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Skin Barrier Repair Moisturizers

It is not easy to find the best skin barrier repair moisturizers unless you understand how to fix the skin moisture barrier.

Skin barrier repair products such as cleansers, oils, and creams may claim to repair the skin barrier when they do not. In fact, some barrier repair moisturizers actually injure the skin barrier if they do not have the correct ratio of ceramides, fatty acids and cholesterol!

How can this be true?

There is no proof needed to say a moisturizing cream "repairs the barrier" and there is much confusion about what a good barrier repair moisturizer is.

We will educate you on how to know if a barrier repair moisturizer is good and really strengthens the skin barrier as it claims. You will learn about the best cholesterol moisturizers and which fatty acids to look for in creams.

You can read here about what the skin barrier is here and what damages the barrier.

 The best barrier repair moisturizers have ceramides, fatty acids and cholesterol

How to Find the Best Skin Barrier Repair Products To Fix the Skin Barrier

The skin moisture barrier is strengthened by moisturizers with lipids. These barrier repair emollients should have all 3 types of lipids. The type of fatty acid can vary.  There are several types of ceramides used in barrier repair emollients. Most cholesterol moisturizers use animal derived cholesterol.  You can use beta sitosterol instead of cholesterol if you want a vegan cholesterol moisturizer.

The best barrier repair moisturizers must have these attributes to be good:

The 6 best dermatologist- recommended barrier repair moisturizers are:

  1. EpiCeram Cream (prescription)
  2. Medature PSL Repair Cream
  3. Zerafite Barrier Repair Cream
  4. Zerafite Soothing and Calming Cream
  5. Zerafite Wrinkle Defense Barrier Cream
  6. Zerafite Skin Brightening Barrier Cream

Here are other barrier repair moisturizers from medical grade skincare brands:


Best Barrer Repair Moisturizers

Find Moisturizers for the Skin Barrier By Skin Concern

It is best to choose moisturizers by your skin type.  We can help you shop once you take the quiz and find out your Baumann Skin Type.


Acne Prone Skin

In my patients that have dry skin and acne, I prefer using one of the Zerafite barrier repair creams or a Medature Moisturizer. I choose which moisturizer for the skin barrier to use based on what other skin concerns are present.

If my patients do not have any redness, stinging, or hyperpigmentation and are 29 years old or younger, I choose the following products:

  1.  Zerafite Barrier Cream if they have dry skin
  2. Medature PSL Repair Cream if they have dry skin
  3. Medature Barrier Balancing Gel Moisturizer if they have oily skin.

 I have tested these products on dozens of acne patients and have not seen any increase in breakouts.


Click here if you do not know if you have oily or dry skin.

I choose the Zerafite Brightening Barrier cream if my patients have dry skin, acne and dark spots from acne or any hyperpigmentation.

In patients who have acne and are over 30 or have an increase amount of sun exposure or aging risk such as pollution exposure, I choose the Zerafite Wrinkle Defense Barrier Cream.

For acne patients who also have very sensitive inflamed skin with redness and stinging, I choose the Zerafite Soothing and Calming that contains allantoin,  argan oil, grape seed oil, niacinamide to soothe the skin.

Aging Skin

For dry, aging skin that is wrinkle prone or sagging, I prescribe a barrier cream that has either retinol or antioxidants.

These are good barrier repair moisturizers for aging skin:

Hyperpigmentation

This barrier repair cream has the maltese cross structure and has many different skin lightening ingredients.  It is the only moisturizer that has the best type of fatty acids (unsaturated) to help lighten skin. (Many moisturizers actually stimulate skin pigment production!)

Sensitive Inflamed Skin

Sensitive skin that is red, has inflammation, or stinging needs soothing anti-inflammatory ingredients. If you have acne and rosacea, or your acne medications are too irritating, these are the best soothing barrier strengthening moisturizing creams for you.


How to repair your skin barrier

Repairing you skin barrier starts with good habits to stop damaging your barrier. I often see patients who are using the wrong cleanser or too much exfoliation and this is injuring their barrier. 

3 steps to repairing your skin barrier are:

  1. Stop habits that are hurting your skin barrier.
  2. Use a barrier safe creamy cleanser
  3. Find a good barrier repair moisturizer that has the characteristics described below.

