Let’s be honest! You were excited to be finally on the retinoid wagon and you used your retinol serum or tretinoin every single night. Results after one week: red, inflamed, and dry skin. Well, my dear friend – all these are signs of a damaged skin barrier.
If you have not read my previous geeky blog post on skin barrier function, it might be useful to read it to get in-depth knowledge about the skin barrier. Here is the short version.
Skin Barrier
Our skin barrier has several different functions and one of the important ones is the “permeability skin barrier function” which we often damage using harsh skin care products. The skin barrier is like a brick wall, better explained by the “Brick and Mortar” model.
“Brick and Mortar model”
The bricks are the corneocytes, the dead cells on the top of the skin surface and the mortar is the intercellular lipid matrix (made up of fatty acids, ceramides, cholesterol, and sterol waxes).
Inside the bricks or skin cells are humectants called natural moisturizing factors, which are essential for stratum corneum hydration, barrier function, and shedding of cells. These NMFs are made up of free amino acids and various derivatives of these amino acids such as urocanic acid, inorganic salts, sugars, lactic acid, and urea.
This wall protects our skin from the entry of any harmful microbes and environmental toxins. In addition, it prevents the loss of moisture from our skin. [1] [2]
How does the acid mantle affect the skin barrier?
The acid mantle is a thin protective layer on the surface of the skin. It is a mixture of sebum (oil) and sweat. Ideally, the pH of this acid mantle is 4.5 to 5.5.
This layer acts as a chemical barrier to protect our skin from microbes.
This layer is also important for processing of our barrier lipids and skin barrier recovery. [1] Some factors like diabetes, harsh high-pH skin care products, and over-exfoliation can alter this pH (unbalanced pH) and can eventually affect our skin barrier.
What is skin barrier damage?
Skin barrier damage means that our skin lacks lipids and natural moisturizing factors. In simple words, it has holes and gaps in its brick wall. Due to this, outside irritants can easily get access deeper into the skin causing more inflammation and damage.
In addition, our skin is not capable of holding onto the water, so it just evaporates leading to dry and scaly skin. There are several factors that can damage this barrier.
Causes
External causes
- Improper skin care including: over cleansing, over-exfoliating, usage of too many active ingredients together, physical exfoliation with a washcloth, scrub, or cleansing devices, and using hot water to wash the face
- Exposure to skin irritants from the environment such as pollution and allergens
- Occupational exposure to certain chemicals, strong acids, and detergents
- Low ambient humidity
- Extreme cold weather
- Prolonged sun exposure
Internal causes
- Inflammatory skin conditions like atopic dermatitis, rosacea, psoriasis
- Diabetes
- Aging
- Stress
So, after all, it’s not always our fault. Some factors are just out of our hands. The only thing we can do is give a helping hand to our skin.
Can the skin barrier repair itself?
The answer is “YES”
Our skin is smarter than us. When we damage our barrier, our skin tries to repair itself. It has several self-repair mechanisms which can restore the barrier. These include:
- Immediate release of precursor lipids into the stratum corneum for the formation of lipid matrix of the skin barrier
- Increase in the synthesis of physiologic lipid precursors and conversion to stratum corneum lipids
- Increased formation of NMFs
- Release of cytokines which increase the epidermal thickness
- Specific antimicrobial peptides may be activated by certain microbes, thus providing protection from the development of infection [1] [2]
On a daily basis, this process can repair and maintain balance within the skin.
However, at a breaking point, when the damage is more than the repair process – our skin cannot cope. That is when signs and symptoms of barrier damage start showing up.
How to know if your skin barrier is damaged?
Wondering if you have damaged your skin barrier? Here are some of the most commonly seen signs and symptoms of skin barrier damage.
- Redness
- Dryness
- Burning and stinging
- Scaly and flakiness
- Skin cracking
- Peeling skin (like on fingertips after exposure to harsh chemicals)
- Shiny leathery appearance of skin
- Thickened skin
- Sensitivity to products that you tolerated well before
What to do
Here are some things to which you should say “NO” if your skin barrier is damaged:
1. Remove the trigger
If you just started something new in your life, it can be a skincare product or a hair product, look into the ingredient label and see if it has anything you are sensitive to. Just removing the trigger can make a big difference.
2. No to self-medication
Trust me, I have been down that road. You read some things online and you feel “I have this or that”. Then you go to a pharmacy to get some over-the-counter steroids or antifungals and things start to get even worse. Please don’t self-medicate.
