorts of stuff. So just from a personal hygiene standpoint, I think showering daily is not a bad idea.

Expectations, whether you're at work, school, just day-to-day, your cleanliness and your appearance.

Other factors, like your lifestyle or activity level, if you're a swimmer, you might want to get that chlorine off your skin, if you're someone that sweats and works out a lot.

Weather in the summertime, you might feel more inclined to shower more often. When it's cold, maybe not as frequently, or maybe just putting soap on those sensitive areas.

Also, looking at people with different skin conditions, if you've had surgery or if you have eczema or sensitive skin.

And then, other factors, like environmentally, if you're trying to conserve water, access to water.

So I think there's a lot of different things to factor in when we determine how often and when one should shower.

John Horton:

Yeah, there's definitely a lot of different factors that might dictate how often you jump in. But I've got to say, if there's one thing I've learned in doing this podcast is that there's always pros and cons to every one of these sorts of debates. And I'm guessing that that's also true with showering.

So with that in mind, let's kind of start breaking it down a little bit and looking at the reasons why people might shower daily or even more frequently. And I guess we can kind of start with the whole hygiene cleanliness question. We're all kind of aware that if you don't shower, there's the whole BO thing that can start kind of coming out. How does that happen? What process has taken place?

Dr. Shilpi Khetarpal:

Yeah. So when we sweat, there is bacteria, yeast and other organisms that live in our sweat. So when we perspire, there is usually a scent to it. And some people perspire more than others, depending on your cleanliness and the area you're in, the environment, how much you sweat. So normally, in our skin, there's bacteria that's there, and then sweating kind of amplifies that. We also have yeast that live in our skin, our scalp, the oily areas of our body. So all of that together can kind of create an odor, if you will. So just showering and removing some of that bacteria, dead skin, yeast, can help with the odor there. So I think, societally, once a day is kind of considered the norm just to help with general cleanliness, I would say.

John Horton:

So that smell, I mean, that's just not from the sweat itself, though, right? It's kind of that breakdown of all that stuff that we don't realize is on our skin, but it's just kind of there?

Dr. Shilpi Khetarpal:

Yes. And then, as we sweat more, that warm, humid environment then breeds more yeast, more bacteria to grow, and then that's what contributes to the odor also.

John Horton:

OK, that would explain it. Because I know we've all had days where you get really ripe. And I take it those are days when just things are, I guess, breaking down even more than normal, whether it's heat or just something that's going on.

Dr. Shilpi Khetarpal:

Right.

John Horton:

Wow. All right.

What about skin care? Because obviously, that's a big issue. You think cleaning your skin is good. Regular showers — how does it help your skin or what kind of conditions can it ease?

Dr. Shilpi Khetarpal:

Starting with common things…

So with acne, there's actually a type of bacteria, the Cutibacterium, or P acnes, is a certain type of bacteria that can cause acne. So by washing your face once or twice a day, you're minimizing the amount of that bacteria. Many times, we will even use medicated cleansers that can kill or destroy that bacteria. So for acne-prone patients on the face, they could certainly wash their face twice a day. If it's on chest, back, shoulders, certainly in the shower, at least once a day with either a regular or medicated cleanser.

Patients with sensitive skin — so like eczema, contact dermatitis, atopic dermatitis — these patients have underlying barrier dysfunction and environmental allergens, we come in contact with hundreds of them. Those can actually make conditions like that worse. So by showering once a day, it actually removes those allergens from our skin and kind of helps take away some of the irritation.

People with drier sensitive skin, like eczema, can be cautious with what they're using to wash their skin and perhaps only soap or a cleanser to areas like the face, the axilla and the groin. They don't need to use soap all over, but just removing those environmental triggers is important.

And then, another common condition, like dandruff for seborrheic dermatitis, that's actually an overgrowth of yeast on the scalp and the face. So these are normal yeasts that live on the skin. Due to genetics, age, environments that you're in, they can overgrow. So by either shampooing the hair or washing the face, you're decreasing those yeast counts to help the dandruff, if you will.

