When explaining the skin barrier and its importance to patients, more help is needed from the industry. For instance, a simple “Got Milk?”-type slogan that makes you immediately think of the skin barrier has not yet emerged. Physicians and scientists need a straightforward way to describe the skin barrier without getting too technical.
“When we think of the skin, meaning we in the industry, what we are really thinking about mostly is the dermis and the collagen,” expressed William Philip Werschler, M.D., F.A.A.D., F.A.A.C.S., a dermatologist and assistant clinical professor of medicine/dermatology, at the University of Washington School of Medicine in Spokane, Wash.
People have been schooled to understand that the skin has seven layers, Dr. Werschler explained.
“However, this really only refers to that millimeter or so of thickness of the epidermis,” he said. “They are cellular layers. Innumerable times people ask me if they have gone through all seven layers of skin. The easiest way to explain is if you scratch yourself and you see blood, then you have gone through all seven layers of skin.”
According to Joel Schlessinger, M.D., a cosmetic surgeon and dermatologist who runs the Advanced Skin Research Center in Omaha, Neb., “The skin barrier is the difference between healthy skin and damaged skin. It is probably something that most dermatologists don’t think about at all. However, the reality is that the skin barrier is a very important concept to articulate to patients.”
In addition to seven layers, skin has seven functions, and the first is the skin barrier, said dermatologist Carl R. Thornfeldt, M.D., the developer and founder of Episciences, Inc. (Boise, Idaho).
“This permeability barrier keeps the aqueous internal environment protected from the dry external environment, which includes all the toxins and contaminants in our environment,” he expressed.
In finding the best way to describe the skin barrier, consider how one might explain it to a child, Dr. Werschler said. “I use a brick wall analogy,” he described. “The bricks are the skin cells and the mortar holding them together is the intercellular cement substance. At the bottom of the barrier you have the retaining wall foundation, otherwise the bricks would fall apart.”
Furthermore, there are specialized structures in the epidermis, Dr. Werschler continued.
“Imagine every ten bricks or so you place a decorative brick. Those are the melanocytes,” he said. “Your pigmentation is in the epidermis, and you are constantly shedding your pigmentation, as well. In addition, you can also have pigmentation after injury.”
Another visual way to explain the skin barrier is to conjur up the image of a shield, said Peter Lio, M.D., a clinical assistant professor of dermatology & pediatrics at Northwestern University Feinberg School of Medicine, and founding director of the Chicago Integrative Eczema Center (Chicago, Ill.).