Signs of skin barrier damage

What does a damaged skin barrier look and feel like?

• Skin looks dry, scaly, flaky or visibly peeling, and feels rough.
• Skin itches, feels tender or becomes sensitive to touch.
• Skincare stings; very dry, cracked or raw skin can also burn when water touches it.
• Cracks develop, sometimes becoming deep enough to bleed.
• Skin becomes inflamed or changes colour. With eczema, affected areas can look red, purple, grey, white, lighter or darker than surrounding skin.

The skin barrier sits in the stratum corneum, the outermost layer of skin. Its cells and surrounding fats help keep water in and irritants, allergens and germs out. When this protection weakens, more water escapes and substances can enter more easily. Excessively dry skin can develop breaks that allow germs inside, increasing the risk of infection.34

What could be causing the damage?

Harsh soaps, chemicals, excessive scrubbing or exfoliation, and not moisturizing can weaken the barrier. Frequent wetting of the hands can strip away needed oils, too. Cold, dry weather and indoor heating can worsen dryness. Barrier problems also occur alongside conditions such as eczema, rosacea and psoriasis; recurring symptoms need more than an assumption that one skincare product caused them.135

Which moisturizer should you use?

For dry skin, choose a cream or ointment rather than a light lotion. An ointment is the thickest moisturizer option, with more interest in keeping water in than looking elegant on a bathroom shelf. Ceramides help support the barrier's fat layers, glycerol helps retain moisture, and petrolatum reduces water evaporation. Choose a fragrance free formula; sensitive skin does not automatically tolerate a product because it is labelled natural. For eczema, leave on moisturizers should also avoid sodium lauryl sulphate, a cleansing ingredient that can irritate dermatitis with prolonged contact.456

What should you do now?

1. 1Wash gently with warm, not hot, water and a mild, fragrance free, soap free cleanser. Massage the cleanser on, then rinse rather than continuing to rub.
2. 2Apply moisturizer straight after washing while skin is damp. Use a moisturizer you can comfortably apply at least twice daily, for example in the morning and evening.
3. 3Stop exfoliating dry, peeling areas and moisturize instead. Avoid introducing products containing alcohol, alpha hydroxy acids or fragrance while addressing dryness.
4. 4Protect skin during the day with shade, protective clothing and broad spectrum sunscreen with SPF 30 or higher.
5. 5If you have eczema, continue moisturizing when symptoms improve. Stop a particular product if it causes a new dermatitis reaction, and seek help if your current treatment is not working.

A richer moisturizer can leave residue on clothes, which is not the finish skincare advertising usually photographs. For eczema, lighter lotions can be more comfortable but need more frequent application; choose a texture you will actually use regularly.6

How long does recovery take?

Barrier recovery takes patience: benefits from gentler habits and consistent care can take three to four months to become apparent. Older skin replaces its barrier less quickly. Do not use that timeframe as a reason to wait through worsening symptoms.1

When should you get medical help?

Book a dermatologist appointment if moisturizing and gentler washing do not help, or dryness becomes painful, cracked, bleeding or very irritating. Yellow crusts, pus, leaking fluid, swelling or discoloration can indicate infection. If eczema becomes warm, painful, swollen, suddenly worse or more widespread, or you develop a fever or feel unwell, seek urgent medical help. Eczema can need prescription treatment as well as moisturizer.235