I generally tell all my patients, regardless of their skin conditions, to shower once a day. But for acne patients, we would use a medicated wash. For patients with dander, we use specific shampoos. For eczema patients, we use specific cleansers and maybe at certain areas. But just rinsing off once a day is not a bad idea just to remove any external triggers that could irritate our skin.

John Horton:

What about just kind of general infection and illness, too? I mean, we all know there's germs everywhere around us.

Dr. Shilpi Khetarpal:

Right.

John Horton:

I take it the regular showering or bathing can kind of help get rid of that and keep you from catching the crud.

Dr. Shilpi Khetarpal:

Absolutely. So the same reason why we say “wash your hands frequently,” our body has bacteria, viruses, fungus all over, things that we come in contact with. So another reason to reduce transmission of that either to others or just infecting ourselves. I think it was really popular during COVID, we knew people that were in a healthcare setting would shower before they left work to not take potential viruses or other things home. So I think for many different reasons that it's a good idea to shower once a day.

John Horton:

And what about even just talking about routine? I know so many of us, you get up in the morning and it's kind of part of your process to wake up. Or if you shower at night, it's kind of that wind-down routine where you just kind of calm everything down and relax and all that. Does showering have an important place there, too?

Dr. Shilpi Khetarpal:

Yeah, absolutely. I think it kind of ties in with our circadian rhythm. So everyone has kind of a different routine, but in the morning, that water can help just get you going for the day.

John Horton:

A little splash.

Dr. Shilpi Khetarpal:

Yeah, like your morning coffee. And then at bedtime, we see this with infants or babies or different people, where just that warm water, low light, low stimulation, very soothing, very relaxing, can also just help wind down before bed. So whatever people prefer and wherever fits in their routine, I think it's also important there.

John Horton:

Yeah. And then, I think the one thing kind of tying all these kinds of pros together is something you had mentioned earlier, the societal norms. You're at work, you're at school, wherever, it's kind of frowned upon to, I guess, have a little BO or have that kind of odor about you.

Dr. Shilpi Khetarpal:

Right. And I think there are other factors, too. Like our skin cells are turning over every day. We have products, deodorant on from the day before, or if you have makeup. Whatever you have on your skin, you just want to clean the canvas or wipe the slate clean before you start reapplying something else on top of that.

John Horton:

Clean the canvas. I like that. That is a great way to phrase it.

Dr. Shilpi Khetarpal:

Yeah, yeah.

John Horton:

All right. So now that we've looked at the pros here, let's look at some of the cons as to maybe why showering too much might be an issue. So why might it be a good idea to occasionally skip a shower?

Dr. Shilpi Khetarpal:

So there's a couple of things when you look at showers. Too much of anything can be a problem. So if you're using water that's too hot, that really hot water can pull moisture out of our skin. Also, depending on what you're using to cleanse your skin, body washes or soaps that are fragranced, if they're antibacterial, certain ingredients can, again, pull moisture out. And some of those fragrances and scents can even irritate our skin and flare up, like eczema or contact dermatitis. And then also, when you get out of the shower, when you dry yourself off, if you're not careful — we recommend padding dry with a towel — but if you rub your skin with a towel, that friction can also create dryness.

So I think either extreme is a problem. So if you are going to shower daily, use lukewarm or just not super-hot water. We recommend using just a mild cleanser, one that's soap-free, avoiding antibacterial products, avoiding fragrance and any scents. And then, limit your showers to a few minutes, pat dry. And then, within those first few minutes, apply a gentle moisturizer to trap that water into your skin. All that ties into our skin's microbiome. Again, it's always a balance of good and bad bacteria, so that's why we recommend using a very mild cleanser so you can kind of keep that balance of good bacteria and also not strip the body from its natural oils.

