Ep 161 – The Rogue Pharmacist: The Key to Proper Skin Barrier Protection

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0:00:55.3 Maggie Staszcuk: Hello and welcome to ASCP and the Rogue Pharmacist with Benjamin Knight Fuchs. In each episode, we'll explore how internal and external factors can impact the skin. I'm Maggie Staszcuk, ASCP's Education Program Manager, and joining me is of course, Ben Fuchs. Hey, Ben. 

 

0:01:11.3 Benjamin Knight Fuchs: Hello Maggie. 

 

0:01:12.2 MS: Glad you could join me. 

 

0:01:13.4 BF: Thank you so much for inviting me. 

 

0:01:15.1 MS: So proper skin barrier protection seems obvious. 

 

0:01:18.3 BF: Yeah. 

 

0:01:18.8 MS: But for many people, even understanding what the "barrier" is can be confusing, and in this industry you often hear the saying, "Break it down to build it up." 

 

0:01:30.0 BF: Oh, I love that. I love it. 

 

0:01:30.8 MS: So yeah, explain to us the skin barrier and the proper way to protect it. 

 

0:01:35.0 BF: First of all, break it down and build it up is so awesome to me, because it's counterintuitive. I want to build it up, break it down. That doesn't... What? I want to build a now not break it down, but it turns out, obviously, like you just said, build up... A breakdown proceeds build up. In fact, I don't if we ever talked about anti-fragility. Did we ever talk about anti-fragility?  

 

0:01:53.7 MS: No. 

 

0:01:53.8 BF: This is a concept that was... It's a title of a book called Anti-Fragile by a guy named Nassim Taleb, and he came up with this concept, which is based on the idea that things... Systems are either fragile, they break down, or non-fragile, they don't break down. Like China, for example, breaks down, right? Steel doesn't break down, but there's a third element, a third type of system, and that's an anti-fragile system, and that's a system that builds up after it's broken down. And this is the title of his book, and he mentions all kinds of anti-fragile systems, and the classic example of an anti-fragile system is the body. When you want to have build... When you have big muscles, what do you do? Break them down. You exercise, exercise is tearing down the muscles, the muscles grow back. Another anti-fragile system is your plants. 

 

0:02:38.4 BF: If you want to have nice bushy leaves, what do you do? You trim them back right? And again, that's counterintuitive. I want to have nice bushy leaves. What do you tell me? Trim them back. Yes, cause you trim them back, they grow and they get bushier, and that's the hallmark of an anti-fragile system. Skin is likewise an anti-fragile system, and it always... I still hear this from people who should know better, estheticians sometimes, skincare professionals sometimes, doctors, and they'll say, "Don't break down the stratum corneum. It's not good to break down the stratum corneum." 

 

0:03:05.3 BF: There's some guy here in town actually who goes around saying, "Don't exfoliate." That's what breaking down the stratum corneum is. And that misses the idea of the system as an anti-fragile system. Can you overdo it? Yes, you can overdo it, obviously, but that doesn't mean you don't want to do it at all. So the stratum corneum, which is the technical name from the barrier, is to me, the most fascinating tissue in all of biology. Why do I say that? What is the key or the most distinguishing feature of the stratum corneum that we all talk about?  

 

0:03:32.0 MS: It's dead. 

 

0:03:32.7 BF: It's dead, right? That is so amazing to me. You have this dead tissue on the surface of the skin, but that dead tissue is incredibly, incredibly important. And even though it's overall dead, there is biochemistry that's occurring in the stratum corneum, so real quick, I'm sure most estheticians all know this, that the skin is stratified, it's layered, right? And don't take that for granted. I mean, we're in the skin business. We all... We're from day one, when we're studying skin, we learn that the skin is stratified, but the average person does not see that. When you look at your skin, where's the stratification? Where's the layers? There's nowhere. In fact, I sometimes wonder what a non-skin professional actually thinks of this thing, right? I mean, it certainly doesn't look like an organ. 

