Lower Transepidermal Water Loss Research Articles

Efficacy of a moisturizing cream and facial mask for alleviating skin problems associated with medical mask use: A half-face, randomized controlled study.

Prolonged use of medical masks has increased skin-related issues. To evaluate the efficacy of a facial cream and facial mask in mitigating medical mask related skin symptoms. Healthy women were randomly assigned to apply a facial cream (n = 32) or a facial mask plus a facial cream (n = 32) on half-faces after wearing medical masks for 4 h (Tb ). Transepidermal water loss (TEWL), dryness score, and redness area were assessed at Tb and 10 min after using the cream (T1 ) in the facial cream group, and at Tb , 1 h after using the facial mask (T2 ), and 10 min after using the cream (T3 ) in the combined use group. In the facial cream group, the treated half-face showed significantly better improvements from Tb to T1 in TEWL (-2.95 ± 0.38 vs. -0.68 ± 0.35 g/h·cm2 , p < 0.001) and skin dryness score (-1.00 ± 0.12 vs. 0.00 ± 0.00, p < 0.001). In the combined use group, the treated half-face showed significantly better improvements from Tb to T2 and T3 in TEWL (T2 , -3.46 ± 0.33 vs. -0.09 ± 0.13 g/h·cm2 ; T3 , -4.67 ± 0.31 vs. -0.28 ± 0.22 g/h·cm2 ) and skin dryness score (T2 , -0.63 ± 0.13 vs. 0.03 ± 0.03; T3 , -0.94 ± 0.17 vs. 0.19 ± 0.07) (all p < 0.001) then the untreated half-face. The combined use group had significantly lower TEWL at T3 than T2 (p < 0.05). The reduction in redness area was similar between the treated and untreated half-faces in both groups. The test facial cream and mask significantly improved skin barrier function and alleviated dryness symptoms associated with medical mask use, with the combined use offering superior benefits.

Associations between sun exposure, skin pH, and epidermal permeability in pregnancy: A longitudinal observational study

AbstractLittle is known about how sun exposure may affect the maternal skin barrier during pregnancy when many hormonal and physiological changes occur. In this longitudinal observational study, 50 pregnant women were recruited at 18–24 weeks' gestation, 25 in summer–autumn, and 25 in winter–spring. At three time points in pregnancy at 18–24, 28–30, and 36–38 weeks' gestation, participants completed a validated sun exposure questionnaire and had skin permeability and surface pH measured on the volar forearm. We identified an association between increased sun exposure and increased skin permeability at 18–24 weeks' gestation (β = 0.85, p = 0.01). Lower transepidermal water loss (decreased skin permeability), mean = 12.1 (SD = 5.1) at 28–30 weeks' gestation was observed, compared to mean = 12.6 (SD = 4.0) at 18–24 weeks' and mean = 13.7 (SD = 8.5) at 36–38 weeks' gestation (n = 27, β = −1.83, p = 0.007). Higher skin pH readings, mean = 5.80 (SD = 0.58) were found at 28–30 weeks' gestation, compared to mean = 5.25 (SD = 0.62) at 18–24 weeks' and mean = 5.47 (SD = 0.57) at 36–38 weeks' gestation (n = 27, β = 0.40, p = 0.004). These gestational fluctuations remained after adjusting for Fitzpatrick skin type, season, and sun exposure. We observed gestational fluctuations in both skin permeability and skin pH, with 28–30 weeks' gestation being a significant point of difference compared to mid‐ and late‐pregnancy periods.

