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Elias and Williams: The Inside-Out of Skin by dermatologists and skin researchers Peter M. Elias, M.D. and Mary L. Williams, M.D.

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Inside the Skin Barrier

This website is devoted to the permeability barrier - the most critical, life-enabling function of skin. By preventing loss of water from the skin's surface, the barrier preserves the body's internal milieu against dessication in a dry environment.

The Skin Microbiome: Good Bugs And The Bugs That Bug Us

January 7, 2020 By Peter M. Elias, M.D. Leave a Comment

We hear a lot about the multitude and diversity the micro-organisms – especially the bacteria – that populate our stomach and intestines. We learn that these bugs living on and in us account for a quarter of our body weight. They even communicate with our brain! We are advised to take proper care of these microorganisms – to take probiotic supplements, or consume those occurring in dairy products, like yoghurt and buttermilk – or even (yuk!) feces.  

Much less attention has been focused on the myriad organisms that reside on our surface – the skin microbiome.

Skin – just like our bowels – hosts a large number and an enormous diversity of microorganisms on its surface. Recent research on the skin microbiome, has identified many species that were previously overlooked, because they could not be readily cultivated in the laboratory. This new appreciation of the broad diversity of our skin’s normal microbial flora was revealed using ultramodern, RNA sequencing techniques.

Most of these microorganisms of skin do not also live in the gut. This is because they thrive in the uniquely acidic environment of our skin’s surface. Recall that, normally, the skin surface has a pH of ~5, instead of the more neutral  ~7.4 pH of our interior.  Although we do not yet fully understand all the functions of the normal skin microbiome, we know they do protect us against colonization by bad bugs, like Staphylococcus aureus and some strains of streptococci.  These ‘bad’ varieties have the capability of causing skin infections – either superficial ones, like impetigo, or deeper ones, like cellulitis.

Recent studies show that the skin microbiome changes dramatically just before outbreaks of atopic dermatitis.  It becomes more simplified – less rich in its variety of species – and the ‘bad’ S. aureus, dominates the colony. This change in the microbiome is the proverbial ‘canary in the coal mine’, portending that a flare of atopic dermatitis may soon follow.

Our research has shown that the permeability barrier, which holds in our body’s water, and the skin’s antimicrobial barrier, which guards against the invasion by ‘bad bugs’ are closely linked – perturb one, and you compromise the other. Vice-versa, when we fix the barrier in a disease like atopic dermatitis we also reconstitute the antimicrobial barrier.

To see how these two barriers – the water and the antimicrobial – are linked, we must take a look inside the cells of the epidermis. 

Epidermal cells (‘keratinocytes’) possess a large number of tiny particles, or ‘organelles’, called ‘lamellar bodies’.  These unique organelles are loaded with the lipids (fats) that makeup the permeability barrier.  And they also contain proteins, called ‘antimicrobial peptides’, that foster the growth of the good bacteria and inhibit the growth of the bad ones.

When lamellar bodies deliver their contents of lipids to form the membranes of the stratum corneum, which waterproof the skin, they simultaneously co-deliver their cargo of antimicrobial peptides that will cultivate a healthy flora.  Therapies, like balanced barrier repair formulations such as EpiCeram®, that replenish the lipid content of lamellar bodies to be delivered to the stratum corneum, can also replenish its delivery of antimicrobial peptides.

But perhaps even more importantly, fixing the permeability barrier also restores the acidic surface of our skin, which also inhibits the growth of the ‘bad bugs’ and fosters the growth of the ‘good’ ones.  The molecules that grant acidity to the skin surface are washed away when the barrier is disrupted and the skin becomes leaky.  When the barrier is restored by replenishing its lipid supply, the acidic molecules are again retained, and their antimicrobial force restored.

