AUTOIMMUNE DISEASE AND THE SKIN BARRIER
General practitioner Dr Ginni Mansberg, one of Australia’s leading women’s health experts, explains what aesthetic practitioners need to know about autoimmune disease and how it affects the skin
Many practitioners are only too aware that their patients with autoimmune diseases have a higher risk of skin sensitivity. There is a growing body of evidence suggesting that autoimmune disease and skin sensitivity may be bidirectional. In other words, skin barrier damage is not just the result of autoimmune diseases but may also be the cause.1
Autoimmune diseases are chronic conditions in which the immune system mistakenly attacks the body’s own tissues.2 More than 150 such diseases have been identified, from systemic lupus erythematosus (SLE) and rheumatoid arthritis to Hashimoto’s thyroiditis, psoriasis, type 1 diabetes, vitiligo and crohn’s disease.3 They can affect virtually every organ system, and in many cases, the skin provides the first visible sign of disease activity through erythematous rashes, pigmentation changes, sensitivity and impaired healing.4
THE SCALE OF THE PROBLEM
Autoimmune diseases have been increasing in prevalence and now affect an estimated 12.5% of the population5 , with nearly 80% of cases occurring in women.6 The recent rise in incidence has been linked to changes in diet, exposure to xenobiotics, air pollution, infections, lifestyle, stress, and climate change.5 As a result, not only are many of our patients likely to be affected (diagnosed or not), but autoimmunity may influence their response to treatments, wound healing, and barrier tolerance.
A BARRIER UNDER SIEGE
Increasingly, research points to the epithelial barrier in the epithelium of our skin, gut and respiratory linings as a critical interface between the body and the outside world. These epithelial cells, supported by a diverse community of commensal microbes (the microbiome), regulate what enters the body and how the immune system reacts.7 When this barrier becomes compromised (sometimes referred to as “leaky” skin or gut)7 periepithelial inflammation (“epithelitis”) is triggered with the release of various chemical “alarmins” (including IL-33, IL-25, TSLP), setting off downstream immune activation that can propagate beyond the original site.7 It can also lead to microbial dysbiosis (loss of diversity and opportunistic colonisation) and a chronic inflammatory response that can amplify or exacerbate autoimmune diseases across the body.8
WHY THIS MATTERS IN AESTHETICS
For practitioners, an impaired barrier means higher reactivity, slower healing, and unpredictable responses to some aesthetic treatments, including laser and energy-based devices and deep peels.9 Even HA fillers, which are generally very well tolerated, have been linked to both delayed-onset nodules (DONs) and autoimmune syndrome induced by adjuvants (ASIA) in people with autoimmune disease.9
Given this, I suggest a careful discussion with any patient with a known autoimmune disease before procedures and documentation of this in their file. I would also suggest avoiding treatments during an autoimmune flare.
This should be done together with a follow-up a week after any treatment, looking for any atypical inflammatory signs (delayed nodules, granulomas, unusual dysesthesia).
SUPPORTING THE BARRIER
While systemic control of autoimmunity requires medical management, aesthetic professionals can play a valuable role in protecting and restoring skin barrier function. Evidence-based steps include:
• Moisturisation using ceramide- and niacinamide-rich formulations to strengthen the stratum corneum.10
• Avoidance of irritants such as soaps, harsh surfactants, and fragrances.11
• Ensure a correct pH of skincare products. The skin’s protective acid mantle is essential for maintaining proper barrier function, and less acidity leads to inflammation and infection.12
• Sun protection to limit UV-induced inflammation.13
• Gentle actives with proven barrier benefits rather than aggressive actives.9
• Lifestyle advice that supports gut and skin microbiome diversity. This includes a balanced, minimally processed diet14 , daily exercise including resistance exercise and reduced exposure to household toxins.15
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DR GINNI MANSBERG
Dr Ginni Mansberg is a GP, TV presenter, podcaster, author and columnist. She is a physician specialising in women’s health, menopause and all things skin. She is also the co-founder and medical director of science-based cosmeceutical skincare brand, Evidence Skincare (ESK), and author of bestseller, The M Word, How to Thrive in Menopause.