Article

Transepidermal water loss and content in the stratum corneum in infantile seborrheic dermatitis

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Abstract

Thirty-seven patients with clinically diagnosed infantile seborrhoeic dermatitis (ISD) were studied in an attempt to establish the significance of transepidermal water loss (TEWL) and water content in the stratum corneum, in active disease and after recovery. All the patients were treated daily with topically applied borage oil (containing 24% gamma-linolenic acid). With this regimen they were completely free from all skin symptoms within 3-4 weeks. Analyses of essential fatty acids in serum showed aberrations as previously described, with elevated levels of 18:1w9 and 20:2w6. TEWL and water content were recorded at the time of diagnosis and after treatment from the right forearm in skin that was free from symptoms and not treated with borage oil. Twenty-five healthy children in an age-matched group without skin disorders were used as controls. Significant differences in TEWL between patients and controls were found before treatment. After treatment no significant differences were found. There were no significant differences between controls and patients regarding water content in the stratum corneum. Gamma-linolenic acid is suggested to be of importance in maintaining normal TEWL and also in promoting recovery in patients suffering from ISD.

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... As for SD, a critical factor in its pathogenesis may be the intrinsic quality of the stratum corneum. One study reported that the mean TEWL of neonatal patients with SD were relatively higher than that of the control group and the mean TEWL of these patients was reduced closer to the value of control group after treatment [12]. ...
... The sample size was estimated based on data from a previous study of TEWL and water content in the stratum corneum in SD [12]. To achieve a power of 80% and a level of significance of 5%, the calculated minimum number of subjects was 17 for each study group. ...
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Background: Scalp seborrheic dermatitis (SD) is a common and chronic inflammatory skin disease which tends to recur over time. By measuring biophysical properties of the stratum corneum, many studies report abnormal biophysical profiles and their association in various dermatologic diseases. The aim of the study is to analyze the biophysical properties and skin barrier defects of scalp SD compared to healthy controls. Materials and methods: This study is a cross-sectional study assessing the correlation of various biophysical and physiological profiles in scalp SD. Forty-two Thai participants with scalp SD were enrolled in the study and 40 healthy participants were also enrolled as the control group. Both SD and control group were subjected to a one-time biophysical and physiological properties' measurement of transepidermal water loss (TEWL), stratum corneum hydration (SCH), skin surface pH, skin surface lipid, and skin roughness. Results: The mean TEWL of lesional skin of SD cases were significantly higher than those of control group (P<0.05). Relating to high mean TEWL, the mean SCH was found to be significantly lower in SD cases (P<0.05). Skin surface lipid was also found to be significantly higher in SD group (P<0.05). However, there were no differences in skin surface pH (P=0.104) and roughness (P=0.308) between the two groups. Pairwise comparison of each subgroup found that moderate and severe SD demonstrated significantly higher mean skin surface lipid than that of control group (P<0.05). Conclusion: Scalp SD may be associated with seborrhea in Thai population. Monitoring of SCH, TEWL, and skin surface lipid could be helpful in assessing severity and evaluating the treatment outcome in patients with scalp SD.
... Topical application of borage oil normalized impaired barrier function of the skin, as measured by TEWL, in infants and children with seborrheic or atopic dermatitis [32,56]. In healthy elderly people, borage oil capsules provide 360 or 720 mg/d. ...
... In 100 adults and children with atopic dermatitis affecting the extremities, 10% borage oil in urea-containing emollient cream applied twice daily to the arm or leg on one side of the body was no more effective than the same urea-containing but GLA-free emollient cream applied to the contralateral side [52]. However, both sides of the body would be expected to improve if topically applied borage oil has beneficial systemic effects and/or improves skin distant from the site of application, as has been previously reported [32,41]. In a small placebo-controlled Japanese study, erythema and itch in children with atopic dermatitis were improved by coating undershirts with borage oil [56]. ...
