Skin Barrier — the unsung hero of skin health: How to repair it and optimize its strength

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Detail of The Fountain of Youth by Lucas Cranach the Elder (1546).

Winter is upon us and it’s time to pay particular attention to our skin, specifically the outermost layer called the stratum corneum, aka the skin barrier.  This thin brick-like cover consists of resilient skin cells called corneocytes that are tightly bound together by mortar-like lipids comprised of cholesterol, fatty acids, and ceramides.  Crucially, the skin barrier not only protects us from external threats like environmental toxins and pathogens, but it also prevents dehydration.

A healthy vs unhealthy skin barrier.

“Defects of the skin barrier can lead to diseases such as eczema, dermatitis, asthma, and allergies,” warns Miami dermatologist Dr. Leslie Baumann.  Moreover, “when skin barrier defects cause inflammation, the risk of inflammatory diseases such as diabetes and heart disease increases.”  In other words, a robust skin barrier is vital to healthy skin and to good health in general.

Board-certified dermatologist, Dr. Leslie Baumann: “Anything that disrupts these beneficial fats [cholesterol, fatty acids and ceramides] can damage the skin barrier. Besides cold weather and lack of humidity, common culprits are foaming cleansers, bubble baths, bar soaps and prolonged water submersion, all of which strip lipids from the skin. If you use any of these, you should stop immediately. Replace your bubble bath with bath oil, and try a creamy cleanser facial cleanser.”

Stress factors on the stratum corneum are numerous, including aging, UV light, medications, over-exfoliation and genetics.  But it is especially vulnerable in winter months.  “Rosacea and skin sensitivity are two of the most prominent skin conditions and concerns that I see and treat at this time of year,” says London-based plastic surgeon, Dr. Yannis Alexandrides.  “Due to the swift change in temperature, the skin can find itself battling between two mediums – external and internal environments that in turn wreak havoc on the skin’s barrier.”

British and American board-certified cosmetic surgeon, Dr. Yannis Alexandrides: “The imbalance [in temperature during winter months] can affect the microbiome of the skin which is the healthy population of bacteria and viruses that cohabit in our skin. If the skin barrier breaks down, it can decrease the good bacteria and increase the population of other bacteria and that means infection or rosacea or acne, depending on how it affects the person.”

So, how do you know if you have an impaired skin barrier and what can you do to fix it?  Telltale signs are dryness, itching, and irritation, according to Dr. Baumann.  Dryness, in particular, offers a big clue.  “When air becomes drier due to colder temperatures, water evaporates off the skin more than when it is humid,” points out the dermatologist.  This is called Transepidermal Water Loss or TEWL.”  The most accurate way of measuring this water evaporation is with a TEWL meter.  But barring the ready availability of such a measure, there is a free questionnaire developed by Dr. Baumann — — that can correctly identify those with a compromised barrier.

For Dr. Yannis, dry, chapped lips is another indicator.  “The first part can be the lips because the lips, unlike the rest of the skin on the face, don’t have protective glands,” he says.  “Eventually, the lips can crack and the same thing can happen to skin.  It’s exactly the same process,” says the plastic surgeon.

Dr. Baumann: “The three main components of a well-functioning skin barrier are cholesterol, fatty acids and ceramides. These are all types of fat (lipid) molecules that must be present in a specific ratio to keep your skin moist and healthy. There are various fatty acids that repair the skin barrier. My favorites are stearic acid (found in shea butter) and palmitic acid, which are common fatty acids found in skincare products. But not all fatty acids repair the skin barrier. In fact, oleic acid, the fatty acid found in olive oil, can cause tiny holes in the skin barrier. For this reason, olive oil is not a good skin hydrator for those with an impaired skin barrier.” Illustration:

The good news is that by using the correct products, the skin barrier can be restored in a relatively short period of time – usually within a week.  Creamy non-foaming cleansers and gentle oils like argan oil figure highly in Dr. Baumann’s curative regimen, but it is barrier repair moisturizers which top the list.

While there are many barrier repair creams on the market, they are not all created equal.  In order to be effective, the moisturizer must contain multi-lamellar emulstion (MLE) technology, reveals the dermatologist.  This combines a ceramide, fatty acid and cholesterol in a 1:1:1 ratio that mimics the skin’s own natural structure, thereby providing the strongest, tightest barrier protection.

