Skin Barrier Function in Psoriasis and Atopic Dermatitis: Transepidermal Water Loss and Temperature as Useful Tools to Assess Disease Severity

Abstract

Multiple diagnostic tools are used to evaluate psoriasis and atopic dermatitis (AD) severity, but most of them are based on subjective components. Transepidermal water loss (TEWL) and temperature are skin barrier function parameters that can be objectively measured and could help clinicians to evaluate disease severity accurately. Thus, the aims of this study are: (1) to compare skin barrier function between healthy skin, psoriatic skin and AD skin; and (2) to assess if skin barrier function parameters could predict disease severity. A cross-sectional study was designed, and epidermal barrier function parameters were measured. The study included 314 participants: 157 healthy individuals, 92 psoriatic patients, and 65 atopic dermatitis patients. TEWL was significantly higher, while stratum corneum hydration (SCH) (8.71 vs. 38.43 vs. 44.39 Arbitrary Units (AU)) was lower at psoriatic plaques than at uninvolved psoriatic skin and healthy controls. Patients with both TEWL > 13.85 g·m−2h−1 and temperature > 30.85 °C presented a moderate/severe psoriasis (psoriasis area severity index (PASI) ≥ 7), with a specificity of 76.3%. TEWL (28.68 vs. 13.15 vs. 11.60 g·m−2 h−1) and temperature were significantly higher, while SCH (25.20 vs. 40.95 vs. 50.73 AU) was lower at AD eczematous lesions than uninvolved AD skin and healthy controls. Patients with a temperature > 31.75 °C presented a moderate/severe AD (SCORing Atopic Dermatitis (SCORAD) ≥ 37) with a sensitivity of 81.8%. In conclusion, temperature and TEWL values may help clinicians to determine disease severity and select patients who need intensive treatment.

Cytotoxicity and Epidermal Barrier Function Evaluation of Common Antiseptics for Clinical Use in an Artificial Autologous Skin Model

“…The reduction in the cell viability resulted in deterioration of the epithelium integrity and this could alter the barrier function. The trans-epidermal water loss is widely used as a marker for skin barrier function in vivo and in vitro [29][30][31]. When skin is damaged, its barrier function is impaired, resulting in a higher water loss [32].…”

Atopic Dermatitis and Sensitisation to Molecular Components of Alternaria, Cladosporium, Penicillium, Aspergillus, and Malassezia—Results of Allergy Explorer ALEX 2

“…Genetic predisposition, abnormal immune response and defective skin barrier are involved in the etiopatogenesis of the disease. Interest in the disease is constantly increasing, due to its increasing prevalence and adverse effects on quality of life [1][2][3][4][5]. The prevalence in Western countries is 10-20% for children and 1-3% for adults [1,2].…”

“…Interest in the disease is constantly increasing, due to its increasing prevalence and adverse effects on quality of life [1][2][3][4][5]. The prevalence in Western countries is 10-20% for children and 1-3% for adults [1,2]. Atopic dermatitis was originally considered to be mainly a childhood disease with an imbalance between the Th2 response and the escalated IgE response to external allergens.…”

“…Atopic dermatitis was originally considered to be mainly a childhood disease with an imbalance between the Th2 response and the escalated IgE response to external allergens. Today, atopic dermatitis is rated as a long-term disease with varying clinical manifestations and expressivity, with epidermal barrier disorder playing a central role [1][2][3][4][5]. A disorder of the skin barrier implies hydration, reparation and non-specific inflammation alertness; there is a higher susceptibility to bacterial colonization and viral infections.…”

“…A disorder of the skin barrier implies hydration, reparation and non-specific inflammation alertness; there is a higher susceptibility to bacterial colonization and viral infections. Transepidermal water loss (TEWL) and temperature are skin barrier function parameters that can be objectively measured and could help clinicians to evaluate disease severity accurately [1]. In atopic dermatitis patients, the skin barrier disorder arises as a result of a genetic defect for filagrin, involucrine and lorikrin [2][3][4][5].…”