In the Part One of this article for Vitality magazine, we examined the physical and chemical elements that make up the Natural Barrier Function (NBF) of the epidermis and the important influence that this structure, and its correct function, has on the overall health and condition of the skin. In part two of this study we will turn to the assessment of the integrity of the NBF, how to correct imbalances and the ways in which to preserve its wellbeing and efficiency for the wellbeing of the skin as a whole.
A severely compromised skin barrier will be instantly evidenced by its dry and flakey condition, extreme reactivity and consequent patches of inflammation. The client will complain of soreness, a tight discomfort and the skin burning or stinging when even the blandest of skin care products are applied. Histamine reactions may also plague this skin with urticarial wheals indicating an overactive allergic reaction – this in turn, if not addressed, can lead to contact dermatitis and more severe NBF disorientation. All of these symptoms are due to a compromised physical barrier function allowing irritant substances to enter the skin and triggering the epidermal surveillance system of the Langerhans cells and Merkel cells instigate the inflammatory cascade. Whilst we use this mechanism to instigate tissue regeneration in aesthetic procedures, it is very harmful to skin health if uncontrolled.
As we discussed in part one of this study, a poor physical barrier leads to a compromised chemical barrier. A rise in pH In any skin can increase the risk of bacterial infection but, in an oily or acne prone skin, or indeed in the case of rosacea sufferers who have extreme NBF dysfunction, it can make a huge difference in the severity of the papulo-pustular condition. For this reason it is particularly vital, although challenging, to gain the compliance of the acne sufferer in the use of appropriate hydration AND lipid replenishment in line with the free fatty acid content of the epidermal lipids which contributes hugely to the protective acidity of the skin surface. This is also a key point in persuading clients not to over use harsh exfoliants and cleansers
While the visual indications of severely impaired barrier function may be very obvious, assessment of its more intricate can involve some serious detective work. Equally, physical examination alone will not help us to understand the underlying cause of the damage and consequently we will be largely unsuccessful in remedying the problem.
Investigative consultation is a skill based on a deep understanding of skin physiology and the numerous extrinsic and intrinsic influences on the skin’s homeostasis. We are all aware of the dehydrating effects of central heating, air conditioning, constant exposure to harsh outdoor weather conditions and, of course, the sun. Think too about pollution – does your client live in an urban area? Many of the toxins in the air, particularly sulphur, are extremely drying and allergenic, leading to the massive surface disruption seen in dermatitis.
Lifestyle choices, occupation, general health and recreational activities should also be considered – smoking alcohol, swimming in chlorinated pools, and exposure to excessive heat. Check also for any issues of ill-health, even the common cold, and medications which can significantly dehydrate the skin. In addition, it is all too common that NBF dysfunction is caused by incorrect skin care, not just the use harsh products by the client at home but this can also be down to an aggressive clinical treatment programme.
Finally, it is essential to explore the client’s diet. We have now established that integrity of the epidermal barrier relies on healthy layers of cells, the epidermal lipid content, hydration and the skin’s pH. Be aware of low fat diets (Fee fatty acids / Omega oils), poor protein levels, a lack of antioxidants (fruit and vegetables) and insufficient water intake (1.5 – litres daily).
So what are the best ways to treat poor barrier function? Your key approach has to be progressive, as opposed to aggressive, incorporating a programme of tissue regeneration underpinned by intense rehydration and lipid replenishment. Begin with a course of superificial epidermal peels preferably using glycolic acid or lactic acid to trigger the skin healing cascade but at the same time being humectant in their action. Combine with tissue healing LED light or A-Lift nanocurrent to increase basal cell renewal and metabolism. Gradually increase the percentage strength and lower the pH over a three to six month programme as the skin becomes stronger.
After the initial peeling treatments you can begin to alternate peels with micro-needling treatments, leaving 4 – 6 week recovery time in between. Accompany this with a mesotherapy infusion of hyaluronic acid and retinol. Sonophoresis is an ideal accompaniment to this protocol as a non-invasive procedure to increase transdermal penetration.
Throughout this programme your client’s skin should be supported in its recovery with a homecare programme of a hyaluronic acid serum, antioxidant serum, retinol and a lipid replenishing cream rich in the epidermal free fatty acids such as palmitic acid, linolieic acid, linolenic acid, myrisitic acid, stearic acid and oleic acid. Of course a sunscreen at 30 – 50 SPF is essential and if your client can increase their intake of the Omega oils and water their results in NBF improvement will increase dramatically.
In conclusion, the functionality of the Natural Barrier Function is fundamental to the healthy condition of the skin as a whole. In truth, its existence and the need for its protection and maintenance has been poorly understood, even to some extent, ignored. If you can get this right, general skin health will follow. Your client’s skins will be more responsive, results will improve dramatically and your reputation as a true specialist in your field will blossom.
By Sally Durant for Vitality Magazine