 

0:04:14.5 MS: It's like a rubber suit. 

 

0:04:15.7 BF: Right?  

 

0:04:16.1 MS: Yeah. 

 

0:04:16.3 BF: It's like this complete 100% covering of the body. And it's a amazing, amazing organ. So it's stratified, and at the very top you have what's called the stratum cornea, which means the hard layer. In fact, the stratum corneum itself is layered. There's layers of the stratum corneum. Keep it on perspective. The skin itself is about as thick as maybe 11 pieces of notebook paper, whole skin. 10 of those pieces of notebook paper are in what's called the dermis. That's the lower levels, and then above that, you have the epidermis. That's about as thick as one piece of notebook paper, and then the stratum corneum, this barrier that's about as thick as a half, maybe a 10th of a piece of notebook paper. Okay, that's pretty thin, but that's stratum corneum barrier, thin as it is, and dead as it is, holds everything in place. If you didn't have a stratum corneum barrier, you'd just be scattered all over this room, right? The stratum corneum is holding everything in place. So it's incredibly, incredibly important. Not only is it holding everything in place, but it also acts as a barrier to protect the tissue underneath. 

 

0:05:18.8 BF: So keeping the stratum corneum healthy is the key to keeping your skin healthy. When the stratum corneum barrier is not as healthy as it should be, you get sensitive skin, you get dry skin, you could get hyperpigmentation, you could have bacterial salt issues. You could have all kinds of health problems just by not having a healthy, strong stratum corneum barrier. So understanding how to build a healthy stratum corneum barrier is the very essence of good skin care. And there's lots of ways to do it. First of all, the stratum... Well, let's just talk about how the stratum cornea is built. So you have these layers, right? The bottom layer of the epidermis, which itself on top of the dermis is made up of stem cells. And then those stem cells give rise or give birth to, if you will, to skin cells. The technical name for skin cell is a keratinocyte. 

 

0:06:11.6 BF: Keratinocyte means a cell, cyte means a cell, and keratin is a hard protein that these cells manufacture. So the keratinocyte is born at the bottom of the basal layer round and plump and juicy. And in one of the coolest processes, in fact, I think it's... I'm partial to the skin, but I think this is the coolest process in all biology. That's keratinocytes round and plump and juicy, born in the stratum, in the basal layer, stratum basale, but rises up to the top, and as it's rising up to the top from the basal layer upwards to the stratum corneum, it's shape-shifting. It's changing shape from round and plump and juicy at the beginning to flatten and dead at the end. And as it's rising from the bottom to the top, it's losing its contents and it's shape-shifting, and its contents are getting dumped overboard, and biochemical changes are occurring inside that keratinocytes as it's rising to the top. This is so amazing how this is happening. And there's a lot of chemistry that has to go right for this to occur. 

 

0:07:09.4 BF: If there's nutritional deficiencies, if there's inflammation, if there's toxicity, that process does not occur as it should. And almost all skin diseases, including psoriasis and acne and eczema and dry skin, hyperpigmentation, all of these can result from defects in the movement of cells as they're rising from the bottom to the top. Now, because they're taking on a different shape as they... Rising from the bottom to the top, these keratinocytes are taking on a different shape, we call this process differentiation. And this differentiation process is the key to healthy, beautiful skin because as the shape-shifting is occurring, as the cell is differentiating and it's dumping its contents overboard and it's changing chemistry inside of the cell, it's making a perfect stratum corneum cell, which is called a corneocyte. 

 

0:08:00.2 BF: And this is what I mean, the contents that are dumped overboard, number one, those will go to form fats that will coat the surface of the skin. Inside the keratinocytes as it's rising from the bottom to the top, there are biochemical changes that are occurring that are going to produce natural moisture factor molecules in the corneocyte to trap water. So, and then the shape-shifting itself is creating a flat dead cell that is perfect for functioning as a barrier. So this stratum corneum barrier, all the elements of the stratum barrier are being produced as the cell is rising from the bottom to the top, which makes this differentiation process key. As we get older, we don't differentiate as quickly, our cells don't rise from the bottom to the top as quickly. And this accounts for stratum corneum barrier defects under conditions of nutritional deficiencies. 