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Nutritional supplementation with omega-6 essential fatty acids (omega-6 EFAs) is of potential interest in the treatment of atopic dermatitis. EFAs play a vital role in skin structure and physiology. EFA deficiency replicates the symptoms of atopic dermatitis, and patients with atopic dermatitis have been reported to have imbalances in EFA levels. Although direct proof is lacking, it has been hypothesized that patients with atopic dermatitis have impaired activity of the delta-6 desaturase enzyme, affecting metabolism of linoleic acid to gamma-linolenic acid (GLA). However, to date, studies of EFA supplementation in atopic dermatitis, most commonly using evening primrose oil, have produced conflicting results. Borage oil is of interest because it contains two to three times more GLA than evening primrose oil. This review identified 12 clinical trials of oral or topical borage oil for treatment of atopic dermatitis and one preventive trial. All studies were controlled and most were randomized and double-blind, but many were small and had other methodological limitations. The results of studies of borage oil for the treatment of atopic dermatitis were highly variable, with the effect reported to be significant in five studies, insignificant in five studies, and mixed in two studies. Borage oil given to at-risk neonates did not prevent development of atopic dermatitis. However, the majority of studies showed at least a small degree of efficacy or were not able to exclude the possibility that the oil produces a small benefit. Overall, the data suggest that nutritional supplementation with borage oil is unlikely to have a major clinical effect but may be useful in some individual patients with less severe atopic dermatitis who are seeking an alternative treatment. Which patients are likely to respond cannot yet be identified. Borage oil is well tolerated in the short term but no long-term tolerability data are available.
... The linoleic acid in borage oil contributes to its therapeutic actions in AD. Topical application of borage oil in infants and children with seborrheic dermatitis or AD has been shown to normalize skin barrier function [130]. A double-blind, placebo-controlled clinical trial was performed to test clinical effects of undershirts coated with borage oil on children with AD [97]. ...
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Plant oils have been utilized for a variety of purposes throughout history, with their integration into foods, cosmetics, and pharmaceutical products. They are now being increasingly recognized for their effects on both skin diseases and the restoration of cutaneous homeostasis. This article briefly reviews the available data on biological influences of topical skin applications of some plant oils (olive oil, olive pomace oil, sunflower seed oil, coconut oil, safflower seed oil, argan oil, soybean oil, peanut oil, sesame oil, avocado oil, borage oil, jojoba oil, oat oil, pomegranate seed oil, almond oil, bitter apricot oil, rose hip oil, German chamomile oil, and shea butter). Thus, it focuses on the therapeutic benefits of these plant oils according to their anti-inflammatory and antioxidant effects on the skin, promotion of wound healing and repair of skin barrier.
... In an uncontrolled study of infantile seborrheic dermatitis, topical treatment with borage oil was shown to improve the skin condition and normalize TEWL. 116,127 Moreover, a physiological lipid mixture decreased TEWL and improved atopic dermatitis in an open study in children. 128 However, in patients with damaged skin as a result of wet work, a moisturizer without humectant did not change TEWL despite clinical improvement. ...
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Moisturizing creams marketed to consumers often contain trendy ingredients and are accompanied by exciting names and attractive claims. Moisturizers are also an important part of the dermatologist's armamentarium to treat dry skin conditions and maintain healthy skin. The products can be regarded as cosmetics, but may also be regulated as medicinal products if they are marketed against dry skin diseases, such as atopic dermatitis and ichthyosis. When moisturizers are used on the so-called dry skin, many distinct disorders that manifest themselves with the generally recognized symptoms of dryness are treated. Dryness is not a single entity, but is characterized by differences in chemistry and morphology in the epidermis depending on the internal and external stressors of the skin. Patients and the society expect dermatologists and pharmacists to be able to recommend treatment for various dry skin conditions upon evidence-based medicine. Learning objective Upon completing this paper, the reader should be aware of different types of moisturizers and their major constituents. Furthermore, s/he will know more about the relief of dryness symptoms and the functional changes of the skin induced by moisturizers.
