Improvements in epidermal function prevent relapse of psoriasis: a self‐controlled study

Abstract

While therapeutic approaches for psoriasis are widely available, preventive regimens are lacking. We aimed to determine whether improvements in epidermal function could prevent psoriasis relapse. Two self-controlled cohort studies were designed, enrolling two cohorts of patients with psoriasis (n = 30 and n = 60) to be treated topically with an in-house-prepared emollient or ATOPALM â cream applied twice daily to one forearm for 20 and 30 days, respectively, while the same sites on the contralateral arm served as the untreated control. Epidermal function on both arms was assessed prior to and at the end of the trials. Delayed relapse on the treated arm was seen in 54.5% and 71% of patients in the first and second cohort, respectively. The time of psoriatic relapse correlated with the extent of abnormalities in baseline epidermal function. These results suggest that improvements in epidermal function with topical emollients can prevent/attenuate the development of psoriasis.Psoriasis is generally considered an immunologically initiated disorder because: (i) it shares certain common susceptibility loci with other autoimmune diseases, 1 (ii) it displays changes in immunological markers both in the skin and circulation 2 and (iii) immunotherapy is effective. 3 However, a pathogenic role of epidermal dysfunction in psoriasis is also thought to occur, 4,5 because: (i) psoriasis preferentially involves the body sites that are vulnerable to epidermal trauma, (ii) Koebner phenomenon indicates that psoriasis can be provoked by perturbations of epidermal function and (iii) occlusion alone often alleviates psoriasis. We assessed whether improving epidermal function with topical emollients could prevent psoriasis relapse.

Altered Epidermal Permeability Barrier Function in the Uninvolved Skin Supports a Role of Epidermal Dysfunction in the Pathogenesis of Occupational Hand Eczema

“…In addition, infants with higher TEWL rates during the first week of life predict a higher risk of atopic dermatitis later in the life independently of filaggrin mutations [39]. Likewise, TEWL rates predict the relapse of psoriasis, i.e., psoriasis relapses sooner in subjects with higher TEWL rates [4]. We showed here that uninvolved skin sites of subjects with hand eczema displayed higher TEWL rates, suggesting that TEWL rates could possibly serve as a proxy in predicting the risk of developing hand eczema, a notion which requires further studies.…”

“…Likewise, topical applications of a barrier repair emollient in combination with topical glucocorticoid cream reduced psoriasis area severity index scores by approximately 25% in comparison to glucocorticoid cream alone [3]. Moreover, recent studies demonstrated that improvements in epidermal permeability barrier function delayed the relapse of psoriasis [4]. Furthermore, expression levels of proinflammatory cytokines in normal-appearing aged murine skin could also be lowered simply by improvements in epidermal permeability barrier function [5].…”

A topical heparinoid‐containing product improves epidermal permeability barrier homeostasis in mice

“…Moreover, a key pathogenic role of defective permeability barrier in the development of atopic dermatitis and psoriasis is also well appreciated. Accordingly, improvements in epidermal permeability barrier can prevent and alleviate both atopic dermatitis and psoriasis . Pertinently, at least one clinical study demonstrated that topical Hirudoid ® cream improves atopic dermatitis .…”

Role of Resveratrol in Regulating Cutaneous Functions

“…In addition to epidermal permeability barrier homeostasis, other epidermal functions, such as pH and stratum corneum hydration, also regulate cutaneous functions [19][20][21][22]. Accordingly, improvements in epidermal function could benefit multiple cutaneous and extracutaneous functions [17,[23][24][25].…”