Keeping our skin surface acidic is beneficial in other ways, as well.  It supports the generation of the lamellar membranes that waterproof us.  It renders the stratum corneum more tenacious – making it more resistant to damage.  It also inhibits the development of skin irritation and allergic sensitization.  Fortunately, a large number of skin cleansers and skin care products, including EpiCeram®, are formulated with an acidic pH.  To learn more about these products, sign up to receive our free booklet, Taking Good Care Of Your Skin.

Cholesterol And Your Skin

December 10, 2019 By Mary L Williams, M.D. Leave a Comment

Diagram of Cholesterol, one of the three key lipids (fats) which form the waterproofing membranes in the outer layers of our skin | Dermatologist and Skin Scientist Mary L. Williams, MD | EliasandWilliams.com

Because of its association with heart disease, most of us are worried about our cholesterol. We try to avoid too much cholesterol in our diet, and if our blood cholesterol is elevated, we may take medications, such as a ‘statin’, to reduce it.

These associations can lead to the notion that cholesterol is simply bad. But in fact, cholesterol is an essential ingredient in all of our cells.

Cholesterol is a major component of the membranes that surround each and every living cell in our body. It is also one of the three key lipids (or fats) that form the waterproofing membranes in the outer layer of our skin – the stratum corneum. These lipids in skin are what form the permeability barrier – that ability of the skin to keep the outside out and the inside in.

Our cells can manufacture their own cholesterol – or they can use the cholesterol in our blood that we get from our diet. That is – most of our cells can use the cholesterol in blood – but some cannot. Brain cells can’t use it, because the ‘blood brain barrier’ keeps out its delivery vehicle, called LDL (for low density lipoproteins).

The epidermal cells (epidermis is the outer layer of skin) that generate lipids for the permeability barrier also can’t use blood cholesterol. This is because they lack LDL-receptors – which are the molecules on the cell membrane that bind the LDL particles and allow the cell to take up the cholesterol carried on these lipoprotein particles.

Bottom line: brain and epidermal cells have to make their own cholesterol from scratch.

[Read more…] about Cholesterol And Your Skin

Hazards Of Our Porous Skin: Why Skin-Lightening Creams Can Be Toxic

November 9, 2019 By Mary L Williams, M.D. Leave a Comment

Consumers have little way to be certain that the skin creams they are using are free to toxic adulterants like mercury, a common ingredient in skin lightening creams.
Off the shelf skin-lightening creams, particularly those originating from outside the US, may be contaminated with mercury. Unfortunately, consumers have little guidance in which creams are safe and which may be poisonous.

We are justly proud of our skin’s permeability barrier, which does such an admirable job of holding our water in – keeping our interior moist as we move about in a dry world. This same barrier also protects us from absorbing many substances with which we come into contact – to the point that we often don’t think about it when we put various lotions and creams on our skin.

Yet sometimes our skin barrier can fail to protect us from poisons in our environment.

A recent health newsletter told an alarming story of a California woman who became comatose after using a skin moisturizer that had been adulterated with mercury. She was using the cream in an effort to lighten her skin color. Her product originated in Mexico, and was a common, off the shelf moisturizer which had been adulterated with methylmercury – (the metal used in thermometers). Another common mercury adulterant in skin lightening creams is ‘calomel’ (mercury chloride). The problem, of course, is that mercury, even at low blood concentrations, is highly toxic, and can cause a host of neurological abnormalities.

[Read more…] about Hazards Of Our Porous Skin: Why Skin-Lightening Creams Can Be Toxic

What’s So Good About Stress? Nature Has A Built-In Pharmacy!

December 29, 2018 By Peter M. Elias, M.D. Leave a Comment

Paradoxical Benefits of Psychological Stress in Inflammatory Dermatoses Models are Glucocorticoid Mediated | The Elias Lab |

In earlier posts we showed  how psychological stress can be potentially harmful to both the skin’s barrier, and to our antimicrobial defenses. But there are also ways in which stress is good for us.

