What is the skin barrier?
The skin barrier serves to protect the body and prevent water loss. It is formed by the outermost layer of the skin, called the stratum corneum, containing the protein keratin and dead skin cells (corneocytes) held together by a lipid intercellular matrix.
What are barrier creams?
Barrier creams and sprays are products that are applied directly to the skin surface to help maintain the skin’s physical barrier, providing protection from irritants and preventing the skin from drying out. Barrier products can also make it easier to remove paint, glue or sealant from hands during or after industrial or occupational work without necessitating the use of harsh solvents. They persist on the skin for several hours, even after gentle washing. They are applied sparingly, and reapplied as necessary.
Barrier creams are particularly useful in the management of:
- Hand dermatitis, due to contact with harsh chemicals, frequent contact with water or repetitive friction
- Napkin dermatitis (also known as diaper rash), due to contact with urine and faeces, in babies and in adults with incontinence
- Stoma dermatitis, due to body fluids and stoma appliances
- Sites prone to pressure sores in bed-bound subjects
- Very dry skin.
Conventional barrier creams
Ingredients in conventional skin barrier creams can be classified as either occlusives or humectants. Some products have a combination of occlusives and humectants.
- Occlusive ingredients are insoluble in water. They include petroleum jelly, silicone/dimethicone and zinc oxide.
- Humectants increase the skin’s ability to hold onto water. They include glycerine, sorbitol, urea, seaweed extract, hyaluronic acid and alpha hydroxy acids.
Petroleum based products are more effective at reducing transepidermal water loss and keeping the skin hydrated. Silicone/dimethicone barrier creams are less greasy and may be preferred aesthetically. Small amounts do not decrease dressing adhesion, hence their usefulness for stoma dermatitis.
Novel barrier creams
Novel barrier creams contain additional ingredients to promote healing of the skin barrier, such as ceramides and vitamin B3.
- Natural ceramides are an important component of the intercellular matrix of the stratum corneum. Creams containing synthetic ceramides are thought to be particularly useful in the management of atopic dermatitis.
- Vitamin B3 (also known as vitamin PP or nicotinamide) reduces trans-epidermal water loss and keeps the skin hydrated. It promotes repair of the skin barrier by stimulating the production of lipids in the intercellular matrix.
What are the risks and contraindications of barrier creams?
Barrier creams are usually very well tolerated. Although uncommon, some people may suffer from allergic contact dermatitis to components such as preservatives, fragrances and other ingredients in barrier creams.
Some occlusive barrier creams may aggravate acne when applied to the face. Most barrier creams should not be applied directly to broken skin.