Skin Barrier 101: Keep Up with What Your Patients Are Reading

“The concept of skin barrier is really emerging very quickly in the press, in journals, like our magazines, like Cosmopolitan, and other things. So basically, dermatologists need to be aware of what patients are reading,” said Jack Arbiser, MD, PhD, FAAD when discussing his session “Understanding the Skin Barrier” with Dermatology Times®. The session presented at the 2023 American Academy of Dermatology Meeting in New Orleans, Louisianawas a deep dive look into why the skin barrier is a hot topic in the derm space and how to enhance it with cost-effective treatments. Arbizer shared takeaways from the session with Dermatology Times Managing Editor Lauren Buchanan.

Jack Arbiser, MD, PhD, FAAD: As we all know, the skin is our largest organ. And it serves as a barrier to both bacteria and outside insults like sunlight, and other chemicals. But what I wanted to talk about is, how to maintain that barrier and how it relates to skin aging. And so basically, the take home message is that you need three things, to maintain the healthy skin barrier. You need in-tact mitochondria, which provide energy for the skin to do what it's supposed to do. You need acid on the outside to basically repel bacteria, and also to decrease inflammation. And you need ceramides, which are these waxy-like substances, which were previously thought to be an inert, waxy covering to the skin, but they're also actually signaling molecules that tell the skin when there's a problem there. It's really kind of amazing, you know, attributed to the creator, that you can have a waxing molecule that can both protect your skin from outside water, and also signal of when there's a problem.

Lauren Buchanan, MA: What are some challenges that those in the dermatology space face when helping patients build up a strong skin barrier?

Arbiser: So first of all, the concept of skin barrier is really emerging very quickly in the press, in journals, like our magazines, like Cosmopolitan, and other things. So basically, dermatologists need to be aware of what patients are reading. As we get older, our skin barrier decreases. One of the things that I want to bring up is that those changes can actually be reversed, at least partially. One of the things that we can do, and I do oftentimes for inflammatory skin disorders, which is really counterintuitive, is to apply acids to them. The concept of applying acid to inflamed skin seems like it's a really bad thing to do, but it’s actually quite helpful. I use chemical peel acids, which are fairly strong acids, and help resolve inflammation. I'm also going to be giving a separate talk on the use of chemical peels for inflammatory skin disorders. Putting acid on open cuts actually sounds barbaric, but doesn't hurt very much. And because you're bringing back the skin to its normal pH. You need a skin that's an acid pH to repel bad staph and strep, and to have the normal commensal bacteria, which protect the skin. The second thing are the ceramides, which are these waxy substances. Every skin product these days contains or says it contains ceramides. And basically, ceramides are anti-inflammatory, but they can be converted under conditions of high pH to pro inflammatory compounds. So just giving extra pheromones to the skin is not enough, you need to do other things, in order for them not to be become pro-inflammatory. And then finally, mitochondria are important because in order for the skin barrier to work, you have to have both an intact epidermis and an intact dermis. And if you if you have bad mitochondria or aging mitochondria, you can't produce a lot of the proteins that are required for the healthy dermis. And that's what leads to wrinkles. And so basically wrinkled skin, even though the wrinkles are below the skin surface is an indication of poor barrier function. And we believe that there are things coming down the pipeline that can help reverse skin aging and also lead to improved cosmetic appearance.

Buchanan: Anti-aging has been a hot topic for a long time. It seems like there are already a lot of anti-aging products on the market. So, what more could be offered?

Arbiser: Well, the question is—do those anti-aging products work? And also, a lot of them are really expensive. It’s the question I raise. Are people getting their money's worth? And so, for instance, one of the ways that I like to supply extracellular or acid to the skin is cider vinegar, which is a lot cheaper than, you know, a lot of the products that you're going to get, you know, that you're going to spend a lot of money on. So, for a lot of stuff, I'm savoring dermatitis, which is a common cause of dandruff. Cider Vinegar works really well, if you apply it on the Q tip and that's, you know, inflamed skin, and you're decent, decreasing the inflammation, and also getting rid of harmful bacteria and bringing it back, bringing back bacteria that are supposed to be there. You know all the products that contain ceramides, but if your skin is at high pH, the steroids aren't going to help. And then finally, we're developing new compounds that stimulate the growth of mitochondria and cells, and therefore, allow the cells to make the proteins that they're supposed to. These compounds aren't on the market yet, but they're quite promising. Basically, the products that are on the market, many of them just benefit the people who make them and don't necessarily benefit the people who are using them.

Transcript edited for clarity.