... Moreover, they provide a morphologic and functional evaluation of the skin, which is more informative than mere inspection. Whereas data referring to transepidermal water loss (TEWL), capacitance, and pH in patients affected by skin diseases such as atopic dermatitis, psoriasis, or allergic or irritant contact dermatitis are available in the literature, little is known about these parameters in healthy infants (1)(2)(3)(4)(5)(6)(7). ...
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The goal of this study was to instrumentally evaluate the skin of healthy infants and to compare it to adult skin. A total of 70 infants, 45 girls and 25 boys, ages 8-24 months, and 30 healthy women were studied by means of transepidermal water loss (TEWL), capacitance, and pH measurements at two different skin sites, the volar forearm and the buttocks. No significant differences in TEWL were found between infants and adults, either on the buttocks or on the volar forearm. On the contrary, capacitance values were higher in infants. Their skin also appeared less acid than that of adults, with high statistical significance. No TEWL, capacitance, or pH variations were observed in infants according to sex and age. On the basis of the above data, the skin of infants 8-24 months of age shows functional signs of immaturity. This may lead to an increased permeability and a reduced capacity for defense against chemical and microbial aggression.
... The predominant LB components with antioxidant activity are peptidoglycans (also called LB polysaccharides, or LBP) (Qiu et al., 2014 andZhang, 1993); vitamin B, C, taurine, and carotenoids in fruits; while flavonoids, such as rutin prevail in the leaves (Jin et al. 2013). The seeds of Fructus lycii also contain oils, which not only have antioxidant activity, but may improve skin barrier and decrease transepithelial water loss through their ability to interact with the lipid matrix of stratum corneum, such as it is the case of other bioactive oils (Tollesson and Frithz 1993). LB oils may also provide vehicle function facilitating the intracellular absorption of other bioactive components, such as carotenoids (as evidenced by the orangeyellow color). ...
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Lycium barbarum (LB) is one of the most intriguing medicinal plants in China. The beauty of its berries combined with the amount of beneficial effects assigned to it would logically make it a strong candidate for skin use, yet relatively few scientific publications address such application. Here, we will review the skin-related effects of oral and topical preparations of LB, based on the published scientific literature and work done in our own laboratory. We will also discuss the obstacles and opportunities for LB in today’s dermatological field.
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Aim: This study aimed to identify the relationship between the skin barrier function after bathing at 2 weeks of age and subsequent facial skin problems during the first 6 weeks of life. Methods: A prospective observational study was conducted from July 2017 to February 2018 on healthy newborns aged 2 weeks. Skin barrier function was evaluated before bathing and at 30 and 90 min after bathing by measuring transepidermal water loss (TEWL), stratum corneum hydration (SCH), sebum secretion, and skin pH. Infantile facial skin problems were assessed using skin condition diaries maintained by a parent for 4 weeks. Results: Analysis of the data from 56 infants showed that 29 infants (51.8%) experienced facial skin problems from 2 to 6 weeks of age. A lesser change in the sebum secretion on the forehead before bathing to 90 min after bathing and a higher SCH of the forehead before bathing were less likely to result in facial skin problems (adjusted odds ratio [AOR] = 0.98, 95% confidence interval [CI]: 0.97-0.99; AOR = 0.96, 95% CI: 0.92-0.99). Conclusions: A greater change in the sebum secretion on the forehead before bathing to 90 min after bathing and a lower SCH of the forehead before bathing were associated with subsequent infantile facial skin problems, indicating that a better ability to recover after bathing is important to prevent facial skin problems. Future studies should identify factors that enhance the recuperative functions of infantile skin.
