Tag Archive: skin barrier

Dermatologist Best Insights to Eczema Treatment

August 4, 2018

Eczema is one of the most common skin disorders in infants and children. Apart from dealing with the medical aspect of the disease, affected patients may experience significant psychosocial effects. As such, any eczema treatment needs to be comprehensively managed and best by an accredited dermatologist

Also termed as atopic dermatitis, it is very common in children but may occur at any age.

How does Eczema arise?

Atopic dermatitis or eczema is caused by a complex interaction of genetic and environmental factors including:

  • Skin barrier dysfunction
  • Genetic predisposition
  • Immune dysfunction

Role of genetics in eczema

Most patients with eczema have a lower amount of filaggrin in the epidermal skin layer., due to mutations in the filaggrin gene. Filaggrin is a structural protein that plays a vital role in normal barrier structure and function. A lack of filaggrin contributes to the development of eczema in several ways.

Filaggrin breaks down into amino acids and protein derivative to form natural moisturizing factors (NMFs) in the outer skin layers. NMFs provide moisture retention, maintain the acidic pH and buffering capacity of the skin barrier and prevent an overgrowth of bacteria.

Inadequate filaggrin would mean a reduced ability to maintain hydration, which can cause xerosis (dry skin), pruritus (itching) and subsequently, eczema. A dysfunction in skin barrier may also allow entry of allergens, leading to an inflammatory response thus causing eczema.

Having an impaired barrier function also causes colonisation of a bacterium called Staphylococcus aureus. Scratching disrupts the skin barrier, thus also leads to the bacteria adhering to the outer skin layers.

The extent of bacterial colonization is associated with the severity of eczema.

Immune dysfunction

Apart from genetic factors, defects in immune pathways are usually observed in patients with eczema. They tend to have high levels Th-2 cells, which contribute to a defective skin barrier. Th-2 cells play an important role in the immune system. A poor skin barrier may mean water is lost from the skin and also allows the penetration of irritants (soap, dirt, detergent) and allergens (pollens, microbes, dust-mites).

There is also an overproduction of cytokines in the body. Cytokines are cell signalling molecules that aid in cell to cell communication. It regulates the movement of cells towards sites of inflammation and infection.

The excessive release of cytokines initiates new responses that eventually leads to inflammation, causing the red, itchy and painful symptoms common in eczema.

Patients also have high levels of an antibody called immunoglobulin E (IgE), which puts them at disposition for hypersensitivity to environmental allergens. Hypersensitivity is when the immune system produces undesirable or detrimental reactions, such as attacking the body’s own cells or tissues instead of protecting them. With elevated IgE levels, it would mean exposure to a certain allergen can causes the immune system to attack the body’s own tissues and therefore skin inflammation that may be observed with eczema patients.

Eczema Treatment

When it comes to eczema treatment, there are 3 main components that target a specific manifestation of the disease. As a chronic, relapsing condition that may flare up at variable intervals, a comprehensive home treatment plan is important for successful management.

Repair & Maintain Healthy Skin Barrier:

Lubrication of the skin is required to maintain skin hydration, commonly known as moisturisation. This helps to alleviate the discomfort that xerosis (dry skin) may bring about.

Patients with eczema should use moisturizers that are fragrance-free and least amount of preservatives, as these are potential irritants.

Eczema Treatment Dermatologist Moisturiser

Reduce inflammation:

Topical corticosteroids are the most effective and common form of eczema treatment. Corticosteroids are drugs that mimic cortisol, a hormone found in the body. They work by diminishing inflammation, itching and bacteria colonisation.

This medication can be classified according to its potency, ranging from class VII (low potency) to class I (super potent). Great care must be taken to balance the potency of drug needed for results so as to minimise potential side effects.

Side effects include:

  • Atrophy (decrease in size or wasting away of a body part/tissue)
  • Striae (stretch marks)
  • Acne
  • Telangiectasisa (small dilated blood vessels)
  • Secondary infections
  • Adrenal suppression (body produces lower levels of cortisol)

For moderate to severe eczema conditions, wet wrap therapy can be used with topical steroids and dermatologist-approved moisturisers. After the medication is applied to the affected area, it is wrapped with a few layers of wet gauze, followed by dry gauze. Such therapy reduces itching and inflammation by preventing scratching and improves penetration of corticosteroids.

Topical inhibitors of calcineurin – protein phosphatase associated with activation of the immune system, are newer forms of eczema treatment, which are considered on areas unsuitable for topical steroids (e.g. eyelids) or if other treatment options do not yield results. For example, Pimecrolimus cream and Tacrolimus ointment are calcineurin inhibitors that have demonstrated good efficacy for eczema treatments and do not cause side effects that corticosteroids bring, but have other considerations of use that should be managed with an accredited dermatologist.

Itch control:

Antihistamines are commonly used to treat itching. Even without a significant rash, itching can be present. Oral antihistamines help to reduce the sensation of itching, ideally to decrease scratching and trauma to the skin.

Antibiotic or antifungal medicines are used to treat the infected rash, to reduce the amount of bacterium Staphylococcus aureus. Topical mupirocin is often prescribed to prevent further infection.

