Mean Transepidermal Water Loss Research Articles

Störung der Hautbarriere und allergische Sensibilisierung bei 16-jährigen Jugendlichen

Abstract Background Transepidermal water loss (TEWL) has been used to measure skin barrier function and has been associated with atopic dermatitis and allergic diseases in infancy. However, few studies have assessed the association between TEWL and allergic diseases in adolescents. Objective To investigate the association between TEWL and allergic sensitizations in 16-year-old adolescents. Materials and methods The study was conducted in 78 adolescents of the PASTURE study. Different types of sensitization (seasonal, perennial, inhalant, food and any) were defined using serum specific immunoglobulin E (IgE) and skin prick test. TEWL was measured on the crook of either right or the left arm using a TEWAMETER® TM 300 (Courage + Khazaka electronic, Cologne, Germany) at mean temperature and humidity of 24.1 °C and 36.1%, respectively. The mean TEWL and interquartile range (IQR) were 11.9 ± 4.4 and 4.8 g/m2/h respectively. Results In our study, TEWL was positively associated with any sensitization (adjusted odds ratio [OR] per-IQR of the probability of increased TEWL [95% confidence interval]: OR 2.64; [1.12–6.19]; p = 0.03) and allergic rhinoconjunctivitis (ARC; OR 1.92; [1.04–3.54]; p = 0.04), but not with asthma or atopic dermatitis. When separating any sensitization into perennial and seasonal, only perennial sensitization (OR 3.30; [1.42–7.43]; p = 0.005) was associated with TEWL. Conclusion In the present study, we show the association of defective skin barrier function measured as TEWL with perennial sensitization and ARC suggesting its possible role in the pathogenesis of ARC through sensitization.

Blockade of IL-13 signaling improves skin barrier function and biology in patients with moderate to severe atopic dermatitis.

Interleukin (IL)-13 is a key driver of inflammation and barrier dysfunction in atopic dermatitis (AD). While there is robust evidence that tralokinumab, a monoclonal antibody neutralizing IL-13, reduces inflammation and clinical disease activity, less is known about its effects on barrier function. To characterize effects of tralokinumab treatment on skin barrier function. Transepidermal water loss (TEWL), stratum corneum hydration (SCH), natural moisturizing factor (NMF) content, histopathological characteristics, biomarker expression and microbiome composition were evaluated in lesional, non-lesional, and sodium lauryl sulfate (SLS)-irritated skin of 16 AD patients over the course of 16 weeks of tralokinumab treatment. All clinical severity scores decreased significantly over time. At week 16, mean TEWL in target lesions decreased by 32.66% (p = 0.01), and SCH increased by 58.44% (p = 0.004), along with histological reduction in spongiosis (p = 0.003), keratin 16 expression and epidermal thickness (p = 0.001). In parallel, there was a significant decrease in several barrier dysfunction-associated and pro-inflammatory proteins such as fibronectin (p = 0.006), CCL17/TARC (p = 0.025) and IL-8 (p = 0.014), with significant changes already at week 8. Total bacterial load and Staphylococcus aureus abundance were significantly reduced from week 2. Tralokinumab treatment improves skin physiology, epidermal pathology, and dysbiosis, further highlighting the pleiotropic role of IL-13 in AD pathogenesis.

563 - Dupilumab improves skin lipid composition in atopic dermatitis irrespective of patient filaggrin (FLG) mutation status