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The use of moisturizers is almost instinctive and is also routinely recommended to reduce the likelihood of developing dryness and eczema. However, recent findings demonstrate that treatment with creams may increase the risks for eczema. Symptoms of dryness may appear in normal skin and the skin susceptibility to outside stressors may increase. Moisturizing creams contain a great variety of ingredients, some of which are found in the stratum corneum. However, knowledge regarding the mechanisms of the impact of different ingredients on the skin is still lacking and, currently, it is a matter of trial and error to find the most suitable moisturizer for an individual. The cosmetic properties and the simplicity to use the products are important parameters for adherence, but even more important are the effects on the skin barrier function. A defect in skin barrier function has been suggested as the major cause for atopic eczema. Increased rate of transepidermal water loss (TEWL) induces signals that stimulate normalization of the skin barrier function, but increased TEWL can also have pathological effects, which results in cutaneous abnormalities. Therefore, we propose TEWL to be a surrogate parameter for the changed risks for development of eczema by moisturizer treatment.
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cis-6-Hexadecenoic acid is a major component of human sebaceous lipids that is involved in skin self-sterilization and atopic dermatitis amelioration. It can be prepared by hydrolysis of isopropyl cis-6-hexadecenoate produced by resting cells of Rhodococcus sp. strain KSM-MT66. To devise an economical industrial-scale process for the production of this rare fatty acid, we optimized the conditions for growing rhodococcal cells. Mg(2+) and Fe(2+) ions are essential for the efficient production of isopropyl cis-6-hexadecenoate. To further increase the production of isopropyl cis-6-hexadecenoate, we created a mutant strain (T64) with reduced esterase activity by random mutagenesis using UV irradiation of MT66. Under an optimized condition, the mutant T64 produced more than 60 g l(-1) isopropyl cis-6-hexadecenoate in a 4-d cultivation, corresponding to about 52 g l(-1)cis-6-hexadecenoate.
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Resting cells of a double mutant noted as KSM-MT66, derived from Rhodococcus sp. strain KSM-B-3 by UV irradiation, were found to cis-desaturate isopropyl hexadecanoate, yielding isopropyl cis-6-hexadecenoate. Addition of sodium glutamate (1.0%), Mg SO4 (2 mM), and thiamine (2 mM) increased the productivity of the unsaturated product in phosphate buffer. Optimal temperature and pH for the reaction were around 26 degrees C and 7, respectively. Under the optimized conditions, more than 50 g/l of isopropyl cis-6-hexadecenoate was produced after a 3-day incubation by resting cells of the mutant. Thus, cis-6-hexadecenoic acid, the main component of human sebaceous lipids, can be manufactured economically by the rhodococcal bioconversion.
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Patients on total parenteral nutrition are known to be at risk of the development of essential fatty acid deficiency, presenting as a syndrome with scaly skin lesions and characterized by low plasma and erythrocyte linoleic acid concentrations. The essential fatty acid status of patients on long-term home parenteral nutrition who do have access to oral feeds has not been studied. With the use of an isocratic high-performance liquid chromatography method, fatty acids were measured in the erythrocytes and plasma of 25 nonfasting patients on long-term home parenteral nutrition and the findings compared with those of 46 hospital outpatients not on nutrition support and five laboratory staff. Statistically significant differences in the two groups were limited to the erythrocytes. Linoleic acid was significantly lower (25.2 vs 40.7 mumol/10(6) red blood cells, p < .0001) and showed a significant correlation with triceps skinfold thickness (r = .52, p = .013). Palmitoleic and oleic acids were higher in patients than controls (10.8 vs 8.4 mumol/10(6) red blood cells, p = .009; 61.2 vs 51.7 mumol/10(6) red blood cells, p = .003). Despite IV linoleic acid administration, patients on long-term home parenteral nutrition have low erythrocyte stores of this essential fatty acid. This appears to be related to their low body fat stores. We suggest that they may be using much of the infused linoleic acid as an energy source and therefore are at risk of subclinical essential fatty acid deficiency.