Steroids are one of the most commonly abused topical drugs and they can cause many side effects like worsening of acne, hyper or hypo-pigmentation, infections, rosacea flare, etc. Similarly, other OTC topical drugs can damage your skin if not used properly.
3. No to all actives
If your routine is very complex with multiple actives – retinoids, exfoliants like glycolic acid, lactic acid, mandelic acid, etc., azelaic acid, and benzoyl peroxide; you need to give up all of them for a while. These are known to cause dryness and irritation.
4. No to ascorbic acid
Ascorbic acid is an amazing ingredient, though very hard to formulate. For it to be effective, it needs to be at an acidic pH of around 3. The low pH of the formulation can irritate your damaged skin. So, take a break from this powerhouse.
5. No to high concentration of niacinamide
Niacinamide is effective at a concentration of 2-5%, so you don’t need a higher concentration to get better results. At this concentration, it can help in the repair of the skin barrier by increasing the synthesis of ceramides. [3]
However, even at a concentration of 2%, it can cause some stinging if the barrier is damaged. Higher concentrations can cause even more irritation and redness. So, skip it for a while.
6. No clay masks
Though clay masks can be amazing for getting rid of surface oils and removing some of the dead skin cells, they can be drying and irritating. Many clay masks have a higher pH and that can disrupt the acid mantle and skin microbiome.
7. No manual exfoliation
I am not a fan of physical exfoliation of any kind: washcloths, cleansing tools, scrubs. Manually rubbing and tugging your skin can cause damage to your healthy skin. So, if you are already having a damaged skin barrier, it is a big NO-NO.
8. No DIY skincare recipes
DIY (Do it yourself) skincare can look tempting and I have tried some myself, but mostly they end up causing more damage than any good. This is the time to put brakes on experimenting with things from your kitchen or mixing 100% pure ingredients to make a serum.
9. No prolonged sun exposure
Sun rays reaching the earth consist of 5% of UV rays; out of which, 95% is UVA (320–400 nm) and 5% is UVB (290–320 nm), and 0% of UVC (100–280 nm, due to absorption from atmospheric ozone).
UV rays can cause significant oxidative damage of proteins and lipids of the skin barrier and disruption of the permeability barrier leading to increased transepidermal water loss and decreased stratum corneum hydration. [4]
10. No to stress
Stress of any kind (psychological, physical, or sleep deprivation) is associated with an increase in epidermal cell proliferation, an increase in inflammatory cytokine production, and impairment of the skin permeability barrier. [5] [6]
11. Go easy on the makeup
While wearing no makeup would have been best, it is not always possible in the real world. If your skin barrier is damaged, go for a BB/CC cream. Avoid using long-wearing makeup products, as they do need a lot of work to be cleansed off the skin.
Repair skin barrier with these tips
Just a little help and your skin will repair that damage. These are the things you need right now:
- Cleanse
- Moisturize
- Protect
- Eat well
- De-stress
1. Cleanse
Go for a gentle cleanser with a pH of around 5. The job of a cleanser is to cleanse and later it just goes down the drain. So, you don’t need a fancy cleanser. Just a simple no-frill cleanser will do.
If you can skip the morning cleanse, that’s even better. No matter how creamy or gentle your cleanser claims to be, it is going to strip your skin of some components of the skin barrier. Since you are already at a barrier loss, you can’t afford to lose more.
2. Moisturize
Moisturizers are meant to seal in the moisture inside your skin cells and give you soft, plump, and smooth skin. They can also help your skin to rebuild its barrier.
Try to use a moisturizer with no actives. Niacinamide, a versatile ingredient, can cause a burning sensation in some people if the skin barrier is damaged. So, if that is you, avoid using it for a while.
There are several studies that show that using a moisturizer alone or in combination with other topical treatments can drastically improve the outcome of an inflammatory skin disease. [7] [8] So, don’t underestimate a basic moisturizer.
3. Protect
Sun protection is one of the most important aspects of barrier repair. UV rays can cause inflammation in the skin which can further increase the damage. So, keep up with the sun protection.
By sun protection, I am not just talking about sunscreen but other elements of sun protection as well including sunglasses, umbrellas, hats, sun protective clothing, and avoiding mid-day sun exposure.
If you cannot tolerate any sunscreen at this time, go for a face covering when you are out in the sun.
4. Eat well
Diet has been linked to skin health in several studies. Antioxidant and carotenoid-rich diets can help your skin from everyday sun exposure and oxidative stress, which causes skin inflammation.
Another common recommendation is to include essential fatty acids (EFAs) in the diet.