Taking care of the skin 

Avoid dry skin. Asian skin is more susceptible to being dry. Dry skin can cause itching and scratching. Tips to avoid dry skin:

  • Moisturize, especially after a bath as evaporation can cause excessive drying. A ceramide-based moisturizer that is suitable for sensitive skin and face could be Radiance Fluide™ Hydrating Emulsion which is also infused with skin rejuvenation properties. For intensive replenishment of ceramides (which are naturally found in healthy skin barrier but deficient in diseased skin),  a dermatologist-tested moisturiser such as the Multi-CERAM may also be considered.
  • Bathe with lukewarm water for 10-15 minutes.
  • Use neutral or weakly acidic pH soap. Consider a mild cleanser that soothes the skin like Le Lait™ Milk Cleanser.
  • Avoid high ambient temperatures.

Avoid irritants that can cause or aggravate a rash, such as perfumes, scratchy clothing or bedding and sweating.

© 2018 TWL Specialist Skin and Laser Centre. All rights reserved.

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Meet with Dr. Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable eczema treatment for your skin.

To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.

A Dermatologist Explains the Skin Barrier and Hydration

June 22, 2018
Skin barrier explained by Dermatologist

Any detailed research you may have done about the skin would have returned you with the term ‘skin barrier’, or in scientific terms the ‘stratum corneum barrier’. You may be aware of how important the skin barrier’s function can affect the condition of the skin, but how exactly does the skin barrier work?

Skin hydration and the stratum corneum barrier has been active areas of study for many years. Yet, consumers are only beginning to get their interest piqued about the skin barrier, largely due to many marketing techniques. Before you commit to any product or treatment that promises to ‘repair’ the skin barrier, have a read on what these terms and processes mean.

The Stratum Corneum Skin Barrier

The skin barrier prevents foreign material from entering the human body. But it does more than just that. It also prevents water loss and serves as a shield against environmental factors. The barrier works to maintain the body’s homeostasis (or stable equilibrium) level. The loss of water from the body through evaporation from the surface of the skin is common, thus a need to keep our corneocytes hydrated.

Corneocytes are the cells found in the stratum cornum layer, that is the outermost layer of the epidermis. These cells are formed through cornification, where the skin cells develop tough protective layers or structures, creating a physical barrier for the skin. When deprived of water, dry skin may be more prone to crack open at stress.

The environment’s humidity also affects the corneocytes. As the level of humidity can vary, corneocytes get their source of hydration from the body, in order to maintain equilibrium with the environment. This may explain why our skin feels drier in winter. The skin battles harsh winds, depleting the skin’s moisture layers.

Skin Barrier Hydration

Skin hydration is an important factor when considering how to attain healthy skin. We look at the stratum corneum’s water content when analyzing skin hydration, with healthy skin containing more than 10 per cent water.

A mixture of water-soluble compounds called natural moisturizing factor (NMF) have been found to affect water content levels. The arrangement of lipids (fats) in the stratum corneum is also important, as it serves as an effective barrier to the passage of water through the layer. A poor arrangement can lead to transepidermal water loss (TEWL). TEWL is essentially when water diffuses and evaporates from the skin surface. Even though this is a natural process, excess TEWL is undesirable as it can lead to many unwanted skin conditions.

TEWL and Moisturizers

TEWL has been one of the most commonly used methods in the skin care industry to measure skin hydration as it directly correlates with skin barrier dysfunction. Healthy skin would score a low TEWL value as it would mean less water loss.

In the same vein, most moisturizers are put to the test by using TEWL values. A good moisturizer should help decrease TEWL. Moisturizers have remained as a ‘staple’ in basic skincare. Yet, not many may fully understand its function, thus some are unable to choose a suitable moisturizer for their skin needs. An effective moisturizer should protect the skin by stimulating and augmenting its natural barrier function, whilst catering to the skin’s requirement for moisture. Environmental attacks on the skin are also shielded with a proper moisturizer which can slow down skin ageing.

What happens if the water content of the stratum cornum falls below a desirable level? Normal desquamation is not able to take place, that is the shedding of the outermost skin layer. With insufficient hydration, skin cells will adhere to one another and accumulate on the surface layer. Visible changes associated with this phenomenon include dryness, roughness, scaling and flaking.

Certain cosmetic ingredients have become a cult favourite in recent years by targeting the stratum cornum water content, such as glycerol (also known as glycerin) and hyaluronic acid.

Glycerol

This ingredient exists in the stratum cornum as a natural endogenous humectant. It has shown that changes in the stratum cornum’s water content correlate with the glycerol content in the layer. Such results have driven the development of glycerol-containing moisturizers. Check the ingredient list of your moisturizer, this star ingredient should appear in any effective moisturizer.

Hyaluronic acid

Though it is known as a major component of the dermis (deeper layer of the skin), hyaluronic acid is also found present in the outermost layer. It plays an important role in regulating the skin barrier function and hydration. Although the skin care industry may recognize hyaluronic acid as a powerful humectant (attracts water to hydrate the skin), this molecule also participates in cellular functions. Hyaluronic acid influences cell-cell interactions that lead to normal structure of the skin barrier.

Conclusion

Though the mechanisms for skin hydration remain complex, a simple understanding about the skin structure and function is crucial when looking for an appropriate product or treatment. With these complex terms tackled, you are now one step closer to understanding your skin and its needs. If your current skincare routine does not yield desired results, you can consider cosmeceuticals as the alternative. A combination of ‘cosmetics’ and ‘pharmaceuticals’, cosmeceuticals are products with bioactive ingredients that can bring pharmaceutical effects to the skin barrier and health.

© 2018 TWL Specialist Skin and Laser Centre. All rights reserved.

—–

Meet with Dr. Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.

To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.