How to Protect Your Skin Barrier with Psoriasis

What’s the Skin Barrier?

The skin barrier is a physical and immune barrier that helps maintain healthy skin and overall health for the body. The physical barrier is the outermost layer of skin that works to protect your body. The immune barrier is present in both the top and bottom level of the skin (called the epidermis and dermis)

Healthy skin barrier function works to keep moisture in, while keeping out external threats such as irritants, allergens, chemicals, bacteria, and infections.

“The skin barrier basically refers to both a physical and a functional barrier that exists in the top part of the skin,” says Marisa Garshick, M.D., an assistant clinical professor of dermatology at Weill Cornell Medical Center and a board-certified dermatologist at MDCS Dermatology in New York City. “Essentially, it’s designed to keep good things in and bad things out.”

But the skin barrier can become less effective when it’s physically disrupted. “Your skin is like a brick wall,” says Tien Nguyen, M.D., a board-certified dermatologist at MemorialCare Orange Coast Medical Center in Fountain Valley, California. “Each skin cell is like a brick in the wall, and between the bricks, there's the mortar, the fat molecules. When you have a gap between the bricks, it means there's something wrong with the mortar, and your skin barrier is compromised.”

An impaired skin barrier can cause the skin to lose moisture, leaving it dry, itchy, and more susceptible to bacteria, allergens, and other harmful substances. It’s like leaving all the windows and doors in your house open, so that all the dust, leaves, and even people can easily wander in and out of your house at any time.

Why It’s Important to Maintain a Healthy Skin Barrier

Not having a healthy skin barrier is one of the key issues in psoriasis. Many treatments currently available for psoriasis—whether it be the topicals, light therapy, or oral or injectable treatments—attempt to restore the skin barrier. They do this by modulating the immune dysregulation part of the skin barrier.

However, there are a few tricks that you can do yourself to help repair, preserve, and maintain the physical portion of the skin barrier, too. When both the physical and immune elements of the skin barrier are working together well, the skin can restore its smooth, clear appearance.

How to Help Protect the Skin Barrier

Here are some simple steps that can help you improve your skin barrier function.

Use Moisturizer

“Moisturizer can definitely be a helpful way to help restore that skin barrier. It helps to reduce some of that flaking on the surface and helps to reduce the itching,” Garshick says.

Stick with gentle moisturizers that your dermatologist recommends, as opposed to harsher moisturizers with colors or perfumes, Nguyen notes. “The best way to ‘seal a leaky wall’ is with lubrication,” he says.

Applying a thick layer of moisturizer once in the day may not be as helpful for your skin barrier as moisturizing several times per day—so moisturize frequently. “Put on a really light coat of moisturizer, but do it three or four times a day versus just once a day,” Nguyen suggests.

This advice is especially helpful during a flare so that that skin can be protected. Going back to the analogy above, moisturizers may act like a thin plastic wrap over the open doors and windows until the windows and doors can be repaired or closed. A gust of wind may rip the plastic wrap, so it may need to be covered many times.

Use Psoriasis Treatments As Prescribed

Use any topical or systemic treatments your dermatologist has prescribed, exactly as they’ve directed you to. Sticking to your prescribed regimen can help address the underlying inflammation, Garshick says. That’ll help keep your skin happier and healthier.

Avoid Skin Trauma

As much as you can, avoid trauma or injury to your skin. Tattoos, cuts, scrapes, and other skin injuries can lead to new psoriasis patches appearing in those areas. This process is called the Koebner phenomenon. In areas of already disrupted skin, more disruptions may aggravate the skin even further. Try wearing protective gloves when you’re gardening or working with your hands, and wear sunscreen when you’re going outdoors to prevent sunburns.

Encourage Gentle Exfoliation

Exfoliation is helpful to get rid of the dead skin cell buildup, which can also help topical treatments work better. But you don't want to use anything too physically harsh on your skin, like a scrub with beads or pumice stone.

Instead, look for chemical exfoliants, such as products with lactic acid and salicylic acid cream, like AmLactin or Cerave Psoriasis Moisturizing Cream. “[These] can help to both break down the dead skin cells and cause them to loosen, and then the exfoliation process helps to get them off the surface," says Garshick. Your doctor can recommend specific products.

Avoid Drying Out Your Skin

"At the end of the day, we know dry skin is itchy skin, and itchy skin becomes inflamed," Garshick says. Take short, warm showers (as opposed to long, hot showers). During dry times of year, you might use a humidifier in your home or workplace.

Check in with your doctor to make sure you’re using psoriasis treatments and products correctly and keeping your skin barrier function as healthy as possible.

You May Also Like:

• What’s the Best Type of Moisturizer for Psoriasis? A Q&A with Dr. Truong
• How to Care for Your Skin Between Psoriasis Flare-Ups
• 3 Ways to Create a Soothing Bath for Your Flaky, Itchy Skin