Skin barrier repair: signs of damage and how to heal it

What is the skin barrier?

It is the outermost layer of your skin, the stratum corneum. Dermatologist Melissa Piliang, MD, of Cleveland Clinic describes it as dead cells, lipids, proteins and fats that keep water in and keep chemicals and bacteria out. The usual picture is a brick wall: flattened skin cells are the bricks, and natural fats called ceramides, cholesterol and fatty acids are the mortar between them.

The barrier renews itself, but more slowly with age. Dr. Piliang says a young person can shower in hot water with soap three times a day and the barrier rebuilds within six or seven hours. In your 50s, 60s and 70s, it does not bounce back as quickly, so the same habits leave skin dry for longer.

Signs of a damaged skin barrier

Cleveland Clinic's list. Most people notice two or three at once.

• Dry, scaly or flaky skin, and rough patches
• Stinging or burning when you put on products that never bothered you before
• Redness, inflammation and itch
• Tenderness or new sensitivity
• Breakouts

Products that sting on a damaged barrier are not proof they work. The AAD says to tell a dermatologist about anything, moisturizer included, that burns or stings.

What damages the barrier, and the swap

Cleveland Clinic and AAD pages, and Engebretsen 2016, under Sources.

Which ingredients actually help repair it?

Barrier lipids, in balance. Researchers in San Francisco showed in 1996 that applying one or two of the barrier's lipids alone slowed repair. An equal mix of ceramides, cholesterol and fatty acids allowed normal repair, and raising any one of the three up to threefold sped it up. That work was done mostly on mouse skin, with preliminary human results. It is why barrier creams list all three.

Petrolatum. In a 1992 study from the same group, skin on human volunteers was stripped with acetone, and plain petroleum jelly sped up barrier recovery instead of slowing it. It worked its way between the cells of the outer layer. The published summary does not give the number of volunteers. The AAD calls ointments more effective and less irritating than lotions for dry skin, with one caution: keep petroleum jelly off your face if you are prone to acne.

Other ingredients the AAD names for very dry skin: glycerin, hyaluronic acid, dimethicone, lanolin, mineral oil, shea butter, jojoba oil and lactic acid. Niacinamide has lab data on ceramide production, covered in niacinamide benefits, and hyaluronic acid has its own guide: hyaluronic acid benefits.

A barrier repair routine, morning and night

1. 1Wash less, and gentlyLukewarm water and a soap-free cleanser. Use just enough to clean; the AAD warns against a thick lather on dry skin.
2. 2Pat, do not rubDry off with a clean towel and leave the skin slightly damp.
3. 3Moisturize within minutesA cream with ceramides, cholesterol and fatty acids, or an ointment. The AAD says to apply moisturizer while the skin is still damp.
4. 4Sunscreen every morningBroad-spectrum SPF 30 or higher. Dr. Piliang's rule: pick one you like, can afford and will wear every day.
5. 5Put the actives awayNo retinoids, acids, scrubs or alcohol toners until the stinging and flaking have stopped. If you have broken skin from a breakout, Dr. Piliang suggests backing down on acne treatments for a while.
6. 6Bring them back slowlyOne product at a time, a week or more apart, so you know what your skin is reacting to.
7. 7Give it monthsCleveland Clinic puts the usual wait at three to four months before you see the benefit.

Is the barrier different on Black skin?

Possibly, and the research is mixed. A 2010 study by Muizzuddin and colleagues compared the outer skin layer of African American, white and East Asian volunteers using tape strips from the face and forearm. African American skin had lower ceramide levels and tighter cohesion between cells in its uppermost layers. The authors linked this to the high rate of dry skin seen in Black skin. The published summary does not give the number of participants, and the authors themselves note that earlier studies on skin and ethnicity often contradict each other.

What is better established is the cost of irritation. The AAD says a skin care product that irritates your skin can cause dark spots, and that once the irritation stops, new spots tend to stop appearing. That makes the gentle routine above the safe default, and it is one more reason to stop actives as soon as skin starts to sting. The guide to post-inflammatory hyperpigmentation covers what to do about marks already there.

Facials while your barrier heals

Exfoliating treatments add to what your skin is already dealing with, so say so when you book. At Karisma Esthetics in Melbourne, the Signature Facial, $125 for 60 minutes with a consultation included, lists hydration and calm for sensitive skin among its goals. The $225 Advanced Facial adds microdermabrasion and a superficial peel, both forms of exfoliation. The sensitive skin facial page explains what to tell Kay Woodson before she starts.