Therapeutic effect of the combination of fractional laser and recombinant bovine basic fibroblast growth factor in acne scar patients

Purpose: To assess the feasibility and safety of a combination therapy involving fractional laser treatment and recombinant bovine basic fibroblast growth factor (rb-bFGF) in acne scar patients.Methods: 90 patients with acne scar admitted at Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology from September 2020 to December 2022 were enrolled in retrospective study. Patients were divided into control group (n = 41), treated with rb-bFGF alone and study group (n = 49), which underwent fractional laser treatment using Lutronic fractional laser device involving 40 days per session for three sessions, with additional application of rb-bFGF in the affected area at a dose of 300 IU/cm2 , three times daily, for seven consecutive days following the completion of each laser treatment session. Treatment effect, skin physiological indices, lactic acid stinging test (LAST) scores, stratum corneum integrity, and incidence of adverse reactions were determined.Results: Study group demonstrated superior efficacy with a total effectiveness of 97.96 %, significantly outperforming control group at 85.3 % (p &lt; 0.05). Pre-treatment, both groups exhibited comparable values in trans-epidermal water loss (TEWL), pH, stratum corneum hydration, and erythema (a-value) (p&gt; 0.05). Post-treatment, both groups exhibited significant improvements, with reduced TEWL, pH, and a-value, along with increased stratum corneum hydration (p &lt; 0.05). Compared to control group, study group showed significantly lower TEWL, pH, and a-value, coupled with higher stratum corneum hydration (p &lt; 0.05). Post-treatment, study group demonstrated lower total LAST scores, improved stratum corneum integrity, and a significantly lower incidence of adverse reactions.Conclusion: The combination of fractional laser and rb-bFGF in patients with acne scar improves skin barrier function, reduces lactic acid-induced stinging, and enhances stratum corneum integrity. Further research and clinical trials are needed to optimize the treatment protocols.

A prospective, split-face, randomized controlled trial of intense pulsed light-photodynamic therapy for seborrhea

BackgroundSeborrhea poses a common cosmetic concern in adolescents and young adults, often accompanied by enlarged pores, and contributing to various skin conditions, including acne vulgaris and seborrheic dermatitis. At present, there is a lack of effective treatment for this problem, and the potential of photodynamic therapy (PDT) in reducing sebum remains inconclusive. ObjectiveThis exploratory, prospective, single-center, double-blinded, randomized split-face controlled trial aimed to compare the efficacy and safety of intense pulsed light-photodynamic therapy (IPL-PDT) versus IPL therapy for seborrhea. MethodsParticipants with seborrhea underwent 3 times of IPL treatment (590 nm, 15–17 J/cm2 based on patient's tolerance) for one hemifacial part and IPL-PDT treatment for the other. Follow-up assessment was conducted up to 8 weeks after the final treatment. ResultsCompared with single IPL treatment, IPL-PDT can significantly inhibit sebum secretion and decrease pore size. PDT group exhibited no additional damage to the skin barrier, with even lower transepidermal water loss (TEWL). Additionally, the PDT group showed superior improvement in scores of porphyrins, red areas, and ultraviolet (UV) spots. Both groups experienced only mild topical adverse effects, well tolerated by the participants. ConclusionIPL-PDT is a more effective method than IPL in the treatment of seborrhea, as well as on the improvement of the skin barrier function.

Benefits of topical natural ingredients in epidermal permeability barrier.

Because of the crucial role of epidermal permeability barrier in regulation of cutaneous and extracutaneous functions, great efforts have been made to identify and develop the regimens that can improve epidermal permeability barrier function. Studies have demonstrated that oral administration of natural ingredients can improve epidermal permeability barrier in various skin conditions, including inflammatory dermatoses and UV-irradiation. Moreover, topical applications of some natural ingredients can also accelerate the repair of epidermal permeability barrier after acute barrier disruption and lower transepidermal water loss in the intact skin. Natural ingredient-induced improvements in epidermal permeability barrier function can be attributable to upregulation of keratinocyte differentiation, lipid production, antioxidant, hyaluronic acid production, expression of aquaporin 3 and sodium-hydrogen exchanger 1. In this review, we summarize the benefits of topical natural ingredients in epidermal permeability barrier in normal skin with or without acute barrier disruption and the underlying mechanisms.

