Decrease In Transepidermal Water Loss Research Articles

A prospective, double‐blinded, randomized head‐to‐head clinical trial of topical adapinoid (oleyl adapalenate) versus retinol

AbstractBackgroundRetinoids, such as retinol, are widely investigated and utilized in skin care products as a treatment for photoaging but their use is limited by tolerability. Adapinoid (oleyl adapalenate, OA) is a novel third generation retinoid that is a pro‐drug of adapalene, but there is little research on its effects on photoaging or its tolerability.ObjectivesThe purpose of this study is to compare the effects and tolerability of OA 0.5% to retinol 0.5% cream regarding visible signs of facial photoaging including facial wrinkles, fine lines and pigmentation.MethodsIn this 12‐week, double‐blind, randomized clinical trial, 48 eligible participants were recruited and enroled from the Greater Sacramento region. The study consisted of a baseline and follow‐up visits at weeks 4, 8 and 12. Participants were randomized to receive either topical OA 0.5% or retinol 0.5% for 12 weeks. The primary outcome was changes in the appearance of wrinkle severity at 12 weeks. Secondary outcome measures include changes in erythema, skin pigmentation, skin hydration and transepidermal water loss (TEWL).ResultsOA improved wrinkle severity by 9.45% (p < 0.0001) at week 12, whereas retinol improved wrinkle severity by 4.11% (p < 0.001) compared to baseline. When comparing the two treatment groups at week 12, the OA group improved significantly more than the retinol group (p = 0.001). OA decreased pigment intensity at week 12 by 3.88% (p < 0.0001), whereas retinol decreased pigment intensity by 3.15% (p < 0.03) compared to baseline. OA‐based improvement in pigment intensity at week 12 was not significantly different from retinol (p = 0.62). OA reduced facial erythema by 13.39% (p < 0.05) at week 12, whereas the retinol group did not have a significant change. OA use led to a 14.92% decrease in TEWL by week 12 (p = 0.07), whereas the retinol group had no significant change. OA was better tolerated than retinol when assessed at all follow‐up visits.ConclusionsOA 0.5% is superior to retinol 0.5% in improving wrinkle severity and similar in improvement of pigment intensity. OA is better tolerated than retinol. Overall, the use of OA as a precursor to adapalene may be an effective method to improving the tolerability of retinoids while maintaining efficacy.Trial RegistrationThis study was registered on www.clinicaltrials.gov (NCT05778760).

The Effect of Topical 100% Sunflower Seed Oil (SSO) Extract on Trans Epidermal Water Loss (Tewl) and Skin PH Levels in a History of Atopic Dermatitis

The skin barrier function can be disturbed in various conditions, one of which is atopic dermatitis (AD). Efforts to improve the skin barrier can be done by using various types of moisturizers. Natural oil from sunflower seed oil (SSO) can be used as "skin barrier therapy" by reducing trans epidermal water loss (TEWL) and skin pH levels. A randomized single blind clinical trial with a two parallel group pre and post design was conducted on subjects with a history of AD who were treated at the Skin and Venereology Polyclinic at Sunan Kalijaga Hospital, Demak. Samples were randomized into 2 groups to receive 100% SSO or petrolatum as a control. TEWL and pH assessments were carried out at the beginning of the study and at week 4. Bathing habits and complaints about using moisturizers were also assessed. TEWL values ​​decreased in the SSO and petrolatum groups (-5.8±1.93 vs -6.1±9.08, p = 0.9). The pH value in AD patients also decreased after administration of SSO extract and petrolatum (-0.4±0.10 vs -0.2±0.75, p = 0.2). The decrease in TEWL and pH in both groups was not statistically significant. This may be related to differences in bathing habits and moisturizer use in the two groups. Most of the samples in the SSO group stated that they had no complaints regarding usage. The entire sample completed the study without any reports of allergic reactions or hypersensitivity. Administration of SSO extract was effective in reducing TEWL and pH in DA with the majority of samples stating that they had no complaints about use.

