Dysregulation Of The Skin Barrier In Ad
Epidermal barrier proteins, including FLG, TGs, keratins, loricrin and intercellular proteins, are cross-linked to form an impermeable skin barrier., Skin barrier defects facilitate allergen sensitization and lead to systemic allergic responses, such as increased IgE levels and airway hyperreactivity.,,, Transepidermal water loss is a noninvasive measurement used to evaluate skin barrier function. Patients with AD have increased TEWL, which reflects skin barrier dysfunction in AD, and can precede clinical AD.,
Keratinocytes differentiated in the presence of IL-4 and IL-13 exhibit significantly reduced filaggrin. Primary human keratinocytes were cultured for 5 days in 0.06 or 1.3 mmol/L CaCl2 in the presence of IL-4 plus IL-13 or interferon -gamma. *P< 0.05 ***P< 0.001 between the exposure groups. Source: Howell et al. J Allergy Clin Immunol 2007 120:1505.
What Drives The Eczema Itch
Your skin is the bodys largest organ, and one of its primary jobs is to act as a filter between you and the outside world. Toxins, bacteria, pathogens, allergens anything that is potentially harmful to the body is filtered out by the skin.
But what if you have eczema? Why is your skin constantly itchy and why is it that you just cant stop scratching? Lets take a closer look.
The Constituents Of Plant Oils
Plant oils can be classified into essential oils and fixed oils. This article focuses only on fixed oils, which are not volatile at room temperature. Although there are different ways to obtain plant oils, cold-pressed plant oils have better nutritive properties than those that have undergone the refining process. This is because cold-pressing procedure does not involve heat or chemical treatments, which may alter their composition and therapeutic effects. Fixed plant oil components include triglycerides, FFAs, tocopherols, sterols, stanols, phospholipids, waxes, squalene, phenolic compounds , etc. These different compounds, when topically applied, influence skin physiology differently.
Unsaponifiables are also essential in the biological function of plant oils . They have a high potential for antioxidant activity. Antioxidant activity is derived from tocopherols, carotenoids, triterpenes, flavonoids, and phenolic acids that protect from ROS .
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What Are The Causes Of Barrier Disruption
Imagine the corneocytes are part of a brick wall, and the lipids are the cement which sits between the bricks or cells.
These lipids create an oil-rich environment, which plays an important role in creating a healthy barrier. They prevent irritants from entering your skin while locking water in, so your skin is beautifully hydrated and moisturised. Hydration is essential for an intact barrier, and you can read all about it in our article on clear skin.
When your skin breaks down, your barrier becomes compromised irritants, microbes, and allergens can easily penetrate, creating conditions such as dermatitis or eczema.
Ever accidentally dripped lemon juice onto a chapped part of your hand? Then you dont need us to tell you it hurts like hell! When your skin is chapped, it has lost the valuable lipids that sit between the skin cells. This increases the penetration of irritants, allergens, and pathogens meaning that nasty acidic irritants like lemon juice can penetrate easily.
An alteration in the stratum corneum lipids has been identified in several skin disorders associated with a damaged permeability barrier, including atopic dermatitis and inflammation.
Try Skin Oils And Moisturizing Creams
The added moisture in the form of skin oils and moisturizing creams helps nourish the lipid matrix, which is vital in how the skin barrier functions.
According to an article titled, Skin Barrier Function featured in the Indian Journal of Medical Research and the National Library of Medicine in 2018, The lipid matrix in the outermost layer of the skin is crucial for the skin barrier function: cholesterol, free fatty acids, and ceramides are important components of this lipid matrix.
In a research project about the skin barrier by Dr. Charlotte Beddoes, postdoc researcher at the Division of Drug Delivery Technology at Leiden University, she further defines this lipid matrix referenced above as a matrix consisting of ceramides, cholesterol, and fatty acids, organized in a crystalline lamellar phase. It is this lipid matrix that has been identified as a major contributor to the skins barrier function.
