Skin Health 101: Peeling back the layers

A must-listen for those who want to dive deeper into understanding how their skin works. From the protective role of the skin to its intricate structure, this episode sets the scene for what we need to do to protect this large organ. In addition, your hosts Dr George Moncrieff and Dr Roger Henderson, also touch on the psychological impact of living with skin conditions like acne and eczema. 

This episode covers: 

• The key functions of the skin, including regulating body temperature 
• How the skin acts as a barrier against infections 
• A breakdown of the skin’s structure, highlighting its roles in hydration, sensory perception, and immune defence
• The psychological toll of skin conditions  

This episode is ideal for anyone curious about how vital and complex our skin truly is. 

Thank you to our kind sponsor AproDerm, who provide a range of emollients designed for the management of dry skin conditions, including eczema, psoriasis and ichthyosis. 

Everyone’s skin is unique and what works for one person, may not work for another. That’s why AproDerm has developed the AproDerm Emollient Starter Pack. This pack contains all four of their emollients varying in their formulation, consistency and hydration, giving you the choice to find a routine which suits you.  

Find out more here. 

IG: https://www.instagram.com/aproderm/ 

FB: https://www.facebook.com/AproDerm  

We hope you find this podcast interesting and helpful. Please leave us a review or email [e-mail] with any feedback on this episode or suggestions on skin-related topics that you would like to hear about in future podcasts. 

The views expressed in this podcast are of Dr George Moncrieff and Dr Roger Henderson. Fontus Health has not influenced, participated, or been involved in the programme, materials, or delivery of educational content. 

Episode Transcript

(00:10):
Hello, and welcome to this SkinDeep podcast, where we'll be
looking at skin-related issues andtreatments in, what I hope is, an
interesting and informative way.
I'm Dr Roger Henderson, andI'm a GP with a long-standing
interest in this area of health.
And I'm Dr George Moncrieff.
I was also a GP, though I retiredfrom my practice a few years ago.

(00:32):
I'm also the past Chair of theDermatology Council for England.
Today, Roger and I will be talkingabout some skin basics, including why
our skin is so vital for our health.

(00:54):
Now, I think many people listening mightactually be quite surprised to learn that
their skin is their biggest body organ.
And indeed, they might not actually thinkof it as being vital to their health.
It really is so vital to their health.
But, asking what may sound to be a simplequestion to kick off, I suppose, just
why is our skin so important to us?

(01:16):
Well, as you say, it'scertainly a very big organ.
It measures, on average,about two square metres.
And surprisingly, actually,it's been taken over by fat
tissue in our modern society.
Adipose tissue is now beginningto become a larger organ.
But apart from that, the skin is, asyou say, the biggest organ in our body.

(01:38):
And it is the interface betweenour sterile, well-controlled,
internal environment and thishostile world we live in.
A world full of microorganisms and it'sthe skin that protects us from these bugs,
these bacteria, viruses, fungi and othernasty creatures getting into our body.

(02:01):
Um, but it also stops usfrom becoming dehydrated.
When a baby is inside the womb, it'sin a lovely, warm, humid environment.
There's, no need for a skin barrier.
But within a few hours of being born,a baby has to, amongst many other
adaptions, has to develop a skinbarrier to prevent water evaporating.

(02:25):
And if the baby doesn't achievethat, they will die from dehydration.
So it's critical forpreventing water loss.
It's also involved incontrolling our body temperature.
So if we're in a hot environment, itenables us to lose heat through sweating,
and, water evaporating off the skin.
But, equally, in a cold environment,it helps us to conserve heat by

(02:48):
restricting the amount of bloodflow that goes to the skin.
So, critical roles in thermoregulation.
It's also the organ thathas our sensory organs.
So it's our skin that lets usfeel what the temperature is
and pain and touch and all othersensations, which are so vital to us.
And then in addition, the skin isinvolved in things like vitamin
D production, um, and so on.

(03:11):
But also when the skin is diseased, whenthere's a rash on the skin, it's visible.
And that can have a devastating impacton patients, um, psychologically.
Hardly surprisingly, it affectstheir self-esteem and it affects
how they interact with otherpeople, affects job opportunities.

(03:32):
It affects relationships.
It has a catastrophic effect on,on wellbeing in so many areas.
Well, that's interesting, George.
You and I, of our long experience ofseeing people with skin disease, both
know that if they have significantskin disease, psoriasis would be a
good example or, you know, significanteczema, what's the first thing they do?
They cover it up.

(03:52):
Yeah.
[They] don't want it to be seen.
And the impact of that, and we'lltalk about this in future podcasts,
but the impact of that is huge.
So yes, the psychological impact.
I recall vividly a young girl, about14, who came to see me with terrible
acne on her face and sitting there withher hair all down in front of her face.
I wasn't sure which way she was facing.