Randomized, controlled, within-patient, single-blinded pilot study to evaluate the efficacy of 12-weeks of endermotherapy with adult burn survivors

BackgroundVacuum massage, or endermotherapy, is applied to scar tissue with the primary therapeutic goal of promoting structural or physiological changes. These changes are intended to enhance pliability, enabling the skin to possess the strength and elasticity required for normal mobility. The advantage of vacuum massage compared to therapist-generated manual massage is that it provides a standardized dosage using rollers and suction valves to mobilize the tissue. However, research documenting and supporting its impact on post-burn hypertrophic scar is lacking. Thus, this study was designed to objectively characterize the changes in scar elasticity, erythema, melanin, thickness, and transepidermal water loss immediately after a vacuum massage session and after a 12-week course of treatment compared to intra-individual matched control scars. MethodsWe conducted a prospective, randomized, controlled, within-patient, single-blinded clinical trial, initially designed as a fully-powered study but limited to a pilot study due to COVID-19 restrictions. Nineteen burn survivors consented to participate and 16 completed the study. Two homogeneous, intra-individual scars were randomized to usual care control or vacuum massage therapy plus usual care. Vacuum massage interventions were provided by a certified massage therapist three times per week for 12 weeks. Scar characteristics were evaluated every four weeks immediately before and after mechanical massage treatment. The evaluations included measurements of elasticity (Cutometer), erythema and melanin (Mexameter), transepidermal water loss (TEWL) (Tewameter), and thickness (high-frequency ultrasound). Linear mixed-model analyses were performed to test for immediate and long-term treatment effects. ResultsThe ANOVA analyses revealed a non-significant time:treatment interaction for elasticity, erythema, melanin, thickness, or TEWL. There was a significant increase in elasticity and erythema and a decrease in TEWL in both the control and treatment sites over time with consistent standard care. However, there was no statistically significant immediate or long-term treatment effect for any of the skin characteristics. Nonetheless, the mean participant satisfaction was 4/5 (SD = 1.5) and the mean participant perception of effectiveness was 8/10 (SD = 1.9). ConclusionsThis pilot study did not find a treatment benefit of vacuum massage therapy for elasticity, erythema, melanin, thickness or TEWL, but it did find an improvement with time in elasticity, erythema and TEWL. Despite the lack of objective improvement of the treated scar site, participants were satisfied with the results and believed vacuum massage was very effective. Further high-quality research is required to better inform clinicians patient education and treatment decisions for this costly, burdensome treatment approach that has high participant satisfaction.

Improvement effects of tapinarof on the skin barrier function in Japanese patients with atopic dermatitis

Background: Tapinarof is a nonsteroidal, topical, aryl hydrocarbon receptor agonist. Tapinarof has been shown to be efficacious and have acceptable safety profile in the treatment of atopic dermatitis (AD).Objective: We sought to evaluate the improvement effect of tapinarof on skin barrier function in patients with AD.Methods: This was an open-label, uncontrolled, single-center study. Japanese patients aged ≥20 years with AD (N = 30) were included in this study. Patients applied tapinarof cream 1% once daily to the target areas on the volar forearm for 8 weeks. The primary endpoints were changes from baseline in stratum corneum hydration (SCH) and transepidermal water loss (TEWL) at the target affected area at week 8.Results: The mean SCH value at the target affected area was 13.656 AU at baseline, 16.904 AU at week 4, and 16.423 AU at week 8. The SCH at the target affected area significantly increased from baseline to week 8, with a mean change of 2.826 AU (p = 0.0433). The mean TEWL value at the target affected area was 17.35 g/m2/hr at baseline, 10.01 g/m2/hr at week 4, and 9.52 g/m2/hr at week 8. The TEWL at the target affected area significantly decreased from baseline to week 8, with a mean change of −8.03 g/m2/hr (p < 0.0001). Clinical signs of AD at the target affected area were improved over time. No serious, severe, or treatment-related AEs were reported.Conclusion: Treatment with tapinarof led to an increase in SCH and a decrease in TEWL in patients with AD, indicating the potential improvement effect of tapinarof on skin barrier function.

The evidence from in vitro primary fibroblasts and a randomized, double-blind, placebo-controlled clinical trial of tuna collagen peptides intake on skin health.

