Dr. Hilary Baldwin shares insights on the role of quality skin care in managing acne and rosacea from ARM 2023.

In the ever-evolving landscape of dermatology, Hilary Baldwin, MD, a board-certified dermatologist, and the medical director of the Acne Treatment & Research Center in Brooklyn, recently shed light on the critical role of quality skin care in managing acne and rosacea during the recent 2023 Acne and Rosacea (ARM) Meeting.

Dr. Baldwin, also a clinical associate professor of dermatology at Rutgers Robert Wood Johnson Medical Center, emphasized the pivotal role of discussions about quality skin care between physicians and patients dealing with acne and rosacea.¹ According to her, such discussions are integral to enhancing patients' ability to use medications effectively and ultimately improving treatment outcomes.

Exploring Skin Barrier and Microbiome Dynamics

Delving into the anatomical and functional layers of the skin, Dr. Baldwin highlighted the evolving understanding of the skin barrier's normal function over the past decade. She underscored the symbiotic relationship between the skin and the microbiome, with the skin providing essential nutrients and the microbiome contributing to homeostasis and host defense.

"When the skin barrier functions well, it keeps harmful substances out and moisture in, preventing inflammation and promoting effective innate immune functions," Dr. Baldwin explained.

Insights into Acne and Rosacea Conditions

She drew attention to acne as a barrier defect disorder, demonstrating increased Transepidermal Water Loss (TEWL) as a definitive sign.² Dr. Baldwin presented compelling evidence that compared to control subjects, acne patients exhibited greater TEWL, especially in more severe cases.² Furthermore, a decrease in ceramide levels, crucial for optimal skin barrier function, was evident in acne patients.²

Addressing the microbiome, Dr. Baldwin explored the baseline differences in the skin microbiome between acne patients and those with healthy skin. She questioned whether improving the microbiome could potentially influence outcomes.

Rosacea, another condition with barrier defects, was scrutinized by Dr. Baldwin. Increased TEWL, decreased stratum corneum hydration, altered lactic acid stinger reactions, elevated stratum corneum pH, and symptoms of itch, burn, and sting were observed in rosacea patients.^1-4 Studies showed that improper skin care exacerbated inflammatory and vascular lesions, emphasizing the direct impact of barrier issues on rosacea severity.^3-6

Practical Solutions: Recommended Products and Approaches

In a chicken-and-egg scenario, Dr. Baldwin questioned whether the abnormal microbiome caused altered barrier function or if barrier dysfunction led to dysbiosis. Regardless, she proposed a solution involving the simultaneous restoration of both microbiome and barrier function through the use of probiotics, prebiotics, and postbiotics:

• Probiotics: Items infused with live and beneficial microorganisms aimed at promoting skin health.
• Prebiotics: Products designed to nourish and support the growth of healthy microorganisms on the skin.
• Postbiotics: Encompassing non-viable bacteria, including heat-treated probiotic cells, lysed microbes, and cell-free supernatants containing metabolites, this category introduces an innovative dimension to skincare, emphasizing the broader spectrum of microbial components for skin well-being.

The discussion then turned to the role of moisturizers as potential prebiotics. Dr. Baldwin highlighted the necessity of moisturizing for microorganisms to thrive on the dry skin, emphasizing the importance of quality moisturizers. She detailed the characteristics of an effective moisturizer, citing Toleriane Double Repair moisturizer as an example. “This dermatologist-recommended product contains essential components like ceramide-3, niacinamide, and glycerin, contributing to its prebiotic nature,” she noted.

Toleriane Double Repair moisturizer has been shown to significantly increase levels of beneficial Xanthomonas spp. while decreasing staphylococcus spp. levels. Dr. Baldwin pointed out that increased hydration and ceramide replenishment, making it a suitable choice for sensitive skin.

Highlighting the potential disruption caused by cleansers, Dr. Baldwin recommended Toleriane cleansers for acne and rosacea patients. “The key criteria for an ideal cleanser include the presence of a gentle surfactant and low pH to effectively remove impurities without disturbing beneficial lipids, proteins, or normal flora,” explained Dr. Baldwin.

As dermatologists continue to explore innovative approaches to enhance patient outcomes, Dr. Hilary Baldwin's insights underscore the paramount importance of addressing skin barrier function and the microbiome in the management of acne and rosacea. The integration of quality skin care into treatment plans has the potential to revolutionize the way clinicians approach these common dermatological conditions.

References

1. 1. Baldwin H. The importance of quality skin care in acne and rosacea. Webinar presented at: Acne and Rosacea (ARM) Meeting; October 3, 2023. Accessed January 10, 2024.
2. 2. Yamamoto A, Takenouchi K, Ito M. Impaired water barrier function in acne vulgaris. Arch Dermatol Res. 1995;287(2):214-8. doi: 10.1007/BF01262335
3. 3. Darlenski R, Kazandjieva J, Tsankov N, Fluhr JW. Acute irritant threshold correlates with barrier function, skin hydration and contact hypersensitivity in atopic dermatitis and rosacea. Exp Dermatol. 2013;22(11):752-3. doi: 10.1111/exd.12251
4. 4. Lonne-Rahm SB, Fischer T, Berg M. Stinging and rosacea. Acta Derm Venereol. 1999 Nov;79(6):460-1. doi: 10.1080/000155599750009915
5. 5. Del Rosso JQ. The use of moisturizers as an integral component of topical therapy for rosacea: clinical results based on the Assessment of Skin Characteristics Study. Cutis. 2009 Aug;84(2):72-6
6. 6. Crawford GH, Pelle MT, James WD. Rosacea: I. Etiology, pathogenesis, and subtype classification. J Am Acad Dermatol. 2004;51(3):327-41; quiz 342-4. doi: 10.1016/j.jaad.2004.03.030