Keep reading for more dermatologist tips to strengthen your skin barrier.

Do I need a barrier cream?

If you have dry dehydrated skin, you need a barrier repair moisturizer and a barrier safe cleanser.

The best way to find a good barrier repair cream is to take our dermatologist-developed quiz and shop by your Baumann Skin Type.


What is skin barrier cream?

A skin barrier cream has lipids that mimic the skin’s natural skin barrier structure. The lipids must be the correct type, shape and number so they match the skin’s intricate bilayer multilamellar structure. When the barrier is intact, the lipids prevent water from passing through.


intact barrier

Dry skin has tiny holes in the bilayer lipid membranes. This allows water to evaporate off the skin, leaving the skin dehydrated and unprotected from allergens, irritants and microbes.


broken barrier

Skin barrier creams replace lost lipids in the skin- which is similar to plugging holes in the skin- to keep the skin watertight and protected. However, the lipids must have the correct shape to properly plug the holes. This si why the type of fatty acids in moisturizers is important.

Barrier repair moisturizers are cream moisturizers that contain lipids that mimic the natural multilamellar structure of cell membranes.

These are the 3 types of lipids that are found in effective barrier repair products:

Most cholesterol is animal derived.  If you want a vegan barrier repair moisturizer, look for the ingredient beta-sitosterol instead of cholesterol.

Barrier repair creams that have a 1:1:1 ratio of lipids

structure of skin barrier

How do you know if a barrier repair moisturizer is good?

It is impossible to know if a moisturizer is good for the barrier by only reading the ingredients on the label.

The only way to know if the moisturizer has a 1:1:1 lipid ratio is if the company tells you (Skinceuticals Triple Lipid Repair has a 2:4:2 ratio for example), or if a cosmetic chemist reviews the formula and this is often proprietary information that the companies do not share.  Usually if there is a 1:1:1 ration, the company will be proud of that and will tell you. 

We analyze a moisturizer’s ability to repair the skin barrier by looking at it under a microscope using cross-polarized light. and look at the light pattern the lipid structure makes.

The best barrier repair moisturizers show the maltese cross pattern under the cross polarized microscope.


These are good barrier repair moisturizers because they show the maltese cross pattern:


  1. EpiCeram Cream (prescription)
  2. Medature PSL Repair Cream
  3. Zerafite Barrier Repair Cream
  4. Zerafite Soothing and Calming Cream
  5. Zerafite Wrinkle Defense Barrier Cream
maltese cross pattern barrier creams

How long does it take to repair the skin barrier?

How long does it take a barrier repair moisturizer to work?

A true barrier repair moisturizer will restore the the skin barrier in 14 days.1

There are many factors that affect how long it takes to fix the skin barrier:

  • Which moisturizer you use
  • Which cleanser you use
  • What caused the underlying skin barrier defect
  • What habits you have that disturb the moisture barrier
  • Other products in your skin care routine

To restore the skin barrier fast, you must make sure you have removed any skin care products that injure the barrier such as foaming cleansers, harsh exfoliants. and alcohol.


For the fastest results, Make sure your entire skin care routine is right for your Baumann Skin Type.


accelerate barrier recovery

How To Accelerate Skin Barrier Recovery

Assuming you are not doing any of the things that compromise the skin barrier, you can speed up how long it takes the skin barrier to be restored.

The following have been shown to affect how fast the barrier recovers:

  • Moisturizers containing humectants like glycerin2, in addition to barrier repair ingredients.3
  • Barrier repair moisturizers with saturated fatty acids like stearic acid and palmitic acid.4
  • Cleansers with saturated fatty acids ,such as creamy cleansers and cleansing oils
  • Exposure to 10-30 kHz of ultrasound waves5
  • The hormone estradiol speeds barrier repair
  • Avoid progesterone supplementation. Estradiol + progesterone slows barrier repair
  • Avoid testosterone supplementation because testosterone slows barrier repair.6
  • Magnesium rich epsom salts or dead sea salts7 8 in bath water speed barrier recovery
  • Decrease psychological stress9
  • Aromatherapy with stress reducing odors like lavender10
  • Red light exposure.11 12
  • Avoid ultraviolet light and blue light.
  • Temperatures between 97- 100 degrees13
  • Adequate sleep14

Using the right skin care products for your Baumann Skin Type is an important way to protect and repair your skin barrier

Many barrier repair products have moisturizing ingredients- but not all of these play a role in restoring the skin barrier.

