Rosacea And The Skin Barrier
Everything you need to know, with expert commentary from Dr Anjali Mahto
The skin barrier has become a real buzzword in recent years, especially if you have a skin condition that relies on that barrier for its health and happiness. But what on earth is the skin barrier, how can we look after it, and what do we do if it’s damaged?
I wanted to make sure this article was full to the brim with information, recommendations, and trustworthy advice, so I asked the wonderful Dr Anjali Mahto, Consultant Dermatologist extraordinaire to review and contribute to this post. I’m so thankful to Dr Anjali and, if you follow her on Instagram you’ll already know that she manages to present in-depth advice and information in both an accessible and empathetic way. She’s the best.
So, rosacea and the skin barrier. Let’s get into it…
What is the skin barrier? Is it the same as a moisture barrier?
The skin barrier is the outermost layer of your skin. In simple terms, your skin’s job is to protect you from potentially damaging external factors, and support your internal health by keeping water in. When the skin barrier is compromised, not only does our skin lose water through trans epidermal water loss (TEWL) making your skin dry, dull, and sensitive, but it then also allows external irritants to enter the skin, making it vulnerable to further damage and potentially contact dermatitis.
What is trans epidermal water loss (TEWL)?
This simply means that water in your skin is being lost through evaporation. This is a normal function of everyone’s skin, and the amount lost will fluctuate depending on many factors (for example, in the winter months, TEWL will increase with the cold and dry air).
But when the skin barrier is damaged, the amount that is naturally lost increases as your body cannot regulate it and this can be detrimental to the skin.
How do I know if my skin barrier is damaged?
The common symptoms are redness and inflammation, sensitivity, itchy, dry or tight skin, acne, dehydration and dullness, increased fine lines, and products stinging or causing irritation when they didn’t before.
The latter is something I hear a lot from followers who don’t understand why suddenly products they love have ‘turned on’ them, or when people who are struggling with their skin say they can’t use anything on their skin without it burning. They assume that they are allergic or reactive to all skincare, when realistically it’s a damaged skin barrier and any product (no matter how gentle) would have the same reaction.
How does the skin barrier get damaged?
There are many possible causes: stripping the skin with products (exfoliators or actives), stress, sun/UV exposure, extremes of weather, poor sleep, dry environment, smoking, ageing, pollution, and some medications.
Can hormones impact the skin barrier?
Yes! Oestrogen is essential for maintaining skin thickness, collagen production, oil or sebum regulation and skin hydration. As we age, and approach perimenopause and menopause, declining oestrogen levels can lead to skin barrier dysfunction and rosacea can either be triggered or become worse over time. Using ingredients such as hyaluronic acid, ceramides, glycerin and panthenol in our skincare can help our skin as its needs change.
Is there a link between rosacea and the skin barrier?
Whilst rosacea is a multifactorial condition related to genetics and the natural microbiome of the skin, amongst lifestyle factors, there is ample research which shows that the skin barrier is compromised in rosacea-prone skin. Inflammation, high levels of certain peptides (known as cathelicidins), potential for enhanced TEWL, and disruption of lipid synthesis in the epidermis have all been linked to skin barrier dysfunction in this condition.
Can the skin barrier repair itself?
Yes… but not if you continue to do the things that damaged it in the first place!
You will have to make changes and take very good care of your skin and general wellbeing for a few weeks to help your skin heal. There’s more information on that below.
How can the skin barrier be repaired?
Firstly, you need to try to pinpoint how it was damaged in the first place so you can remove or reduce your exposure to those irritants. Some of these will be easier than others (as most people with rosacea will know, some TRIGGERS are unavoidable) but it’s worth keeping them in mind.
The most common reason for a damaged skin barrier is overuse of stripping skincare. This typically means actives (e.g. retinoids, vitamin c) and exfoliants (skincare scrubs, handheld devices, scrubbing with a flannel, and chemical exfoliants like AHAs).
So in the first instance, it’s important to take your skincare routine right back to the basics: cleanser, moisturiser, sunscreen. Use the most simple versions of these three products (for example, continuing to use a moisturiser that has actives is probably not a great idea if you’re trying to heal) and be patient. It can feel frustrating to plug away with a ‘boring’ skincare routine when you’re not seeing changes, but slow and steady wins the race here.
Can the skin barrier be permanently damaged?
It’s very unlikely, but it may seem that way if you continue to expose your skin to the things that damage it, or if you are genetically more likely to have a more vulnerable skin barrier, e.g. if you have eczema, rosacea, psoriasis, or any skin condition that can impact the physical health of your skin.
Following the tips in this blog post will help you to get your skin back on track, but if you are still struggling after a few months you may need medical intervention to help you.
What products to use when the skin barrier is damaged?
As mentioned above you need simple, basic skincare to help your skin heal. I’ll share some of my favourites below, but remember to also do your own research to find the products that work best for you.
Ingredients to look out for: ceramides, allantoin, aloe vera, centrella asiatica, green tea, liquorice, squalane, bisabalol, panthenol hyaluronic acid, glycerin, niacinamide.
Ingredients to avoid: alcohol, witch hazel, fragrance, menthol, peppermint, eucalyptus, glycolic acid, salicylic acid.
