SF | DERMATOLOGY
October 2021 | Vol. 21 No. 10 www.medicalacademic.co.za
This article was independently sourced by Specialist Forum.
Why skin barrier protection is important
T
he purpose of moisturising is to repair and support the skin barrier, thereby reducing the risk of flares, one of the hallmarks of AD. Proven clinical effectiveness in improving the skin barrier and improving the symptoms of AD are two important characteristics when choosing an effective moisturiser. Daily moisturisers can be used as primary therapy, and as complimentary therapy in mild to severe disease.1 Overall, clinical studies demonstrate that daily moisturisation increases skin hydration and decreases trans-epidermal water loss (TEWL) in both children and adults, resulting in skin barrier improvements.1
Why is epidermal barrier protection important? A healthy skin is characterised by invisible desquamation, smooth texture, elasticity, and the ability to respond to shearing forces without rigidity and micro-fissuring. The epidermis, which is constructed of multiple sub-layers such as the stratum corneum (often referred to as the skin’s brick wall), stratum lucidum, stratum granulosum, stratum spinosum, and stratum basale, acts as the body’s first line of defence (barrier) against the external environment and is therefore essential in the maintenance of a healthy skin. 2,3 The skin barrier is responsible for the maintenance of water content and balance (permeability), prevention and responses to invasion by microbial organisms and antigens (antimicrobial and immune response barrier), reduction of the effects of ultraviolet (UV) light exposure (photoprotection), and mitigation of the effects of oxidative stresses.2,3 In AD, a compromised or dysfunctional skin barrier has been shown to provoke
increased TEWL, which result in excessive cutaneous dehydration, allowing allergens, microbes, and irritants to penetrate the skin. This causes a proinflammatory reaction typically seen in patients with AD. The extent of barrier dysfunction strongly correlates with the degree of inflammation within AD lesions. 3
Brick and mortar The stratum corneum is made up of two components: the corneocytes and the extracellular lipid matrix. Each of these play a different role. The corneocytes, which are the
Photo credit: Shutterstock.com
Twice-daily, liberal application of moisturisers on lesioned and non-lesioned skin is the bedrock of atopic dermatitis (AD) management, as recommended by international guidelines.1
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