Isn't medicine a panacea? One article teaches you how to repair the skin barrier and defeat acne

author：Editor date：2024-03-15 15:22:50 popularity： column：article

Acne is a common, complex, multifactorial inflammatory skin disease, the occurrence and development of which is closely related to the skin barrier function. Factors such as increased sebum secretion, epithelial hyperkeratosis of hair follicles, colonization of pathogenic P. acnes, and inflammatory response can lead to damage to the skin barrier function, which in turn exacerbates acne. Therefore, it is crucial to restore the skin barrier function when treating acne. This article will explain the pathogenesis of acne and the skin barrier, and how to repair the skin barrier.

Pathogenesis of acne and skin barrier

Hair follicle sebaceous glands and skin barrier:

Adolescent acne is affected by androgens, resulting in sebaceous gland hyperplasia and increased sebum production in hair follicles. Changes in sebum composition, such as squalene oxidation, promote hair follicle hyperkeratosis, alter the structure of skin biofilms, and damage skin barrier function.

Microbial & Skin Barrier:

Skin microbes play an important role in acne. Inflammation can be triggered by a compromised skin barrier or dysbiosis. Microorganisms such as Propionibacterium acnes are involved in acne development by activating the immune response and influencing keratinocytes.

Inflammatory and skin barrier:

The inflammation of acne is associated with damage to the skin barrier. Inflammatory factors such as IL-1α promote excessive proliferation and inflammation of keratinocytes, disrupt the skin barrier, and exacerbate acne.

Diet and Skin Barrier:

High-carbohydrate, greasy, and dairy diets may increase insulin resistance and androgen release, affecting the retinoid signaling pathway, which can worsen acne.

Improper care and skin barrier:

Excessive cleansing or use of alkaline cleansing products, choosing inappropriate skincare products, using cosmetics containing harmful substances, etc., may further damage the skin barrier and affect the effectiveness of acne treatment.

Drugs and skin barriers

Oral medications

Isotretinoin is the first-line treatment for severe acne. However, while taking isotretinoin, the skin barrier may be further damaged. This is characterized by an increase in skin TEWL and a decrease in water content, resulting in dry, scaling of the mucocutaneous membranes. In addition, factors such as decreased sebum secretion, accelerated turnover of epidermal keratinocytes, and desmomeric shedding between keratinocytes may also exacerbate the damage to the skin barrier.

Topicals

Benzoyl peroxide (BPO): used to treat inflammatory acne, has a dissolving and anti-inflammatory effect. However, due to its keratolytic properties, vitamin E may be depleted and may irritate the skin depending on the concentration.
Topical retinoids (e.g., adapalene, tazarotene, trofarotene): may induce epiepidermal acanthosis, keratolysis, and adhesion disorders, leading to worsening erythema and desquamation.
Topical antibiotics (e.g., erythromycin): may have an irritating and drying effect on the skin.

Table 1 Skin irritation and dryness associated with acne treatment

Therefore, medication should be actively used in conjunction with skin care products to help control the barrier disruption that is common with acne and related prescription treatments.

Repair the skin barrier

Repairing the skin barrier is a key part of the prevention and treatment of skin diseases, and it is also the basic treatment method for many diseases. According to the 2022 expert consensus, its restoration is divided into the following three parts:

General Treatment:

Eliminate the cause: Find and remove the cause, pay attention to sun protection, use cosmetics carefully, and maintain an optimistic mood.
Clean your skin properly: Avoid over-cleansing, using hot water, and rubbing violently to prevent damage to the skin barrier.
Application of humectant: the key means, with the three characteristics of water locking, moisturizing and softening.
- Lock in water: Reduce the TEWL value by forming a waterproof membrane, common ingredients include dimethicone, glycerin, mineral oil, etc.
- Moisturizing: Increase skin hydration, improve the moisture content of the stratum corneum, common ingredients are hyaluronic acid, lactate, urea, etc.
- Softening: Smooths the skin, common ingredients include dimethicone.
Use functional skincare products: Contains moisturizing ingredients such as ceramides, hyaluronic acid, and urea, as well as natural botanical ingredients such as green thorn fruit oil, avocado oil, etc., to help speed up the repair of broken barriers.

Topical drug therapy:

When the skin epidermis is intact: use ice, hydrogel cold compress, external scald cream, etc.
When the skin is damaged: use drugs containing epidermal growth factor (EGF) to promote healing and, if necessary, antibiotic ointment to fight infection. At the same time, vitamin E helps repair the broken skin barrier due to its photoprotective, moisturizing, antioxidant, and anti-inflammatory properties.

Photoelectric therapy:

It uses strong light to promote metabolism and blood circulation, produces a phototonic effect on epidermal cells, and promotes the repair of skin barrier function.
Q-switched laser: large light spots, low energy, can decompose pigment particles through the epidermal layer, does not damage normal skin tissue, and is conducive to the repair of skin barrier function.
Radiofrequency: Enhance the skin's moisturizing ability and improve symptoms such as dryness and itching.
Weak lasers: including red light, blue light, yellow light, etc., can improve skin itching, stinging and other symptoms, and speed up skin barrier repair.

Chemical peels:

A chemical peel is a type of epidermal reconstruction that uses chemical exfoliants to create skin lesions of varying depths, followed by epidermal and dermal regeneration. However, it is necessary to pay attention to the manipulation technique and concentration to avoid aggravating the damage of the skin barrier.

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