Dr Celine Leong: Maintaining your skin’s barrier integrity

It is a well-known fact that the skin loses its integrity as we age, inevitably. If this is lost, we will be more susceptible to injury, loss of moisture, and excess sun exposure. All these age us prematurely and may even lead to other serious complications such as skin cancer. So how do we maintain our skin barrier integrity? Read on to find out more! 

What is your skin barrier and what does it do?

The skin is the largest organ of our body, so it makes complete sense to take care of it well. Its main responsibility is to protect the body from external stressors such as bacteria, toxins, sunlight, etc. This protection is provided by the skin barrier. 

The skin is made up of many layers, with each layer responsible for different things. The outermost layer of your skin, also known as the stratum corneum, is your skin barrier. It is made of cells that act as a layer of protection and contains:

• Ceramides
• Cholesterol
• Fatty acids

Without your skin barrier, you will be exposed and vulnerable to harmful bacteria, toxins, and ultraviolet (UV) rays that are detrimental to your body. Additionally, your body will also lose copious amounts of water, causing you to become dehydrated. 

The skin barrier is essential to our survival, so it is important to keep its integrity intact and undamaged.

How do I maintain my skin barrier?

There are several ways to help maintain the integrity of your skin barrier. As a start, always look at your daily skincare routine to ensure that your skincare is not contributing to the destruction of your skin barrier.  

Here are some things you should consider:

• Simplify your skin care routine: if you’re performing a complicated daily skincare regimen that involves many products, you may inadvertently be weakening your skin barrier. This can be due to various active ingredients having additive effects on each other. I like to review my patients’ skincare routine with them and help them eliminate what they do not need so as to prevent the unintended weakening of their skin barrier.
  
• Look for formulations that include ceramides: ceramides are lipids that help form the skin barrier. The integrity of the skin barrier is highly dependent on these lipid components of the stratum corneum or outermost layer of the skin.
  
• Moisturisers with hyaluronic acid and/or glycerin: keeping your face hydrated will help to improve your skin and maintain your skin barrier. Hyaluronic acid and glycerin have been scientifically proven to draw or add moisture to your skin, thus keeping your skin plump and vibrant.
  
• Sun protection: apply good quality sunscreen and wear protective clothing, wide-brimmed hats, and sunglasses to protect your skin from harmful UV rays.
  
• Healthy lifestyle: the benefits of leading a healthy lifestyle are aplenty. Staying hydrated and eating a healthy diet can help keep your skin healthy

What are the causes of a damaged skin barrier?

There are a number of things that can damage your skin barrier, these are:

• Age: as we age, our skin loses the ability to produce oil, thus making it difficult to maintain the skin barrier. However, skin age does not always equate to one’s actual age. A 50-year-old individual who has taken good care of his/her skin for the past 20 years may have better skin barrier integrity than a 40-year-old.
  
• Genetics: various skin conditions have been linked to genetics and these skin conditions are associated with having a poor skin barrier. For example, adult acne, atopic dermatitis (eczema), rosacea, and psoriasis – when your skin barrier is not functioning properly, you may be more prone to developing dry, rough, scaly skin, itchiness, acne, sensitive or inflamed areas, and secondary skin infections.
  
• Environmental factors: pollution and exposure to UV rays damages the skin barrier causing it to break down. Dry air during winter or from the aircon can also contribute to damaging your skin barrier.

• Skincare habits: moderation is key. Incorrect or aggressive skincare habits can contribute to the breaking down of your skin barrier. Scrubs, exfoliants, over-cleansing, or over-washing are all examples of incorrect or aggressive skincare habits.

Now that we know what contributes to the degradation of the skin barrier, let’s find out what can be done to restore the skin barrier.

How do I know if my skin barrier is damaged?

If your skin barrier is damaged, you may experience the following:

• Dry, itchy skin
• Prone to infections
• Rough, discoloured patches of skin
• Acne

How do I restore my skin barrier?

If your skin barrier has been damaged or broken, there are various ways to restore skin barrier, these are:

• Profhilo: Profhilo is an injectable anti-ageing treatment made from hyaluronic acid, a natural substance found in the skin. It stimulates the production of collagen and elastin, attracts water deep within the layers of the skin, and helps to tighten and strengthen the skin barrier.  

• Rejuran: commonly known as Rejuran Healer, it works by strengthening the skin barrier and revitalises it by improving the skin’s hydration. It promotes the production of collagen and elastin, improves the skin’s healing capabilities, tightens the skin, repairs skin cells, refines pores, and hydrates the skin. 

In general, Profhilo is recommended if the patient has purely just dry/dehydrated/aged/lax skin; Rejuran is recommended, if the patient also has skin problems such as acne and rosacea. 

Both treatments are not mutually exclusive and many patients either do both or alternate the treatments to get benefits from both.

Is there a minimum/maximum age for treatment of damaged skin barrier?

There is no minimum or maximum age to start skin barrier treatment. However, it is never too early to start protecting your skin from the elements. 

Protection can start as early as age 10-12—start with the basics such as a gentle cleanser, moisturiser, and daily sunscreen. Once you reach puberty, be sure you switch your gentle cleanser to one that controls oil if you suffer from acne and pimples. 

Who is the ideal candidate for treatment with regards to preserving skin barrier integrity?

Anyone can benefit from skin barrier treatment, but it is especially important for those with dry, sensitive, or eczema-prone skin. People with mature skin can also benefit from skin barrier treatments to help maintain their skin’s natural moisture and prevent wrinkles.

How many treatments are required to restore the skin barrier?

In general, two treatments of Profhilo done one month apart is recommended while three treatments of Rejuran can be done one month apart. There is no harm to do additional treatment if one requires it, e.g., older age group or more damaged skin.

Frequently asked questions

How soon will I see results after treatment for damaged skin barrier? 

The time it takes to see results from skin barrier treatment varies depending on the product and the individual’s skin type. However, it is possible to notice benefits within days, as it helps to strengthen the skin barrier to help keep moisture in and keep irritants out.

Full effects are seen at the end of the total treatment course, e.g., two treatments for Profhilo and three treatments for Rejuran.

Do over-the- counter creams (OTC) and lotions work to restore damaged skin barrier?

It depends. Pay attention to pH. Your skin has a pH, also known as an acid mantle, and is usually around a pH of 4.7. However, the pH of some skincare products can be as high as 9 or 10, this can disrupt your skin barrier. 

To assess the efficacy of OTC creams and lotions, on average, you have to use a product for six to 12 weeks before seeing optimal results, depending on the concerns you’re targeting.

What else can I do to protect my skin barrier from further damage?

Know your skin well and pay attention to your skin. If you observe dry, itchy, or red skin, do not just brush it off as ‘sensitive skin’ as these may indicate a compromised skin barrier.

Hydration and moisturising with the above ingredients are key but those with combination acne-prone skin should avoid comedogenic or thick formulations, especially in tropical Singapore where humidity is high.