Abstract Introduction/Background Type 2 inflammatory cytokines interleukin 4 (IL-4) and IL-13 play an important role in skin barrier disruption in atopic dermatitis (AD). Filaggrin and ceramides play a crucial role in skin barrier integrity. Loss of function mutations in the FLG gene are associated with the impaired skin barrier function and more severe AD.1,2 FLG mutations only affect a minority of AD patients; however, increased IL-4 and IL-13 cytokines are a common cause of reduced filaggrin expression in patients with AD, independent of FLG genotype. Objectives To explore whether dupilumab treatment improves skin barrier function in patients with or without FLG mutations. Methods In the BArrier function and LIpidomics STudy in Atopic Dermatitis (BALISTAD; NCT04447417), a 16-week study in patients with AD aged 12 to 65 years, adult patients with AD received dupilumab 300 mg every 2 weeks; adolescent patients with AD received dupilumab 200 mg every 2 weeks if their baseline weight was <60 kg and 300 mg if ≥60 kg. FLG mutations were evaluated in DNA from blood samples of consenting patients with AD and healthy volunteers. Transepidermal water loss (TEWL) was assessed longitudinally after 5 skin tape strippings (STS) from AD lesions (n = 26) and from the skin of healthy participants (n =26) (age: 12 to 63 years) over a 16-week course of dupilumab treatment. Quantitative N(C18)S-ceramide analysis of STS samples collected on Days 1, 15, 29, 57, and 85, and at Week 16 from AD lesions and from the skin of healthy participants was performed using liquid chromatography tandem mass spectrometry. Results At baseline, mean TEWL after 5 STS (TEWL5) was significantly higher in AD lesional skin than healthy skin (p<0.0001). The mean TEWL5 in AD lesions in subjects with FLG mutations (n = 6/19) was significantly higher at baseline than in AD subjects without mutations (P < 0.0001). Dupilumab treatment significantly reduced TEWL5 in AD lesional skin as early as Week 2 with a progressive decrease through Week 16 (P < 0.0001). Reduction in mean TEWL5 was similar from Week 2 to Week 16 in AD patients with and without FLG mutations. At Week 16, TEWL5 was comparable to healthy skin in the lesional skin of AD patients with and without FLG mutations (P > 0.05). AD skin lesions had increased levels of N(C18)S-ceramides at baseline (P < 0.0001); but no differences were noted in subjects with or without FLG mutations (P > 0.05). Dupilumab treatment significantly reduced levels of N(C18)S-ceramides in AD lesional skin as early as Week 2 with a progressive decrease through Week 16 (P < 0.0001). Dupilumab treatment decreased levels of N(C18)S-ceramides in STS samples similarly in subjects with and without FLG mutations from Week 2 to Week 16. Conclusions Dupilumab treatment normalizes TEWL5 and decreases levels of N(C18)S-ceramides in AD lesional skin of subjects with and without FLG mutations.

432 Fluctuations in Equine Cutaneous Ph and Trans-Epidermal Water Loss Associated with Anatomical Location, Time, and Weather

Abstract Although skin health is of critical importance for all horse owners, understanding of cutaneous pH and trans-epidermal water loss (TEWL) and the normal ranges of these variables is lacking. Cutaneous pH and TEWL measures provide insight into the barrier function of the epidermis and have the potential to determine the resident dermal microbiota. However, these measures have been recorded to fluctuate due to a variety of factors such as environment and anatomical locations in other species. Accordingly, the objectives of this study were to identify the impacts of anatomical location, weather, and time of day on cutaneous pH and TEWL in equines. This study utilized nine (n = 9) stock type mares, group-housed in a pasture setting at Southern Illinois University Equine Center. Researchers measured cutaneous pH and TEWL three times (6:00 AM, 12:00 PM, 6:00 PM) daily across five anatomical locations (nose, whither, heart-girth, mid-back, and base of tail) for five consecutive days. All statistical analysis was conducted using SAS On Demand for Academics (P < 0.05). Analysis of changes in variables associated with time, anatomical location, and day were conducted utilizing a PROC GLM three-way repeated measures ANOVA utilizing a Greenhouse-Geiser correction. Cutaneous pH results displayed significant main effects of day (P = 0.0052) and time (P = 0.0073) as well as a significant interaction of day and location (P = 0.0004). Mean cutaneous pH fluctuated daily, however, certain anatomical locations fluctuated more than others each day. Additionally, pH was highest in the morning (mean of 7.28) and lowest in the evening (mean 7.011). However, the mean overall pH for the study is 7.14 which is congruent with other work. TEWL measurements had significant main effects of day (P < 0.0001), time (P < 0.0001), and location (P = 0.0231), as well as a significant interaction of day, time, and location (P < 0.0001). TEWL measurements fluctuated with day, likely a result of weather changes. Mean TEWL measurements were less in the morning (mean 24.68) and greatest in the afternoons (mean 38.52). Overall mean TEWL measurement was 30.25. The results of this work indicate fluctuations in dermal barrier variables are associated with day, anatomical location, and time of day. These findings may have implications for applications of dermal treatments for horses as well as catalog the natural fluctuations which may affect future research.

A randomised, double-blinded, controlled trial to determine the efficacy of combined therapy of oclacitinib and marine oil extract PCSO-524 in dogs with atopic dermatitis.