John Horton:

The whole concept that showering too much is going to make your skin dry always kind of blows my mind because you just don't think having more water on you is going to somehow create drier skin.

Dr. Shilpi Khetarpal:

Right. It's almost counterintuitive. But yeah, I think we see this most in certain climates where it's really cold and dry in the winter and it feels good to take a nice long, hot, steamy shower. So while it temporarily feels good, you can kind of wreak some havoc on your skin down the road. So all those tips, we do say shower once a day, but it's caveats. Like with water that's not too hot, keep it to under five minutes, pat dry, use a moisturizer, be conscious of the cleanser or soap that you're using.

John Horton:

Yeah. I always feel like you hear things about stripping the oils off your skin if you shower too much. Is that kind of a risk people have?

Dr. Shilpi Khetarpal:

Yeah. So our skin has its own oil and its own barrier. Ceramides are molecules in our skin that kind of keep everything hydrated. So it's not necessarily the shower, it's the soap that you're using. So if you're using an antibacterial or something very harsh, yes, you're going to keep taking those off, and then that contributes to dryness and an impaired skin barrier. So that's why we say don't let the temperature get too hot, and then limit the time, and then just be really conscious of a cleanser you're using.

Something to keep in mind because patients say, "Well, what cleanser should I use?" Most of them are fragrance and they do smell good. The National Eczema Foundation has a seal that you'll see, it's a little silver seal, on many products when you go to the drugstore. So if you look for that, even if you don't have eczema, it's going to be, generally, very safe and not too irritating or drying to your skin. So you could look for that either on a bar soap, a body wash, or some sort of cleanser.

John Horton:

Yeah, that's a great tip there.

I know you've mentioned a few times, the whole pat yourself dry, which I have to tell you, I do not do. I'm very much one of those people that gets that thing on there and you're going back and forth. I take it that's something that can also be pretty rough on your skin.

Dr. Shilpi Khetarpal:

And I think something we didn't talk about, but also comes out when we talk about showering, especially women and their hair. So showering the body is one thing, but then just looking at hair washing and things like that. Everyone is a little bit different, but the question comes up, too, "Well, if I'm showering, how often do I wash my hair?" So I think that's also a popular topic.

I generally tell people, men, you can certainly wash your hair every day, you don't have to, but you can. But I generally recommend not going more than every other day for hair washing for women, because again, the yeast bacteria buildup — when we get dandruff in the scalp that promotes an unhealthy environment, people can get itching inflammation and, actually, shedding of the hair when the scalp is unhealthy. So as tedious as it is, I do recommend for women to wash their hair at least every other day. Or men and women. Certain hair types can go maybe once a week if you have drier, coarser or a certain curl pattern, maybe do once a week, but otherwise for most people every one to two days, they should wash their hair.

John Horton:

Yeah. Is there a way to tell whether or not your hair needs a wash? Just how it's feeling, how it's looking, just tips people can kind of gauge.

Dr. Shilpi Khetarpal:

Yeah. So if you're sweating, doing high-intensity exercise and your scalp is very sweaty and you're getting, say, bumps or acne lesions in it, I would recommend washing it daily. For women, if you're not sweating and you just want to know when and how often to wash your hair, I would say every other day. So either daily, if it feels sweaty or dirty, and then otherwise every other day.

But I have some patients that come in and say, "I wash my hair once a week," or "Every two weeks." We're going to see high levels of yeast, dander or flaking, inflammation in the scalp, just because you're letting that yeast overgrow. So if you see flaking, if you're getting itching, it's probably because you're not washing your hair often enough. And it's more so with women because it takes time to style their hair. And nowadays, if you have dry hair, if you have … in the wintertime, it's harsh on your hair, you could look for sulfate-free shampoos. There are many that are color-safe, they won't strip the color out of your hair, and they're gentle on the scalp. So they clean without stripping, again, all of the natural oils and other things on our cuticle that we don't want to remove.