How do the skin barrier and microbiome adapt to the extra-uterine environment after birth? Implications for the clinical practice.

The multiple protective functions of the skin derive from the interactions between epithelial skin and immune cells as well as the commensal microbiota. Developed in the last trimester of intra-uterine life, the skin barrier adapts dynamically after birth. Specific differences in the structure and physiology have been disclosed between infant and adult skin. The stratum corneum of infants is thinner and structured by thicker corneocytes with a more anisotropic surface in comparison to adult skin. Lower levels of the natural moisturizing factor and its constituents, together with the increased protease activity in the epidermis result in dry baby skin and ongoing adaptation of the desquamation to the extra-uterine environment. Infant epidermis is characterized by an accelerated proliferation rate and clinically competent permeability barrier in term neonates, despite the higher baseline values of transepidermal water loss in infants. The skin surface of newborns is less acidic, which could increase susceptibility to diaper and atopic dermatitis. Immediately after birth, skin is colonized by commensal bacteria-a process dependent on the mode of delivery and of major importance for the maturation of the immune system. Skin bacterial diversity and dysbiosis have been related to different pathology such as atopic and seborrheic dermatitis. This paper focuses on the ongoing structural, functional and biochemical adaptation of the human skin barrier after birth. We discuss the interactions on the 'skin barrier/ microbiota/ immune system' axis and their role in the development of competent functional integrity of the epidermal barrier.

Skin-specific mechanisms of body fluid regulation in hypertension.

Increasing evidence suggests excess skin Na+ accumulation in hypertension; however, the role of skin-specific mechanisms of local Na+/water regulation remains unclear. We investigated the association between measures of sweat and trans-epidermal water loss (TEWL) with Na+ content in the skin ([Na+]skin) and clinical characteristics in consecutive hypertensive patients. We obtained an iontophoretic pilocarpine-induced sweat sample, a skin punch biopsy for chemical analysis, and measures of TEWL from the upper limbs. Serum vascular endothelial growth factor-c (VEGF-c) and a reflectance measure of haemoglobin skin content served as surrogates of skin microvasculature. In our cohort (n = 90; age 21-86 years; females = 49%), sweat composition was independent of sex and BMI. Sweat Na+ concentration ([Na+]sweat) inversely correlated with [K+]sweat and was higher in patients on ACEIs/ARBs (P < 0.05). A positive association was found between [Na+]sweat and [Na+]skin, independent of sex, BMI, estimated Na+ intake and use of ACEi/ARBs (Padjusted = 0.025); both closely correlated with age (P < 0.01). Office DBP, but not SBP, inversely correlated with [Na+]sweat independent of other confounders (Padjusted = 0.03). Total sweat volume and Na+ loss were lower in patients with uncontrolled office BP (Padjusted < 0.005 for both); sweat volume also positively correlated with serum VEGF-c and TEWL. Lower TEWL was paralleled by lower skin haemoglobin content, which increased less after vasodilatory pilocarpine stimulation when BMI was higher (P = 0.010). In conclusion, measures of Na+ and water handling/regulation in the skin were associated with relevant clinical characteristics, systemic Na+ status and blood pressure values, suggesting a potential role of the skin in body-fluid homeostasis and therapeutic targeting of hypertension.

