4-part series on What Causes Your Child’s Eczema – Defective Skin Barrier

Restoring Defective Skin Barrier (taken from nationaleczema.org, article by Peter Elias M.D.)

This is a 4-part (a little more technical) series inspired by a review article “Features of childhood atopic dermatitis” by Hugo Van Bever and Genevieve Illanora. The article summarizes 4 players involved in atopic dermatitis, and I’ve tried to understand whatever I could from the article and other research papers published online and hopefully digested the information accurately for you to read.

Why does my baby get eczema?

I’ve asked the same question countless times and I know it’s something to do with the genes (if you read my family tree post here); but exactly what causes eczema? Medical professionals are still trying to find the answer as finding the right answer can help them to find the right way to prevent/treat eczema. Apparently, it has all along been thought that eczema has something to do with a hyperactive immune system, which being too sensitive has wrongly thought that matters not harmful to the skin/body are harmful. Now, there’s a new outside-in hypothesis that it is the defective skin barrier that leads to more irritant and allergen penetrating the skin, inducing the immune system to increase production of IgE (that work as antibody). Too much IgE will lead to skin inflammation, asthma, hayfever and food allergy.

But why is the skin barrier defective?

This is caused by a few types of proteins, the most commonly cited one being the filaggrin (FLG), which serves to produce and protect the skin barrier. In people with eczema, there is lower level of FLG, resulting in flatter skin surface cells, disrupted protective fatty layer, reducing the moisturizing function of the skin and increasing water loss from the skin. Reduced FLG also increases the skin pH and leads to increased skin inflammation. The FLG does not explain all cases, because there are people without defective FLG but still has eczema and people with eczema, but no defective FLG. (Thus, it’s currently accepted as a few possible factors such as the gene, environment, allergy reacting together, in some way that we don’t know yet)

The Implication

In the table above, there are some current ways to restore our baby’s skin barrier mainly by moisturizing, FROM DAY ONE. This is because if the outside-in hypothesis is true, then the stronger the skin barrier, the less chances of allergen/irritant penetrating the body to cause the body to react hypersensitively. There is a chance then for us to stop the allergic march in our children, where eczema is replaced by asthma and rhinitis. Humidifier also helps to ensure that the environment is not too dry for the skin, especially during winter or if your air-con is on.

If you are interested in reading the research paper details, click here. To learn more about skin pH, read this very informative interview with dermatologist Dr Cheryl Lee where we break down for you the what is the normal skin pH, eczema skin pH (more alkaline), why it is important to get our skin to be slightly acidic and how much harm alkaline skincare products can do to our skin.

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Last update was on: 22 October, 2018 2:03 pm


  1. […] This is an interesting study and possibly have implications for people with defective skin barrier. Often, the skin barrier is considered defective for eczema children because it is dry (inability […]

  2. […] rash is triggered by contact with allergens. Secondly, the nature of eczema skin is dry and the skin barrier is defective. It requires applying emollient for moisturizing, protection from moisture (occlusion) loss and […]

  3. […] This is an article that looks at the studies being conducted, and it’s not exactly recent but I like it because it reinforces the understanding of outside-in hypothesis. […]

  4. […] moisture and have low skin lipids. The defectiveness of skin barrier is in-part genetic, linked to filaggrin gene, but also have an environmental element to it. In the study, the researchers put it succinctly […]

  5. […] I do KNOW that from the very beginning, eczema is partly due to the defective skin barrier, that one is born with. Why the bible? God knows even the hairs on our head, He would know that my […]

  6. […] Moisturize lots, within three minutes after shower and at every diaper change and do use a lotion or cream that does not contain the top allergens. You can click here to learn about reading label of sensitive skincare products. There are also studies showing that moisturizing reduces the severity of eczema and may help to prevent the allergic march. […]

  7. […] to form an effective natural barrier and  lacking in filaggrin, lipids and proteases (read post on cause-skin barrier) – point was made that no oral medication can improve skin barrier, but moisturizing remains […]

  8. […] – Related to filaggrin gene, read more in previous post here […]

  9. There’s a great new helpful skin care site at http://www.skinsalveation.com definately worth a visit

  10. […] covers what’s atopic dermatitis, its causes and treatment, including house dust mite and defective skin barrier (see the video link in the comments). Something new I’ve learnt from the video which has Dr […]

  11. Watch Dr Claudia’s video to see a wonderful illustration of how filaggrin works.

  12. […] is important to maintain the skin barrier, particularly when eczema child has a weaker skin barrier that allows for more allergens to penetrate. The recommended guideline is about 500ml per week, […]

  13. […] the 4-part series, you’ll see that there is no one clear cause of eczema. If it’s the skin barrier, then you may decide to take care of your child yourself to make 100% sure that her skin is […]

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