There are many ingredients in skin barrier creams that claim to strengthen the skin barrier.

Best Ingredients to Repair the Barrier

Dermatologist Dr. Peter Elias and his team3 first described how to use lipids to restore the skin barrier.4

Since then, there have been many moisturizers that claim to use lipids to restore the skin barrier- however- very few barrier repair moisturizers contain the correct lipids in the correct ratio to restore the skin barrier.

Ceramides, fatty acids and cholesterol are the fats in barrier repair products that strengthen the skin barrier.

The best fatty acid to repair the skin barrier is stearic acid which is found in many oils like argan oil.

beta-sitosterol

Lipids (fats)

The best lipid  ingredients to repair the skin barrier:

Correct ratio of lipids for optimal barrier repair

As demonstrated by many studies5 6 7 the best ratio of lipids to restore the skin barrier is 1:1:1 (ceramides: fatty acids: cholesterol in equal amounts).

Using the wrong ratio of ceramides, cholesterol and fatty acids actually injures the skin barrier and delays repair.8

If a moisturizer has more ceramides than fatty acids and cholesterol, or more fatty acids than ceramides and cholesterol, the moisturizer will injure the skin barrier.9

This means that the barrier repair cream must have the same amount of ceramides as fatty acids and as cholesterol.

Skincare Ingredients and the Barrier

Alpha hydroxy acids (AHAs)

Is AHA good for a damaged skin barrier? Alpha hydroxy acids temporarily disrupt the skin barrier because they are humectants and exfoliants. However with time they improve the skin's ability to protect itself by making the stratum corneum more compact . AHAs and BHAs are not very effective at strengthening the skin barrier.

ceramides

Ceramides

There are many types of ceramides in skin care products. Why are ceramides important in skin creams?

  • The skin can make its own ceramides, but ceramide production is reduced in aged skin.11
  • Ceramides play a role in inflammation
  • Ceramides can be deficient in psoriasis and eczema.12

Avoid ceramide-containing moisturizers that do not have fatty acids and cholesterol as discussed above.

What are the best ceramides to look for on moisturizer ingredient labels?

Look for ceramide 1, ceramide 3, ceramide NP, or pseudoceramides on the product label.

cholesterol

Cholesterol

Barrier repair moisturizers must have cholesterol. In order for a moisturizer to truly repair the barrier, you need:

  1. The same amount of cholesterol as fatty acids and ceramides in a 1:1:1 ratio
  2. A maltese cross pattern of lipids

Moisturizers with cholesterol but no ceramides and fatty acids injures the skin barrier by disrupting the natural lipid puzzle piece pattern.

Is there a specific type of cholesterol to look for in barrier repair moisturizers?

The product label will say cholesterol or Beta Sitosterol, which is a vegan form of cholesterol. Cholesterol is able to get into the skin because of its hydrophobic lipophilic structure and a membrane transporter called ABCA1 that regulates cholesterol flow into the skin.13

Will cholesterol in skin care products raise my cholesterol levels in my body?

No. Cholesterol molecules stay in the top layers of the epidermis and are not absorbed into the bloodstream.

fatty acids to repair the skin barrier

Fatty Acids

It is hard to look at the product label to find which fatty acids are in a moisturizer because they go by many names that can be found in oils.

To learn more about how to find out the best fatty acids in barrier creams, click here.

What are the best fatty acids to repair the skin barrier?

There are many different things to consider when choosing which fatty acid to use in a moisturizer.

Stearic acid, linoleic acid and palmitic acid are the most commonly used fatty acids in barrier repair moisturizers.

The best fatty acids to look for depends upon your Baumann Skin Type®.