 

0:08:52.2 BF: This we don't differentiate correctly. Again, this accounts for stratum corneum barrier defects. If we have toxicity from the digestive system such as leaky gut, and there's inflammatory factors located in the skin that are dumped off into the skin through the bloodstream, again, we don't differentiate correctly, and we have stratum corneum barrier defects. And stratum corneum barrier defects are epidemic. They're endemic in the culture. Almost everybody who's not taking care of their skin is going to have some degree of stratum corneum barrier defects, and this is where eczema shows up. This is where psoriasis shows up. This is where acne shows up. This is where dry skin shows up, hyperpigmentation shows up, sensitive skin shows up. So building the stratum corneum barrier is the very essence of anti-aging skin care and it's what every aesthetician should be focusing on with their clients and what every patient should be focusing on with their skin. 

 

0:09:44.7 BF: So how do you do it? Well, speeding up or stimulating the movement of cells from the bottom to the top is very important. That is helping cells go from the stem cell level to the keratinocytes level and then rising up to the stratum corneum. And that's where exfoliation comes in. And exfoliation is like exercise. And this to me, it's crazy not to be exfoliating on a regular basis because this is your main weapon for turning on the growth or the movement of cells from the bottom to the top. Now, exfoliation also has stimulating effects on the dermis. We won't even get into that, but also has effects on the fibroblasts for collagen and elastin and hyaluronic acids and such. But just for the epidermis and just for the stratum corneum barrier, exfoliation is very important. 

 

0:10:24.9 BF: But if you have a defective stratum corneum, you gotta be careful because you wanna stimulate. But if you've got a defective stratum corneum, you could be overstimulating. So you've gotta know it's an art form. You gotta know how to do it just right. You can't overstimulate, but you gotta stimulate. Anything that's gonna build the stratum corneum barrier is gonna be stimulating. And if your skin is already defective or barriers already defective, things that are stimulating can be overstimulating. So it's kind of an art form on how to stimulate the skin. You gotta start off slowly, you gotta take days off, kinda like an exercise program. If you just got outta the hospital, you're not gonna get on the bench and start benching 225 pounds, but that doesn't mean you don't wanna start somewhere. Likewise, with an exfoliation program. 

 

0:11:07.3 BF: I like alpha hydroxy acids for a couple of reasons. There's lots of ways to exfoliate. You can exfoliate with washcloth or you can exfoliate with enzymes or you can exfoliate men when they shave or loofah pad. There's lots of ways to exfoliate, but alpha hydroxy acids are really neat. And I'll tell you why. Alpha hydroxy acids not only turn on the growth of cells by virtue of their ability to disrupt the stratum corneum, they dissolve the glue that holds the corneocyte together, and that in turn sends a signal down to the bottom: "Hey, let's get some more cells going." But alpha hydroxy acids do a couple of other very interesting things. Number one, they deliver acids in the form of something called protons to the cells underneath, and that has an extra stimulating effect at the level of the keratinocytes. So you get a stimulating effect by virtue of the dissolution or the disturbance of the corneocytes, but then you get an extra benefit by protons and by acid, which turn on the... Which further stimulate the keratinocytes. 

 

0:12:02.7 BF: And also the skin is acidic. The stratum corneum has to be acidic. That's its nature. As we age or as our skin is unhealthy, or if there's any kind of barrier disruption issues or nutritional deficiency issues, the skin pH becomes alkaline and under alkaline or relatively alkaline, if not frankly alkaline. Relative alkalinity of the skin creates an unhealthy environment for the microbiome, the skin microbiome. It creates an unhealthy environment for the skin cells. It creates overall disturbances in skin health. So alpha hydroxy acids have an acidifying effect. In fact, alpha hydroxy acids are actually in the stratum corneum anyway. One, remember, the stratum corneum is acidic, and it maintains this in that acid is called the acid mantle. You probably know that. The acid mantle is made up of alpha hydroxy acids, lactic acids specifically, as well as amino acids and fatty acids. So alpha hydroxy acids restore the acidity of the skin surface. They stimulate the keratinocyte by delivering protons or pieces of acid, if you will. And they have a exfoliating effect, a disturbing effect on the corneocytes, which also triggers the growth of cells. That triad of benefits to me makes alpha hydroxy acids the ideal way to exfoliate the skin. There are other ingredients that you could use. 

