How to repair a damaged skin barrier, step by step

A damaged skin barrier repairs itself once you stop damaging it. Your skin barrier is the top layer of skin that keeps water in and irritants out, and the body keeps rebuilding it. Your job is to remove what is hurting it, protect it while it heals, and wait. This guide gives the steps in order, what the research says about how long each stage takes, and how to bring your usual products back without starting over. It is part of Skinli's guide to a damaged skin barrier.

Skinli gives general education and is not a doctor. If you use a prescription product, ask the doctor who prescribed it before you stop or change it.

Before you start: is it a damaged barrier?

The usual signs are stinging from gentle products, redness, tightness and flaking where you apply products, soon after a change in your routine. Skinli's guide to the signs of a damaged skin barrier explains how to check. Blisters, weeping, crusts, a spreading rash or swelling need a doctor first, and this plan does not replace that visit.

Step 1: stop what is causing it

The NHS says that for contact dermatitis, the skin reaction to an irritating substance, "one of the most important steps in treating contact dermatitis is identifying and avoiding the allergens or irritants that affect you." The same applies to a barrier damaged by your routine.

Pause these until your skin is calm:

• Exfoliating acids, such as glycolic, lactic and salicylic acid, in any product
• Scrubs, brushes, cleansing devices and peel pads
• Retinoids, including retinol, adapalene and tretinoin
• Benzoyl peroxide
• Toners and astringents with alcohol
• Anything with fragrance

The American Academy of Dermatology (AAD) tells people with dry skin to stop products containing alcohol (except hand sanitizer), fragrance, and retinoids. The adapalene 0.1% store label says not to use it on damaged skin, "cuts, abrasions, eczema, sunburn." For prescription tretinoin, the Retin-A label says that if the skin becomes excessively red, swollen, blistered or crusted, the medicine "should either be discontinued until the integrity of the skin is restored, or the medication should be adjusted to a level the patient can tolerate." That decision belongs to your prescriber.

Step 2: wash less, and more gently

• Wash your face twice a day at most, with a gentle cleanser that does not contain alcohol, as the AAD advises.
• Use your fingertips. The AAD says a washcloth, mesh sponge or anything other than fingertips can irritate the skin.
• Use lukewarm water and pat dry with a soft towel.
• Keep showers to five to ten minutes in warm water, as the AAD recommends for dry skin.

Skinli's guide to gentle cleansers for a damaged skin barrier explains what to look for on the label.

Step 3: moisturize often

Moisturizer is the one product that actively helps. MedlinePlus says emollients, another word for moisturizers, "help keep the skin moist, and also help skin repair itself," and are "a key part of preventing and treating irritant contact dermatitis."

• Apply right after washing, while skin is still damp, and again whenever your skin feels dry or tight. The AAD says to apply moisturizer several times a day when skin is dry. The NHS says emollients can be used as often as you like, ideally at least 3 or 4 times a day, and that "you cannot overuse them."
• Choose a cream or ointment that is fragrance-free. The AAD says creams and ointments add more moisture than lotions. Skinli's guide to moisturizers for a damaged skin barrier covers ingredients.
• Use petroleum jelly on the sorest areas. The AAD suggests petroleum jelly or a cool compress to relieve a skin reaction, and calls it an inexpensive product for moisturizing dry skin. A 1992 study published in the AAD's journal found it helped the barrier recover faster in volunteers whose barrier had been damaged on purpose.

Step 4: protect it from the sun

Some of the products you paused increase sun sensitivity: the AAD says retinoids can make skin more sensitive to the sun. Keep using sunscreen every morning. If your usual sunscreen stings, the AAD suggests one with zinc oxide, titanium dioxide or both (a mineral sunscreen), without fragrance. The AAD also recommends a physical sunscreen with these ingredients for people with sensitive skin who use retinoids. On days when even that stings, rely on shade and a hat.

Step 5: protect it from dry air

The AAD recommends a humidifier when the air is dry, for example in winter with the heating on, and says to place it in the bedroom and run it while you sleep, cleaning it regularly to prevent mold. The Retin-A label warns that wind and cold can irritate skin treated with tretinoin, so cover up outdoors in harsh weather.

Step 6: wait, and know what to expect

What happened	How fast the barrier recovered	Source
Barrier stripped with tape or a solvent, adults aged 20 to 30	50% at 24 hours, 80% at 72 hours	1995 study in the Journal of Clinical Investigation
The same test, adults over 80	15% at 24 hours, then slower	Same study
Dry skin treated with good self-care	Improvement within 2 weeks	AAD
Contact dermatitis with the cause avoided	Clears in 2 or 3 weeks in most cases	MedlinePlus

The lab study damaged the barrier once, in a controlled way. Weeks of over-exfoliating or a strong peel can take longer. Use the table as a guide only, and judge by how your skin feels and looks.

How to tell it has recovered

No home test measures the skin barrier. Researchers use a probe that counts water escaping from the skin. At home, Skinli's practical test is that the barrier has recovered when all of these are true for a few days in a row:

• Your moisturizer and sunscreen do not sting.
• Your face does not feel tight an hour after washing.
• The redness and flaking are gone.
• Water on your face feels like water, with no burning.

Bringing products back

Go slowly, or you will be back at step 1. Skinli's approach:

1. One product at a time. Wait two to three weeks before adding the next, so you know what caused any reaction. The AAD warns that trying new products too often can leave you with irritated skin and no progress.
2. Test it first. The AAD's home test is to apply the product to a small spot twice a day for seven to 10 days. See how to patch test a new skincare product.
3. Start retinoids every other night. An AAD dermatologist advises using the least intense retinoid you can find every other night at first. NICE, which writes guidance for England, suggests alternate-day use or washing the product off after an hour at first. The AAD adds that a dermatologist may suggest a smaller amount or moisturizer first.
4. Leave exfoliating acids for last, and use them less often than before.

For acne treatment, Skinli's free acne plan starts adapalene 0.1% and benzoyl peroxide 2.5% every other night for two weeks, and for easily irritated skin it washes the gels off after an hour at first.

Why it might not be healing

If two weeks of this plan have not helped, look for these:

• A hidden irritant. Acids in a cleanser or moisturizer, fragrance, or a product you forgot to count.
• A reaction to the moisturizer. The NHS says an emollient can start to irritate the skin after a while, and that burning or stinging that does not settle after a few days of use is usually a reaction to an ingredient.
• A skin condition. Eczema, contact allergy, rosacea and perioral dermatitis can all look like a damaged barrier. The AAD says to see a dermatologist when dry skin continues after good self-care, because an underlying condition may be the cause. Skinli's guide to eczema vs dry skin explains one difference.
• Infection. Yellow crusts, pus, or hot, swollen skin need a doctor.

When to see a doctor

See a doctor or pharmacist if your skin blisters, cracks, bleeds or weeps, if a rash spreads, if you see signs of infection, or if nothing has improved after two weeks. The NHS says a doctor can prescribe a steroid cream for sore, inflamed skin from contact dermatitis. Call emergency services for swelling of the lips, tongue or throat, or trouble breathing.