CLEANSERS
Remove your cleanser with lukewarm water, as cold or hot water can flare up the skin. I don’t use flannels/washcloths even when my skin barrier is happy, but if you do I’d recommend skipping them for a while to help reduce irritation from the friction. If you find that even water is causing you issues, there are cleansers that can be removed with tissue.
Recommendations: La Roche-Posay Toleriane Dermo Cleanser (can be removed with cotton pads), Cerave Hydrating Cleanser.
MOISTURISERS
You need something gentle and soothing, but something that contains skin-strengthening ingredients to help your skin get back to its healthiest state. The ingredients list I shared above will help guide you.
Recommendations: I love the Beauty Pie Happy Face Extreme Relief Cica Moisture Cream. I also recommend the La Roche-Posay Toleriane Sensitive Fluid (if you’re oily/combination) or Cream (if you’re dry).
SUNSCREENS
Personally, I am a big fan of chemical sunscreens and my rosacea isn’t bothered by the majority of them, but when I’m struggling with my skin barrier I would typically reach for a mineral sunscreen to avoid stinging. If you’re unsure whether a sunscreen is mineral, look for zinc oxide or titanium dioxide in the ingredients.
Dr Anjali Mahto’s Sunscreen Recommendations:
Mineral
Chemical
Lex’s Sunscreen Recommendations:
Mineral
Chemical
I second Anjali’s recommendation for the La Roche-Posay Anthelios UVMUNE 400 SPF50+. It’s been a favourite of mine for years!
I share more details and more recommendations in this post:
What are your tried-and-true barrier-friendly products?
Let us know in the comments:
Do barrier repair creams work?
Yes, if you choose carefully. Barrier repair creams have suddenly appeared everywhere, and they sometimes come under different names: balms, salves, sleep masks. But their goal is the same: to hydrate and protect the skin. They are more intense than a typical moisturiser and often form a physical barrier on the skin. As they are thick and designed to not let anything penetrate that protective barrier, they should always be applied last in your routine, for this reason they’re best used just before bed.
Recommendations: La Roche-Posay Cicaplast Baume B5 is a long-term love for me. I also really like the REN Evercalm Overnight Recovery Balm and the By Sarah Tender Skin Balm.
How long does it take the skin barrier to recover?
Roughly 3-4 weeks but more severe skin barrier issues can take up to 6 months to heal, so it really is about patience and perseverance.
Can I reintroduce products if they previously damaged my skin barrier?
Depending on the products, yes. I would wait at least a week after the visible signs of a damaged skin barrier have disappeared (e.g. no dry patches, sensitivity, or unusual redness) to reintroduce products and even then you should take it very slow and space out the products you’re reintroducing. For example, reintroduce your Vitamin A (retinoid) slowly to see how your skin reacts, but wait a few weeks after you’re sure that went okay to then reintroduce Vitamin C. You need to be able to pinpoint what is causing issues just in case it all starts again, and you don’t want to set yourself back weeks just because you were impatient.
You could also consider swapping active ingredients to decrease your risk of irritation. Instead of retinol, you could look for retinaldehyde which is a form of retinoid that is less irritating for sensitive skin (Medik8 products are fantastic if you are in the market for a sensitive skin appropriate retinoid). You can also replace more irritating chemical exfoliants like AHAs (alpha hydroxy acids) or BHAs (beta hydroxy acids) with PHAs (poly hydroxy acids) – there’s more information about this in my review of Medik8 Press & Glow which you can read HERE.
Are there lifestyle changes I can make to help with the skin barrier?
Better quality sleep will help with skin health overall, as this is the time when our skin has time and space to repair itself. I wrote a post about that HERE.
Lowering stress levels is a very easy phrase to type but much harder to actually implement but it is very important. I wrote THIS ARTICLE a few years ago about the impact of stress on the skin, and anything you can do to minimise your stress will help.
Simple things like lowering both the temperature of your showers and the water used to wash your face can add up.
Make sure you are drinking enough water (I am terrible at this, although I’m really trying to be better!) You don’t need to heave around one of those enormous water bottles that everyone and their mums seem to have, but just make sure you always have some water within reach to remind you to take a slurp every so often.
If you live in a dry climate or in colder winter months, consider using a humidifier to counteract the dry air in your home. Unfortunately, I live in a typical Victorian terraced house which means any more water in the air would turn my entire house into a mushroom!
If you’re a smoker or vaper, add this to the pile of reasons to quit. Nicotine inhibits the delivery of blood circulating to the skin, which means oxygen and nutrients are also not reaching your skin, impacting its health overall.
Diet changes and supplements can help. It’s worth investigating the different foods that fall under the following categories and finding ones that best fit into your life: omega-3 fatty acids, omega-6 fatty acids, vitamin E, and antioxidants. I’ve been taking an omega 3 supplement for years to help with my skin health, as well as improving symptoms of my ocular rosacea – THESE are the ones that I currently take.
I hope you found this article useful, let me know in the comments below or come natter on instagram (it’s really nice to know I’m not just shouting into the void, so it’d be lovely to hear from you!)
This is a really useful read! I don’t have rosacea but do suffer with dry and itchy skin in the winter, so all these tips are good to know for when I flare up! 🤩
Facetheory’s Ectoin Barrier build milk has made SUCH a difference to my rosacea. Thanks for this really helpful article :)