S-27-2: RENAL WATER LOSS-INDUCED SKIN WATER CONSERVATION LEADS TO HIGH BLOOD PRESSURE IN SPONTANEOUSLY HYPERTENSIVE RATS

Objective: Although previous studies have demonstrated the pathophysiological basis of hypertension in basic and clinical sciences, the decisive mechanism of essential hypertension remains to be clarified. We recently reported that 5/6 nephrectomized rats exhibited renal water loss due to impaired renal concentration ability and that the renal water loss triggered suppression of transepidermal water loss (TEWL). This skin water conservation was achieved by skin vasoconstriction-mediated reduction in skin vascular mass, which increased blood pressure in 5/6 nephrectomized rats. In this study, we examined the effect of renal and skin water handling on high blood pressure in spontaneously hypertensive rats (SHR). Design and method: We used male 9 weeks old SHR and its control normotensive Wistar Kyoto rats (WKY) in this study. The rats were kept in metabolic cages to collect urine for 24 hours. We also collected urine under water deprivation. After the urine collection, the rats were sacrificed and their plasma and tissues were collected. Skin sodium and potassium content were measured by the ashing-flame photometer method. In a separate experiment, we compared blood pressure and TEWL in anesthetized SHR and WKY. Body temperature was raised by elevating room temperature. Results: Compared with WKY, SHR exhibited a significant increase in urine volume and a decrease in urine osmolality. There were no significant differences in plasma osmole concentrations, urinary sodium, potassium, and urea excretion between the groups. SHR showed significantly higher urine volume and lower urine osmolarity than WKY even in water deprivation, suggesting that SHR has renal water loss. SHR exhibited significantly lower TEWL and higher blood pressure and skin sodium and potassium content compared with WKY. Skin vasodilation induced by elevating body temperature significantly reduced blood pressure in SHR but not WKY. Conclusions: These findings suggest that renal water loss due to the impaired renal concentration ability induces suppression of TEWL and skin osmole accumulation in SHR. This skin water conservation leads to high blood pressure via skin vasoconstriction to reduce skin vascular mass and TEWL. Skin water conservation as a compensatory mechanism for renal water loss may be a key mechanism and novel therapeutic target for essential hypertension.

Contributions of renal water loss and skin water conservation to blood pressure elevation in spontaneously hypertensive rats.

We recently reported that skin vasoconstriction to suppress transepidermal water loss (TEWL) leads to hypertension in renal injury model rats with impaired urine concentration ability. In this study, we investigated the pathogenesis of hypertension in spontaneously hypertensive rats (SHRs) from the perspective of renal water loss and skin water conservation. We compared the urinary concentration ability, body sodium and water balance, blood pressure, and TEWL in SHRs and control normotensive Wistar-Kyoto rats (WKYs). SHRs showed significantly higher urine volume and lower urinary osmolality than those of WKYs, while there were no significant differences in water intake, urinary osmolyte excretion, and plasma osmolarity between the groups. SHRs exhibited significantly higher blood pressure, skin sodium content, and lower TEWL compared with those is WKYs. Skin vasodilation, induced by elevating body temperature, increased TEWL in both SHRs and WKYs, and significantly reduced blood pressure in SHRs but not WKYs. These findings suggest that physiological adaptation can reduce dermal water loss in SHRs to compensate for renal water loss. Vasoconstriction required for successful cutaneous water conservation explains SHR hypertension. Renal concentration ability and skin barrier function for water conservation may become a novel therapeutic target for essential hypertension.

Moisturizing effectiveness of immediate compared with delayed moisturization.

Moisturizers play an essential role in maintaining the integrity of the skin barrier by increasing stratum corneum hydration (SCH) and reducing transepidermal water loss (TEWL). According to dermatology and allergy guidelines, moisturizers should be applied on the skin within 3min after bathing or showering. However, there is very little evidence supporting this recommendation. This study aimed to investigate the effectiveness of immediate and delayed moisturizing after bathing/washing on the improvement of SCH and TEWL. This was a crossover study of 60 healthy Vietnamese volunteers aged 18-25years. In each subject, SCH and TEWL levels were measured at three areas: non-moisturized, immediate moisturizing after washing, and delayed moisturizing at 30min after washing. In non-moisturized skin, SCH and TEWL levels were significantly different from the baseline at 60min after washing, while significantly decreased TEWL levels were observed immediately after moisturizing. In addition, moisturized skin had significantly higher SCH and lower TEWL levels compared with non-moisturized areas at every time point (p<0.05). Interestingly, the percentage changes of SCH and TEWL levels from baseline did not differ between immediately and delayed moisturized areas. Tested moisturizer helped increase SCH and decrease TEWL; however, there was no difference in moisturizing effectiveness between immediate and delayed moisturizing in healthy skin. The recommendation of immediate application of moisturizers after bathing/washing should be reconsidered, and more studies are needed to establish a stronger recommendation.

