It’s easy to think of our skin as just what we see on the surface, but skin is made up of many layers. The skin’s barrier and microbiome make up the outermost layer, and they play an essential role in protecting the body from external aggressors. According to Dr. Edgar Martinez of U.S. Dermatology Partners Plano, “For patients who suffer from cycles of irritation, breakouts, and flareups, I often recommend products to strengthen skin’s barrier and increase biodiversity in the microbiome. When chronic and persistent skin health issues like eczema, acne, and rosacea are resistant to traditional management approaches, it may mean the skin barrier or microbiome need to be repaired to improve treatment efficacy. For those wondering how to take care of skin barrier and microbiome health, I say keep it simple and focus on balance and consistency.” In this blog, Dr. Martinez breaks down the differences between the skin barrier and microbiome, explains how they work together, and discusses some treatment options.
What Is the Skin Barrier?
The skin barrier is made up of the very outer protectives layers of skin cells. These cells form a strong barrier keeping external allergens, irritants, and aggressors out and holding in moisture. To make a solid layer, the cells are held together with lipids like ceramides, cholesterol, and fatty acids. When the skin barrier is healthy, skin looks and feels strong and smooth. Damage to the skin barrier is common. Something as simple as washing or exfoliating too often can damage barrier cells. A damaged skin barrier leads to increased skin dryness, heightened skin sensitivity, and elevated risk for skin infections and flareups in chronic skin conditions.
What Is the Skin Microbiome?
Dr. Martinez says, “The skin barrier interacts with the microbiome, which is composed of a community of microorganisms like bacteria, fungi, and viruses that live on the skin’s surface.” A healthy microbiome is made up of beneficial microorganisms that regulate skin inflammation, support skin repair and immune response, and prevent the overgrowth of harmful microorganisms. When the balance of these organisms is disrupted leading to negative overgrowth, an imbalance called dysbiosis occurs. Microbial diversity in the microbiome is key to skin health. Dysbiosis is linked to increased skin reactivity and greater risk for flareups in chronic skin conditions like acne, eczema, and rosacea.
How the Skin Barrier and Microbiome Work Together
Together the skin microbiome and barrier combine to protect the body from external irritants and keep skin calm and healthy. Unfortunately, if either the skin barrier or microbiome are damaged, neither function well. That means it’s important to maintain the health of both. A healthy skin barrier supports a healthier microbiome, and that means:
- Skin maintains pH balance.
- Hydration levels are stable.
- Beneficial bacteria flourish.
- Harmful microorganisms are kept at low levels.
- Inflammation is reduced.
- Skin sensitivity and reactivity are diminished.
- Chronic skin conditions are easier to manage.
How Microbiome Imbalance (Dysbiosis) Impacts Common Skin Conditions
When it comes to dysbiosis and skin health, Dr. Martinez says, “Being in a state of dysbiosis leads to inflammation and irritation in the healthiest skin. For those who struggle with chronic skin conditions, dysbiosis makes managing symptoms and minimizing flareups challenging. It’s essential to practice good skincare to keep the skin barrier intact and balance the microbiome as part of any treatment plan for chronic skin conditions.”
Eczema (Atopic Dermatitis)
Eczema and microbiome health are closely linked. In fact, eczema is one of the clearest examples of how an unbalanced microbiome impacts skin health. Overgrowth of staphylococcus aureus and reduced microbial diversity in those with eczema leads to inflammation and poor barrier health. This means skin is dry, itchy, and red. Alongside prescription oral or topical medications and biologics, skincare to support a strong skin barrier and healthy microbial balance makes it easier to reduce the number and severity of eczema flareups.
Acne
Acne and skin barrier health are very closely linked. When normal bacteria levels on skin are disrupted, inflammatory response and acne breakouts increase. Additionally, many acne treatments are harsh, which can lead to barrier damage. For patients with acne, a gentler acne routine that also heals the skin barrier and balances the microbiome is often more effective than harsh, stripping acne treatment plans.
Rosacea
Patients with rosacea already have very sensitive and highly reactive skin. The heightened inflammatory response in rosacea-prone skin is worsened by damage to the skin barrier or imbalanced microbiome. This can prolong flareups and increase the severity of rosacea symptoms.
