By
Melbourne Functional Medicine
Rebecca Hughes
Medically reviewed by:
The skin is our barrier or membrane between us and our environment, especially water, air, and everything they carry. It’s also sensitive to temperature changes, UV rays, touch, and substances we apply to it. Caring for the skin barrier is important for everyone, particularly those with chronic skin dryness, dermatitis, eczema, and psoriasis. In this article, I delve into the essentials of skin barrier care.
The skin barrier, primarily composed of lipids, proteins, and corneocytes, acts as a membrane preventing moisture loss and shielding against pathogens such as bacteria and fungi. Disruptions in the skin barrier function are associated with various dermatological conditions, including eczema and psoriasis.
The following strategies are ones I share with my patients with skin conditions to help them improve and maintain healthy skin.
When we hear about moisture, we often think of water. Whilst drinking water is valuable for the skin, keeping the moisture in is just as critical. We do that by preserving the skin’s integrity, and ensuring it’s coated with the natural oils secreted by skin glands. Most people are unaware that dry skin is actually a sign of broken or damaged skin. Once dry, skin becomes porous, and can be infiltrated by pathogens like bacteria and fungi. That’s why it’s important to keep damaged skin moisturised, in addition to whatever therapeutic topical agents are being used. Additionally, because the skin contains immune cells, these can be sensitised by allergens.
Due to hygiene practices and social standards, we bathe and shower regularly, often for long periods of time, and with warm or hot water, and in doing so wash away that protective layer on a regular basis. I hold the controversial opinion that you don't need to wash your entire body daily, particularly if you're someone who primarily works at a desk in a very clean environment.
Obviously those who have physical jobs where they may be covered in dust, dirt, pollen, chemicals, or those who work in the healthcare system and need to adhere to hygiene practices for themselves and their patients are the exception here.
If you need to bathe regularly using soaps and washes, it’s important to replace that protective layer with moisturising to maintain the skin’s health.
You mightn’t like this if you live in a cold environment, however lukewarm water instead of hot water is preferable, as hot water strips the skin of its natural oils. I also recommend limiting bathing time to 5 -10 minutes for the same reason. Additionally, consider reducing the frequency of bathing. Finding the right balance in water temperature, duration, and frequency of bathing can contribute to healthier skin overall.
Harsh cleansers can compromise the skin barrier, leading to irritation and inflammation. When you’re looking for soaps and cleansers, try to avoid surfactants, such as sulfates (e.g., sodium lauryl sulfate), which create a foamy lather but can be overly drying and irritating. Opt for milder surfactants, such as coco-glucoside or sodium cocoyl isethionate, that effectively cleanse the skin without stripping away its natural oil.
I generally avoid recommending specific products since people have individual reactions to various ingredients. However, here are a few options that are free of surfactants:
Alcohol is also very drying. Fragrances/perfume can be irritating and should also be avoided if you have irritated skin. Even essential oils are too much for sensitive or reactive skin types.
Incorporating barrier-strengthening ingredients like ceramides and niacinamide in skincare routines can fortify the skin barrier. A clinical trial published in the Australian Journal of Dermatology demonstrated the efficacy of ceramide-based formulations in improving skin barrier function and hydration levels.
Several other ingredients are renowned for their ability to strengthen and protect the skin barrier:
The quality of water can significantly impact skin barrier health. Hard/alkaline water, which contains high levels of minerals like calcium and magnesium, can disrupt the skin's natural pH balance and strip away its protective oils, leading to dryness, irritation, and impaired barrier function.
Additionally, chlorinated water commonly used in swimming pools (and treated town water) can further exacerbate skin barrier issues, as chlorine can strip the skin of its natural oils and disrupt its protective barrier.
If you have especially delicate, fragile, dry, broken or sensitive skin, be mindful of the chemistry of your water, in particular calcium carbonate and chlorine concentrations. Calcium carbonate is quite drying. Chlorine is needed to sanitise the wider water supply, but it can burn and irritate fragile skin. If you suspect that the water supply at your home has a high chlorine concentration (which you should be able to smell) or is particularly alkaline, then you may want to consider devices that reduce that.
There are filters that can be retro-fitted to shower heads that soften the water. If you also don’t want to drink water that contains chlorine, complete home filtration systems are more affordable than they ever have been.
UV radiation poses a significant threat to the skin barrier, causing oxidative damage and impairing its functionality. There’s a balance to strike between antioxidant damage and vitamin D absorption.
Several nutrients obtained through diet or supplementation have been identified for their ability to protect, maintain, and repair the skin barrier. They include:
Ensuring adequate intake of these nutrients through a balanced diet or supplementation regimen can complement topical skin care efforts and promote optimal skin barrier health.
Caring for your skin barrier is essential for maintaining healthy, radiant skin. By altering bathing, prioritising hydration, protecting against environmental stressors, and embracing a nutritious diet, you can fortify your skin barrier and promote long-term skin health.