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Emollients and moisturizing creams are used to break the dry skin cycle and to maintain the smoothness of the skin. The term ‘moisturizer’ is often used synonymously with emollient, but moisturizers often contain humectants in order to hydrate the stratum corneum. Dryness is frequently linked to an impaired barrier function observed, for example, in atopic skin, psoriasis, ichthyosis, and contact dermatitis. Dryness and skin barrier disorders are not a single entity, but are characterized by differences in chemistry and morphology in the epidermis. Large differences also exist between moisturizing creams. Moisturizers have multiple functions apart from moistening the skin. Similar to other actives, the efficacy is likely to depend on the dosage, where compliance is a great challenge faced in the management of skin diseases. Strong odor from ingredients and greasy compositions may be disagreeable to the patients. Furthermore, low pH and sensory reactions, from lactic acid and urea for example, may reduce patient acceptance. Once applied to the skin, the ingredients can stay on the surface, be absorbed into the skin, be metabolized, or disappear from the surface by evaporation, sloughing off, or by contact with other materials. In addition to substances considered as actives, e.g. fats and humectants, moisturizers contain substances conventionally considered as excipients (e.g. emulsifiers, antioxidants, preservatives). Recent findings indicate that actives and excipients may have more pronounced effects in the skin than previously considered. Some formulations may deteriorate the skin condition, whereas others improve the clinical appearance and skin barrier function. For example, emulsifiers may weaken the barrier. On the other hand, petrolatum has an immediate barrier-repairing effect in delipidized stratum corneum. Moreover, one ceramide-dominant lipid mixture improved atopic dermatitis and decreased transepidermal water loss (TEWL) in an open-label study in children. In double-blind studies moisturizers with urea have been shown to reduce TEWL in atopic and ichthyotic patients. Urea also makes normal and atopic skin less susceptible against irritation to sodium laurilsulfate. Treatments improving the barrier function may reduce the likelihood of further aggravation of the disease. In order to have optimum effect it is conceivable that moisturizers should be tailored with respect to the epidermal abnormality. New biochemical approaches and non-invasive instruments will increase our understanding of skin barrier disorders and facilitate optimum treatments. The chemistry and function of dry skin and moisturizers is a challenging subject for the practicing dermatologist, as well as for the chemist developing these agents in the pharmaceutical/cosmetic industry.
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Evening primrose oil was investigated in a randomized, open-label, controlled, parallel-group study, for baby skin care and prevention of napkin rash. Sixty-six healthy infants were allocated randomly to treatment with either evening primrose oil or a leading baby skin protection cream. The parents used the supplied test products instead of their conventional skin care product for 8 weeks and kept a diary as to the condition of the skin of the napkin area with respect to type and severity of symptoms of skin irritations. All infants completed the study. No adverse reactions were reported. Medically diagnosed napkin rash was not observed in either group. There was no significant difference between the mean total scores for skin redness, skin rash and skin dryness in the evening primrose oil and the control group. Evening primrose oil could qualify as a safe and natural baby skin care product, as efficacious as currently used ointments or creams for the prevention of napkin rash.