So, although the ingredient list may include cholesterol and ceramides, it won’t divulge the proportion of these lipids.  This is important because “if you put the wrong ratio of lipids on the skin, it actually impairs the skin barrier,” explains Dr. Baumann.  “For this reason, it’s best to stick to brands recommended by your dermatologist who understands the underlying science of these complex moisturizers.”  To that end, Dr. Baumann recommends Zerafite and Skinceuticals Triple Lipid Restore 2:4:2.

Dr. Baumann: “I have tested barrier repair moisturizers from around the world and [Zerafite Barrier Repair Moisturizer] made in South Korea is superior to the others I have tested and has good research to back it up.”

In addition to Zerafite, Dr. Baumann also favors the following trio of products: a PSL (physiologic skin liquid) moisturizer like Medature, a prescription-strength cream called EpiCeram and argan oil, her favorite being PAORR Organic Argan Oil.

Choosing the right skin care products is also paramount for Dr. Yannis who favors moisturizers and serums which contain a combination of moisture-retaining hyaluronic acid and anti-oxidants.  The latter protect the skin and the skin barrier by neutralizing free radicals, the production of which increases during winter due to the added stress that cold weather imposes on the skin.

“Free radicals are bad guys because they destroy DNA that makes skin cells break down,” explains the plastic surgeon. “Antioxidants neutralize free radicals and protect the skin from this damage.” Vitamin C and the tri-peptide, glutathione, are two anti-oxidants particularly important in winter months, according to Dr. Yannis. Both are powerful contributors to healthy skin – the former with its collagen-building properties and the latter “master antioxidant” for boosting elasticity.  To that end, the surgeon and 111SKIN founder, recommends his Vitamin C Brightening Booster serum.

Vitamin C Brightening Booster.

Dr. Yannis, a fan of masks, also recommends his best-selling Y Theorem Bio Cellulose mask which contains the requisite antioxidants and hyaluronic acid.  For the surgeon, masks are a potent add-on to a reparative skin care regimen.  Because they are applied directly to the skin, masks facilitate the absorption of healing ingredients. “They will give you a super dose of these ingredient straight into the skin,” he says.

111SKIN Y Theorem Bio Cellulose Mask.

For more intense hydration, Dr. Yannis recommends mesotherapy, a treatment consisting of several hyaluronic acid and Vitamin C injections. “We are very busy in the winter months with mesotherapy here in London,” reveals the surgeon. “They’re the months that skin needs it the most.”

And where do retinols and retinoids fit in if you’ve got a damaged skin barrier?  Caution is the name of the game. “Retinoids can be used in conjunction with the correct creamy cleanser and a barrier repair moisturizer, but only a pea size every third night when beginning,” instructs Dr. Baumann. “Having an impaired barrier means things get into the skin easier so you need to use less of retinoids than normal when beginning.”  A slow, measured approach is the ticket when it comes to retinols and the more powerful, prescription-strength retinoids, concurs Dr. Yannis, who counsels a once-a-week graduating to twice-a-week application of the potent Vitamin A derivate, but only after the skin has healed.

The skin barrier, crucial as it is to our well-being, is vulnerable, targeted regularly by numerous aggressors, particularly during wintertime.  The good news is that with proper, gentle care, it can be repaired and strengthened in a relatively short period of time, thereby helping to optimize skin health and overall health in general.

Beauty Tips

Improving the strength of the stratum corneum requires more than a skin deep approach however, because what you ingest affects your kin.  Statins, for example, can have an adverse effect as they lower cholesterol, one of the key building blocks of the stratum corneum.  “They don’t have any studies giving a quantitative amount of how statins affect the barrier, but we know it does,” says Dr. Baumann.

Dr. Yannis: The connection between gut and skin is a big developing science right now.  We don’t know everything about it, but we do know that when we take statins, we reduce the production of some key elements in the skin such as phospholipids and Vitamin E which are protectors of the skin and contribute to the structural strength of the epidermal layer.  In that case, we want to supplement the skin with Vitamin E both, applied topically and taken orally.  Another ingredient is ceramides [essentially the glue that holds skin cells together].  That also improves the strength of the epidermal layer.

Dr. Baumann: You can also repair your skin barrier from the inside out by taking borage seed, fish oil or evening primrose oil supplements, or by adding salmon and other sources of fatty acids to your diet.  I find that vegans are more likely to have a disrupted skin barrier and dry skin. I tell my vegan patients to add flax seeds to their diet, and I’ve seen dry skin improve from this alone.

For more beauty tips and information, follow Delia on Instagram: @chasingbeautywithdvn

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