Signs of a damaged skin barrier

What does barrier damage look and feel like?

• Dryness and texture changes include flaking, scaling, peeling and patches that feel rough.
• Discomfort includes itching, tightness after bathing, tenderness and increased sensitivity.
• Products can sting, including skincare that touches already irritated skin.
• Inflammation can appear as redness or irritation. Eczema can also change skin color, leaving areas lighter or darker than the surrounding skin.
• More severe dryness can cause cracks that bleed. Blisters, oozing and crusting can occur with dermatitis and deserve assessment rather than being treated as ordinary dryness.

Breakouts can occur alongside barrier damage, but a pimple alone does not identify the cause. Likewise, itchy skin does not have to look dramatic: with atopic dermatitis, itching can begin before a rash appears. Pay attention to discomfort as well as what you can see.4

What is a damaged skin barrier?

Your skin barrier is the protective outermost layer of skin, called the stratum corneum. Dead skin cells sit within a matrix of fats that helps prevent water loss and protects against outside irritants. Damage makes water escape more easily and increases sensitivity to irritants and allergens, which can lead to inflammation. The barrier has a practical job, despite being given the sort of name usually reserved for a security contractor.5

What can damage your skin barrier?

Harsh soaps, scrubbing, too much exfoliation and not moisturizing can damage the barrier. Long, hot showers, frequent handwashing, cold dry air and indoor heating can also contribute to dryness. Some medicines and skin conditions are involved too, so the problem is not always something you did in the bathroom. Barrier damage can accompany eczema, rosacea or psoriasis.12

If a rash follows contact with a product or substance, consider contact dermatitis: an itchy or painful reaction to an irritant or allergen. The reaction can appear hours or days after contact, so the last product you applied is not automatically responsible. A product you have used for years can also cause a new reaction because its formula changed or you developed an allergy. Familiarity is useful for finding the bottle, not clearing it of suspicion.36

How should you care for irritated, dry skin?

These are general care steps for dry, irritated skin, not a substitute for treating a diagnosed skin condition.

1. 1Remove known triggers. Avoid a substance that causes your rash. Stop scrubbing and excessive exfoliation. For dry skin, stop skincare containing fragrance, alcohol or retinoids. Discuss changes to prescribed treatment with your prescriber.
2. 2Wash gently. Use warm rather than hot water and a mild, fragrance free cleanser. Keep baths and showers to five to ten minutes, and bathe no more than once daily.
3. 3Rinse and pat dry. Avoid rubbing with a towel or scrubbing your skin. Leave skin slightly damp for moisturizer.
4. 4Apply moisturizer promptly. Use it after bathing or washing your hands, then reapply two to three times daily or whenever skin feels dry.
5. 5Protect skin during the day. Use broad spectrum, water resistant sunscreen with SPF 30 or higher, seek shade and wear protective clothing.
6. 6Reduce repeated exposure. Wear gloves for wet chores and protection from cold air. Choose soft clothing rather than rough fabrics against irritated skin.

What should you look for in a moisturizer?

For excessively dry skin, creams and ointments generally moisturize more effectively than lotions. Look for fragrance free products. An unscented product can still contain chemicals that hide ingredient odors and irritate sensitive skin; the absence of a smell is not an ingredient list. If you are prone to contact dermatitis, test a new moisturizer before applying it widely.67

A barrier cream can still cause an allergic reaction to fragrance, preservatives or another ingredient. Some occlusive creams can aggravate facial acne, and most barrier creams should not be applied directly to broken skin. Lanolin is another ingredient to be careful with if you have eczema, because it can act as an irritant.45

What if your skin itches or everything stings?

For an itchy contact dermatitis rash, a clean, cool damp towel applied for ten to fifteen minutes a few times daily can provide relief. Avoid scratching, which can worsen the rash and lead to infection. Ask a dermatologist before using an itch relief cream on excessively dry skin, since some ingredients can make irritation worse. Tell your dermatologist if even moisturizer causes burning, stinging or irritation.67

How long does repair take?

Barrier care takes patience: benefits from changes to products and habits typically start becoming noticeable after three to four months. Older skin replaces its barrier less quickly. Eczema can be a long lasting or recurring condition that needs ongoing treatment, not just a temporary change of moisturizer. Do not wait months for assessment if symptoms worsen or home care is not helping.14

When should you see a doctor?

• Seek medical care for signs of infection, including fever, redness or pain.
• Arrange an assessment for a rash that blisters, repeatedly returns or causes discomfort.
• Contact a clinician if itching disrupts sleep, occurs without a visible rash or leaves open cuts or sores.
• See a dermatologist if dryness persists despite gentle care, symptoms worsen or your current treatment is not working.

Dermatitis means skin inflammation; eczema is one type. Rosacea and psoriasis can resemble dermatitis, and treatments for one condition do not necessarily treat another. A clinician can examine your skin and history to identify the cause. Eczema sometimes needs prescribed medicine alongside moisturizing, while contact dermatitis requires finding and avoiding the trigger.346