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Skin barrier repair: Often neglected; always needed

Sponsored by Episciences, Inc. Topical retinoids, alpha hydroxy acids, chemical peels and laser resurfacing procedures are some of the ways in which we rejuvenate the skin. The truth is, however, that we will never achieve optimal results unless we simultaneously address repair of the skin’s protective barrier.

Sponsored by Episciences, Inc.

Topical retinoids, alpha hydroxy acids, chemical peels and laser resurfacing procedures are some of the ways in which we rejuvenate the skin. The truth is, however, that we will never achieve optimal results unless we simultaneously address repair of the skin’s protective barrier.

Protecting what protects us

In 1989, dermatologist Peter Elias, MD, and I began what would be nine years of basic research to better understand all of the biological aspects of the stratum corneum barrier, epidermis and basement membrane. We found that any disruption to the stratum corneum barrier would trigger inflammation. Sometimes, the inflammation would be sub-clinical. Nevertheless, chronic inflammation would trigger further tissue disruption and thinning of the epidermis.

During our research we discovered that within two hours of entirely disrupting the skin barrier via chemical peels, laser and electrocautery, upregulation of synthesis of cholesterol, linoleic acid and ceramides occurred. That’s when we realized the real trigger for many disease states, from eczema and melasma to premalignant keratoses and polymorphous light eruption, was related to skin barrier function. The activity that started the whole chronic inflammation cascade was disruption of the stratum corneum barrier.

We found it is not just the presence of cholesterol, free fatty acid (linoleic acid) and ceramides in products to treat the skin barrier, but also the ingredient ratio. Research taught us that while all ratios had some benefit, only one ratio optimally improves skin barrier function. And, interestingly, when used alone, each of the three components actually disrupted the skin barrier.

Implications for practice

Any procedure meant to rejuvenate the skin that activates acute regenerative inflammation requires special attention to close the skin barrier. By doing so, you can avoid moving into the chronic inflammation pathway and mitigate proinflammatory environmental insults from invading the healing tissue.

We did a head-to-head study post-laser and chemical peel procedures comparing use of either Aquaphor healing ointment or the Epionce barrier-repairing post-care Essential Recovery Kit. Barrier repair was similar in the two groups in the early days post-procedure. But four weeks later, we saw a profound statistical difference in the reversing of fine lines, wrinkles, texture and skin firmness from our barrier repair technology over Aquaphor.

Closing the barrier not only improves clinical results from procedures, but it also reduces complication risks, including scarring, hyperpigmentation and hypopigmentation risks, secondary infection risk and more.

Finally, the environmental aggressors in life require maintaining skin barrier health as part of one’s daily at-home routine in order to prevent chronic inflammation due to barrier disruption. The workhorse products for my patients are products that do just this – the Epionce Renewal products.

About the author

Carl Thornfeldt, MD

Carl R. Thornfeldt, MD
Dr. Thornfeldt is the CEO and founder of Episciences, Inc., the manufacturer of the Epionce skincare line. He is a practicing dermatologist with more than 40 years of skin research experience, 22 U.S. patents granted and over 50 scientific publications in the area of treatment of skin diseases and conditions. He has spent more than two decades focusing on researching the skin barrier and cutaneous inflammatory conditions.

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