Polyunsaturated fatty acids (PUFA) can be beneficial in the management of canine atopic dermatitis (cAD). A commercial product PCSO-524 containing PUFA has demonstrated anti-inflammatory effects in dogs. To evaluate the efficacy of PCSO-524, in combination with oclacitinib in dogs with cAD. Seventeen client-owned dogs with cAD. A randomised, double-blinded, controlled trial. All dogs were treated with oclacitinib (0.4-0.6 mg/kg) twice a day for 14 days, then once a day until Day (D)42. They were randomly divided into two groups: PCSO-524 (n = 9) and sunflower oil (n = 8). Clinical status was assessed by Canine Atopic Dermatitis Extent and Severity Index, 4th iteration (CADESI-04) and pruritus Visual Analog Scale (pVAS) at baseline (D0), D14, D28 and D42. Trans epidermal water loss (TEWL) was measured at the same time points. CADESI scores decreased significantly after treatment and there was a significant difference between the PCSO-524 and the control group at D28 (p = 0.04) and D42 (p = 0.03). The PCSO-524 group also demonstrated a significantly decreased pVAS on D28 and D42 (p < 0.001 and p < 0.001) compared to D0, while significant differences were observed in the control group at D14 and D28 (p < 0.01 and p = 0.04) and not at D42 (p = 0.12). The mean TEWL showed a significant decrease at D28 and D42 in the PCSO-524 group, compared to the control group (p = 0.002 and p < 0.001). The combination of PCSO-524 and oclacitinib may help to alleviate the rebound effect that occurs when tapering down the dosage of oclacitinib, as compared to using oclacitinib alone for the management of cAD.

P40 Dupilumab treatment restores skin barrier function in lesional and nonlesional skin of patients with atopic dermatitis and improves patient-reported outcomes

Abstract The objective of this analysis is to report the effect of dupilumab treatment on skin barrier function and patient-reported outcomes (PROs) in adults and adolescents with moderate-to-severe atopic dermatitis (AD). BALISTAD (NCT04447417) was an open-label trial in which transepidermal water loss (TEWL) was assessed repeatedly before and after skin tape stripping (STS) samples were taken from lesional and nonlesional skin of 26 patients with AD treated with dupilumab, and from normal skin of 26 matched healthy volunteers aged 12–65 years over a period of 16 weeks. PROs assessed included Patient-Oriented Eczema Measure (POEM), Peak Pruritus Numerical Rating Scale (PP-NRS) and Dermatological Life Quality Index [DLQI; for patients &amp;gt; 17 years old; Children’s DLQI (CDLQI) for patients aged &amp;gt; 12 to &amp;lt; 17 years]. At baseline, the median TEWL after five STS was statistically significantly higher in the lesional and nonlesional skin of patients with AD compared with healthy skin (P &amp;lt; 0.001 and P &amp;lt; 0.01, respectively) and statistically significantly decreased following dupilumab initiation as early as week 2 (P &amp;lt; 0.001 and P &amp;lt; 0.05, respectively). After 16 weeks of dupilumab treatment, there was no statistically significant difference in adjusted mean TEWL in AD lesional and nonlesional skin compared with matched healthy skin (P = 0.225 and P = 0.163, respectively). Significant improvement from baseline [mean (SD) change from baseline] was seen as early as week 2 in mean POEM [−8.4 (5.1)], DLQI [−5.3 (4.7)], CDLQI [−6.2 (4.7)] and PP-NRS [−2.2 (1.8); P &amp;lt; 0.001 and P &amp;lt; 0.05)] for CDLQI. Improvement was sustained through to week 16 [mean (SD) change from baseline; P &amp;lt; 0.001] for POEM [−13.6 (8.5)], DLQI [−8.6 (7.4)] and PP-NRS [−4.2 (2.6)] and with a P-value of &amp;lt; 0.01 for CDLQI [−9.2 (5.0)]. Dupilumab treatment normalizes epidermal barrier function in lesional and nonlesional skin in patients with moderate-to-severe AD, as measured with TEWL, and improves PROs. Funding sources: research sponsored by Sanofi and Regeneron Pharmaceuticals Inc.

A New Moisturiser Improves DNCB-induced Atopic Dermatitis-like Symptoms and Restores Skin Barrier Function in BALB/c Mice.