Effects of golden tomato extract on skin appearance—outlook into gene expression in cultured dermal fibroblasts and on trans‐epidermal water loss and skin barrier in human subjects

ScopeTwo experiments were performed to test the effects of rich tomato extract (Golden Tomato Extract, GTE) on human skin. In one experiment, the effects of this extract on gene expression in cultured human dermal fibroblasts were examined. In a second experiment, human subjects consumed the extract and trans‐epidermal water loss (TEWL), and aspects of skin appearance were monitored.Methods and resultsPrimary human dermal fibroblasts in culture were treated with the extract. After six hours, RNA was extracted, and gene expression was examined using Affymetrix Human Clariom D array processing. For the clinical study, 65 human subjects consumed a capsule once a day for 16 weeks, and various skin parameters were assessed at predetermined time intervals. Among the genes upregulated by GTE are genes that augment innate immunity, enhance DNA repair, and the ability to detoxify xenobiotics. GTE significantly reduced TEWL in subjects who had high TEWL at baseline, but it had no effect on TEWL in subjects who had lower TEWL at baseline.ConclusionsGolden tomato extract may provide benefits to the skin by enhancing innate immunity and other defense mechanisms in the dermis and by providing antioxidants to the skin surface to optimize TEWL and the appearance of the skin.

Reliability and validity of the Japanese version of the overall dry skin score in older patients.

Dry skin is the most common skin problem, especially in the elderly. However, there is no effective instrument to assess dry skin in Japan. This study aimed to evaluate the reliability and validity of the Japanese version of the overall dry skin score (ODS-J), the gold standard for dry skin assessment. A cross-sectional study was conducted on 47 patients aged>65 years. Images of skin on their limbs were captured using a digital camera; both upper and lower limbs were assessed (n=4/patient). One dermatologist; two wound, ostomy, and continence nurses; and three nursing researchers independently evaluated the images using the ODS-J to assess the intraclass correlation coefficient (ICC) for inter-rater reliability. Stratum corneum hydration (SCH) and transepidermal water loss (TEWL) were the external criteria used to verify concurrent and known-groups validity. In total, 182 sites at which the SCH and TEWL could be measured were evaluated for the ODS-J. The ICC for inter-rater reliability of the six raters was 0.939 (p<0.001). A higher ODS-J was associated with lower SCH (ρ=-0.374; p<0.001) and lower TEWL (ρ=-0.287; p<0.001) values. The ODS-J for the lower legs was significantly higher than that of the forearms (p<0.001). The ODS-J showed good inter-rater reliability, concurrent validity, and known-groups validity. It can be used by clinical nurses in Japan to observe patients' skin and is an effective indicator for the evaluation of skin care.

Scalp Biophysical Characteristics in Males with Androgenetic Alopecia: A Comparative Study with Healthy Controls.