Collagen peptides from various sources demonstrate benefits in health and well-being both in vitro and in clinical trials. However, there is a scarce study of collagen peptides from Tuna on skin health. To investigate the impact of collagen peptides derived from Tuna (Katsuwonus pelamis and Thunnus albacares) on skin health, utilizing in vitro biological studies and a randomized controlled trial. In vitro biological studies on human dermal primary fibroblasts were evaluated in terms of collagen and elastin synthesis and senescent cell inhibition. A randomized, placebo-controlled, double-blind clinical trial was conducted on 72 women who were randomly assigned to receive either tuna collagen peptides (n = 36) or a placebo (n = 36) orally for 8 weeks and 2 weeks post-ingestion by measuring skin hydration, transepidermal water loss (TEWL), skin elasticity, and skin density. In vitro biological effects demonstrated dose-dependent positive results in increasing collagen and elastin synthesis and reducing senescent cells. The effects on collagen and senescent cells plateaued at high concentrations. A clinical trial showed that the test group experienced a significant increase in skin hydration, elasticity, and density, along with a decrease in TEWL compared to the baseline. The test and placebo groups showed statistically significant differences at 8 weeks for all parameters except for the TEWL at the face. All positive effects were substantially retained even after 2 weeks of discontinuation. These findings demonstrate the significant potential of tuna collagen peptides to promote human skin health, warranting further investigation as a potential nutraceutical.

Analysis of the effect of components of chemical peels based on lactic and mandelic acid on skin parameters

Up to now, research studies have compared various peeling substances affecting the skin, without taking into account the parameters responsible for the penetration and potency of the compounds. The aim of this study was to analyze the effects of lactic acid and mandelic acid on hydration, melanin, sebaceous gland activity and the stratum corneum barrier. Equal concentrations of chemical peels, similar pH of the solutions, and the base enabled comparison of results. A series of treatments with lactic acid resulted in a decrease in transepidermal water loss, an increase in hydration levels and a reduction in sebaceous gland activity, as well as a significant drop in melanin levels. Mandelic acid applied in a series of four treatments resulted in a noticeable improvement in the appearance of the epidermis. The activity of the sebaceous glands also decreased significantly. The use of both, a series and a single treatment with mandelic acid, strengthened the epidermal barrier. Comparing a series of treatments and a single procedure it was found that the value of transepidermal water loss increased. The study demonstrated that whereas many carboxylic acids exhibit similarities, they also possess notable distinctions in their topical effects and medicinal applications.

The effectiveness of topical vitamin D3 for dry skin in elderly

Dry skin is one of the most common dermatoses found in the elderly. Vitamin D is an essential fat-soluble vitamin that has a role in repairing the skin barrier. Topical administration of vitamin D3 is expected to increase skin hydration in the elderly. Thirty-two participants were divided into two groups, namely 5000 IU vitamin D3 and the base lotion groups. The assessment was carried out by calculating the overall dry skin score (ODS), transepidermal water loss (TEWL), and skin capacitance every 4 wk for 12 wk. All groups showed an improvement in ODS, a decrease in TEWL, and an increase in skin capacitance value at the end of the measurement, and no significant side effects were reported. The 5000 IU vitamin D3 lotion group had the highest level of skin hydration compared to the other group (p>0,05). We conclude that the administration of 5000 IU vitamin D3 lotion may be administrated safely and improve skin hydration in the elderly but is not more effective than base lotion.

The study of tryptophol containing emulgel on fungal reduction and skin irritation

Tryptophol (TOH), a fungal quorum-sensing molecule, that possesses anti-fungal activities for controlling the growth of human pathogenic fungi. In the present study, we developed TOH-containing emulgel formulations and examined the antifungal activities and potential use as topical treatments on the skin. The results showed that TOH-containing emulgel at 1000 μM has excellent physical characteristics as homogenous, stability, and inhibits the growth of 30 species of human pathogenic fungi in vitro. TOH-containing emulgel did not cause skin irritation in mouse model of irritation and in healthy human volunteers. Moreover, an increase in skin hydration and a decrease in trans-epidermal water loss (TEWL) were observed after TOH-containing emulgel treatment on human skin. Our findings indicated that TOH-containing emulgel can be utilize as an antifungal agent for topical treatment against fungal infections on the skin.

Effects of a lotion containing probiotic ferment lysate as the main functional ingredient on enhancing skin barrier: a randomized, self-control study

There is an emergent need to develop functional cosmetic ingredients for the topical management of skin barrier function. This study aimed to investigate the efficacy of a lotion containing fermented lysates VHProbi® Mix R for enhancing the skin barrier. In vitro studies demonstrated that fermented cultures of both Lacticaseibacillus rhamnosus VHProbi® E06 (E06) and L. paracasei VHProbi® E12 (E12) had antioxidant capacity, showing promising scavenging capability for 2,2-diphenyl-1-picryl-hydrazyl. The antioxidant capacity of these strains was also demonstrated in the model of Caenorhabditis elegans. In addition, the fermented lysates of both E06 and E12 enhanced the proliferation of HaCaT cells and ameliorated the toxicity induced by Staphylococcus aureus ATCC 25923, hydrogen peroxide, and ultraviolet B radiation in the HaCaT cell models, which simulated the irritants that facial sensitive skin is exposed to. Subsequently, the ingredient VHProbi® Mix R was formulated using four kinds of fermented lysates: E06, E12, Lactiplantibacillus plantarum VHProbi® E15, and Lactobacillus helveticus VHProbi® Y21. A clinical study was conducted to investigate whether a lotion containing VHProbi® Mix R would be beneficial for people to enhance skin barrier. The participants were asked to use the investigational product for 30 days. Several indicators, including transepidermal water loss (TEWL), skin moisturization, and redness were measured at day 0 and day 30 using VISIA®-CR and CK®-MPA systems. Meanwhile, the burden of sensitive skin (BoSS) and self-assessment questionnaires were performed at baseline and endpoint of this study. The study data showed that at day 30, there was a significant decrease in TEWL (P < 0.01), redness measured by CK®-MPA (P < 0.01), and redness profile measured by VISIA®-CR compared with the baseline measurements. Skin moisturization had significantly increased after treatment with the lotion for 30 days. BoSS and self-assessment questionnaires also substantiated that the participants felt a markedly positive change in their sensitive skin. Hence, we hypothesize that applying the topical functional VHProbi® Mix R could confer effective benefits for people with sensitive skin and this represents a promising intervention for enhancing skin barrier.

Effect of biomicroneedling and active ingredients on skin parameters in women with visible signs of ageing. Pilot study

The use of biomicro-needles, splinters derived from marine and freshwater sponges, is the subject of research worldwide. Their regenerative potential is due to their ability to form microchannels in the skin and persist for 72-120 hours. The study aimed to evaluate the effect of preparation based on biomicro-needles from the Spongilla spicules species on the skin parameters of women with visible signs of ageing. A significant improvement in skin hydration was demonstrated, as evidenced by a decrease in transepidermal water loss, an increase in hydration of the stratum corneum, or a statistically significant decrease in the echogenicity of the dermis. In addition, the thickness of the dermis increased significantly. A decrease in pH, an improvement in barrier function, and a visible reduction in hyperpigmentation,erythema, and wrinkles were demonstrated.

Efficacy of ceramide-containing sunscreen on skin barrier.

UV rays not only cause oxidative damage to the skin, but also damage its barrier function. The use of sunscreen is crucial in preventing skin from UV radiation, but it may have an impact on the function of the skin barrier. While much research has focused on the protective effects of sunscreen against UV oxidative damage, little is known about the impact of daily sunscreen use on the skin barrier. This study mainly investigated the changes in skin barrier function of volunteers (including those with sensitive skin) before and after using a ceramide-containing sunscreen. A total of 60 volunteers used SPF30 sunscreen containing ceramide every morning. Using non-invasive methods to detect skin barrier changes in TEWL, hydration, facial redness based on VISIA-CR image, and Erythema index (EI) value after 4 weeks of using ceramide-containing sunscreen. Adverse reactions were also assessed. After 4 weeks of using ceramide-containing sunscreen, significant reductions were observed in skin redness with both an 11.89% decrease in a* value and a 5.68% decrease in skin EI, while there was also a significant decrease in transepidermal water loss (TEWL) with a reduction of 22.96%, and a significant increase in skin hydration with a 21.96% increase in the moisture content of the stratum corneum. No adverse events occurred during the entire testing process. Daily application of ceramide-containing sunscreen can increase skin hydration while enhancing the function of the skin barrier.