Atopic dermatitis (AD) is a chronic, inflammatory skin disorder with eczematous and pruritic lesions. Topical moisturisers and either topical corticosteroids or calcineurin inhibitors are usually recommended. Restoring the skin barrier function alleviates AD symptoms. To evaluate the efficacy of a new moisturiser compared to commercially available products in an AD murine model. Experimental AD was induced with topical applications of 2,4-DiNitroChloroBenzene (DNCB) on the shaved back skin of BALB/c mice from Day 1 to Day 38. Mice were randomized to either Vehicle/-, DNCB/-, or DNCB/Eczekalm (test product), DNCB/Atopiclair®, or DNCB/Lipikar (reference products) groups. Once daily application of either Eczekalm or Atopiclair® or Lipikar on the AD lesion was performed from Day 32 to Day 38. The AD severity index (ADSI) and animal behaviour were monitored throughout the study. The trans-epidermal water loss (TEWL) was measured on the sacrifice day (Day 39). At Day39, ADSI in the DNCB/Eczekalm, DNCB/Lipikar, and DNCB/Atopiclair® groups were significantly lower by -70%, -68%, and -57%, respectively, as compared to DNCB/- (p < 0.001). No sign of erythema was observed in the DNCB/Eczekalm group. Mean scores of skin oedema, excoriation, and dryness in the DNCB/Eczekalm, DNCB/Lipikar, and DNCB/Atopiclair® groups were significantly lower than in the DNCB/-. No significant difference was observed between DNCB/Eczekalm and DNCB/Lipikar groups. Mean TEWL in DNCB/Eczekalm group was significantly lower than the ones of DNCB/Atopiclair® (-43%, p < 0.001) and DNCB/Lipikar (-15%, p < 0.05). Eczekalm treatment significantly reduced the inflammatory effects due to AD and itching episodes and restored the skin barrier function.

Profile of Transepidermal Water Loss (TEWL), Skin Hydration, and Skin Acidity (pH) in Indonesian Batik Workers.

Chemical substances used during batik processing may affect the physiological function of the batik worker's skin barrier. This study assessed the level of transepidermal water loss (TEWL), skin hydration, and skin acidity in 61 batik workers from the batik center in Paseseh village, Tanjung Bumi subdistrict, Madura Island, Indonesia. Forty-five batik workers involved in dry work including drawing patterns on the cloth with wax and sixteen batik workers involved in wet work including dyeing the cloth with a dye bath were included in this study. The mean TEWL level in the dry work section was 59.87 ± 11.94 g/m2/h on the palmar and 29.00 ± 13.09 g/m2/h on the dorsal side of the hand, while the mean TEWL in the wet work section were 47.39 ± 9.66 g/m2/h on the palmar and 37.07 ± 10.00 g/m2/h on the dorsal side of the hand. The mean skin hydration level in the dry work section was 49.80 ± 19.16 arbitrary units (a.u.) for the palmar side and 52.77 ± 16.21 a.u. for the dorsal side of the hand, while the mean levels of skin hydration in the wet work section were 47 ± 12.73 a.u. and 62.94 ± 10.09 a.u. for palmar and dorsal side, respectively. The mean levels of skin acidity in the dry work section were 5.45 ± 0.19 for the palmar side and 5.30 ± 0.20 for the dorsal side of the hand, while the wet work section had 5.30 ± 0.19 and 5.10 ± 0.19 for the palmar and dorsal side of the hand, respectively. The TEWL levels were found to be higher on the palmar side of the hand in both the dry work and wet work sections, which was consistent with the measurement of skin hydration levels that were lower on the palmar side of the hand. The mean skin pH levels for both work sections were considered within the normal range.

33557 Dupilumab treatment restores skin barrier function and improves clinical and patient reported outcomes in adults and adolescents with moderate to severe atopic dermatitis

Objective: To determine the effect of dupilumab on skin barrier function in adults and adolescents with moderate to severe atopic dermatitis (AD). Methods: Transepidermal water loss (TEWL) was measured before and after skin tape stripping (STS) in AD lesional skin (n = 26) over 16 weeks of dupilumab therapy, and matched healthy control skin (n = 26) in an Open Label Exploratory study (BALISTAD [NCT04447417]). TEWL before and after STS was assessed repeatedly between baseline and Week 16. Change from baseline in TEWL was analyzed using a mixed model, adjusting for age, gender, and lesion location. Secondary and exploratory endpoints included clinical, and patient reported outcomes. Photographic documentation was also obtained during the study. Results: The mean TEWL in AD lesions was significantly reduced from baseline, (both before STS and following 5/10/15/20 STS) ranging from 47.2, 62.5, 73.0, 80.4, and 88.0 g/m2 x h at baseline to 23.6, 28.3, 34.3, 42.9, and 49.2 g/m2 x h at Week 16, respectively; representing 48% to 57% reduction (P < .0001). By week 16, the mean distribution of TEWL in AD patients was close to matched healthy controls. Clinical and patient reported outcomes (EASI, SCORAD, peak pruritus NRS, sleep quality NRS, POEM and DLQI/CDLQI) significantly improved from baseline (P < .0001 for all endpoints except CDLQI [P < .01]). Conclusions: Dupilumab treatment leads to significant improvement in TEWL in AD lesional skin, demonstrating restoration of epidermal barrier function and improvement in signs and symptoms of AD.

Performance and Acceptability of a New Dexpanthenol-Containing Hand Cream in Subjects with Sensitive and Very Dry Skin: A Randomized Controlled Study

A new dexpanthenol-containing hand cream (ND-HC) was developed for people with dry, sensitive, and/or environmentally stressed hands. To explore the performance and acceptability of ND-HC, we conducted a randomized, intraindividual comparison study in 40 healthy adult subjects with sensitive and very dry skin on the hands. Instrumental measurements determined the effects on stratum corneum (SC) hydration and transepidermal water loss (TEWL) after single and/or 4 weeks’ use of ND-HC. Single and continued at least four times daily applications of ND-HC to very dry skin of the hand for 4 weeks triggered significant increases in SC hydration. On day 29, the mean change in skin capacitance from baseline was significantly greater when ND-HC was applied to the test area compared with the untreated area on the contralateral hand (12.41 vs. 4.46 a.u.; p &lt; 0.001). Upon use of ND-HC over 4 weeks, mean TEWL decreased significantly (bilateral difference: −1.8 vs. 1.0 g/m2/h; p = 0.003), indicating an improvement in SC barrier function. A reduction in dry hand symptoms was observed over the study course. ND-HC was well tolerated and achieved a high level of acceptance and satisfaction. Our findings suggest that ND-HC complies with the required features of a state-of-the-art hand cream.

The efficacy and safety of a fractional microneedle radiofrequency device for the treatment of axillary hyperhidrosis: clinical prospective pilot study.

We aimed to evaluate the efficacy and safety of a fractional microneedle radiofrequency device (FMRD) for the treatment of primary axillary hyperhidrosis (PAH). The FMRD adopted insulated microneedles, which could be located at a depth of up to 4.5mm and deliver a radiofrequency current in a fractional manner. Also, the device could automatically regulate the amount of the delivered energy. Sixteen Korean patients with PAH received two FMRD treatment sessions at a 3-week interval and were followed-up until week 15. The primary outcome was Patient Satisfaction Scale (PSS) score at each visit. Hyperhidrosis Disease Severity Scale (HDSS) and Global Aesthetic Improvement Scale (GAIS) were also assessed. The area and amount of sweat produced were evaluated by specific tests. Mean PSS score significantly improved from 1.6 at week 3 to 2.5 at week 15 by 56%. More than a 50% improvement in sweating assessed by the PSS score was seen in 63% and 50% of patients at weeks 11 and 15, respectively. Mean HDSS score significantly decreased by week 3 and further decreased by week 7. Mean GAIS scores improved from the first follow-up visit at week 3 and improved again at week 7. The mean hyperhidrosis area assessed by starch-iodine test significantly decreased by 36% at week 15 compared with baseline. Mean transepidermal water loss level significantly decreased by 42% at week 15 compared with baseline. No patients experienced any serious adverse events. FMRD can be an effective and safe treatment modality for PAH.

Cancer Cachexia May Hinder Pain Control When Using Fentanyl Patch.

The objective of this study was to evaluate the influence of cancer cachexia on pain control in cancer patients receiving a transdermal fentanyl patch (FP) and to investigate whether dry skin was a factor related to cancer cachexia and uncontrolled pain. We retrospectively reviewed the medical records of 77 patients receiving FP treatment for the first time, who were classified into cancer cachexia and non-cancer-cachexia groups, according to European Palliative Care Research Collaborative criteria. On day 7 after FP administration, the mean FP dose and morphine equivalent dose (MED) in the cancer cachexia group were significantly higher than in the non-cancer-cachexia group. Additionally, in the cancer cachexia group, there was a significantly larger degree of variation in pain intensity over 7 d than in the non-cachexia group. In patients who were switched from FP to morphine injection, the mean pain intensity and MED on day 3 after morphine injection were significantly lower than those immediately before morphine injection. Subsequently, to investigate whether dry skin was involved in poor pain control in the cancer cachexia group, transepidermal water loss (TEWL) was compared between 15 additional patients classified into cancer cachexia and non-cancer cachexia groups; the mean TEWL in the cancer cachexia group was found to be significantly lower. Our data suggest that cancer cachexia may be a risk factor for poor pain control in patients receiving FP treatment, and that uncontrolled pain in FP treatment may be caused by the inhibition of fentanyl transdermal absorption due to dry skin.

Combined effects of glycerol and petrolatum in an emollient cream: A randomized, double‐blind, crossover study in healthy volunteers with dry skin

The stratum corneum plays an important protective physiological role in providing a barrier to preventing skin desiccation and penetration of external agents. Emollients are used commonly to improve barrier function and skin hydration. The primary objective of this study was to evaluate the effect of an emollient, V0034CR cream, and its active ingredients, to restore the cutaneous barrier. Secondary objectives included assessment of the moisturizing activity of each product and tolerance. The study was not designed to evaluate therapeutic benefit. In this randomized, double-blind, 4-arm crossover, clinical pharmacology study, the full emollient V0034CR, its vehicle formulation alone, or with glycerol, or petrolatum, was applied to the forearms of healthy volunteers (n=51) with dry skin (Kligman score of 2 or 3). Cutaneous permeability by Trans Epidermal Water Loss (TEWL) and skin moisture content by corneometry were serially measured for 12hours following application. An analysis of variance with repeated measures was performed on the evolution of TEWL and corneometry. V0034CR emollient significantly reduced mean TEWL compared to vehicle (P=.0018) and vehicle + glycerol (P=.0001) and significantly increased mean corneometry scores compared to vehicle (P<.0001) and vehicle + petrolatum (P<.0001). The emollient V0034CR presented combined effects, with the petrolatum component improving skin barrier function, with a reduction in TEWL, and the glycerol component improving skin hydration.

The influence of treatment with lokivetmab on transepidermal water loss (TEWL) in dogs with spontaneously occurring atopic dermatitis.

Atopic dermatitis (AD) is one of the most common skin diseases in dogs. Monitoring the progress of treatment may include assessment of lesion severity by use of Canine Atopic Dermatitis Extent and Severity Index (CADESI), assessment of pruritus and measurement of biophysical parameters of the skin. This study aimed to assess changes in transepidermal water loss (TEWL) during 12weeks of treatment with lokivetmab and its correlation with the CADESI-04 and the severity of pruritus. Ten client-owned dogs with canine AD. The animals were administered lokivetmab three times at four week intervals. Pruritus and CADESI-04 were assessed, and TEWL was measured at six body regions, on Day 0 and repeated at weeks 4, 8 and 12. There was a significant decrease in the CADESI-04 score, the severity of pruritus and the mean TEWL between baseline and each of the time points. TEWL also decreased in the majority of body sites examined. Significant correlations between the CADESI-04 and mean TEWL (r=0.519, P=0.0003), and between pruritus severity and mean TEWL (r=0.517, P=0.0003), were found. Overall TEWL decreased during lokivetmab treatment but not at all body sites. If TEWL is used to assess the effectiveness of a treatment, a mean TEWL score should be calculated from several areas of the body.

Abstract P4-16-07: The CHANCE study: Mechanical skin changes among women with non-metastatic breast cancer receiving chemotherapy and endocrine therapy

