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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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You are here: Home / Archives for Skin Disorders: When The Barrier Fails

Skin Disorders: When the Barrier Fails

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

Dry skin can resemble mud as it dries out and cracks.
Dried out mud flat. Like this mud flat, skin when it is too dry, becomes flaky and can even fissure or crack.

Who is at risk?

Many people are prone to develop dry skin. Examples include those who have or have in the past had atopic dermatitis. This is a common form of eczema that affects up to 20% of the population at some time in their lives. Atopic dermatitis is an inherited disorder of the skin barrier, characterized by an increase in surface pH and a deficiency in the lipids (fats) – especially of ceramides – that form the permeability barrier. Dry skin, even in regions not affected by the eczema, almost always occurs in people with atopic dermatitis.

Dry skin is a sign of a leaky skin barrier.

When the barrier is weak, not only does it allow our precious internal water to leak out, it also is less able to hold water within its outer skin cells – or ‘corneocytes’. This leads to the drying, flaking, and often, the itching that we experience as dry skin.

It becomes increasingly common as we age. Our research has shown that skin barrier function begins to decline as early as 50 years of age. This age-related barrier dysfunction is attributable to an increase in the pH of the skin surface, as well as a decreased production of the lipids required for a competent permeability barrier.

It’s also more common in winter – earning the name, ‘winter itch’. But why in winter? Those of us who live in higher latitudes tend to remain indoors for extended periods of time, where we are surrounded by forced air heating. Typically, the humidity inside our homes declines to less than 5% during winter. 

When the atmosphere is this dry, it places substantial stress on the skin’s ability to hold back water from leaking out. In normal individuals, the epidermis is able to adjust, and retain optimal function. But in many people, such as those with atopic dermatitis or the elderly, the skin cannot fully adjust.  And under this seasonal stress, dry skin makes its appearance, or if always present, it worsens.

[Read more…] about Dry Skin: Who Is At Risk and What Can Be Done About It?

Scaly Skin and Ichthyosis (Nothing to Do with Fish Skin)

October 18, 2019 By Mary L Williams, M.D. Leave a Comment

Fish on ice in a market.  Inherited skin diseases with scaly skin are called 'ichthyosis’, because in past centuries skin disorders were named for what they resembled in nature.  But these conditions have nothing to do with fish.  They are single gene traits that are teaching scientists much about how the skin works.
Fish on ice in a market. Ichthyosis represents a family of skin disorders in which the outer skin fails to shed normally, and instead accumulates with visible scales.
Photo by Mary L. Williams

Scaly Skin and Ichthyosis

Probably everybody at some point notices some flakes – some scales – on their skin. Maybe some dry patches on the lower legs? Or the peeling that happens after a sunburn. But most of the time our skin – if it is healthy – doesn’t produce visible scales or flakes. Instead we shed our skin invisibly, single invisible cell by single invisible cell.

But some people are born with a condition in which visible scales accumulate on most or all of their skin surface. This condition, called ‘ichthyosis‘, we now recognize is not just one thing, but instead represents a whole family of inherited conditions that have this feature in common.

Although each member of the ichthyosis family may be quite uncommon to rare, as we learn about their underlying genetic causes, these conditions are teaching us a lot about how the skin works.

[Read more…] about Scaly Skin and Ichthyosis (Nothing to Do with Fish Skin)

Atopic Dermatitis: The View From The Outside-In

February 24, 2019 By Peter M. Elias, M.D. & Mary L. Williams, M.D. Leave a Comment

Remnant of a fence in a weedy field.  Atopic dermatitis is a common skin disorder linked to allergic conditions like asthma and hay fever.  Its underlying cause is a leaky skin barrier allowing water to escape and foreign antigens to enter the skin- just as this ineffective fence would provide no barrier to the movement of farm animals.
A broken fence provides no barrier to the escape of farm animals. Similarly, when the skin’s permeability barrier is broken, foreign antigens can enter the skin and provoke an immunological response, producing eczema or atopic dermatitis.

What Is Atopic Dermatitis?

More than one person in five will suffer an outbreak of atopic dermatitis at some point in their lives.

Atopic dermatitis is an extremely common form of eczema. Most often it occurs in individuals with a family or personal history of other ‘allergic’ disorders, such as food allergies, asthma and hay fever. Typically, the dermatitis starts in infancy or early childhood with recurrent outbreaks of red, itchy rashes. While outbreaks can involve any part of the skin, some areas are more commonly affected. In infants and young children, the dermatitis most often erupts on the face, scalp, and the outer surfaces of arms and legs, while in older children and adults, involvement of the folds of the elbows and knees is typical. Hands are commonly affected at any age. Some adults only have outbreaks on their hands, while others may have widespread, treatment-resistant disease.

There are treatments for atopic dermatitis, but no cures.

Many effective anti-inflammatory therapies are available for atopic dermatitis. Yet, to the frustration of patients and their caregivers, the itchy rashes come back as soon as these medications are stopped. Parents are often offered the hope that their child will likely one day ‘outgrow’ his or her eczema. But not all children do – and, as a result, many people continue to struggle with atopic dermatitis throughout their adult years.

What Causes Atopic Dermatitis?

So much suffering for so many for so long fuels an urgency to understand what is causing this condition. In addition, the prevalence of allergic diseases, including atopic dermatitis, are on the rise – especially in developed countries, such as the United States and European Union. This increase in the number of people who are being affected and the increased severity of their disease has added to this sense of urgency to understand what is behind it.

[Read more…] about Atopic Dermatitis: The View From The Outside-In

Thoughts on the Rational Treatment of Atopic Dermatitis

August 5, 2018 By Peter M. Elias, M.D. Leave a Comment

This is the 4th in our series of updates on atopic dermatitis. In the preceding articles we considered why so many more children nowadays are developing eczema, what we know about the genetic underpinings of the disease, and how defects in the skin barrier and loss of the acidic pH on the skin surface are key to understanding how the dermatitis develops. In this post we consider how this information provides the basis for new, rational paradigms for treatment.

Atopic Dermatitis and the Hygiene hypothesis
The epidemic of atopic diseases is commonly attributed to the move from rural to urban habitats (the so-called Hygiene Hypothesis). Photo by Mary L. Williams.

Migration back to life on the farm is probably not an option for many, but there are steps that people with atopic dermatitis can take to address their skin’s vulnerability.  For a start, they can practice ‘gentle skin care’.  By doing so, they can avoid extracting the natural oils from their skin that are essential for its barrier function by modifying their bathing routines. [Read more…] about Thoughts on the Rational Treatment of Atopic Dermatitis

Atopic Dermatitis: Is It All About pH?

May 3, 2013 By Peter M. Elias, M.D. Leave a Comment

lemons crop

In two earlier posts we discussed why atopic dermatitis is becoming more prevalent and what is known about the genetic underpinings of this common disorder. In this installment, we look at how the most common gene associated with atopic dermatitis acts to produce the skin condition.

It has known for decades that the skin has a “sour surface”. The pH of the skin surface is acidic (~5), while our cells and blood have a nearly neutral (~7.4) pH. This low surface pH is assumed to be critical to discourage the growth of bacteria and other microorganisms. Indeed, the microbes that normally inhabit our skin (our so-called ‘normal skin flora’) thrive in an acidic environment, while the pathogens that cause serious infections,  such as Staphylococcus aureus and the streptococci, do not. [Read more…] about Atopic Dermatitis: Is It All About pH?

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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...

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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...

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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...

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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...

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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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