Dry or Flaky Skin
Very dry, flaky skin means the barrier isn’t doing its job to prevent moisture loss. For those who have chronic skin dryness, improving the microbiome composition and healing the skin barrier often leads to long-term improvement over simply applying moisturizer to the drier areas of skin as needed to improve symptoms.
How Research Is Changing the Way Dermatologists Treat Skin Conditions
A greater understanding of how the skin barrier and microbiome work has prompted changes in how chronic skin conditions are treated. According to Dr. Martinez, “It’s easy to recommend a topical treatment to address individual skin health symptoms, and we may even see short-term improvement. However, for a long-term benefit, it’s important to approach skin health with a more wholistic understanding. That means incorporating skin barrier repair and microbiome balance into treatment plans for chronic skin conditions as well as regular daily skincare routines.” Modern dermatology is moving away from harsh exfoliation and over-cleansing to treatment that reduces inflammation, strengthens skin’s barrier, and encourages a thriving microbiome.
How to Take Care of Your Skin Barrier and Support Your Microbiome
Beneficial skin barrier and microbiome skincare means taking a gentle approach to addressing skin health concerns and sticking to a consistent skincare routine that includes:
- Gentle cleansers – look for cleansers that won’t strip natural oils or disrupt balance in the microbiome. Instead, sensitive skin products that are free of fragrance, dyes, and other unnecessary chemicals should be incorporated into morning and evening skincare routines.
- Exfoliate sparingly – exfoliation is great to remove dead and damaged skin cells and to encourage skin cell turnover. However, daily exfoliation isn’t necessary for most people. Instead, start with exfoliation a few times a week and increase if skin tolerates the exfoliation and there are still dull or uneven areas.
- Choose moisturizers to strengthen skin barrier – moisturizers with ceramides, cholesterol, and fatty acids repair and strengthen skin’s barrier.
- Apply moisturizers daily – even those who have oily or acne-prone skin still benefit from keeping the skin hydrated by applying moisturizer that is non-comedogenic and oil-free.
- Stay consistent – don’t switch products frequently and only introduce one new product at a time. Once you have an affective skincare routine, stay consistent.
- Prevent sun damage – apply sunscreen every day. UV exposure disrupts the microbiome and damages the barrier, so it’s essential to keep skin safe from sun damage.
- Avoid harsh, antibacterial products – these products disrupt healthy microorganisms on skin, so they aren’t recommended for regular use unless deemed medically necessary.
Signs Your Skin Barrier or Microbiome May Be Compromised
Some of the common warning signs of skin barrier or microbiome compromise include:
- Dry or tight skin.
- Burning or irritation when skincare products are applied.
- Breakouts or flareups that increase or worsen despite treatment.
- Persistent skin redness and inflammation.
- Chronic skin conditions like eczema, psoriasis, and acne that aren’t responsive to treatment.
When to See a Dermatologist
Damage to the skin barrier or microbiome is common. In many cases, boosting hydration and avoiding harsh products for a short time is adequate to restore balance. You may want to consider visiting a dermatologist if:
- Skin issues don’t improve with consistent use of gentle skincare.
- Chronic or worsening flareups occur.
- You don’t know what products to use, or you’re not sure which are working.
- Infection or other concerns occur that may require prescription treatment.
Achieve Balanced, Healthy Skin
According to Dr. Martinez, “Achieving a healthy skin barrier and microbiome is all about balance and consistency. You don’t want to double or triple down on aggressive or harsh skin treatments or constantly change your routine. Instead, invest in high-quality products that heal skin and increase moisture retention. Focus on long-term skin health rather than band-aid fixes.”
Discuss Microbiome-Friendly Skincare with a Dermatologist
You don’t have to struggle with ongoing skin health concerns alone. Dermatologists are equipped to support patients with in-office treatments as well as helping them develop an effective at-home skincare routine. When you’re ready to get started discussing microbiome friendly skincare with a trusted dermatologist at U.S. Dermatology Partners, take a few moments to complete our scheduling request form.
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