Research Techniques Made Simple: Transepidermal Water Loss Measurement as a Research Tool

Alexander, H; Brown, Sara J.; Danby, Simon; Flohr, Carsten

doi:10.1016/j.jid.2018.09.001

Cited by 164 publications

(143 citation statements)

References 37 publications

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“…Biophysical parameters are strongly influenced by intrinsic and extrinsic factors like age, sex, race, circadian rhythm, season, exercise and acclimatization period; 22,95,99,100,[124][125][126][127][128][129][130][131] therefore data collection is inherently difficult to standardize.…”

Section: Discussionmentioning

confidence: 99%

“…For TEWL, open measurement chambers are more vulnerable to environmental influences than are closed chambers; 129,132 condenser closed chambers seem to be the most sensitive TEWL system, 132 but this device type was not used in rosacea. For pH, all three studies used pH900 meters, possibly overestimating true pH due to a small electrode area and short stabilization period of only 3 s. 130 For erythema, skin light absorption by components other than haemoglobin (melanin, bilirubin) may influence outcomes 64,105,114 and application of variable skin pressure can change haemoglobin level and skin colour.…”

Section: Discussionmentioning

confidence: 99%

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Noninvasive objective skin measurement methods for rosacea assessment: a systematic review

et al. 2019

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Summary Background Rosacea assessment and therapy monitoring can be challenging to standardize, as most clinical evaluation systems are prone to interobserver variability and not always validated. Therefore, objective, reliable and preferably noninvasive measurement tools are needed. Objectives To give insight into available noninvasive imaging techniques and biophysical methods in rosacea by performing a systematic review. Methods PubMed, Embase, Cochrane and Web of Science databases were searched until 1 September 2018 in accordance with PRISMA guidelines, to identify studies providing original data about objective noninvasive imaging and/or biophysical skin measurement techniques for diagnosis, assessing severity or therapy monitoring of adult patients with cutaneous facial rosacea. Risk of bias of included articles was assessed with the Cochrane Risk of Bias tool, Quality in Prognosis Studies tool, and the Newcastle–Ottawa Scale. Results A total of 78 studies were included, describing 14 imaging and biophysical methods. Widespread information about (sub)surface cutaneous morphology and functionality was obtained. Methodological study quality was relatively low and interstudy outcome variability was large. Several tools show promising value in research settings: for treatment follow‐up Demodex mites are countable with reflectance confocal microscopy, spectrometry can quantify erythema, and rosacea severity could be objectified with skin hydration‐ and transepidermal water loss measurements. Conclusions This systematic review describes the spectrum of noninvasive imaging and biophysical methods in rosacea assessment, giving multifaceted information about structure and properties of rosacea skin, especially useful for research purposes. Larger studies with good methodological quality are needed to create validated protocols for further implementation into research. What's already known about this topic? Rosacea is a chronic inflammatory skin disease with a variety of clinical manifestations. Most clinical evaluation systems are subjective, not always validated, and subsurface skin processes remain unnoticed. Currently, different types of noninvasive measurement tools are available for rosacea assessment and therapy monitoring, but a comprehensive overview is lacking. What does this study add? Seventy‐eight publications were included, describing 14 imaging and biophysical tools, providing a wide range of information about rosacea skin morphology and functionality. Reflectance confocal microscopy and spectrometry are especially promising in therapy monitoring and skin barrier measurements for rosacea severity assessment. Larger studies with better methodological quality are needed to create validated protocols for implementation into research.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Noninvasive objective skin measurement methods for rosacea assessment: a systematic review

et al. 2019

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“…TEWL measurement is widely used to assess skin barrier function (211). During this procedure, sensors are placed in contact with the skin surface to measure water evaporating from the skin.…”

