Abstract
Multiple diagnostic tools are used to evaluate psoriasis and atopic dermatitis (AD) severity, but most of them are based on subjective components. Transepidermal water loss (TEWL) and temperature are skin barrier function parameters that can be objectively measured and could help clinicians to evaluate disease severity accurately. Thus, the aims of this study are: (1) to compare skin barrier function between healthy skin, psoriatic skin and AD skin; and (2) to assess if skin barrier function parameters could predict disease severity. A cross-sectional study was designed, and epidermal barrier function parameters were measured. The study included 314 participants: 157 healthy individuals, 92 psoriatic patients, and 65 atopic dermatitis patients. TEWL was significantly higher, while stratum corneum hydration (SCH) (8.71 vs. 38.43 vs. 44.39 Arbitrary Units (AU)) was lower at psoriatic plaques than at uninvolved psoriatic skin and healthy controls. Patients with both TEWL > 13.85 g·m−2h−1 and temperature > 30.85 °C presented a moderate/severe psoriasis (psoriasis area severity index (PASI) ≥ 7), with a specificity of 76.3%. TEWL (28.68 vs. 13.15 vs. 11.60 g·m−2 h−1) and temperature were significantly higher, while SCH (25.20 vs. 40.95 vs. 50.73 AU) was lower at AD eczematous lesions than uninvolved AD skin and healthy controls. Patients with a temperature > 31.75 °C presented a moderate/severe AD (SCORing Atopic Dermatitis (SCORAD) ≥ 37) with a sensitivity of 81.8%. In conclusion, temperature and TEWL values may help clinicians to determine disease severity and select patients who need intensive treatment.
Highlights
The skin is the largest organ of the human body and accomplishes multiple defensive and regulatory functions [1]
No systemic or topical treatments was allowed three hours before the measurements were taken. These variables were measured at two body sites in psoriatic patients, at two body sites in atopic dermatitis (AD) patients, at one body site in healthy volunteers
Arbitrary Units (AU), arbitrary units; OR, odds ratio; psoriasis area severity index (PASI), psoriasis area and severity index; SCH, stratum corneum hydration; TEWL, transepidermal water loss. * p value after using a logistic regression to evaluate the association between disease severity, as a categoric variable (PASI < 7 or PASI ≥ 7) and each skin homeostasis parameter cut-off point, considered as a categoric variable
Summary
The skin is the largest organ of the human body and accomplishes multiple defensive and regulatory functions [1]. The barrier function of skin resides in the epidermis, mainly in the stratum corneum [2] This epidermal barrier maintains cutaneous homeostasis and protects the body against numerous external stressors [3]. The psoriasis area severity index (PASI) is the most widely used scale for assessing psoriasis severity [18] This score quantifies extent (the percentage of involvement of the four anatomical regions: head, trunk, and upper and lower extremities) and intensity of the psoriatic plaques (evaluating erythema, desquamation, and induration separately for the four anatomical regions) [19]. The measurement of skin homeostasis and epidermal barrier function in psoriatic and AD patients could help clinicians to assess the disease severity objectively [24]. The objectives of this study are (1) to compare cutaneous homeostasis and skin barrier function between healthy skin, psoriatic skin, and AD skin; and (2) to assess if skin homeostasis and skin barrier function could predict disease severity
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