How can I tell if my skin barrier is damaged?

What does the skin barrier actually do?

The barrier is your outer skin layer, made from dead skin cells and natural fats. It keeps water in and helps keep harmful chemicals and infectious bacteria out. The barrier is part of your skin, not an optional extra that arrived with a serum.1

What are the signs of a damaged skin barrier?

Look for changes in both how your skin looks and how it feels:

• Dry, scaly or flaky skin.
• Rough patches.
• Itching or irritation.
• Stinging when you apply skincare.
• Tenderness or increased sensitivity.

Inflammation is not always bright red. With contact dermatitis, lighter skin can become red, while darker skin can become dark brown, purple or grey. Dryness, cracking, itching and blisters are also signs to notice. Contact dermatitis can affect any area, but the hands and face are common sites.3

Itch alone does not tell you whether your barrier is damaged. Itching can come from a skin condition, nerve changes or a problem elsewhere in the body. Constant scratching can then damage the skin and weaken its protective function. Persistent scratching can also leave scratch marks and eventually thicken the affected skin.4

What causes skin barrier damage?

Harsh soaps, scrubbing, excessive exfoliation and not moisturising can damage the barrier. An underlying condition, including eczema, rosacea or psoriasis, can also be involved.1

Contact dermatitis is eczema triggered by contact with a substance. An irritant directly damages the outer skin layer; an allergen triggers an immune reaction that affects the skin. Common irritants include soaps, detergents, solvents and regular contact with water. That means repeated washing or cleaning exposure deserves attention alongside skincare products.3

Winter weather, low humidity, frequent washing, very hot water and swimming pool chlorine can make dry skin worse. In atopic eczema, barrier problems can also involve inherited differences and inflammation driven by the immune system. Eczema is not simply the result of using the wrong cleanser, and avoiding irritants is only one part of managing it.5

Is it barrier damage or a reaction to a product?

The two can overlap: irritant contact dermatitis directly affects the outer skin layer. Symptoms can appear immediately after exposure or take up to 48 hours to develop. They range from dryness, redness, burning and stinging to painful, fluid filled blisters. An allergic reaction can also be immediate or delayed, so timing alone cannot reliably separate irritation from allergy.6

A product does not have to be new to cause contact dermatitis: products used for years can still cause a reaction. Facial redness with oily looking, scaly patches can occur with seborrheic dermatitis. A tendency to flush, followed by redness that lasts longer, can occur with rosacea. These conditions need different treatment, which is why persistent redness should not automatically become a shopping list for barrier creams.2

What should I do while my skin is irritated?

1. 1Remove the suspected trigger. If a skincare product causes a reaction, gently wash it off and stop using it.
2. 2Cleanse gently with warm water and a mild, fragrance free, soap free cleanser. Massage it on, then rinse rather than continuing to rub.
3. 3Apply moisturiser regularly to reduce dryness. For contact dermatitis, emollients can be applied frequently and generously.
4. 4Reduce ongoing exposure. Protect your hands from cleaning chemicals with gloves, taking breaks from wearing them because sweating can worsen dermatitis.
5. 5Use sunscreen every day as part of protecting your skin.

An emollient is a moisturiser that helps skin retain moisture and combats dryness. Moisturiser helps skin retain water; the useful part is the moisturising, not how ambitious the jar sounds. For dry skin, a brief shower or bath once daily is enough unless your doctor has given different bathing instructions for an eczema flare.5

How can I test a new skincare product?

Before adding a product to your routine:

1. 1Choose a spot about the size of a quarter on the underside of your arm or the bend of your elbow.
2. 2Apply the normal amount twice daily for seven to 10 days.
3. 3Leave the product on for its usual duration. For a cleanser, use five minutes or the duration in its instructions.
4. 4If no redness, itching or swelling develops, start using the product. If a reaction develops, wash it off and do not use it again.

Home testing helps predict a negative reaction; medical patch testing is used to investigate what is causing a rash. If the trigger is difficult to identify, a dermatologist can help. If fragrance causes your reactions, choose products labelled "fragrance free". "Unscented" products and products containing botanical ingredients can still contain fragrance related ingredients. Retinol and glycolic acid can also cause temporary irritation, particularly on sensitive skin.7

How long does it take to repair the skin barrier?

Benefits from barrier care can take three to four months to become visible. Skin also replaces its barrier less quickly with age. Contact dermatitis usually improves or clears when its trigger is identified and avoided, but persistent inflammation can need treatment as well as moisturiser.13

When should I get medical help?

See a doctor for persistent, recurring or severe dermatitis, or symptoms that are not responding to treatment. Facial redness lasting more than two weeks warrants a dermatologist appointment. Do not wait months for a barrier routine to work before having these symptoms assessed. A pharmacist can help with moisturisers for troubling contact dermatitis.23

Seek immediate medical advice for a severe reaction or suspected infection. Warning signs include rapidly worsening symptoms, discharge, increasing pain, feeling generally unwell, or feeling hot, cold or shivery.6

Unexplained widespread itching also needs assessment rather than an assumption of barrier damage. During pregnancy, itching without an obvious rash can sometimes be related to cholestasis, a problem involving bile flow. Tell your maternity clinician about unexplained itching so its cause can be checked.4