 

0:13:20.0 BF: Retinol also has an exfoliating effect, or retinoic acid, if you get a prescription, has an exfoliating effect. And that will also turn on the growth of cells. And then, as I said, even like a washcloth or a loofah pad can do it too. In terms of the composition of the stratum corneum, it's made up of... In a brick and mortar, you've heard this kind of brick and mortar model they talk about, the bricks are the corneocytes, the corneocytes, building the strong cornea acidic section or compartment of the stratum corneum is done by exfoliation, but then there's the mortar. And the mortar is just as important as the bricks, if not more important. And the mortar is made up of fats. So making sure that you're ingesting enough fats, dietary fats through foods and through supplements, is really important to keep the fat, to keep the fatty compartment of the stratum corneum healthy. Specifically a type of fat called phospholipids as well as ceramides, which are derived from essential fatty acids, are key for keeping the mortar component or mortar compartment of the stratum corneum healthy. 

 

0:14:23.6 BF: So making sure you're supplementing with lecithin, essential fatty acids, making sure you're eating eggs and grains and avocados and fatty fish. All of these are great ways to make sure that you keep the fatty compartment of the stratum corneum healthy, and then stimulating the growth of cells or the differentiation of cells from the basal layer to the top will keep the corneocytes compartment healthy. And then last but not least, those molecules inside the corneocytes called the natural moisture factor are derived from various proteins, various amino acids. And so making sure you have a good source of aminos is also important. Specifically things like glutamine, arginine. And then also there's a really, really important and very underappreciated amino acid that everybody with dry skin should be using is an amino acid called histidine, which is very underappreciated and most people don't know about it. 

 

0:15:17.3 BF: Everybody with dry skin, dermatitis, barrier defect issues should be supplementing with histidine or using... Eating high protein foods that contain histidine. If the barrier is defective and you have water loss, they call it TEWL, Trans-epidermal water loss which you don't wanna do, except maybe in the short term for emergencies, is use a moisturizer, because what a moisturizer will do is it's gonna suppress all that wonderful chemistry that we just talked about. The differentiation, the production of the natural moisture factor, the deposition of fats, or the production of fats. All of that's gonna be suppressed by a moisturizer. So if you use a moisturizer, use it temporarily, very short term, don't use it long term. 

 

0:15:58.6 BF: I always find it incredibly ironic that everybody has moisturizers everywhere in their purse and in their car and in their locker and in their bathroom cabin, in their kitchen cabin, in their office, and everybody has dry skin. And we sell billions of dollars of moisturizers in this country, and everybody has dry skin. So obviously moisturizers are not the answer. The answer is exfoliation, nutritional supplementation, dietary strategies, making sure you build the stratum corneum barrier from the stratum... The basal layer upwards, not coating the skin with some kind of wax or oil or whatever it is that would suppress it. If you do wanna use a moisturizer, use a nutritional moisturizer, something like fat soluble vitamin C, which will always get you the nutritional benefits that will help support the building and the strengthening of the stratum corneum barrier, not just have a suppressant effect. 

 

0:16:46.5 MS: Ben, that was an amazing recap on the skin and the barrier function, and that wraps our show for today. And we thank you for listening. But if you just can't get enough of Ben Fuchs, the ASCP Rogue Pharmacist, you can listen to a syndicated radio program @brightsideben.com. For more information on this episode, or for ways to connect with Ben Fuchs or to learn more about ASCP, check out the show notes.