(04:12):
I thought she might be facing[backwards] because all I could
see was this hair completelycovering down the front of her body.
As if I was looking atthe back of her head.
She really was so distressed by theappearance of her face and this is a
beautiful, young woman who happenedto have quite severe facial acne.
It can be really devastating.
The most extreme example, Isuppose, George, and it's almost

(04:35):
a terrible thing to think about,is when people have severe burns.
The reason why people withsevere burns die is directly
because of their, skin loss.
Modern medicine is remarkable, butit still cannot cope with someone who
has 80, 90 plus percent burns becauseof the impact of losing their skin.

(04:57):
I suppose that's a dramatic exampleof just how important skin is to
us and what happens if we lose it.
But it's such a complicated organ.
The two major problems that theyface in those first few days are, of
course, infections getting in and,affecting the skin and water loss.
Keeping up with that waterloss through that damaged skin.

(05:19):
Those are the two critical thingsthat, in the first few days after a
severe burn, would kill a patient.
Absolutely and we'vetragically all seen that.
I mean, skin structure as such, you know,you might look at your skin and think,
"Well, that's just a bit of skin".
The skin structure is actually,not only remarkable, complex,

(05:39):
but also absolutely crucial.
What do you think we should be knowingreally about our skin structure to
help us understand just how it worksand what a magnificent organ it is?
It is truly magnificent.
It really is and the more Ilook into it, the more amazed
I am at how magnificent it is.
Under the skin we have fat tissue.

(06:01):
What's called the subcutaneous, meaningunder the skin fat, which buffers, um, the
skin and by buffer I mean, if you knockit, it doesn't hurt the bones underneath.
It's soft and it, overliesthings and, sort of, moulds
over, contours quite nicely.
But the skin itself ismade up of two main layers.
The deeper layer, called the dermis,which is where your hair follicles are

(06:24):
and most of your sensory organs are.
Then the top layer, whichis called the epidermis.
Now the epidermis is actually very thin.
In some parts of the body, forexample on the eyelid, it's half
as thick as a piece of paper.
It's incredibly sophisticated.
The cells mature as theymove to the surface.
These cells are growing upfrom the junction between

(06:46):
the dermis and the epidermis.
They're growing up to the surfaceand as they grow, they change their
structure and change their shape.
The very top layer of the skin wecall the stratum corneum and that
top layer is the skin barrier.
The cells here are amazinglyadapted to live in this dry,
hostile world that we live in.
They have a, they're very long cells.

(07:08):
They've been stretched out.
So there's enormous overlap,one on top of another.
And they're held together by very,very strong bonds that are created
in that top layer of the skinto hold them together tightly.
Those bonds are broken in a verycarefully, orchestrated way so the top
layer just falls off at the right time.
In between the cells is a fatty layercalled the lipid lamellar bi-envelope.

(07:32):
It's fat that, sort of, fatty materialmade up of things like ceramides and
triglycerides, cholesterol and thingslike that, which seals the gaps between
the cells and confers some flexibilityto the skin and to the surface.
But the other thing, in fact, is thatin the process of making these changes,

(07:52):
which is orchestrated through a verylarge protein called profilaggrin,
which breaks down into filaggrin.
That is broken down also into a hugenumber of very small molecules, and all
these molecules draw moisture to them.
They're what's called 'hygroscopic'.
They even draw moisture from deeperin the skin into that cell, pumping

(08:13):
it full of water so it's pumpedup tight against its neighbours.
The other remarkable thing about all thesesmall molecules is they're all acids.
Most of them are fairly weakacids, but they're acidic.
And that drops what's called the pH.
It makes the skin moreacidic on the surface.
Deeper down in the skin, only amillimetre or less, the pH is neutral.

(08:34):
But when you get onto the surface, youhave this acidity, which is so important.
It's called the acid mantle.
And that acid mantle controls the activityof the chemicals, the enzymes that break
down those bonds in that beautifullyorchestrated way I was talking about.
But it also favours the adhesionof healthy bacteria, which is

(08:55):
what we need on our skin, andalso kills pathogenic bacteria.
So that acid mantle is really important.
I'll be talking more about theacid mantle in this series.
So that's just a very quick glimpseinto how remarkably clever it is.
Deeper in the skin we makealmost 2,000 different,
natural, antimicrobial peptides.

(09:18):
Our body's natural antibiotics.
So the skin has this criticalimmune role at killing bacteria
that penetrate it and other waysin which it deals with bad bacteria
and viruses and things that get in.
It's remarkably sophisticated and,um, remarkably well-adapted for
this dry, hostile world we live in.

(09:40):
I think a lot of people would be reallysurprised at just how complicated it is.
I think a lot of the time wethink skin is skin and actually
don't give a second thought.
You know, it is as complicated asthe heart or the liver or the kidneys
or any organ you want to think of.
And I haven't even startedtalking about the role of hairs...
No.
[Laughter]
... or sweat glands, or grease glands,or sensory organs, or so many other

(10:05):
things that are going on there.
It is utterly fascinating.
Absolutely.
Huge thanks to AproDerm® forall their help in putting these
Skin Deep podcasts together.
We couldn't have done it without them.
Absolutely.
So, until the next time,it's goodbye from George.
Goodbye.
And it's goodbye from me.
Goodbye.