Supporting The Skin Barrier Through The Winter
If you have dry, scaling, and cracked skin this winter, you’re not alone.
The skin barrier commonly becomes disrupted during this time of the year, and it’s important to support the skin barrier (especially if you have eczema-prone skin, like me).
While topicals and skincare products are essential for a resilient skin barrier, it’s only half the picture.
The skin is one of the few organs in the body that inferfaces both the external and internal environments. So, yes, the external world affects our skin (and skin barrier). And yes, our inner health affects our skin (and skin barrier).
So, if you’re into holistic skin health, like me, you’re going to love this blog post. We are going to chat about 1) what the skin barrier is, 2) what skin barrier disruption looks like; 3) what topicals support skin barrier resilience, and 4) how inner factors influence skin barrier function.
DISCLAIMER: This blog post does not constitute as medical advice; it is not meant to diagnose, prevent, treat, or cure any medical conditions or disease; and is meant for educational purposes only. The information in this blog post does not replace the medical advice of your medical provider. Speak to your doctor before starting anything new.
What is the skin barrier?
The skin barrier is the skin’s outer-most protective layer. The skin barrier is composed of 4 different layers that rely on each other in order for the whole skin barrier to function optimally. So, it’s important to make sure we keep each layer of the skin barrier healthy for the whole skin barrier to perform optimally in order for our skin to be protected.
Microbiome layer:
This layer consists of all of the bacteria and other living organisms on the skin. The microbiome layer is usually kept at-bay with the acidic pH of the chemical layer. When at balance, the microbiome layer is mainly composed of Staphylococcus epidermis and Corynebacterium bacteria.
When the acidic pH of the chemical layer is off, it allows for the growth of Staphylococcus aureus and other disease-causing bacteria.
Chemical layer:
The chemical layer is made up of natural moisturizing factors (NMF) and other compounds that naturally make the skin acidic with a pH of 4-6. This layer can be disrupted by skincare products with more-alkaline pH.
Physical layer:
The physical layer’s purpose is to keep water in the skin. This layer is composed of the stratum corneum, which is the outermost-layer of the skin/epidermis, in addition to a fatty layer (called the lipid matrix). Corneocytes (the skin cells in the stratum corneum) naturally make the the lipid matrix by making enzymes and releasing lipids that make fats, such as ceramides and cholesterols.
This layer can be disrupted when there is an imbalance in the types of fatty acids, such as omega-6 to omega-3 ratio, and changes in stratum corneum thickness.
Immune layer:
This layer is composed of immune cells that prevent microbes from entering past the epidermis and play a role in regenerating the skin barrier.
What happens when the skin barrier is disrupted?
Skin dryness
Skin barrier disruption can commonly lead to skin dryness. Skin dryness can happen because of water loss from the skin (called transepidermal water loss), and this can happen because of changes to skin barrier function.
What we see in those with high transepidermal water loss is that there are reductions in NMF in the chemical layer and ceramide deficiencies in the physical layer.
Eczema
If you're eczema-prone, like me, I want to make sure my skin barrier is resilient! In eczema, we see all 4 layers of the skin barrier disrupted, leading to chronic and recurrent rashes with dry skin. What we see in eczema is that there is an immunological component in addition to changes in ceramides, filaggrin (a protein that plays a role in the integrity of the physical layer), and the skin microbiome.
What we also see in eczema is that as the skin barrier gets more and more disrupted, there is a possibility of bacterial infections with Staphylococcus aureus - demonstrating how important the skin barrier is at preventing infections.
Acne
I’m also blessed to have acne-prone skin on top of my eczema-prone skin. Acne can be described as a chronic, immune-mediate inflammatory disease of the skin that is, in part, due to changes in the microbiome layer of the skin barrier. Researchers suggest that naturally-occurring skin bacteria, Cutibacterium acnes, play contributing a role in the development of acne.
Literature reveals that lower numbers of C. acnes causes a state of skin microbiome imbalance triggering the development of acne. In addition to this, Malessezia furur, a type of yeast naturally found on the skin, can lead to the development of fungal acne when the skin barrier is disrupted (click here to read blog post about fungal acne).
Topicals & Skin Barrier Resilience
There was a moment in time when I started to see that my skincare routine was either making me breakout or causing me to have dry skin that would flare my eczema.
Because of that, I chose to rebuild my skincare routine and focus on the basics by concentrating on rebuilding my skin barrier.
When supporting my skin barrier, I focus on several things, such as:
Patch testing for skin irritation. You know, since I’m eczema-prone. I don’t want to flare my already-sensitive skin with an irritating product.
