Article

The Clinical Relevance of Maintaining the Functional Integrity of the Stratum Corneum in both Healthy and Disease-affected Skin

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Abstract

It has been recognized for approximately 50 years that the stratum corneum exhibits biological properties that contribute directly to maintaining and sustaining healthy skin. Continued basic science and clinical research coupled with keen clinical observation has led to more recent recognition and general acceptance that the stratum corneum completes many vital "barrier" tasks, including but not limited to regulating epidermal water content and the magnitude of water loss; mitigating exogenous oxidants that can damage components of skin via an innate antioxidant system; preventing or limiting cutaneous infection via multiple antimicrobial peptides; responding via innate immune mechanisms to "cutaneous invaders" of many origins, including microbes, true allergens, and other antigens; and protecting its neighboring cutaneous cells and structures that lie beneath from damaging effects of ultraviolet radiation. Additionally, specific abnormalities of the stratum corneum are associated with the clinical expression of certain disease states. This article provides a thorough "primer" for the clinician, reviewing the multiple normal homeostatic functions of the stratum corneum and the cutaneous challenges that arise when individual functions of this thin yet very active epidermal layer are compromised by exogenous and/or endogenous factors.

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... The skin is the organ of the body with the largest surface area. Among these many functions, it has a basic role as the body's first protective barrier to defend against bacteria, virus, chemicals, particulates, solar ultraviolet, and even mechanical injury [1][2][3][4][5]. Because of direct and frequent contact with the exterior environment, the skin usually suffers more damage than most other organs in the body. ...
... The epidermis is the outermost skin layer. The epidermis outer layer is the stratum corneum, which consists of approximately 15-20 layers of keratinocytes and provides most of the effective barrier function [4][5][6][7]. The other epidermis layers are the stratum lucidum (only in the hands and feet), stratum granulosum, stratum spinosum, and stratum basale. ...
... The PCE was analyzed by ultra-high-performance liquid chromatography (UPLC, ThermoDionexUltiMate 3000 UHPLC system, Waltham, MA, USA) ( Figure 1) and the total content of six lanostane triterpernoid compounds ( Figure 2, compounds 1~6) was 21.81%. (1)(2)(3)(4)(5)(6) P. cocos dried sclerotium (10 kg) was extracted three times by refluxing with 75% ethanol for 3 h. The concentrated extract was chromatographed on silica gel (70-230 mesh) using increasingly polar mixtures of CH2Cl2-MeOH (CH2Cl2: MeOH, 97:3; CH2Cl2: MeOH, 96:4; CH2Cl2: MeOH, 90:10; and MeOH only). ...
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The global aging population is expanding at an increasingly rapid pace, with approximately one-fourth of the world’s population expected to be composed of elderly individuals by 2050. Aging skin is one of the major characteristics expressed in the elderly. The study comprehensively utilizes both cell and animal experiments to confirm the skin anti-aging effects of Poria cocos (P. cocos), which is one of the most important traditional Chinese medicines classified as tonic Chinese medicine, commonly used to treat physical weakness and aging-associated diseases. We demonstrate in this study that P. cocos lanostane triterpenoids extract (Lipucan®) ameliorates aging skin and promotes collagen accumulation and hyaluronic acid production in galactose-induced aging rats. Purified lanostane triterpenoids were initially identified as active components in P. cocos, which significantly increased collagen and hyaluronic acid levels in cultured human skin cells.
... Moreover, the type and mix of surfactants in cleansing products determine whether there will be skin damage or not [91]. Surfactants also remove debris from the surface of the skin, and collectively with the increase in TEWL this signals an increase in epidermal 'turnover' via repair mechanisms, especially the synthesis of sphingolipids for ceramides [92]. In studies, however, no significant correlation could be found between the degree of hyperproliferation and TEWL changes [93]. ...
... Studies have also shown that by using adequate surfactant(s), barrier integrity is respected and the normal epidermal turnover homeostasis in 'non-compromised' skin is maintained [92,94]. Furthermore, shaving studies have shown that epidermal turnover can be increased due to the mechanical removal of the upper layers of the SC, as monitored by the increase in Merkel cells [95]. ...
... Dimension 2: Socio-cultural and interpersonal relevance [28][29][30][31][32][33][34][35][36][37][38][39][40] Enhancing and supplementing skincare efficacy Beneficial part of skincare regimes [75,78,81] Improving skin appearance and sensory aspects Providing a pleasant/fresh skin feeling [85] Dimension 5: Corneobiological interactions [60, Stimulating of desquamation and epidermal turnover Activation of skin recovery/renewal mechanisms [92,95,96] Maintenance of the physiological skin pH Supporting and keeping the skin pH Normalizing the acidic nature of aged skin [99,[119][120][121][122][123][124] [125] ...