BackgroundAndrogenetic alopecia (AGA) is the most common type of hair loss in men. Its prevalence increases with advancing age. Characteristics of hair loss in male AGA reveal the possibility of different biophysical and physiological profiles between androgen-sensitive (vertex) and androgen-insensitive (occipital) scalps. However, these variations have not been well investigated.ObjectiveWe aimed to evaluate and compare scalp biophysical and physiological characteristics in male AGA patients and healthy controls.MethodsScalp biophysiological profiles were evaluated by non-invasive measuring techniques, including skin surface lipids (SSL), transepidermal water loss (TEWL), and stratum corneum hydration (SCH) on both vertex and occipital areas. Values were compared between scalp areas and study groups. Participants with AGA were further categorized based on disease severity (Hamilton–Norwood classification) for subgroup analyses. Correlation coefficients were evaluated to determine the effects of AGA severity and age on each functional parameter.ResultsParticipants were 31 AGA subjects and 31 healthy controls. The vertex scalp of AGA patients had significantly higher SSL (p = 0.03) and lower SCH (p = 0.02) compared to the occipital scalp. TEWL was not significantly different (p = 0.31). AGA group SSL showed a positive correlation with severity of hair loss (r = 0.61, p = 0.03). When compared to controls, the AGA group vertex scalp had significantly higher SSL (p = 0.03) and lower TEWL (p < 0.001). The occipital area showed no statistically significant differences.ConclusionMale AGA presents with different biophysical and physiological characteristics in androgen-sensitive and androgen-insensitive areas, and with further differences from controls. These findings could direct further research and aid in the development of optimal hair and scalp treatments to improve scalp functional profiles in particular patients.

Epidermal barrier changes in patients with psoriasis: The role of phototherapy.

Some skin diseases may modify epidermal barrier function. Psoriasis is a chronic multi-systemic inflammatory disease that affects the epidermal barrier. Phototherapy is an option for treating psoriasis, but little is known about how epidermal barrier function is modified by phototherapy in psoriatic patients. (a) To compare skin homeostasis between involved and uninvolved skin in psoriatic patients with healthy controls (b) To evaluate changes in the epidermal barrier function in psoriatic patients treated with phototherapy. Sixty patients with plaque-type psoriasis and sixty gender and age-matched healthy controls were enrolled. Temperature, transepidermal water loss (TEWL), stratum corneum hydration (SCH), pH, elasticity, erythema and melanin index were measured using non-invasive tools in the healthy control and involved and uninvolved psoriatic skin before and after phototherapy. Healthy controls had lower TEWL and erythema index and higher SCH than psoriatic patients, both at uninvolved psoriatic skin and psoriasis plaques. TEWL was higher at psoriasis plaques than at uninvolved skin (19.20 vs 11.57g/h/m2 ; P<.001). Following phototherapy, a decreasing trend was observed for TEWL, of 1.03 (SD 0.75) and 0.97 (SD 0.81)g/h/m2 for uninvolved and involved skin respectively. SCH was significantly lower at psoriatic plaques than at uninvolved skin (7.32 vs 36.62Arbitrary Units [AU]; P<.001). SCH increased by 1.15AU (SD 0.26) on psoriatic plaques after the phototherapy session (P<.001). Psoriatic plaques showed epidermal barrier dysfunction compared to uninvolved skin and healthy controls. Phototherapy may improve epidermal barrier function in psoriatic patients. SCH increased after a phototherapy session on the psoriatic plaques.

Assessment of serum concentrations of matrix metalloproteinase 1, matrix metalloproteinase 2 and tissue inhibitors of metalloproteinases 1 in atopic dermatitis in correlation with disease severity and epidermal barrier parameters.

IntroductionMatrix metalloproteinases (MMPs) are a group of proteolytic enzymes, conditioning the integrity of skin cells, however, their role in the inflammatory process of atopic dermatitis (AD) and the direct effect on the epidermal barrier parameters remain unexplained.AimTo assess MMP-1, MMP-2, tissue inhibitors of metalloproteinases (TIMP)-1 concentrations in blood serum in the context of transepidermal water loss (TEWL) and stratum corneum hydration in AD. Moreover, serum levels of MMPs and TIMP-1 were analysed in relation to the Eczema Area and Severity Index (EASI).Material and methodsForty-three AD patients and 22 control group subjects have been investigated. Serum concentrations of MMP-1, MMP-2, and TIMP-1 have been evaluated with ELISA. TEWL and stratum corneum hydration have been assessed with a TM300 Tewameter and a CM825 Corneometer. Skin lesions in patients with AD have been evaluated with the Eczema Area and Severity Index.ResultsMMP-1 and MMP-2 serum concentrations were significantly higher in the AD group. The results of TIMP-1 serum concentration were similar for both groups. The correlation between the serum concentration and the EASI was demonstrated only for MMP-2 for patients with severe and moderate AD. Patients with AD and TIMP-1 serum concentration greater than MMP-1 presented lower TEWL and higher epidermal hydration.ConclusionsThe results of this study warrant further investigation. The predominance of TIMP-1 over MMP-1 in blood serum can potentially limit TEWL and maintain the proper water content of the epidermis. Future work is necessary to establish how reliable the role of MMP-2 concentration is as an indicator of the severity of AD.

Topical 0.5% Timolol Maleate Significantly Enhances Skin-Barrier Restoration After Fractional Carbon Dioxide Laser Treatment for Acne Scars.

Skin barrier is often compromised following ablative fractional carbon dioxide laser (AFCO2 ) therapy for acne scarring. The resultant downtime, even of a few days' duration, can be of significant concern to patients. We evaluated the efficacy and safety of topical 0.5% timolol maleate (TM) for its role in short-term restoration of the skin's biophysical properties after laser treatments. This double-blind, placebo-controlled trial included participants aged 18-50 years with atrophic acne scars for at least 3 months. After undergoing laser therapy, they applied 0.5% TM to one cheek and normal saline to the contralateral cheek (control) for 7 days. Corneometry, transepidermal water loss (TEWL) measurement, colorimetry, and clinical outcome parameters (erythema, edema, crusting, pruritus, and tightness scores) were evaluated at baseline and 48, 96, and 168 hours after AFCO2 treatment. Twenty-five healthy participants completed the study. Most participants had Fitzpatrick skin phototype IV. The TM-treated side showed statistically higher corneometry values and lower TEWL than the control side at every follow-up visit (P < 0.001). The crusting score at 96 hours post-AFCO2 treatment was also significantly better on the TM side. No adverse events occurred during the follow-up period. Application of topical 0.5% TM twice daily improves the skin-barrier function and might promote re-epithelialization after laser procedures. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Rosacea is associated with conjoined interactions between physical barrier of the skin and microorganisms: A pilot study

BackgroundRosacea is a common condition characterized by transient or persistent central facial erythema, and often papules and pustules. Currently, the role of bacterium in the development and progression of rosacea remains controversial. This study aimed to investigate the difference in the physiological conditions and microorganisms between the lesional and non‐lesional areas of papulopustular rosacea.MethodsTwenty‐five French patients with papulopustular rosacea were enrolled in this pilot study. Each patient was subjected to clinical assessment, and the skin barrier function was tested in lesional and non‐lesional areas. In addition, samples from the lesional and non‐lesional areas were collected for bacterial culturing.ResultsOf all subjects included in the study, a lower skin conductivity was measured in lesional areas than in non‐lesional areas (43.5 ± 12.4 vs. 57.2 ± 11.6 U, P < .05), and a higher transepidermal water loss (TEWL) value was found in lesional areas than in non‐lesional areas (17.2 ± 5.9 vs. 14.2 ± 4.1 g/(m2 h), P < .05). We found a lower TEWL in lesions in rosacea patients with bacterial dysbiosis than in those with bacterial balance (P < .05). In addition, there were significant differences in the skin conductivity and TEWL between lesional and non‐lesional areas in patients with bacterial dysbiosis (P < .001), and no significant differences were seen in patients with bacterial balance (P < .05).ConclusionThe results of the present study demonstrate that the physiological features of rosacea are closely associated with the interactions between the host and the microorganisms.

Distinct Skin Microbiome and Skin Physiological Functions Between Bedridden Older Patients and Healthy People: A Single-Center Study in Japan.

With the increase in the older populations, the number of bedridden older patients is becoming a matter of concern. Skin microbiome and skin physiological functions are known to change according to lifestyle and community; however, such changes in case of movement- and cleaning-restricted bedridden older patients have not yet been revealed. To address this issue, we analyzed skin microbiome and skin physiological functions, including pH, hydration, sebum level, and transepidermal water loss (TEWL), of bedridden older patients, compared with those of ambulatory older and young individuals. For this analysis, we enrolled 19 healthy young and 18 ambulatory older individuals from the community and 31 bedridden older patients from a single, long-term care hospital in Japan. The area of interest was set to the sacral (lower back) skin, where pressure injuries (PIs) and subsequent infection frequently occurs in bedridden older patients. We observed a higher number of gut-related bacteria, fewer commensals, higher skin pH, and lower TEWL on the sacral skin of bedridden older patients than on that of young or ambulatory older individuals. In addition, we observed that 4 of the 31 bedridden older patients developed PIs during the research period; a higher abundance of pathogenic skin bacteria were also observed inside the PI wounds. These findings imply distinct skin microbiome and skin physiological functions in bedridden older patients in comparison with healthy individuals and may suggest the need for more stringent cleaning of the skin of bedridden older patients in light of the closeness of skin and wound microbiome.

Cutaneous Biophysical Parameters in Different Stages of Chronic Kidney Disease and the Relationship with Water Content and Severity of Pruritus

Background: Local cutaneous change is one of the factors involved in the pathophysiology of skin manifestations in chronic kidney disease (CKD). Objectives: To determine the skin’s biophysical parameters in different CKD stages and the relationship with biochemical and hematological parameter, pruritus severity, and body water content. Methods: A cross sectional study involving stage 1 - 5 CKD patients aged ≥ 50 years was performed. Transepidermal water loss (TEWL), hydration, pH and body water content were measured at eight sites. Results: A total of 83 patients aged 66.8 ± 8.4 years participated. There were no differences in TEWL, hydration, pH, and body water between the CKD stages and pruritus severity. Pruritus did not correlate with biophysical, haematological, and biochemical parameters. Hydration correlated with glomerular filtration rate (r = 0.25, P = 0.02, urea r = -0.28, P = 0.01) and creatinine (r = -0.25, P = s0.02). pH correlated with urea (r = 0.34, P = 0.00), creatinine (r = 0.28, v0.01), and hemoglobin (r = -0.28, P = 0.01). Total body water correlated with TEWL, r = -0.25, P = 0.02, but not hydration or pH. Conclusions: There were no differences in TEWL, hydration, pH, body water, and pruritus between non-dialysis CKD stage 1 - 5. Higher urea and creatinine was associated with lower hydration and pH. Increased total body water was associated with lower TEWL. There was no relationship between pruritus with biophysical, haematological, and biochemical parameters.

Young children with moderate-to-severe atopic dermatitis can be treated safely and effectively with either topical tacrolimus or mild corticosteroids.

We collected evidence and safety data for topical tacrolimus in small children with atopic dermatitis (AD) and compared the usage with topical corticosteroid. This was an interim analysis of 75 patients (55% female) at 1year of an ongoing 3-year randomised open-label comparative follow-up study of topical tacrolimus vs corticosteroid treatment. One- to three-year-old children with moderate-to-severe eczema referred to the Skin and Allergy Hospital in Helsinki, Finland, were enrolled. Efficacy parameters, the Eczema Area and Severity Index (EASI), Investigator's Global Assessment (IGA), transepidermal water loss (TEWL), eczema area, serum total immunoglobulin E (IgE) and the blood eosinophil count, showed improvement in both groups during the study. However, patients with signs of early sensitisation at baseline (elevated serum total IgE, elevated eosinophil count, positive prick tests or specific IgEs to aero or food allergens) had statistically significantly lower TEWL at the eczema site and a smaller eczema area at 12months in the tacrolimus group. No severe adverse effects were seen during the treatment. Children with AD and signs of early sensitisation appeared to benefit more from early tacrolimus than corticosteroid treatment. Small children may need stronger but nevertheless safe ointment options when treating moderate-to-severe AD.