Using products with ingredients that pull water into the skin. Some of my personal favorites are: Hyaluronic acid, glycerin, and gluconolactone (a type of polyhydroxy acid, or PHA)
Using products with ingredients that seal water in the skin. My all-time favorite ingredient that does this is ceramides. Slugging has also been helpful for my skin, and I usually use a thick cream or a petrolatum-based product for slugging. However, I do not slug when I have many actives on my skin.
Making sure that the pH of the product is close to skin pH (pH 4-6) to prevent disruption of the microbiome layer.
Being mindful of excessive exfoliation as this can disrupt the physical barrier. I’ve noticed that when I over-exfoliate, I get an eczema flare.
Remembering to always put on sunscreen and frequently re-apply.
Inner Health & Skin barrier resilience
As a licensed naturopathic doctor, I strive to see health holistically. When I say that to people in discovery calls and in the office, I tell them that as a holistic-minded provider, I want to identify and address the root issues behind their concerns
I also let them know that some of these root issues may go beyond the primary organ system of concern since the body is composed of systems that all speak and interact with each other.
So, many people who choose to see me as their provider also believe that skin health is a reflection of inner health!
When looking at inner health and the skin barrier, there are interesting findings on how gut health impacts skin barrier resilience and how sleep influences the skin barrier.
According to literature, gut-derived short-chain fatty acids may influence skin barrier resilience. Now, what are short-chain fatty acids?
Short chain fatty acids
Well, short chain fatty acids are small fats that are produced by gut bacteria in the intestines. And, gut bacteria makes short chain fatty acids after they metabolize fiber from foods.
And, if you’re familiar with the term prebiotic, fiber from food is basically a prebiotic!
Now, when looking at these SCFA-producting bacteria, it seems like there are several factors that determine their numbers.
gut bacteria and sleep (Yes, they’re linked!)
The gut microbiome is all of the microbes in the gut, and all of these microbes influence each other.
When looking at gut microbiome literature, scientists found that a keystone gut bacteria species influences SCFA-producing bacteria
This bacteria, called Akkermansia muciniphilia, has been shown to promote the growth of SCFA-producers. And, researchers found that polyphenols from foods act as a prebiotic for A. muciniphilia!
Sleep has also been shown to influence SCFA-producers! Research completed in animal models showed that sleep deprivation negatively influenced SCFA-producing bacteria and negatively influenced skin barrier resilience.
And, after researchers used melatonin to regulate circadian rhythms, they found that SCFA-producers were restored and that skin barrier improved!
Gut bacteria and food (Yum!)
When going back to nutrition, researchers found that the number of plants and vegetables people consume may support SCFA-producers.
Authors of a 2018 study found that when subjects are more than 30+ edible plants (fruits, vegetables, herbs, and spices), it led to an increase in SCFA-producing bacteria and an increase in gut microbiome diversity.
Researchers of another study published in 2021 found that green tea may promote SCFA-producing bacteria.
Putting the pieces together (TL;DR)
As mentioned earlier, the skin is one of the few organs that interacts with both the outer and inner worlds. And, skin barrier resilience seems to be dependent on both of these.
So, it’s important to support the skin & the skin barrier from a holistic point of view that focuses on both topicals and inner health.
When I support my skin barrier, I combine both topical and inner strategies. With topicals, I make sure that I have the foundation set with hydrating and moisturizing products that nourish my skin barrier. I also make sure that I consistently use sunscreen to protect my skin barrier.
With inner strategies, I make it a goal to get my daily dose of fiber and polyphenols. I usually make a smoothie with foods rich in these.
On top of that, I also make it a goal to get 30+ different edible plants a week. I find it a fun challenge, as it forces me to be creative with my foods, try new recipes, and revisit plant-diverse ones each week.
I tried to get on the green tea trend, but I just couldn’t get into it. So, I feel that it’s important to find strategies that works for me in order for me to be consistent with something in order for me to see change.
As mentioned earlier, always speak to your doctor before starting anything new because what works for me might not work for you (or might not be safe for you).
You and your doctor can find the best strategies and make the best decisions to support your skin health holistically. And, honestly, some people may need probiotics, supplements, medications, and other strategies beyond diet and lifestyle to help them reach their goals. And, these are conversations that are best achieved between you and your provider.
Want a holistic approach to your skin goals?
The answer is simple: Work with a licensed naturopathic provider. Licensed naturopathic providers are experts in holistic and integrative medicine.
As integrative medicine experts, we are trained in both natural and conventional options. So, you will be able to capture a wide array of treatment options to help you achieve your skin goals when you work with a licensed naturoapthic doctor.
If you want to see me for holistic skin support, I see patients in-person at The Things We Do in Downtown Los Angeles at ROW DTLA.
Schedule your appointment by clicking on the button below OR call the office at 424 268 8976.
Want to learn about skin health from a holistic & integrative POV? Read these blog posts to learn more: