Devices measuring transepidermal water loss: A systematic review of measurement properties

Abstract

Objective The objective of this review is to examine the reliability and measurement error of devices that measure transepidermal water loss (TEWL). Introduction TEWL is a physiological property of skin which increases when the epidermis is damaged. It is, therefore, a commonly utilised measure of skin barrier integrity. Devices measuring TEWL are available as open, semi‐open or closed chamber. Studies of reliability examine the consistency of measurement, and/or responsiveness whereas measurement error scores in absolute terms the amount of error due to sources of variation. Inclusion criteria Studies examining the reliability and/or measurement error of TEWL measurement devices were included. Studies that only report on measurement of TEWL outcomes without examination of reliability and/or measurement error were excluded. Methods The search strategy aimed to locate published and unpublished studies. Databases searched included PubMed, Embase, CINAHL and Web of Science, utilising identified keywords and limited to studies in English. Grey literature sources were searched to identify any unpublished documents. Study selection using the inclusion criteria was then assessed by two reviewers for methodological quality utilising the COnsensus‐based Standards for the selection of health Measurement INstruments (COSMIN) risk of bias tool to assess the reliability and measurement error of outcome measurement instruments. Results A total of 22 devices were examined in the 38 included studies. The quality of study design was on average rated as ‘Adequate’ however reliability and measurement error statistical methods were on average rated as ‘Doubtful’. Discussion and conclusion TEWL measurement devices were found to demonstrate good reliability and frequently correlated with other devices. However, measurement error was highly variable but improves under in vitro conditions. Future research should consider risk of bias factors when designing studies.

Effectiveness and Safety of Transplantation of the Stromal Vascular Fraction of Autologous Adipose Tissue for Wound Healing in the Donor Site in Patients with Third-Degree Skin Burns: A Randomized Trial

“…The most expressed functional change in the skin after SVF administration was a decrease in the amount of transepidermal water loss. It is known that TEWL correlates to the greatest extent with the state of the skin surface layer—the epidermis: in the case that its integrity is damaged or it is thinned, water loss increases, while, on the contrary, full epithelialization of the wound surface is followed by a decrease in the level of TEWL ( 45 ). Other authors have described a direct correlation between the state of the newly formed cover tissues and their ability for thermal regulation: the horny layer of epidermal keratinocytes is crucial as a physical barrier ( 46 ).…”

In vivo transepidermal water loss: Validation of a new multi‐sensor open chamber water evaporation system Tewameter TM Hex

“…Furthermore, the study did not address barrier alterations and repair dynamics. Repair mechanism and their modulation are known not to be instrument dependent since each volunteer/patient serves as its control 4,11 . Future clinical studies will include the assessment of TEWL values of patients suffering from inflammatory dermatosis with epidermal involvement and the modulation of TEWL values by topical treatments.…”

“…mechanism and their known to be instrument dependent since each volunteer/patient serves as its control. 4,11 Future clinical studies will include the assessment of TEWL values of patients suffering from inflammatory dermatosis with epidermal involvement and the modulation of TEWL values by topical treatments. We expect that TM Hex will be used in studies assessing barrier alterations and their treatments.…”

“…Instrumentation technology for transepidermal water loss (TEWL) assessment has not been substantially modified since its introduction by Nilsson in 1977 when a method for direct measurement of the rate of evaporation from the skin surface has been described 1–4 . Classically two sensor pairs for relative humidity (rH) and temperature are placed in an open chamber to detect the concentration difference along increasing distance from the skin.…”

Evaluating the Irritant Factors of Silicone and Hydrocolloid Skin Contact Adhesives Using Trans-Epidermal Water Loss, Protein Stripping, Erythema, and Ease of Removal

“…A range of experimental devices to study TEWL, including the vapometer used in this study, are well utilized in clinical practice and have been compared by Klotz et al We have identified in Table where equivalent, or alternative, instrumentations have been used to indicate a normal distribution of TEWL against the body site within the literature. Depending on the device used, the exact measured value of a skin site can vary as much as from 2 to 12 g –2 h –1 , but each device is generally internally consistent .…”