Effects of oral intake fruit or fruit extract on skin aging in healthy adults: a systematic review and Meta-analysis of randomized controlled trials.

In recent years, oral various fruits or supplements of fruits natural extracts have been reported to have significant anti-aging effects on the skin (1, 2), However, despite many studies on this topic, there is often no clear evidence to support their efficacy and safety. In this paper, we present a comprehensive review and Meta-analysis of the evidence for the safety and efficacy of oral fruits and fruits extracts in improving skin aging. Four databases, Pubmed, Embase, Web of Science, and Cochrane Library (CENTRAL), were searched for relevant literature from 2000-01 to 2023-03. Seven randomized controlled trials (RCTs) of fruit intake or fruit extracts associated with anti-skin aging were screened for Meta-analysis. Compared to placebo, oral intake of fruit or fruit extracts showed significant statistical differences in skin hydration and transepidermal water loss (TEWL), with a significant improvement in skin hydration and a significant decrease in TEWL. No significant statistical difference was observed in minimal erythema dose (MED), overall skin elasticity (R2), or wrinkle depth, and no evidence of significant improvement in skin condition was observed. Meta-analysis results suggest that consume administration of fruits or fruit extracts significantly enhances skin hydration and reduces transcutaneous water loss, but there is insufficient evidence to support other outcome recommendations, including minimal erythema dose (MED), overall skin elasticity(R2), and wrinkle depth. PROSPERO (york.ac.uk), identifier CRD42023410382.

396 Rapid, substantial and sustained reduction of itch in adults with atopic dermatitis applying ruxolitinib cream 1.5% (SCRATCH-AD)

Abstract Atopic dermatitis (AD) is a chronic, recurring, highly pruritic inflammatory skin disease. The mechanical injury from scratching contributes to skin inflammation and barrier disruption, exacerbating the itch–scratch cycle, which perpetuates the disease. Ruxolitinib cream is a topical formulation of ruxolitinib, a selective Janus kinase (JAK) 1/JAK2 inhibitor, approved in the USA for the short-term and noncontinuous chronic treatment of mild to moderate AD in patients ≥12 years old whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable. In two pivotal phase 3 trials (TRuE-AD1 and TRuE-AD2) in adolescents and adults with AD, ruxolitinib cream 1.5% demonstrated significant improvement in itch vs. vehicle cream, as early as 12 h after initial application. A phase 2, open-label, single-site study (SCRATCH-AD; NCT04839380) was undertaken to further understand the short-term clinical benefits of ruxolitinib cream to control pruritus and reduce disease severity in participants with AD. Participants enrolled in the study were aged 18–65 years with AD for ≥6 months, with chronic itch related to AD for ≥3 months, 1–20% affected body surface area (BSA), Investigator’s Global Assessment (IGA) of ≥2 and a peak pruritus numerical rating scale (PP-NRS) score ≥4 at baseline. Participants applied ruxolitinib cream 1.5% twice daily to all lesions identified at baseline and any new lesions for 28 days. The primary endpoint was change from baseline in PP-NRS at Day 2 (24 h after the first application of ruxolitinib cream). Secondary endpoints included change from baseline in modified PP-NRS (mPP-NRS; current itch intensity) at 15 and 30 min and at 1, 2, 4, 6 and 12 h post-treatment on Day 1, as well as change from baseline in PP-NRS from Days 3 through 29, change from baseline in IGA at Days 8, 15 and 29, and safety. The primary analysis included 46 participants in the modified intent-to-treat population. Median age (range) was 30 (18–64) years; 69.6% were female, and 89.1% were White. At baseline, mean (SD) affected BSA was 9.5% (4.94%), mean (SD) 7-day average PP-NRS score was 6.7 (1.36), mean (SD) pretreatment mPP-NRS score was 6.4 (1.72) and 89.1% had an IGA score of 3. The mean (SD) change from baseline in PP-NRS on Day 2 was –3.4 (1.85). The mean (SD) change from baseline in mPP-NRS at 15 min post-treatment was –2.3 (2.34), peaking at –4.2 (2.12) at 4 h post-treatment and was –3.1 (2.00) at 12 h post-treatment. The mean (SD) change from baseline PP-NRS continued to increase through Day 29 [–5.7 (1.60)]. The mean (SD) changes from baseline in IGA score on Days 8, 15 and 29 were –1.4 (0.73), –2.0 (0.87) and –2.2 (0.90), respectively. Treatment-emergent adverse events (TEAEs) were reported in 15/49 (30.6%) participants (none were serious); one participant had a treatment-related TEAE [grade 1 application site reaction (acne)]. No participant discontinued treatment due to TEAE. Lesional skin treated with ruxolitinib cream 1.5% twice daily showed substantial decrease in transepidermal water loss from a baseline mean (SD) score of 35.0 (17.47) to 13.1 (4.42) over 4 weeks, thus reaching similar levels to the nonlesional skin score of 12.7 (4.56) at Day 29. Participants with AD applying ruxolitinib cream 1.5% experienced rapid, substantial improvement in itch, which was sustained and further improved through 28 days of treatment. Itch reduction was observed as early as 15 min, and peak reduction was observed at 4 h after first cream application. These results further demonstrate the clinical benefits and are consistent with the established data on ruxolitinib cream as an effective, well-tolerated topical treatment for AD.