Fight or Flight

Indeed, one way that it’s helpful has been known for many decades, thanks to the pioneering work of Hans Selye and for which he received a Nobel Prize. We are programmed to respond to new threats from the environment – such as attacks by predators or surprise assaults by enemies – with the classic, ‘fight or flight’ stress response. These types of alarms cause a prompt release of the hormones, adrenaline and steroids (‘corticosteroids’, that is), which quickly generate the additional energy we will need to escape or confront such threats.

Our lab recently discovered another way in which stress can be helpful in certain situations. [Read more…] about What’s So Good About Stress? Nature Has A Built-In Pharmacy!

How Stress Affects Skin

November 12, 2018 By Peter M. Elias, M.D. Leave a Comment

 

mice as useful laboratory animals to study the skin barrier
Detail of Jan Bruegal’s Mouse in the Pinicoteca Ambrosiana, Milan
Photo by Mary L. Williams

In an earlier post we described how psychological stress can be hard on people’s skin barrier. But to gain a better understanding of how stress affects skin, how feeling anxious or depressed can be detrimental to the skin’s barrier, we needed to return to the laboratory.

Only in a laboratory setting could we learn what was happening inside the skin during stressful situations.

Mice don’t take exams – the stressful situation we studied in our medical student volunteers  – but they can be stressed by sleep deprivation, or by crowded housing, or physical restraints. (Let us reassure our readers that all of these animal studies were approved in advance by our institution’s Animal Care Committee). We did indeed confirm that mice when stressed in these ways developed an impaired skin permeability barrier, just as we had found in our anxious medical students during exam periods. But we also learned that there were other ways that stress is hard on the skin. [Read more…] about How Stress Affects Skin

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INSIDE THE SKIN BARRIER

The Skin Microbiome: Good Bugs And The Bugs That Bug Us

January 7, 2020 By Peter M. Elias, M.D.

We hear a lot about the multitude and diversity the micro-organisms – especially the bacteria - that … Read More...

MORE FROM INSIDE THE SKIN BARRIER >>

SKIN DISORDERS

Dry Skin: Who Is At Risk and What Can Be Done About It?

December 1, 2019 By Peter M. Elias, M.D. Leave a Comment

Who is at risk? Many people are prone to develop dry skin. Examples include those who have or … Read More...

MORE FROM SKIN DISORDERS

REPAIRING THE SKIN BARRIER

The How and Why of Sensitive Skin

November 1, 2018 By Peter M. Elias, M.D. 1 Comment

An alarming percentage (about 60%) of normal adults, mostly women, self-report that they regularly … Read More...

MORE FROM REPAIRING THE SKIN BARRIER >>

CLIMATE AND THE SKIN

The Skin’s Many Barriers and Climate Change

October 9, 2020 By Mary L Williams, M.D.

Skin's Many Barriers And How Climate Change May Affect Them Skin has many barriers: it keeps us … Read More...

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Q & A

Q& A: Preventing Dry Skin From COVID-19 Hand Washing And Toxic Hand Sanitizers

December 1, 2020 By Peter M. Elias, M.D. & Mary L. Williams, M.D. Leave a Comment

Q: I have developed dry skin from COVID-19 because I have to wash my hands so often. Hand sanitizers … Read More...

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Research: From The Elias Lab

Top 5 Scientific Discoveries About Skin Of The Decade

December 26, 2019 By Peter M. Elias, M.D. & Mary L. Williams, M.D. Leave a Comment

We have learned a lot about skin and its permeability barrier in recent years.  Here are our … Read More...

MORE FROM THE ELIAS LAB >>

Research: From Labs Around the World

Top 5 Scientific Discoveries About Skin Of The Decade

December 26, 2019 By Peter M. Elias, M.D. & Mary L. Williams, M.D. Leave a Comment

We have learned a lot about skin and its permeability barrier in recent years.  Here are our … Read More...

MORE FROM RESEARCH AROUND THE WORLD >>

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