Protective layer

Dr. Vikas Sharma

An intact and healthy skin barrier is very important part of our body system as it forms our first line of defense against various harmful pathogens and environmental allergens. It is formed by the outermost layer of the skin, called the stratum corneum, containing the protein keratin and corneocytes (skin cells) held together by a lipid intercellular matrix. 

What causes it?

The skin barrier is the difference between healthy skin and damaged skin. There are various lifestyle factors which can influence skin barrier function thus predisposing to skin diseases. The chances of skin barrier disruption are higher in winter.

One of the most critical functions of the skin is to provide a barrier from the outside world: to keep water in and keep allergens, irritants, and infectious agents out. When the skin barrier is not performing optimally—due to a genetic disease, the presence of inflammation, or physical disruptors—the vicious cycle of recurrent skin disorders may ensue.

When this occurs, application of prescription based dermatological skin barrier creams and serums become paramount as these can stand in for the skin barrier function, while also helping to restore the skin to its natural state. Consumers spend billions of rupees each year on these products in hope of a solution for impaired skin barrier and thus treatment of their skin disease. Despite all the popularity and a dizzying array of options, only selective barrier creams are effective.

Novel technologies

Some of the newest formulations contain ceramides or waxy lipid molecules composed of sphingosine and fatty acids. Ceramides help restore skin water permeability and barrier function.

Prescription barrier creams are commonly formulated with ceramides coupled with cutting-edge delivery technologies to provide a controlled release of ingredients over time. Some of these delivery mechanisms utilise biologically inert microscopic polymer particles (microspheres) that absorb, trap, or bind to specific ingredients thus playing an important role in cosmetic skin problems like wrinkles and pigmentation as well.

Eczema (atopic dermatitis) is perhaps the “poster child” for skin barrier products and there is reasonably good evidence that using these in a prescribed format leads to improvement in eczema severity. A barrier cream is a product applied directly to the skin surface to help maintain the skin’s physical barrier, providing protection from irritants and preventing the skin from drying out. Barrier products can persist on the skin for several hours. They should be applied sparingly, and reapplied as necessary.

(Dr Sharma is a Chandigarh-based dermatologist)

Make it work

Barrier creams are particularly useful in the management of:

• Hand dermatitis, due to contact with harsh chemicals, frequent contact with water, or repetitive friction.
• Napkin dermatitis (also known as diaper rash), due to contact with urine and faeces , in babies and in adults with incontinence.
• Sites prone to pressure sores in bed-bound individuals.
• Very dry skin.  
• Pre-mature skin ageing and skin hyperpigmentation.

Many of these conditions share common defects in the skin barrier and an association with inflammation. The skin’s inherent ability to heal itself can be optimised.