The addition of externally applied creams and oils adds bonus moisture, ceramides, fatty acids, and lipids to this ever-so-important matrix. More moisture strengthens the layer and contributes to a strong, healthy skin barrier that functions at a top-notch level.
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Ways To Fix Your Skin And Stop The Itch
If youve been trying to fight off the itch with moisturizers, then you might find that its often not enough to stop the chronic itchy feelings. Thats because an impaired skin barrier and excess histamine needs to be addressed from both the outside AND inside.
While we might not be able to undo our genetics, there are some things that we can do to improve and build a healthy skin barrier.
Here are some ways!
Repair The Lipid Barrier
We mentioned the layer of lipids located in the stratum corneum. These lipids are mainly made up of fatty acids, ceramides, and cholesterol.
For example, studies show that topical use of creams formulated with ceramides can help repair the damaged skin barrier function .
Similarly, fatty acids help restore the skin barrier function and improve the skins natural moisturizing factors. They are labeled as linoleic acid or oleic acid. They can also be listed as omega-3 or omega-6 fatty acids in skincare products.
Other ingredients to include in your products are aloe vera, niacinamide, and known anti-inflammatory skincare ingredients like colloidal oatmeal.
So look for these ingredients in your moisturizers to promote a healthy skin barrier thats resistant to external harmful agents and transepidermal water loss.
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The Pathogenic Role Of Elevated Ph In Ad
An inevitable consequence of both the flawed barrier and the inflammation in AD is an elevation in pH on the skin surface .The deleterious consequences of an elevated pH in AD include the activation of yet another outside-to-inside cytokine cascade, that begins with the activation of the serine protease, kallikrein 5, followed by the generation of the pro-Th2 cytokine, thymic stromal lymphopoietin , which in turn recruits Th2 and Th17 cells that secrete the bad cytokines, i.e., interleukin -4, IL-5, IL-13, IL-17A, and IL-33 . Th2 cytokines further compromise the barrier by downregulating the synthesis of: epidermal structural proteins , tight-junction proteins , ceramides , fatty acid elongases , and a key antimicrobial peptide, LL-37 . Hence, the initial outside-to-inside cytokine cascade in AD quickly morphs into an outside-to-inside back to outside vicious circle . Furthermore, KLKs exhibit a neutral-to-alkaline pH optimum, and their activation in AD further compromises another set of critical functions .
Fig. 2.
Central role of an increased pH in AD pathogenesis .
Finally, the low pH of normal SC inhibits the growth of Staphylococcus aureus and Streptococcus pyogenes, so that the normal flora, e.g., Staphylococcus epidermidis and Corynebacterium thrive . In contrast, the elevated pH of the inflamed skin in AD favors pathogen colonization and growth.
Moisturizers Can Harm Individuals With A Defective Barrier
In a sensitive skin animal model, we recently identified a serious flaw in most of the moisturizers currently on the market . While they may appear harmless when applied to normal skin that displays a robust barrier, many of these products could prove to be toxic if/when they are applied to the skin of individuals with self-reported sensitive skin, likely also involving subjects with a history of AD . However, these products rarely are tested in such at-risk individuals. Instead, typically, these subjects are specifically excluded from any such investigations. The bottom line is that, while short-term relief may be obtained with these agents, if they further disrupt the skin barrier they can initiate a vicious cycle that requires repeated applications of the same or alternate products.
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What Can Cause A Damaged Skin Barrier
“While there are unavoidable daily contributions There are ways you personally can be contributing to the damage of your skin barrier,” Viscusi says. And a lot of that starts with cutting out some bad skincare routine habits and taking care of your skin. Here’s what to avoid or be mindful of when it comes to your skin barrier.
1. Over-washing:“This can strip the barrier and leave the skin vulnerable and dry,” says SkinSpirit lead aesthetician Karen Fernandez. And you’ll also want to choose face washes and cleansers that are gentler on the skin, like this one below from CeraVe.
2. Over-exfoliating: Aguilar says this is the most common way to damage your skin barrier. “It can happen from using a face scrub too often or using an exfoliant composed of harsh ingredients like apricot seeds, sharp salt, or high percentages of or using too many acids,” she says. “Stripping away dead skin aggressively, and too often, will damage our skin’s barrier. Over-exfoliating your skin can leave it bare with no protection or defense system.” When you do exfoliate, try to use a product that is a bit gentler on the skin, like this one below.
3. Hot water: Cleansing with really hot water can play a role in damage, Riyaz says. Instead, try water which is best for the skin.
6. Doubling up on active ingredients: This is another issue that Riyaz sees each week with Docent patients.
How To Repair Your Damaged Skin Barrier
- 2 min read
Your skin barrier is the lipid matrix found in the outermost layer of your skin, the stratum corneum, and essentially sits on top of this layer. When healthy, the skin barrier helps keep moisture in and external irritants out – acting as your skins bodyguard.
What is the skin barrier?
The skin barrier, ormoisture barrier, is mainly composed of three lipids: ceramides, cholesterol, and free fatty acids. These lipids work together to prevent water loss and to protect your skin from the environment. Damage to the skin barrier occurs in the form of miniscule cracksthrough which moisture can easily escape and irritants can enter more easily.
Signs your skin barrier is damaged:
When your skin barrier is healthy, your skin generally looks plump and smooth and feels soft to the touch. If you have oily skin thats also dehydrated, thats a common sign that you may have a damaged skin barrier.
Some other damaged skin barrier symptoms:
- Redness
- Rashes like eczema
- Increased breakouts
When you read over this list of these symptoms, you might notice that a whole range of skin issues can be traced back to a damaged skin barrier. Thats why caring for your skin barrier is so important.
My skin barrier is rekt. Can I repair it?
What ingredients to avoid?
Using gentle products is critical for your skin. Here are some ingredients to avoid:
What are the best skin barrier repair ingredients?
- Hyaluronic acid
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How Inherited Mutations In Structural Proteins Give Rise To Ad
Though much attention in recent years has focused on filaggrin, AD is associated with mutations in a diverse group of structural and enzymatic proteins that interfere with either the loading and/or delivery of the lipid and enzymatic contents of lamellar bodies into the extracellular spaces of the SC . Normally, these secreted lipids form stacks of lamellar bilayers that fill the extracellular spaces, accounting for around 10% of the mass of the SC in normal skin. In AD, the failure to deliver a full complement of lipids to the SC results in reduced amounts of extracellular lipids, producing a leaky extracellular matrix that permits excessive loss of water . An immediate consequence of a flawed delivery mechanism is a decline in the total lipid content needed to fill the extracellular spaces with lamellar bilayers. It also should be noted that, because the permeability and antimicrobial barriers are both closely linked and interdependent , a permeability barrier defect results in a parallel defect in antimicrobial defense that allows an unimpeded penetration of microbial pathogens and allergens into the skin .
Fig. 1.
The outside-to-inside homeostatic responses provoke a cytokine cascade that leads to inflammation in AD.
Build A Healthy Skin Barrier From Inside
Do you constantly get red chapped lips, or itchy skin at night? If you have a weakened skin barrier, water loss is more common when the weather is drier , and your skin can become dehydrated more easily. Your face is always one of the first places to show, which is why chapped lips always mean a sign of dehydration.
One thing that really made a difference for my skin, was to drink 8 glasses of water daily, especially in the morning when I woke up, and AS SOON as I felt an itch coming.
Getting adequate water is extremely important as it makes up for more than 60 percent of your skin barrier!
Other ways to build a healthy skin barrier is by eating lots of healthy fats like coconut oil or avocados, as well as collagen and protein. This helps to improve cell membranes, making your skin strong and healthy.
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Barrier Repair: Where Do We Stand
An update on skin moisturization and the use of prescription barrier repair agents for atopic dermatitis.