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Objective: Cleansing is an important human ritual practiced for hygiene, well-being, and relaxation over centuries. As part of body care it is often taken for granted, yet its relevance cannot be underestimated. Although cleansing the skin may seem trivial to some, it is accepted, that this fundamental function of skin cleansing products is highly complex, diverse, and crucial for a variety of reasons in the personal, public, healthcare, and dermatological settings. Employing a comprehensive and strategic approach in viewing cleansing and its rituals, supports innovation, understanding, and development. Apart from being a fundamental function, as far as we know, there is no comprehensive presentation of skin cleansing with all its effects besides "removing dirt". To our knowledge, comprehensive analyses on the multi-dimensional facets of skin cleansing are either rare or not published. Against this background, we examine the importance of cleansing in terms of function, relevance, and concepts. Methods: First, the key functions and efficacies of skin cleansing were investigated by literature research. Based on this survey, the functions were analysed, sorted, and merged and a novel approach of skin cleansing "dimensions" was developed. Herewith, we took into consideration the evolution of skin cleansing in terms of concept evolution, complexity, and testing methods for cleansing products and their claims. Conclusion: Several multi-dimensional functions of skin cleansing were identified and then established to five skin cleansing dimensions, namely: Hygienic and medical importance; Socio-cultural and interpersonal relevance; Mood, emotion, and well-being; Cosmetic and aesthetic function; and Corneobiological interactions. It became obvious, that these five dimensions with their corresponding eleven sub-dimensions, are influenced by each other throughout history by culture and society, technical progress, scientific knowledge and consumer trends. This article presents the enormous complexity of skin cleansing. Skin cleansing has evolved from basic care up to a highly complex and diverse cosmetic product category in terms technology, efficacy, and usage routine(s). In view of future challenges, such as the effects of climate and associated lifestyle changes, the development of skin cleansing will remain an exciting and important topic and thus will finally, again, further increase the complexity of skin cleansing itself.
... 2 The epidermis with emphasis on the stratum corneum (SC) which exists as the outermost layer of this tissue structure, is predominantly responsible for skin barrier protection. 3 The SC not only exists as a physical barrier, but its role extends to involve an interconnected microbiome, chemical and immune system function. 4 Through the maintenance of skin hydration, the SC is able to uphold its structural integrity, which enables the aforementioned barrier functions to succeed. 3 From a physiological perspective, the SC contains a matrix of microbial communities, which act as a first level of defence to environmental factors. ...
... 4 Through the maintenance of skin hydration, the SC is able to uphold its structural integrity, which enables the aforementioned barrier functions to succeed. 3 From a physiological perspective, the SC contains a matrix of microbial communities, which act as a first level of defence to environmental factors. 4 These microbial communities send signals to the functional immune network of the skin, stimulating a response in resident immune cells located within the epidermis and dermis. ...
... 8 A disruption to this functional network would therefore contribute to inflammation, loss of hydration and alteration in pH, ultimately leaving the SC vulnerable to breakdown. 3 Therefore, the SC can provide vital information on the function and biophysical properties of the skin. 9 Skin that is dry, or inadequately hydrated, is increasingly vulnerable to PU development, 10 as the fragility and inelasticity of the superficial skin becomes more susceptible to breakdown from external mechanical forces. ...
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This systematic review aimed to examine skin hydration and determine if this biophysical parameter can predict pressure ulcer development in at risk adults. A literature search was conducted in March 2022, using PubMed, CINAHL, SCOPUS, Cochrane, and EMBASE databases. A total of 1727 records were returned, with 9 studies satisfying the inclusion criteria. Data were extracted using a pre‐designed extraction tool and a narrative synthesis of the data was undertaken. The methodological quality of the included articles was assessed using the evidence‐based librarianship checklist. Included studies were published between 1997 and 2021, with most using a prospective cohort design (88.9%, n = 8). The mean sample size was 74 participants (SD = 38.6; median 71). All studies measured skin hydration objectively, with 55.6% (n = 5) using the Corneometer® CM825 and 33.3% (n = 3) of studies reported a statistically significant association between skin hydration and pressure ulcer development. The mean evidence‐based librarianship percentage was 66.6% (SD: 20.7%), however, only 33.3% (n = 3) of studies scored ≥75%, indicating validity. The quality of included studies, methodology variation, and reported results has reduced the homogeneity of outcomes. This review highlights the requirement for future research evidence to ascertain the role of skin hydration in pressure ulcer development.