I usually stick with including natural sources like nuts, plant seeds like sunflower seeds, flax seeds, chia seeds, etc., and fish into my diet.
Note: Intake of any supplement should always be discussed with your physician since they can interfere with your other medications or cause side effects.
5. De-stress
Stress can have adverse effects not only on your skin’s health and barrier, but it also affects your physical and mental health. Try to relax by meditation, breathing exercises, walking, listening to music, talking to someone, and expressing your feelings.
How long does it take to repair the skin barrier?
It depends on how much damage was done in the first place and secondly on how you are approaching your current skincare. It can take anywhere from a week to 4 weeks to see signs of improvement in the skin barrier.
What to do if nothing helps?
If things are getting worse or a simple skincare regimen is not leading to any skin barrier improvement, it’s time to make an appointment with your dermatologist.
Some inflammatory skin conditions can have overlapping features with the damaged skin barrier. So, it’s important to get the right diagnosis and treatment if needed.
Key points
Our skin barrier is like a brick wall, which can get damaged leading to holes and gaps in it. Due to this, external elements can get deep into the skin and cause inflammation and damage.
Many external factors like skincare habits, environment, or internal factors like stress, age, or underlying skin condition; can cause damage to the skin barrier.
Our skin can self-repair and undo some of the damage. However, if the damage is more than repair, we will start seeing signs and symptoms of a damaged skin barrier.
These include redness, dryness, scaly rough skin, burning and stinging, leathery appearance of skin, and skin thickening.
The first step towards repairing your skin barrier is simplifying your skin routine and getting rid of all the extra steps. Basic steps of cleansing with low pH cleanser, well-formulated moisturizer, and sun protection are important.
Changing your eating habits (including antioxidant and carotenoid-rich foods, nuts, fish, etc.) and managing stress, can also have a huge impact on skin health. If things don’t go well, don’t hesitate to seek professional help.
References
1. Del Rosso JQ, Levin J. The clinical relevance of maintaining the functional integrity of the stratum corneum in both healthy and disease-affected skin. J Clin Aesthet Dermatol. 2011;4(9):22-42.
2. Rosso JD, Zeichner J, Alexis A, Cohen D, Berson D. Understanding the Epidermal Barrier in Healthy and Compromised Skin: Clinically Relevant Information for the Dermatology Practitioner: Proceedings of an Expert Panel Roundtable Meeting. J Clin Aesthet Dermatol. 2016;9(4 Suppl 1):S2-S8.
3. Levin J, Momin SB. How much do we really know about our favorite cosmeceutical ingredients?. J Clin Aesthet Dermatol. 2010;3(2):22-41.
4, Hernández AR, Vallejo B, Ruzgas T, Björklund S. The Effect of UVB Irradiation and Oxidative Stress on the Skin Barrier-A New Method to Evaluate Sun Protection Factor Based on Electrical Impedance Spectroscopy. Sensors (Basel). 2019;19(10):2376. Published 2019 May 23. doi:10.3390/s19102376
5. Altemus M, Rao B, Dhabhar FS, Ding W, Granstein RD. Stress-induced changes in skin barrier function in healthy women. J Invest Dermatol. 2001 Aug;117(2):309-17. doi: 10.1046/j.1523-1747.2001.01373.x. PMID: 11511309.
6. Kahan V, Andersen ML, Tomimori J, Tufik S. Can poor sleep affect skin integrity? Med Hypotheses. 2010 Dec;75(6):535-7. doi: 10.1016/j.mehy.2010.07.018. Epub 2010 Aug 1. PMID: 20678867.
7. Lucky AW, Leach AD, Laskarzewski P, Wenck H. Use of an emollient as a steroid-sparing agent in the treatment of mild to moderate atopic dermatitis in children. Pediatr Dermatol. 1997 Jul-Aug;14(4):321-4. doi: 10.1111/j.1525-1470.1997.tb00968.x. PMID: 9263319.
8. Draelos ZD. Moisturizing cream ameliorates dryness and desquamation in participants not receiving topical psoriasis treatment. Cutis. 2008 Sep;82(3):211-6. PMID: 18856161.
9. Parke MA, Perez-Sanchez A, Zamil DH, Katta R. Diet and Skin Barrier: The Role of Dietary Interventions on Skin Barrier Function. Dermatol Pract Concept. 2021;11(1):e2021132. Published 2021 Jan 29. doi:10.5826/dpc.1101a132
Disclaimer: This blog post is for information purposes only and does not replace medical advice.