An oral French maritime pine bark extract improves hair density in menopausal women: A randomized, placebo-controlled, double blind intervention study.

Female pattern hair lossaffects females of all ages with a trend to increase after menopause. This disorder may have significant psychological impact and lead to anxiety and depression. In a single center, double blind, randomized, placebo-controlled study, the effects of oral Pycnogenol® intake (3 × 50 mg/day for a total of 6 months) on hair density, scalp microcirculation, and a variety of skin physiological parameters was studied in Han Chinese menopausal women (N = 76) in Shanghai, China. Measurements were taken at the beginning and after 2and 6months, respectively. Hair density was determined by digital photographs and further evaluated by Trichoscan software. Transepidermal water loss was measured by a humidity sensor in a closed chamber on the skin surface. Changes in microcirculation were detected as resting flux on the scalp by reflection photoplethysmography. Pycnogenol® intake significantly increased hair density by 30% and 23% after 2and 6months of treatment, respectively, as detected by Trichoscan® evaluation of digital photographs. Interestingly, photoplethysmography revealed that this beneficial effect was associated with a decrease in resting flux of the scalp skin, which might indicate an improvement of microcirculation. None of these effects were observed in the placebo taking group. In addition, a significant transient decrease of transepidermal water loss was observed in scalp skin under Pycnogenol,®but not placebo treatment. Oral intake of Pycnogenol® might have the potential to reduce hair loss in postmenopausal women.

The Use of Urea Cream for Hand Eczema and Urea Foam for Seborrheic Dermatitis and Psoriasiform Dermatoses of the Scalp.