... magnitude of transepidermal water loss (TEWL). Such mechanisms are highly dynamic and function continuously to maintain homeostasis of the SC, the epidermis and the skin in its entirety [2]. As such, the SC is a robust factory that is in operation at all times, ensuring the maintenance of the skin's adaptive and protective barrier [2,11]. ...
... Such mechanisms are highly dynamic and function continuously to maintain homeostasis of the SC, the epidermis and the skin in its entirety [2]. As such, the SC is a robust factory that is in operation at all times, ensuring the maintenance of the skin's adaptive and protective barrier [2,11]. Exogenous stressors can impede the skin's protective properties, so reducing exposure to, and minimising practices such as skin cleansing with, harsh cleansers (e.g., alkaline soaps) that can cause perturbation and damage to the SC proteins, lipids and natural moisturising factor (NMF) components (e.g., free amino acids, sugars) is critical to decreasing the stress load on the skin's structural and functional integrity [2]. ...
... As such, the SC is a robust factory that is in operation at all times, ensuring the maintenance of the skin's adaptive and protective barrier [2,11]. Exogenous stressors can impede the skin's protective properties, so reducing exposure to, and minimising practices such as skin cleansing with, harsh cleansers (e.g., alkaline soaps) that can cause perturbation and damage to the SC proteins, lipids and natural moisturising factor (NMF) components (e.g., free amino acids, sugars) is critical to decreasing the stress load on the skin's structural and functional integrity [2]. ...
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Products designed to cleanse the skin commonly do so through surfactant action, which leads to the lowering of the surface tension of the skin to facilitate the removal of dirt from its surface. Skin cleansers generally come in one of two types: soap-based and synthetic detergents, or syndets. While the latter can effectively maintain the native skin structure, function and integrity, the former tends to negatively affect the skin by causing barrier disruption, lipid dissolution and pH alteration. Despite this, soap is still often preferred, possibly due to the negative connotations around anything that is not perceived as ‘natural’. It is, therefore, important that the science behind cleansers, especially those designed for the maintenance of healthy skin and the management of common skin conditions such as eczema, be understood by both formulators and end-users. Here, we carefully weigh the advantages and disadvantages of the different types of surfactant—the key ingredient(s) in skin cleansers—and provide insight into surfactants’ physicochemical properties, biological activity and potential effects. Fine-tuning of the complex characteristics of surfactants can successfully lead to an ‘optimal’ skin cleanser that can simultaneously be milder in nature, highly effective and beneficial, and offer minimal skin interference and environmental impact.
... The pathophysiology of acne is related to skin barrier dysfunction [15]. The higher sebum secretion, larger sebaceous gland, and subclinical inflammation could contribute to alterations in barrier integrity: an increase in filaggrin expression, decreased free fatty acids, linoleic acid, sphingosine, and total ceramide levels could be observed [16][17][18][19]. A study conducted by Yamamot et al. [18] showed elevated TEWL and lower conductance in the mild-moderate acne patients compared to healthy subjects. ...
... In addition, some ingredients in topical acne products (e.g., Benzoyl peroxide and retinoids) may irritate the skin. Therefore, some topical acne therapies can induce skin barrier alteration [17]. ...
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Acne-prone skin is a common condition in adult women, and skin imperfections could affect quality of life and self-esteem. This study aimed to investigate the efficacy of a cosmetic combination regimen for face care (a cleanser gel and a serum containing niacinamide, retinol, and alpha hydroxy acids). A total of 20 women with acne-prone mixed or oily skin were enrolled in a prospective 42-day trial. Sebum content, skin radiance, skin profilometry, and evaluation of face area occupied by pores were evaluated at baseline and after 14, 28, and 42 days. In addition, a face lipidomic evaluation was performed at baseline and after 42 days. Finally, self-assessment questionnaires at each visit checkpoint were performed to evaluate efficacy and tolerability of the tested products. All the subjects but one concluded the study. Both products were very well tolerated and 84% of the subjects reported a global clinical improvement. Skin sebum content was significantly (p < 0.05) reduced at each of the evaluation time points (−9.9% at day 14, −19.4% at day 28, and −23.7% at day 42). The tested regimen significantly decreased the gloss parameter (mattifying effect) at day 14, 28, and 42, with a maximum reduction of 7.2% at the end of the study period. The pores area demonstrated a significant reduction at each of the checkpoint evaluations in comparison with baseline. Inflammatory and non-inflammatory lesions were significantly reduced by 16% at day 28 and day 42 (p < 0.01). Lipidomic analysis demonstrated that this cosmetic face care regimen induced significant and positive effects in face sebum lipids composition, characterized by a significant increase in ceramides and triacylglycerols and a decrease in fatty acids and oxidized fatty acids.
