How a Compromised Skin Barrier Leads to Chronic Dehydration in Eczema

The Connection Between Skin Barrier Health and Eczema

In my previous post, I discussed the complexities of treatment resistant eczema and why some cases of eczema do not respond to standard treatments. One of the critical factors contributing to these tricker cases of eczema is the health of the skin barrier. The skin barrier plays a vital role in protecting the body from external irritants and retaining moisture. When this barrier is compromised, it can lead to chronic dehydration of the skin, which exacerbates eczema symptoms and makes the condition more difficult to manage.

What Is the Skin Barrier and Why Is It Important?

The skin ‘barrier’ is the outermost layer of the skin. It acts as a protective shield against environmental threats like bacteria, allergens, environmental irritants and pollutants, while also preventing excessive water loss from the skin. A healthy skin barrier maintains the skin’s hydration and elasticity, keeping it smooth and resilient.

However, in individuals with eczema, the skin barrier is often weakened or damaged. This compromised barrier allows moisture to escape and irritants to enter, leading to a cycle of dryness, irritation, and inflammation. Understanding the role of the skin barrier is crucial in developing effective treatment strategies for managing treatment resistant eczema.

How a Compromised Skin Barrier Contributes to Eczema

A compromised skin barrier can set off a cascade of negative effects that exacerbate eczema symptoms;

• Increased Transepidermal Water Loss (TEWL): When the skin barrier is damaged, it loses its ability to retain moisture. This results in increased transepidermal water loss (TEWL), where water evaporates from the skin at a higher rate than normal. The loss of moisture leads to chronic dehydration, making the skin dry, tight, and more prone to cracking and itching.
• Entry Point for Allergens and Pathogens: A weakened skin barrier creates an entry point for allergens, irritants, and pathogens. These external invaders can penetrate the deeper layers of the skin, triggering an immune response that leads to inflammation and further weakens the skin’s defences. This cycle of inflammation and repair is particularly challenging to break in treatment resistant eczema.
• Difficulty in Healing: The compromised barrier also impairs the skin’s ability to heal properly. As the skin struggles to repair itself, the ongoing cycle of damage and inflammation makes it harder to achieve and maintain a healthy skin barrier, which is essential for long term eczema management.

The Importance of a Comprehensive Approach

When dealing with treatment resistant eczema, it’s essential to take a comprehensive approach that goes beyond just treating the symptoms. This involves identifying and addressing all the factors that could be contributing to the persistence of the condition.

Chronic Dehydration and Its Effects on Eczema Prone Skin

Chronic dehydration of the skin is a consequence of a compromised skin barrier. Dehydrated skin becomes more fragile and less effective at protecting against external irritants. This constant state of dryness not only worsens the physical symptoms of eczema but also increases the risk of secondary infections. 

• Enhanced Itching and Discomfort: Dry, dehydrated skin is more likely to be itchy, leading to more scratching. This can create a vicious cycle where scratching damages the skin further, causing more itching and increasing the risk of infection.
• Increased Fragility: Dehydrated skin is more prone to cracking and breaking, which can turn eczema into an open wound that is now susceptible to infection. These cracks also allow more irritants to enter the skin, worsening the eczema symptoms.
• Reduced Healing Capacity: Dehydration impairs the skin’s natural healing processes. Without sufficient moisture, the skin cannot repair itself efficiently, leading to prolonged flare ups and persistent eczema.

Strategies to Restore and Protect the Skin Barrier

Given the critical role the skin barrier plays in eczema management, restoring and protecting it is a key component of treatment. 

• Moisturisers and Emollients: Regular use of moisturisers and emollients helps to replenish lost moisture and strengthen the skin barrier. Products that contain ceramides, fatty acids, and other lipid rich ingredients are particularly effective.
• Barrier Repair Creams: Specialised natural eczema creams designed to repair the skin barrier can provide targeted support. These creams often contain ingredients like niacinamide (Vitamin B3), cholesterol, and hyaluronic acid, which help to restore the barrier function.
• Avoiding Irritants: Reducing exposure to known irritants such as harsh soaps, detergents, essential oils, and environmental pollutants can help prevent further damage to the skin barrier.
• Humidifiers: Using a humidifier in dry environments can help maintain skin hydration by adding moisture to the air, which reduces TEWL and supports the skin’s natural barrier function.

Protecting the Skin Barrier to Manage Eczema

A compromised skin barrier is a significant factor in treatment resistant eczema, leading to chronic dehydration and a vicious cycle of skin damage and inflammation. Understanding the importance of the skin barrier and taking steps to protect and restore it can make a substantial difference in managing eczema effectively. By focusing on barrier repair and hydration, it is possible to alleviate symptoms and improve the quality of life for children and families who are battling chronic eczema.

– Ash Yates, Children’s Health Naturopath