Urea as an ingredient in topical skin applications can aid skin integrity and hydration and have keratolytic, anti-fungal, anti-bacterial, and anti-pruritic effects. Skin conditions that urea-containing formulations have been utilized to treat include hand eczema/dermatitis, seborrheic dermatitis and psoriasiform dermatoses of the scalp. Two monocentric, simple blind, observational studies were carried out in healthy participants to examine the efficacy and safety of two urea-containing products in these skin conditions. Study 1 tested the actions of a commercially available 30% urea topical cream on hand eczema. The product was applied ≥2/day for 28 ±2 days. Transepidermal water loss, skin redness, skin hydration, and participant ratings of efficacy and qualities were assessed prior to first product application and on days 14 and 29. Study 2 tested the actions of a commercially available foaming product containing 10% urea on seborrheic dermatitis and scalp psoriasiform dermatoses. The product was applied ≥2/day for 28 ±2 days. Desquamation index and surface occupied by squames, analysis of extracted squames, microscopic assessment of scalp photos and participant ratings of product efficacy and qualities was carried out prior to first product application and on days 14 and 29. In Study 1 (n = 20 females), results showed a significant (p < 0.05) decrease in transepidermal water loss, with an increase in hydration level of the upper skin layers, and a decrease in skin redness. In Study 2 (n = 13 females, 7 males), product use led to significant (p < 0.05) decreases in desquamation measures and dryness. In both studies, the majority of participants "agreed" or "slightly agreed" that the product had good efficacy and was easy to apply. No adverse reactions were reported. These findings point to the utility of urea in topically applied vehicles for hand eczema, seborrheic dermatitis, and psoriasiform dermatoses.

Dupilumab significantly improves skin barrier function in patients with moderate-to-severe atopic dermatitis.

Atopic dermatitis (AD) is characterized by abnormal skin lipids that are largely driven by hyperactivated type 2 immune responses. The antibody to the α-subunit of interleukin (IL)-4 receptor, dupilumab, was recently approved to treat AD and demonstrated strong efficacy. However, the role of dupilumab therapy in the regulation of skin barrier structure and function has not been fully explored. We have evaluated the content of lipids and transepidermal water loss (TEWL) in lesional and non-lesional skin of adults and adolescents with moderate-to-severe AD over the course of 16-week treatment with dupilumab and compared those values with that of matched healthy volunteers. Dupilumab treatment provided a significant decrease in TEWL in AD lesions, lowering it almost to the levels seen in the skin of healthy subjects. Blocking IL-4/IL-13 signaling with dupilumab normalized lipid composition (decreased levels of ceramides with non-hydroxy fatty acids and C18-sphingosine and increased the level of esterified omega-hydroxy fatty acid-containing ceramides) and increased ceramide chain length in lesional as well as non-lesional stratum corneum of AD patients. Partial changes for these parameters were already observed after 2 weeks, with a full response achieved after 8 weeks of dupilumab treatment. Inhibition of IL-4/IL-13 signaling by dupilumab allows restoration of skin lipid composition and barrier function in patients with moderate-to-severe AD.

Efficacy of Pseudo-Ceramide-Containing Steroid Lamellar Cream in Patients with Mild to Moderate Atopic Dermatitis: A Randomized, Double-Blind Study.

IntroductionAtopic dermatitis (AD) is a chronic inflammatory skin disorder involving decreased barrier function of the stratum corneum. This decrease, caused by a reduction in ceramide, the primary component of intercellular lipids in the stratum corneum, leads to a disturbance in the lamellar structure.MethodsWe developed a formulation (test cream) containing a steroid and synthetic pseudo-ceramide (SLE: N-(3-hexadecyloxy-2-hydroxypropyl)-N-2-hydroxyethyl hexadecanamide) that forms a lamellar structure on the skin after its application and drying. The formulation or control cream (a formulation containing a steroid but not pseudo-ceramide that does not form a lamellar structure) was applied twice daily for 2 weeks to the lesional area of 34 participants with mild to moderate AD symptoms.ResultsThe test cream showed a periodic structure with an interface space of approximately 8.2 nm in transmission electron microscopy and small- and wide-angle X-ray scattering, similar to the lamellar structure in the human stratum corneum. In the double-blind test, the anti-inflammatory effects of the test cream (n = 17) were comparable to those of the control cream (n = 17). In the test cream group, a significant increase in the stratum corneum moisture content (p < 0.01) and significant decrease in transepidermal water loss (p < 0.05) were observed at weeks 1 and 2 after application compared with those before application. No such change was observed in the control group.ConclusionThe results indicate that, even with a relatively short application period of 2 weeks, the test cream not only suppressed inflammation of the lesional area, but also improved the inherent barrier function of the stratum corneum, suggesting its potential as a treatment option for patients with AD.

