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

The Inside-Out of Skin

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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.

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

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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

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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

Stress Affects The Skin

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Detail of 10th C sculputre from Lombardy, Italy. Stress has always been with us. We use it here to illustrate how stress affects skin.
10th Century Scupture from Lombard Region of Italy; now in the Pinocoteca Ambrosiana in Milan. Stress has always been with us.  This figure may even be scratching herself, illustrating how stress affects skin. Photo by Mary L. Williams

There seems little doubt that stress affects skin – and not in a good way. As dermatologists, we have often heard from our patients how the stress in their lives is making their skin condition worse. Big pimples erupt just before prom night, or as a wedding approaches. Eczema (or atopic dermatitis) flares during exams or from stress at work. It seems there is widespread belief among patients, if not always their doctors, that stress is bad for health – in general, and across a wide swath of medical conditions. This bad effect of stress on health is most often attributed to weakening (or in some cases perhaps, an over-reacting) of the immune system

But this concept – stress affecting the immune system – seemed too vague. We wondered, “Where’s the beef?” We were indeed convinced from our clinical practice that stress does indeed affect some skin diseases, and especially atopic dermatitis (or eczema). And knowing that the skin barrier is impaired in this condition, we thought that this might be a good place to begin to investigate how stress can affect the skin. [Read more…] about Stress Affects The Skin

2018 IID Meeting Update: Even Fat Is Linked To The Skin Barrier

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Fat is healthy for elephant seals. Could it also be good for the skin barrier as dome fat is for humans?
Resting elephant seals on San Simeon State Beach.

Fat Cells And The Skin Barrier?

What do fat cells have to do with the function of the epidermal permeability barrier? Before the recent International Investigative Dermatology Meeting in Orlando, we – although generally obsessed with all things related to the skin’s permeability barrier – would reluctantly have had to admit, “Alas, nothing.”

Therefore, we were most intrigued to learn of the discovery by Dr. S. Hong, of Dankook University in Cheonan, Korea, and his colleagues that some of our fat cells are at work, fine-tuning the permeability barrier. [Read more…] about 2018 IID Meeting Update: Even Fat Is Linked To The Skin Barrier

How The Skin Barrier Works

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The skin barrier is like a brick wall. The cells or "bricks" are surrounded by fat (lipids) or "mortar"
The outermost layers of skin, the stratum corneum, is like a brick wall. The cells, or ‘corneocytes,’ which no longer contain nuclei and are considered dead, are the ‘bricks.’ They are surrounded by membrane sheets composed of lipids (fats). The fibrous protein-filled cells impart mechanical strength, while the lipids prevent water movement across the stratum corneum.

To understand how the skin barrier works, we need to return to our ‘bricks and mortar’ model of the outermost layers of the epidermis, the ‘stratum corneum.’ In this layer, the cells (called ‘corneocytes’) no longer possess a nucleus – they are essentially dead. But they are filled with tough, fibrous proteins, called ‘keratins,’ and many small molecules derived from the breakdown of proteins and other components of these once-living cells.

Simply stated, the bricks (or corneocytes)  provide a durable defense against the ordinary frictional wear and tear of life.

As long, protein polymers, it is the keratins that give the skin much of its remarkable mechanical strength.  Another contributor to its strength is another protein structure, the so-called ‘cornified envelope.’ This polymer is made up of several different protein precursors. It surrounds the corneocyte, rather like a hedgerow of rose bushes, and replaces the cell membrane of the former, living cell. [Read more…] about How The Skin Barrier Works