  1. Is skin dry or oily?
  2. Does skin have inflammation?
  3. Does the skin have an uneven skin tone?

Each of these skin issues should be considered when choosing fatty acids in moisturizers.


glycerin

Glycerin

Is glycerin good for the skin barrier? Glycerin is a humectant, not a barrier repair ingredient.

It pulls water to the skin's surface which helps the skin compensate for a defective skin barrier, but glycerin does not repair the skin barrier.

Glycerin does not hurt the skin barrier.  It is able to pass through aquaporin channels to help increase skin hydration but does not directly affect the skin barrier.

hyaluronic acid

Hyaluronic acid

Does hyaluronic acid repair the skin barrier ?No ! hyaluronic acid does not repair the skin barrier. Hyaluronic (HA) serums are humectants that pull water to the skin's surface. This gives temporary hydration but does not repair the barrier.

In fact, HA is not good for the skin barrier unless it is combined with an occlusive type of moisturizing ingredient. Using hyaluronic acid on skin with a broken barrier in a dry climate will actually dehydrate the skin. This occurs because humectants pull water from the skin in a dry environment.


If you want to use HA and your barrier is impaired, you must combine the HA with a barrier repair ingredients and occlusive ingredients such as oils.

Check out this barrier repair cream:


Derma Made Ceramide Barrier Cream 

niacinamide

Niacinamide

Does niacinamide help repair the moisture barrier? No it does not.

Niacinamide is a very interesting skin care ingredient used for anti-aging and soothing the skin. However, it does not have any effect on the skin barrier.

Niacinamide is often combined with barrier repair ingredients, but does not repair the skin barrier itself.


These are the 5 best skin barrier creams with niacinamide:

  1. Medature Barrier Balancing Gel Moisturizer
  2. Medature PSL Repair Moisturizer
  3. Zerafite Soothing and Calming Moisturizer
  4. Zerafite Skin Brightening Barrier Cream
  5. Zerafite Wrinkle Defense Barrier Cream

Oils to repair the skin barrier

Natural plant derived oils with large amounts of the fatty acids linoleic acid and stearic are the best oils to restore the skin barrier naturally.

Good oils for the skin barrier are:

Our favorite dermatologist recommended soothing oils that support the skin barrier:


retinol

Retinol

There are not many  barrier repair creams with retinoids at this time that are good. I usually tell my patients to use a retinol with a separate barrier repair moisturizer.  When you use the moisturizer with the retinol matters a lot

Using a barrier repair cream before retinol can decrease the penetration of the retinol and decrease side effects.

This is a good way to slowly begin using retinol.

Once you are used to your retinol, you can apply the retinol first and the barrier repair moisturizer on top. This can help push more retinol into the skin through occlusion.


A great barrier repair moisturizer with retinol:

Revision DEJ Night Face Cream

This is the only good barrier repair moisturizer wtht retinol that I could find.

Do you need a barrier repair moisturizer?

You need a skin barrier repair moisturizer if you have:

Let us help you see if you need a barrier repair moisturizer and if you do- we will help you find the best barrier repair products for your skin type!


Level up your skin care knowledge with medical advice from dermatologists

How long to repair the skin barrier?

If you are doing everything right in your skin care routine and use a good barrier repair moisturizer, you can repair the barrier within 14 days.

How to repair the skin barrier?

Stop using soaps, foaming cleansers, hot water and exfoliants and use a barrier repair moisturizer that shows the maltese cross pattern when viewed under a microscope.

How to repair the skin barrier naturally?

Use soothing oils on the skin and add flax seed oil or salmon to your diet.

Can a washcloth harm the skin barrier?

Any excess friction can harm the skin barrier. Also heavy fragranced detergents can cause barrier problems. Use a soft washcloth that has been washed with gentle fragrance free detergents.

What is the best ratio of lipids for optimal barrier repair?

As demonstrated by many studies (5, 6, 7) the best ratio of lipids to restore the skin barrier is 1:1:1 (ceramides: fatty acids: cholesterol in equal amounts). Using the wrong ratio of ceramides, cholesterol and fatty acids actually injures the skin barrier and delays repair. (8) If a moisturizer has more ceramides than fatty acids and cholesterol, or more fatty acids than ceramides and cholesterol, the moisturizer will injure the skin barrier. (9) This means that the barrier repair cream must have the same amount of ceramides , fatty acids and cholesterol.