Abstract Background: The persistent effects on skin hydration and elasticity resulting from cytotoxic and endocrine agents used in early stages of breast cancer are poorly understood. The objective of this preliminary analysis of the CHANCE study is to describe the pattern of persistent biomechanical skin changes in non-metastatic breast cancer patients treated with cytotoxic chemotherapies and/or endocrine therapies. Methods: This is an ongoing single-center, prospective, longitudinal cohort study of non-metastatic breast cancer patients treated with cytotoxic chemotherapies and/or endocrine therapies. Objective skin hydration and elasticity measurements of the forearm were measured using Tewameter® (TM 300; Courage &amp; Khazaka) and Cutometer® (MPA 580; Courage &amp; Khazaka) devices under a controlled ambient environment at baseline and 6 months after chemotherapy completion, or one year after initiation of endocrine therapy. Results: A total of 107 patients were assessed at baseline and follow-up for transepidermal water loss (TEWL) (median age 53, range 26-82) and 106 patients for skin elasticity (median age 53.5, range 26-82). Fifty-three healthy controls were evaluated at baseline with median age 47 (range, 22-73). The mean TEWL at baseline and follow-up among patients were 6.922 g/h/m2 and 8.521 g/h/m2, respectively (p&amp;lt;.0001). Skin firmness (0.420 versus 0.421 mm, p=0.949) and elasticity (77.2% versus 77.4%, p=0.836) did not significantly change during follow-up. When comparing chemotherapy recipients with endocrine therapy recipients, chemotherapy patients had a mildly lower TEWL at follow-up (8.369 versus 8.928 g/h/m2, p=.247) but a greater net increase in TEWL (1.687 versus 1.359 g/h/m2, p=.5) compared to endocrine patients over the study period. Conclusions: An increase in TEWL was observed in patients receiving cytotoxic and endocrine therapies, suggesting a deterioration of the protective skin barrier possibly attributed to these therapies. No significant changes in skin firmness or elasticity were found in this preliminary analysis. Further studies are needed to elucidate the pathophysiologic mechanisms involved in persistent skin changes after systemic breast cancer therapies. Objective skin hydration and elasticity in patients receiving breast cancer therapy Control (n=53)Baseline (n=107)Follow-Up (n=107)p-value*TEWL (g/h/m2)9.4626.9228.521&amp;lt;.0001Cutometer Baseline (n=106)Follow-Up (n=106) Immediate recovery, R0 (mm)0.4150.4200.4210.949Gross elasticity, R2 (%)79.3%77.2%77.4%0.836*p-value calculated from baseline and follow-up only Citation Format: Lacouture ME, Phillips GS, Freites-Martinez A, Patil S, Samuels A, Shapiro J, Kukoyi O, Goldfarb S. The CHANCE study: Mechanical skin changes among women with non-metastatic breast cancer receiving chemotherapy and endocrine therapy [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-16-07.

Skin pH and Transepidermal Water Loss Values in Children with Diaper Dermatitis in Ibadan, Nigeria.

Diaper dermatitis (DD) is one of the most common skin conditions in infants and young children. Among the factors associated with greater frequency of DD are high skin pH and transepidermal water loss (TEWL). This study examined the prevalence of DD in healthy black children in Nigeria and evaluated the association between skin surface pH, TEWL, and DD in this population. The study was cross-sectional in design and involved children younger than 2years attending eight immunization clinics in Ibadan, Nigeria (N=424). Children were recruited into the study using multistage sampling. Information collected included sociodemographic data, diapering and feeding practices. Physical examination of the diaper area was performed on each child to determine whether dermatitis was present. TEWL and skin pH were measured on the anterior chest wall and gluteal areas of each child. A total of 165 (38.9%) children had clinical evidence of DD. The mean skin pH and TEWL values were higher in the gluteal area than the anterior chest wall in all subjects, with or without dermatitis. The mean skin pH and TEWL were significantly higher on the anterior chest wall and in the gluteal area in children with DD. In Nigerian children with DD, skin pH and TEWL are higher in the diaper area and at an unaffected skin site.

Cutaneous Side Effects and Transepidermal Water Loss To Gefitinib: A Study of 11 Patients.

IntroductionCutaneous side effects caused by epidermal growth factor receptor (EGFR) inhibitors occurred in 45–100% of patients which may lead to therapy modification or interruption. This study aimed to evaluate cutaneous side effects and transepidermal water loss (TEWL) values in non-small cell lung carcinoma (NSCLC) patients who received gefitinib EGFR inhibitor.MethodsA descriptive observational study with cross-sectional design and a consecutive sampling method was conducted from 1 February to 4 March 2016. Eleven NSCLC patients with EGFR mutation who visited the Hemato-Oncology Clinic/Internal Medicine Department, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, were assessed through history taking, physical examination, and TEWL examination using Tewameter.ResultsTen of the eleven patients experienced cutaneous side effects. The most frequently observed was xerosis cutis (8/10 patients), followed by acneiform eruptions (7/10 patients), and paronychia (3/10 patients). None of these patients experienced hair changes, mucositis, or drug hypersensitivity. Mean TEWL value of these patients was higher than normal (11.205 ± 1.881 g/m2/h).ConclusionsPatients who received gefitinib EGFR inhibitor experienced cutaneous side effects including xerosis cutis, acneiform eruptions, and paronychia, and have mean TEWL values higher than normal. Therefore, it might affect the skin barrier function.Electronic supplementary materialThe online version of this article (doi:10.1007/s13555-016-0163-0) contains supplementary material, which is available to authorized users.