Section: Noninvasive Approaches For Assessing Skin Functionmentioning

confidence: 99%

Epithelial barrier repair and prevention of allergy

Goleva¹,

Berdyshev

Leung

2019

Journal of Clinical Investigation

177

173

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Allergic diseases such as atopic dermatitis (AD), food allergy (FA), asthma, and allergic rhinitis affect more than 30% of the population (1-3). These diseases have in common a dysfunctional epithelial barrier, resulting in the penetration of allergens and microbes, accompanied by the release of epithelial-derived cytokines (e.g., thymic stromal lymphopoietin [TSLP], IL-25, IL-33), which drive type 2 immune responses. Although other immune pathways can modify the course of illness, cytokines including IL-4, IL-13, IL-31, TSLP, and IL-33 play a key role in allergic diseases (4-8), eliciting local tissue injury and repair (5,(9)(10)(11)(12)(13)(14).AD is the most prevalent chronic inflammatory skin disease (3,(15)(16)(17)(18)(19). In a subset of allergic patients, it is thought that ADrelated skin epithelial dysfunction contributes to the atopic march, which starts with AD and often leads directly to FA (20-23). The link from AD to respiratory allergy is more controversial; however, atopic march progression is facilitated in patients who develop IgE to both food and inhalant allergens (24).In this Review, we describe formation of the skin barrier, review the link between altered skin barrier formation and AD, discuss evidence for epithelial barrier dysfunction in other allergic diseases, and explore epithelial barrier intervention/repair strategies with the goal of preventing AD and the atopic march. The cornified envelope and keratinocyte differentiation in the skinThe skin's barrier function primarily depends on the outermost epidermal layer, stratum corneum (SC). To form SC, keratinocytes pass through a tightly regulated differentiation program and sequentially form stratum basale (SB), stratum spinosum (SS), stratum granulosum (SG), and SC layers of the skin (Figure 1). In human skin, keratinocytes irreversibly exit the cell cycle after mitosis in the basal layer and differentiate progressively across the epidermis toward the SC. Each layer is defined by its expression of characteristic morphological and biochemical features indicating its state of differentiation (25-27). The keratins KRT5 and KRT14 are predominantly expressed by basal keratinocytes. The markers of early differentiation KRT1 and KRT10 are made in SS. The cornified envelope precursors involucrin (IVL) and transglutaminase-1 (TGM1) are also present in SS. Late differentiation markers including the cornified envelope protein loricrin (LOR) and the precursor of the keratin cross-linking protein filaggrin (FLG) are expressed in SG keratinocytes. TGM1 cross-links IVL, LOR, and other structural proteins to form the cornified envelope.Calcium forms a steep gradient across the human epidermis, increasing from the SB (5 μM) to the outer SG (>20 μM) (27, 28). Importantly, there is cell-to-cell heterogeneity in average Ca 2+ concentrations in the epidermis (28). Formation of the Ca 2+ gradient coincides with key developmental milestones of skin barrier formation and differentiation into the SC.Primary human keratinocyte cultures are an excellent model for...

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“…To measure TEWL, we used the Aquaflux, a condenser closed-chamber system. Earlier research showed that this chamber system is the most sensitive TEWL system, allowing continuous measurements, and is the least vulnerable to environmental influences [21,29]. However, some drawbacks have to be taken into account.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, measurements in subjects after controlled skin barrier perturbation (e.g. tape-stripping [21]) or in patients with disturbed skin barrier function could provide more insight into the effect of cream application. It would also be interesting to expand our method with other skin-barrier-related parameters (sebum, pH).…”

Section: Discussionmentioning

confidence: 99%

Noninvasive Skin Barrier Assessment: Multiparametric Approach and Pilot Study

et al. 2019

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The epidermal barrier function is disrupted in various inflammatory skin diseases. Accurate methods to measure skin barrier function are needed to assess the effect of therapeutic agents. Therefore, we developed a noninvasive multiparametric approach to measure four different parameters regarding the skin barrier. In the current pilot study, we evaluate this method in 14 healthy volunteers. We assessed erythema, transepidermal water loss (TEWL), water content, and epidermal thickness at both cheeks before and 30 min after application of Lanette and Vaseline-Lanette cream. For this, we used spectrophotometry, the Aquaflux device, the Epsilon device, and reflection confocal microscopy, respectively. Stratum corneum (SC) thickness was significantly increased after application of both creams (p < 0.05), and this increase was larger after Lanette cream compared to after Vaseline-Lanette cream (p = 0.035). Erythema, TEWL, and water content did not significantly change after cream application. Our multiparametric approach is promising and offers a feasible and practical way to quickly obtain multifaceted information about skin barrier function. Further exploration of this approach after prolonged use of cream and in conditions of disrupted skin barrier are recommended areas for future research.

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Research Techniques Made Simple: Transepidermal Water Loss Measurement as a Research Tool

Cited by 164 publications

References 37 publications

Noninvasive objective skin measurement methods for rosacea assessment: a systematic review

Noninvasive objective skin measurement methods for rosacea assessment: a systematic review

Epithelial barrier repair and prevention of allergy

Noninvasive Skin Barrier Assessment: Multiparametric Approach and Pilot Study

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