What conditions do barrier repair moisturizers treat?

Eczema, psoriasis, dry skin, rough skin, keratosis pilaris, xerosis, ashy skin, and hypersensitive skin.

References

  1. De Paepe, K., Roseeuw, D., & Rogiers, V. (2002). Repair of acetone?and sodium lauryl sulphate?damaged human skin barrier function using topically applied emulsions containing barrier lipids. Journal of the European Academy of Dermatology and Venereology, 16(6), 587-594.
  2. Park, B. D., Youm, J. K., Jeong, S. K., Choi, E. H., Ahn, S. K., & Lee, S. H. (2003). The characterization of molecular organization of multilamellar emulsions containing pseudoceramide and type III synthetic ceramide. Journal of investigative dermatology, 121(4), 794-801.
  3. Elias, P. M. (2004). The epidermal permeability barrier: from the early days at Harvard to emerging concepts. The Journal of investigative dermatology, 122(2), xxxvi.
  4. Mao-Qiang, M., Feingold, K. R., Thornfeldt, C. R., & Elias, P. M. (1996). Optimization of physiological lipid mixtures for barrier repair. Journal of Investigative Dermatology, 106(5), 1096-1101.
  5. Man MQ, Feingold KR, Elias PM. Exogenous lipids influence permeability barrier recovery in acetone-treated murine skin. Arch Dermatol. 1993;129(6):728-38.
  6. Baumann L. Ch 43 Moisturizers in Baumann’s Cosmetic Dermatology 3rd edition (McGraw Hill 2022)
  7. Man, M. Q., Feingold, K. R., & Elias, P. M. (1993). Exogenous lipids influence permeability barrier recovery in acetone-treated murine skin. Archives of dermatology, 129(6), 728-738.
  8. Mao-Qiang, M., Feingold, K. R., Thornfeldt, C. R., & Elias, P. M. (1996). Optimization of physiological lipid mixtures for barrier repair. Journal of Investigative Dermatology, 106(5), 1096-1101.
  9. Man MQ, Feingold KR, Elias PM. Exogenous lipids influence permeability barrier recovery in acetone-treated murine skin. Arch Dermatol. 1993;129(6):728-38.
  10. Zettersten EM, Ghadially R, Feingold KR, Crumrine D, Elias PM. Optimal ratios of topical stratum corneum lipids improve barrier recovery in chronologically aged skin. J Am Acad Dermatol. 1997;37(3 Pt 1):403-8.
  11. Jensen, J. M., Förl, M., Winoto?Morbach, S., Seite, S., Schunck, M., Proksch, E., & Schütze, S. (2005). Acid and neutral sphingomyelinase, ceramide synthase, and acid ceramidase activities in cutaneous aging. Experimental dermatology, 14(8), 609-618.
  12. Li, Q., Fang, H., Dang, E., & Wang, G. (2020). The role of ceramides in skin homeostasis and inflammatory skin diseases. Journal of dermatological science, 97(1), 2-8.
  13. https://cdn.mdedge.com/files/s3fs-public/issues/articles/70891_main_0.pdf
  14. Elias, P. M. (2022). Optimizing emollient therapy for skin barrier repair in atopic dermatitis. Annals of Allergy, Asthma & Immunology, 128(5), 505-511.
  15. Harris-Tryon, T. A., & Grice, E. A. (2022). Microbiota and maintenance of skin barrier function. Science, 376(6596), 940-945.
  16. Li, Z., Jiang, R., Jing, C., Liu, J., Xu, X., Sun, L., & Zhao, D. (2022). Protective effect of oligosaccharides isolated from Panax ginseng CA Meyer against UVB-induced skin barrier damage in BALB/c hairless mice and human keratinocytes. Journal of Ethnopharmacology, 283, 114677.
  17. Tricarico, P. M., Mentino, D., De Marco, A., Del Vecchio, C., Garra, S., Cazzato, G., ... & Calamita, G. (2022). Aquaporins are one of the critical factors in the disruption of the skin barrier in inflammatory skin diseases. International Journal of Molecular Sciences, 23(7), 4020.

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