The pathogenesis of atopic dermatitis is notfully understood, but ongoing discoveries continueto expand our knowledge of the condition. Weknow that epidermal barrier dysfunction is an integralcomponent of AD, and this understanding has allowedus to reassess our understanding of AD and its management.
For example, the skin of patients with atopic dermatitismay be described as irritable or hyper-sensitive. We nowrecognize that these characteristics may not truly reflect astate of the skin. Instead, they are symptoms of epidermalbarrier dysfunction and associated cutaneous inflammation.Given the accumulated evidence that barrier dysfunctionmay be present even in clinically normal appearing skin ofAD patients,1,2 it makes sense that patients may experienceskin sensitivity even when they do not have an active flare.
Similarly, AD patients may experience dry skin and pruritusas a consequence of epidermal barrier dysfunction andmay have a lower threshold to perceive itch with a varietyof stimuli, such as contact with coarse fibers like wool.3 This is not an allergic or irritant reaction, per se rather,such sensitivity may be a symptom of the patient’s underlyingdisease.
Stop Scrubbing And Exfoliating
Harsh exfoliants and vigorous rubbing is doing your precious skin barrier no favors. Far too many people mindlessly use a brush or skin cleansing cloth that is too rough for their skin type, and they have no idea. When skin problems arise, people rarely correlate their harsh scrubbing with the issues, but they can be connected.
Toss those brushes and instead opt for a super-soft piece of flannel to give your face its lather. If you like a mechanical face scrubbing product, look for one thats so smooth its almost like a skin massage rather than a scrub.
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How Do You Fix A Damaged Skin Barrier
In my case, cutting most of my serums, oils, and favorite cleansers out and swapping them for mild formulas did the trick to fixing my skin. I also cut out the acne products because they were further irritating the rash of eczema on my forehead.
A personal routine that Dr. Wexler recommended is gentle micellar water, like Simple’s Micellar Cleansing Water , Eucerin Eczema Relief Creme , a prescription for my rash on my forehead, Elta MD Clear SPF Broad Spectrum 46 , and SkinMedica HA5 Rejuvenating Hydrator . I was also instructed to pat all my products on my face, instead of rubbing which could trigger an allergic response.
On top of eliminating potentially irritating ingredients, Dr. Chimento says to look for skincare ingredients such as ceramides, hyaluronic acid, petrolatum, or glycerin in your product formulas to improve dryness and strengthen your skin barrier. The key to repairing your skin barrier is all about keeping it simple and hyper-focusing on moisturizing.
Over six weeks, the redness faded, the rash on my forehead completely cleared up, and my skin felt and looked like my moisture levels were rising. The stinging subsided, and I started to feel more confident not wearing foundation or concealer on the weekends because my tone was getting back to normal. When the skin returns back to normal, Dr. Wexler says patients can slowly add back in favorite products.
Start By Simplifying Your Skincare Regimen
Thats right. Its time to go back to the basics: no fancy creams and no magic prescription.
For some people, a damaged skin barrier can be a vicious cycle. Their skin is irritated and showing signs of a damaged skin barrier, so they try a new product. The skin reacts negatively to that, creating more aggravation, stinging, redness, and more. This in itself has damaged the skin barrier more, leaving it more susceptible to further irritants and skin problems.
Overcomplicated skincare routines sometimes are just asking for trouble. Instead, give your skin a break. Take several days off of skin products. Reach for a gentle cleanser to wash away oils, dirt, and makeup of the day, and then let your skin be.
Also, consider simplifying your skin makeup routine by considering removing a product or two. Let your skin breathe, heal, and recoup for a bit.
Dr. Samantha Bunting, a cosmetic dermatologist in Central London, recommends keeping things super simple to give yourself effectively, nurturing skincare. Take a long, hard look at your beauty practices. Paring your routine right-back is key. Get rid of products with astringents, like alcohol and witch hazel, and avoid foaming cleansers, which leach away our natural moisturizing factor.
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