Cymbopogon citratus (DC.) Stapf essential oil: Unraveling potential benefits on human skin

The essential oil of Cymbopogon citratus (DC.) Stapf is widely used for the production of fragrances, cosmetics, and detergents. However, there is no information on the effects of formulations containing C. citratus essential oil (EOCC) on human skin. This study aimed to evaluate the effects of formulation containing EOCC on human skin physiology. The study involved participants of both sexes (n=12). Two areas (3 cm x 3 cm) were drawn on both forearms. One randomly chosen area was treated for 14 days, 2 times/day with polyacrylic acid gel containing 5% EOCC and the other was used as a control for the same time period. Transepidermal water loss (TEWL), hydration, epidermal lipids, and biomechanics were measured (D0 and D14). High resolution Sonography images were also obtained. Results revealed a significant decrease in TEWL, a significant increase in hydration, firmness and elasticity, and a decrease in lipids, in the areas treated with EOCC. Sonography showed an increase in echogenicity of the epidermis after applying the formulation indicating that the essential oil penetrates only the most superficial layers of the skin. Results also suggest that formulations containing EOCC are safe for topical application and can improve and protect human skin. Keywords: Cymbopogon citratus; essential oil; citral; lemongrass

Simvastatin cream alleviates dermal fibrosis in a rabbit ear hypertrophic scar model.

Hypertrophic scars (HTS) result from injury to the skin and represent a clinical burden with limited treatment options. Previously, we demonstrated that statin drugs could attenuate HTS formation, but convenient topical delivery and retention of these drugs at the wound site remains a challenge. Here, we aimed to develop a topical cream formulation that can deliver statin drugs simply and conveniently to reduce scar hypertrophy. We formulated creams containing 10% pravastatin, 2% simvastatin, and 10% simvastatin. We tested these creams for their ability to reduce scar hypertrophy and attenuate dermal fibrosis in a clinically relevant HTS wound model performed in rabbit ear skin. We also monitored trans-epidermal water loss (TEWL) over the course of wound healing in order to understand the effects of statin treatment on epidermal barrier recovery. Of the three creams formulated, only application of 10% simvastatin cream significantly attenuated hypertrophy of resultant scars compared with vehicle cream application. Application of 10% simvastatin cream resulted in a decrease in macrophage and myofibroblast density at post-operative day 28 (POD28) harvest. Application of 10% simvastatin cream resulted in visible symptoms of dryness and increased TEWL at POD28, but subsequent withdrawal of statin cream treatment resulted in rapid alleviation of dryness and decrease in TEWL back to normal levels. Our data demonstrate that topical administration of 10% simvastatin cream antagonizes dermal fibrosis and reduces hypertrophy in an HTS model, and withdrawal of the cream enables recovery of epidermal barrier and resolution of skin dryness.

Efficacy and Safety of Topical Urea for Treatment Atopic Dermatitis as a Reference in the National Drugs Formulary

Atopic dermatitis (AD) is a chronically relapsing skin disease that occurs most commonly during early infancy and childhood. One of the most important clinical features of AD which results from a dysfunctional epidermal barrier (EB) is very dry skin (xerosis). Moisturizers are often used as supplements to topical and/or systemic anti-inflammatory drugs in various types of skin conditions and disorders. Humectan, this class of moisturizer is used to improve the appearance and texture of skin by filling in the crevices between corneocytes. One of the humectant included in the list of the National Drugs Formulary that is needed and must be available at health service facilities as a reference in the implementation of National Health Insurance (NHI) is urea. The literature searches using Pubmed, Academia, Google scholar and published in the last 10 years. Urea is effectively increasing skin hydration as well as niacinamide, significantly reducing local Scoring Atopic Dermatitis (SCORAD) and stratum corneum (SC) hydration. Urea had a decrease in transepidermal water loss (TEWL) which was not significantly better than lanolin and ceramide. The ceramide had a lower mean Visual Analogue Scale (VAS) score for irritation compared with the urea. More participants also preferred the ceramide-based cream over the urea. Urea is an effective and safe treatment although not as well as ceramide. Ceramide has been shown to be more effective and less irritating than urea. Ceramid can be quite expensive, while urea is a moisturizer that is easily found and accessible to the public.