John Horton:

All right. Well, Dr. Khetarpal, I've got to tell you, I'm convinced I've washed my hair too much. I got the color right out of it, too. So I think that's kind of what happens over time. As I mentioned at the start of this, a lot of times over the course of the year, I will shower two to three times a day. I sweat a lot. I work out a lot. I'm outside doing things. And I've got to say, after reading everything in advance of our chat, really starting to worry if I'm doing this too much or things like that. But I've got to be honest, I've never really noticed big problems with my skin, even though I do jump in that often. Are there signs that you should look for that would tell you that, "Hey, maybe you're over showering, you need to dial them back a bit," or just that, "Hey, everything's good?”

Dr. Shilpi Khetarpal:

So the most common signs we would see are scaling on the skin, dryness. Sometimes, that can become itchy and red. So if you're getting any kind of irritation on the skin or if it looks dry, people describe it as “lizard skin,” it means you are either not moisturizing enough or you're showering too much or perhaps using a cleanser that is too irritating to the skin. So if you need to shower multiple times a day, that's fine, but maybe limit the soap you're using and then the areas you put the soap on. And then, if you can moisturize after each shower, that would be ideal.

John Horton:

I've got to say, I'm not good at moisturizing. I do not do that. But I do try to get in and out pretty quickly. I'd say it's because I'm taking care of my skin, but in true dad mode, I just like to keep my water bill down, so I'm an in-and-out sort of guy.

I think we went over it. So if you are going to shower daily or even more frequently, sounds like the big tips are don't make the water too hot because that will dry your skin out, keep the showers a little shorter, which will also keep that water bill down, focus on the smelly spots. And I think you had mentioned, what would be the key spots there to hit?

Dr. Shilpi Khetarpal:

So generally, it's the face, the underarm area and the groin, and then the scalp would be once a day or every other day.

John Horton:

All right. And then you said limit the scented soaps and shampoos and definitely moisturize when you're done, just to kind of keep that moisture barrier on your skin.

Dr. Shilpi Khetarpal:

And then patting dry, not rubbing.

John Horton:

Patting. See, I got to start doing that. Like I said, I'm very much of a going back and forth. So I'm probably breaking the skin.

Dr. Shilpi Khetarpal:

Yeah. I would also say the towels, like looking for the 100% cotton, that's gentler on the skin than any of the blended materials. So the cotton towels are ideal. And then also making sure you wash your towels frequently because that dirt bacteria, old skin cells sometimes are on the towel. So at least once a week, if not twice a week to wash your towels.

John Horton:

All right. Well, Dr. Khetarpal, I feel like we have taken this topic through a full wash and rinse cycle. So before we turn the knob off, what's the main point you want folks to kind of take away from this chat?

Dr. Shilpi Khetarpal:

So I would say if you're taking these steps and limiting your showers, they're not too hot, you're showering once a day, using a gentle cleanser, but you're getting areas that are dry or itchy or you notice a rash, those would be the times to come in and see a dermatologist to evaluate your skin because there could be something else going on.

But just day-to-day, know that showers are really important regardless of your age, whether you're an infant, kid, adult. Once a day, we just want to rinse off all those allergens and keep our skin as healthy as we can. So you could limit the soap, limit the temperature, limit the time, but just rinse off every day. It's a good idea for everyone.

John Horton:

It's a great place to end. So thanks again for coming in, Dr. Khetarpal — always wonderful to talk with you.

Dr. Shilpi Khetarpal:

Great. Thanks for having me.

John Horton:

When it comes to how often you should shower, once a day is typically fine, but skipping a day isn't bad at times, and neither is doubling up if you need a little extra scrubbing. Do what feels right to you. And if you're still unsure, maybe use the sniff test to make your final decision.

If you liked what you heard today, please hit the subscribe button and leave a comment to share your thoughts. Until next time, be well.

Speaker 3:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.