Understanding Eczema and the Skin Barrier
How to Repair, Protect, and Restore Your Skin this Autumn/Winter
by Dr Caroline Warden NHS GP, cosmetic dermatology and aesthetic doctor in Hale, Cheshire
Eczema is more than just dry, itchy skin. For many people, it’s a daily struggle that brings discomfort, stress, and sometimes embarrassment. Sleepless nights, avoiding short sleeves, worrying about flare-ups at the worst possible time, these are things my poor patients tell me regularly.
The good news? At the root of eczema lies something we CAN target: the skin barrier.
When this barrier is repaired and protected, flare-ups become easier to manage and confidence begins to return.
In this guide, i’ll explain:
What eczema really is
How the skin barrier works
Why it breaks down
A real-life patient story from our Hale clinic
Practical steps to support and repair your skin
What Is Eczema?
Eczema (also known as atopic dermatitis) is a chronic inflammatory condition that causes:
Dry, flaky patches
Itching and irritation
Redness and inflammation
Cracked, sore, or weeping skin
It can affect just about anyone, babies, kids and adults, usually coming in cycles of flare-ups followed by calmer periods.
But the core problem isn’t just inflammation.
It’s a weakened skin barrier.
Meet Your Skin Barrier
Think of your skin barrier as a brick wall:
Bricks = skin cells (corneocytes)
Mortar = lipids (ceramides, cholesterol, fatty acids)
This wall locks in hydration, keeps irritants and microbes out, and protects against infection.
When strong, skin feels smooth, supple, and healthy.
When damaged (as in eczema), moisture escapes, irritants sneak in, and inflammation takes over.
The Eczema Cycle
Eczema often follows the same frustrating cycle:
Barrier weakens → moisture escapes.
Irritants and allergens enter the skin.
The immune system flares → redness, itching.
Scratching damages the skin more.
Cycle repeats.
It’s this itch–scratch–flare loop that makes eczema so stubborn.
Why Does the Barrier Break Down?
Several factors play a role:
Genetics → mutations in the filaggrin gene weaken the barrier.
Lipid imbalance → fewer ceramides = drier, leakier skin.
High pH → less acidic skin encourages bacterial growth.
Immune overactivity → chronic inflammation keeps the cycle going.
Case Study: Ellie’s Journey in Hale
*Ellie, 29, came to our Hale clinic feeling desperate and defeated. She told me she had always struggled with eczema on her face, hands and elbows since childhood. Winters were the worst giving her cracked, painful skin that sometimes bled. She avoided getting her hands out and long-sleeved tops had become her “safety blanket.”
She told me:
“I’ve tried every cream on the pharmacy shelf and recommended on Instagram. Steroids helped for a bit, but it always came back. I just wanted to feel normal again.”
My Plan for Ellie
Barrier Repair.
I switched her to the Obagi gentle cleanser and a ceramide-rich moisturiser called Adex, used twice daily.
Calming Inflammation
Thoclor (hypocholorous acid) twice a day as a toner
Supporting the Microbiome
We introduced a probiotic-based cream to rebalance her skin’s natural defences called obagi ‘rebalance’
Lifestyle & Education
I helped her identify triggers (stress, hot water, fragranced products) and taught strategies to protect her barrier.
Results (6 weeks later)
70% fewer flare-ups
No more cracked, weeping skin
Skin felt stronger, less reactive
Confidence improved, she wore short sleeves again for the first time in years! WIN
Ellie said:
“Understanding my skin barrier changed everything.
For the first time, I feel like I’m in control”
How to Repair and Protect Your Skin Barrier
1. Moisturise - you can’t lather in on enough
Choose products with ceramides, cholesterol, fatty acids, urea, or colloidal oatmeal. Apply after bathing and reapply as needed.
2. Avoid Barrier-Damaging Ingredients
No fragrance, essential oils, harsh soaps, scrubs, or alcohol-based toners.
3. Protect Against Triggers
Use lukewarm water, not hot.
Moisturise within 3 minutes of bathing (“the 3-minute rule”).
Wear cotton instead of wool.
Use gloves when cleaning or washing up.
4. Calm Inflammation
During flare-ups, prescription creams or barrier repair creams with niacinamide or panthenol can help.
5. Support Your Skin Microbiome
Probiotic skincare and medical treatments can help reduce bacterial overgrowth and restore balance.
FAQs About Eczema and the Skin Barrie
1. Can eczema be cured?
Eczema is a chronic condition, but with the right care and barrier support, flare-ups can be managed and reduced.
2. Is eczema caused by allergies?
Not always. Allergies can trigger flare-ups, but the underlying issue is usually a weakened barrier.
3. What’s the best moisturiser for eczema?
Fragrance-free creams rich in ceramides and fatty acids. Ointments are often more effective than lotions.
4. Can stress make eczema worse?
Yes, stress increases inflammation and often triggers flares.
5. Is it safe to use steroid creams?
Short-term use under medical guidance is safe, but long-term management usually involves barrier-focused treatments.
6. How quickly will I see results?
Many patients see improvements within 4–6 weeks when the barrier is consistently repaired.
7. Can diet help with eczema?
For some, yes. Omega-3s, anti-inflammatory foods, and avoiding individual triggers may help.
Final Thoughts: Treating the Cause, Not Just the Symptoms
Eczema can be overwhelming, but real progress happens when you focus on repairing the skin barrier, not just fighting inflammation.
With the right skincare, medical support, and lifestyle changes, your skin can become calmer, stronger, and more resilient.
👉 At my Hale clinic, we create personalised eczema management plans that focus on barrier repair, medical-grade skincare, and microbiome support. Book your consultation today.
Dr Caroline Warden is an experienced NHS GP and aesthetic doctor. She has been a medical doctor for over 18 years. Her Skin and Aesthetic Clinic is located in Hale, Cheshire
Whether you're new to aesthetic treatments or ready to refine your routine, her bespoke skin assessments are the best place to start. She’ll design a tailored plan based on your skin goals, lifestyle, and timeline.
Book your consultation at the clinic in Hale, Cheshire and experience aesthetic medicine.
You’ll be guided through your medical history, goals, and expectations so you can make an informed choice.
Our main Hale clinic is local To:
Alderley Edge, Altrincham, Bowdon, Bramhall, Hale Barns, Knutsford, Manchester, Mobberley, Sale, Timperley, Urmston, Wilmslow, Handforth, Poynton, Cheadle, Didsbury, Warrington
Our satellite Disley clinic on Thursday nights at Scott, Skin & Co, is local to:
New Mills, High Lane, Marple, Mellor, Whaley Bridge, Hayfield, Stockport