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Contact dermatitis is a common clinical problem [15]. Even though irritant contact dermatitis is considered far more common than the allergic form [15, 28], most research has been focused on the contact allergic reaction during the past decades. Irritant contact dermatitis is the result of a nonspecific cellular damage to the skin caused either by physical factors, such as mechanical friction or cold, or more commonly chemicals [4, 62]. In clinical practice, the disease can display a broad spectrum of signs and symptoms and it has been described under several different clinical names. Irritant contact dermatitis can be divided into four main clinical types, namely acute irritant contact dermatitis (following a single exposure to a noxious factor), chronic irritant contact dermatitis (following repeated exposures to noxious factors over a period of time), chemical burns, and sensory irritancy (stinging) (c.f. [28, 95]). The most frequent clinical sign of the dermatitis and other inflammatory diseases is dry skin. However, the term "dry skin" is not well defined [49]. In most instances, it reflects the clinical appearance of a rough and/or scaly skin surface and no functional parameter. However, dry skin usually exhibits an impaired barrier function [95], which is believed to make skin more susceptible to chemicals in the environment (Fig. 1). Furthermore, increased transepidermal water loss (TEWL) has been suggested to enhance the risk of a more persistent dermatitis [19]. Chemically different irritants cause different responses in the skin both at the cellular and subcellar level, for example in the production of inflammatory mediators, the expression of adhesion molecules, and the composition of cell infiltrate (reviewed in [4, 46, 97]). The dynamics of chronic irritant reactions are less well known, both regarding mechanisms and possible changes in the skin. External factors may disturb the stratum corneum and thus impair the diffusion barrier. There can also be an indirect effect on the production and maintenance of the permeability barrier in the stratum corneum, as irritants can affect the keratinocytes and their maturation and migration and also induce a release of inflammatory mediators causing the appearance of an inflammatory cell infiltrate [4, 19, 46, 68, 97]. There are three key points in the strategy for treatment of irritant contact dermatitis: 1. Identification and reduction of external noxious factors 2. Treatment of the inflammation (e.g., with local corticosteroids, UVA-UVB phototherapy, PUVA treatment, or other immunomodulating agents such as cyclosporine) 3. Application of moisturizers to improve the structure and function of the diffusion barrier in the stratum corneum (Fig. 2). The beneficial effect of moisturizers in clinical practice is compatible with the recently proposed hypothesis that a normalization of a defect barrier function is prerequisite to preventing persistent dermatitis (Fig. 2) [19]. Combined with the increasing knowledge on the structure and function of stratum corneum, this opens up new possibilities to design and adapt treatments for different skin conditions with a perturbed barrier function. This paper will focus on stratum corneum, its lipids, and the possibility of using moisturizers to repair or improve a disrupted barrier function in irritant contact dermatitis.
Chapter
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Chapter
Sodium lauryl sulfate (SLS) is an anionic surface active agent used as an emulsifier in pharmaceutical vehicles, cosmetics, foaming dentifrices, and foods; it is the sodium salt of lauryl sulfate that conforms to the formula: CH3(CH2)10CH2OSO3Na (Nikitakis et al., 1991). The action of SLS on surface tension is putatively the cause of its irritancy, and its great capacity for altering the stratum corneum makes it useful in enhancing penetration of other substances in patch tests and animal assays. Kligman (1966) found no sensitization to SLS in a hundred volunteers in whom SLS was employed in provocative or prophetic patch test procedures
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When it comes to helping customers make wiser and safer choices in their use of over-the-counter treatments, the pharmacist's best source of information is Nonprescription Product Therapeutics. This text emphasizes the pharmacist's role in triage--assessing the best nonprescription products for a client and knowing when medical conditions warrant a referral to another health professional. Organized by condition rather than by drug, the text is easy to consult, and complements a disease-based approach to therapeutics. Pharmacists will find useful information on ingredients, interactions, contraindications, and other essentials for helping customers choose appropriate nonprescription products. The Second Edition contains additional charts, drawings, illustrations, and tables. The book includes decision-making algorithms, case studies, patient counseling tips, and warnings on dangerous or life-threatening ingredients, actions, or situations. Another unique feature of this text is A Pharmacist's Journal--real-life reports from the front lines by an award-winning professor and researcher with over twenty years of experience in retail community pharmacy.
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It has been reported that gamma-linolenic acid contained in borage oil is effective against atopic dermatitis. The clinical effects of undershirts coated with borage oil rich in gamma-linolenic acid on atopic dermatitis were evaluated. Thirty-two children, aged 1-10 years, were involved in the clinical control study. Sixteen had worn undershirts coated with borage oil everyday for 2 weeks, and 16 had worn non-coated undershirts as a placebo. Their symptoms were assessed on a 4-point scale. Those children who had worn undershirts coated with borage oil for 2 weeks showed improvements in their erythema and itch, which were statistically significant. Transepidermal water loss from the back was decreased. In the placebo group, there were no statistically significant differences. The undershirts coated with borage oil were found to be statistically effective, and had no side-effects on children with mild atopic dermatitis.
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