The effectiveness of using a bath oil to reduce signs of dry skin: A randomized controlled pragmatic study

BackgroundDry skin (xerosis cutis) is increasingly recognized as a relevant health problem in daily life and in health and nursing care. The use of bath additives such as oils is common to reduce dry skin, but empirical evidence supporting this practice is limited. ObjectivesThe aim of this study was to investigate the effectiveness of using a bath oil additive in improving skin barrier function and ameliorating dry skin in comparison to non-oil containing skin cleansers for bathing or showering. DesignSingle centre randomized observer blind pragmatic parallel group trial. SettingsOutpatient/community care. ParticipantsVolunteers showing clinically mild to moderate dry skin recruited from the city of Berlin. MethodsHealthy children and adults were randomly assigned to use either a commercially available bath oil or to continue using their regular non-oil containing skin cleansers every other day over a study period of 28days. Skin barrier parameters and the severity of dry skin were assessed at baseline and at two follow-up visits at the study centre. Transepidermal water loss was the primary outcome. ResultsAll sixty participants randomized completed the trial. Median age was 32.5 (IQR 8.3 to 69) years. At the end of study the mean transepidermal water loss in the intervention group was statistically significant lower compared to the control group (mean difference −1.9 (95% CI −3.1 to −0.8) g/m2/h). Stratum corneum hydration was statistically significantly higher in the intervention group at the end of the study. Skin surface pH and roughness were comparable in both groups and remained unchanged, while both groups showed a trend to improvement in dry skin symptoms ConclusionsThis pragmatic trial provides empirical evidence that the regular use of the investigated bath oil is effective in improving the skin barrier function in children and adults with mild dry skin when used in routine skin care and supports its use as a basic element for the management of a broad spectrum of dry skin conditions. Trial registrationClinicalTrials.gov Identifier NCT02557698.

Transepidermal water loss measured with the Tewameter TM300 in burn scars

Transepidermal water loss (TEWL) is a physiological characteristic to measure the efficiency of the skin barrier. The aim was to investigate the reliability of the Tewameter TM300 for the assessment of TEWL (g/m2/h) in burn scars. Also the relation between TEWL scar values and scar quality parameters was investigated. Three different study areas (scar, healthy adjacent and contralateral skin) were assessed in 55 adult patients. The intra- and inter-observer reliability were tested using the intra-class correlation coefficient (ICC) and the standard error of measurement (SEM). The inter-observer reliability for the three areas was excellent with ICC values between 0.85 and 0.94. SEM values were between 1.76 and 3.97g/m2/h. Bland–Altman plots showed relatively wide LoA values for scar and healthy skin. Mean TEWL scar values were significantly higher than healthy skin (p<0.001). Significant correlations were found between TEWL hypertrophic scar values and erythema (r=0.60, p=0.001) and a negative correlation for weeks after burn (r=−0.61, p=0.001). TEWL values were significantly different between 3 and 6 months and 3 and 12 months old scars (respectively p=0.021 and p=0.002). To evaluate the skin barrier function over time as a measure for scar maturation, Tewameter TM300 measurements have to be performed according to strict and standardized protocols.

Transepidermal Water Loss in Neonates: Baseline Values Using a Closed-Chamber System.

Transepidermal water loss (TEWL) is the normal, constitutive loss of water vapor from the skin in the absence of sweat gland activity. It is regarded as one of the most important parameters for characterizing skin barrier function, and the values are dependent on multiple variables. The objective of this study was to evaluate TEWL in neonates using a closed- chamber system, and determine if there is a variation of TEWL with the mode of delivery, pre-term birth, low birthweight or phototherapy. This prospective study was conducted in 104 healthy neonates, 30 neonates in the Neonatal Intensive Care Unit (NICU) and 40 adults using a noninvasive, closed- chamber system (VapoMeter™). A statistically significant difference in TEWL was noted between newborns and adults. No remarkable difference in TEWL was seen between boys or men and girls or women or those born via normal vaginal birth and caesarean section, but TEWL was significantly higher in preterm and low birthweight neonates. Significantly higher TEWL was noted from the antecubital fossa of the neonates who received phototherapy when compared with six other sites. The closed- chamber system is an acceptable alternative to the more widely used open-chamber system. The higher mean TEWL in neonates suggests that the epidermal barrier is still adapting to extrauterine life, making newborn skin more sensitive and requiring appropriate, age adapted care.