I spend my Sundays from 4-7 talking to people at the Elephant Pharmacy in Berkeley about skin issues. I love doing this because it is the one day out of the week that I actually get to have face time with my many customers, and I am always enriched by the experience and gratified by how much I learn from them. Last Sunday I saw quite a range of skin problems; one young woman with severe adult acne, another young woman with combination skin (breakouts on her forehead and clear everywhere else), another young woman with congested skin (consisting of tiny blackheads that pretty much covered her face) a woman in her 30’s with intermittent eczema, an older woman with very dry skin, and finally someone who thought she had rosacea. I was struck by a common denominator in these varying skin concerns-the problem that I am coming to believe underlies most of the benign skin abnormalities I see. It has to do with what is called the “lipid barrier” of the skin, and what happens when it is compromised.
The lipid barrier is located in the stratum corneum, so let’s have a quick anatomy lesson before we proceed.
The Stratum Corneum
The stratum corneum is the top layer of the epidermis, and is, on the face and genitals, quite thin. It is your protective barrier against the elements in much the same way as a brick wall protects us from the weather. In fact, the metaphor used to describe the SC is usually bricks and mortar, where the flattened dead skin cells, called corneocytes, are the bricks, and the mortar is the intercellular lipid lamellae.
The bricks or corneocytes are composed of a tough, highly cross-linked protein cornified envelope, with a lipid coating surrounding the envelope. The mortar, the intercellular lipid lamellar sheets, are formed when lamellar granules discharge their lipid contents into the intercellular space. It is principally the lipid lamellae between corneocytes that are thought to form a barrier to water loss.
(In an interesting side note, a recent study indicates that an essential fatty acid deficiency may cause a failure of the lamellar granules to assemble, thus preventing the formation of lamellar sheets. This is just one of the reasons I steer just about every person I talk to over to the cod liver oil section when we are done talking.)
The Lipid Barrier
The lipid barrier is located in the stratum corneum. Beneath the stratum corneum, the lipids in the intercellular spaces are also responsible for the barrier function of the skin. They protect skin cells from moisture loss and supply a fresh source of lipids to the lipid barrier in the stratum corneum. A compromise of lipid barrier function can result in:
1) First, an increase of moisture loss leading to dry, scaly or even cracked skin.
2) Next, further damage occurring by moisture loss in skin cells in the lower layers of the epidermis. The health of these cells is affected because dehydrated cells function poorly. The immune system of the skin eventually becomes weakened.
3) Finally, the risk of infection or the incidence of other skin diseases increases. Secondary effects of gaps in the lipid barrier can show up as bacteria-related acne, eczema, rosacea-type inflammation, atopic dermatitis, and skin congestion among other problems. Cosmetic problems can range from skin dryness to the appearance of fine lines and a deepening of wrinkles.
Protecting the lipid barrier
1) Remember that lipids are not immune to the environment. When in contact with sunlight (specifically UV light) or air, lipids will undergo what is known as peroxidation. These peroxidized lipids lose their barrier ability and gaps occur in the lipid matrix. This is just another reason to make sure that you are wearing sufficient UV protection. I recommend a sun block with zinc oxide. In cold and windy weather wrap up. Wear a scarf. You will probably find that you need to moisturize your skin more frequently in inclement weather.
2) The use of soaps and detergents leads to pronounced loss of lipids from the skin. For most of us, washing at night with a gentle, cream or gel-type cleanser is sufficient. In the morning just splash with tepid water before continuing with your daily skin care routine.
3) If you want soft and supple skin lay off exfoliation. If you must exfoliate (and really, the benefits are overrated) the best way is to use oils. Remember your basic chemistry–lipids dissolve lipids. So to really get to the where the problems originate avoid the AHAs and scrubs and so on that strip your skin of oils. Instead, massage in an oil or an oil blend. You will feel the excess dead skin cells float way, and you won’t have damaged your lipid barrier.
4) Lipid barrier damage occurs on a daily basis requiring a continuous input of lipids to the skin to maintain an effective lipid barrier. Moisturize in the morning and evening, and more often in dry, cold weather or if you have dry skin. Be sure and moisturize at night to help your skin heal and repair. Don’t worry about suffocating your skin, believe me, it’s still going to be breathing.
5) A note to those who suffer from blackheads, congestion, and breakouts. I know everyone tells you to exfoliate like crazy and avoid oils. Here’s why I think this is bad advice. First of all, stripping your skin of its lipid barrier is going to open your skin to possible further infection. Second, oil stripping does not get to the source of the infection, and may, in fact, exacerbate it. Bacteria feed on waste material and debris, not oil. Massage in an oil and let it penetrate to break up congestion and clogged pores.
6) Don’t forget your EFA’s. Everybody can benefit from taking a daily teaspoon of cod liver or other fish oils.
The lipid barrier and topical applications
Should we be applying oils to our skins? If so, why and what? The answer to the first question is a resounding yes in my book. To answer the other questions will require at least one more essay so I will save it for next time. In the meantime, happy oiling!