... 9 On the other hand, variables such as age, race, anatomic location, mask-use, stress, and genetic variability can affect TEWL, making it important to control for these factors to obtain accurate measurements. 10 Apart from TEWL, another critical parameter for evaluating barrier function is skin hydration, 11 which refers to the water content within the stratum corneum. 12 Maintaining adequate hydration in this layer is pivotal for processes such as skin proliferation, differentiation, enzymatic activities, and inflammation. ...
... 12 Maintaining adequate hydration in this layer is pivotal for processes such as skin proliferation, differentiation, enzymatic activities, and inflammation. 11 Age has been identified as a significant factor affecting skin hydration, with older individuals generally exhibiting lower levels. 13 Water loss and hydration of the stratum corneum are linked to its lipid content and the generation of new lipids in the skin. ...
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Background Dietary marine omega‐3 fatty acids and phospholipids have individually shown favorable effects on skin barrier function. Krill oil offers a combination of omega‐3 in phospholipid form which might enhance the efficacy in supporting skin health. Aims The aim was to investigate the impact of two different doses of krill oil on skin transepidermal water loss (TEWL) in healthy adults. Secondary outcomes were skin hydration, elasticity and the omega‐3 index. Methods Two randomized, double‐blind, placebo‐controlled, pilot studies were conducted in healthy adults with a baseline TEWL of >10 and ≤24.9 g/m²/h. In study 1, 51 participants consumed 1 g of krill oil or placebo daily. In study 2, 50 participants consumed 2 g of krill oil or placebo daily. The outcomes were assessed at baseline, 6 and 12 weeks. Results The krill oil supplemented groups significantly increased their omega‐3 index versus placebo in both studies. Furthermore, the krill oil groups in both studies showed statistically significant beneficial reductions in TEWL (from 14.47 ± 3.65 to 13.83 ± 3.78 in study 1 and from 14.25 ± 3.21 to 13.02 ± 2.76 in study 2) and increases in hydration and elasticity when compared to placebo. There were significant linear relationships between changes in the omega‐3 index and changes in TEWL, hydration and elasticity in both studies. Conclusions Daily oral supplementation with 1 and 2 g of krill oil showed significant and dose‐dependent improvements in skin TEWL, hydration, and elasticity compared to placebo that correlated with changes in the omega‐3 index.
... This matrix is primarily composed of three classes of lipids: ceramides, free fatty acids, and cholesterol [29]. A deficiency in unsaturated fatty acids can lead to SC dysfunction, characterized by abnormal exfoliation and a diminished barrier capacity [30]. Drying oils, with a composition containing over 50% PUFAs, can induce more robust, positive changes in skin characteristics due to the high percentage of PUFA in the triglycerides that constitute oils like raspberry seed oil. ...
... The cited studies focus on skin exposed to irritants and skin affected by disease. In pathologically altered skin, the correlation is reversed-as SC hydration decreases, TEWL increases [30]. In this study, baseline TEWL values did not exceed 25 g/m 2 /h, indicating normal (average) skin condition. ...
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The skin serves protective roles for internal organs and is responsible for maintaining homeostasis between the body and the environment. The outermost and most exposed part of the skin to environmental factors is the stratum corneum (SC). SC hydration and transepidermal water loss (TEWL) values provide information about the physiological state of the skin. Plant oils, owing to their chemical structure, possess moisturizing and protective functions. This study assessed the impact of a single application of drying oil (Rubus idaeus seed oil), semi-drying oil (Sesamum indicum seed oil), and nondrying oil (Cocos nucifera (coconut) oil) on specific skin characteristics in young, healthy women. Thirty-five female volunteers (age: 20.03 ± 1.69) participated in the study. Before commencing the investigation, a questionnaire survey on the subjective assessment of skin condition and a body composition test were conducted. Subsequently, each participant had three oils applied to nonoverlapping skin areas on the forearms. Skin characteristics were assessed before and 1 h after the oil application using specialized probes: a corneometer and a tewameter. An enhancement in skin hydration was evident after the application of each of the tested oils (p = 0.001). Raspberry oil demonstrated the most significant moisturizing effect, while coconut oil showed the weakest impact. Only raspberry seed oil (p = 0.012) resulted in a noteworthy decrease in TEWL. The initial skin condition did not correlate with the subjects’ body composition, and the improvement induced by the application of the oils was not dependent on body weight, body water content, or BMI (body mass index). The applied vegetable oils positively influence the level of SC hydration. Improvement in barrier function, as measured by TEWL, was observed only for raspberry seed oil.
... The skin barrier maintains the balance of water content (permeability barrier), protection against microorganisms and antigens, protection against ultraviolet, and protection against the effects of oxidative stress. A well-functioning skin barrier will produce healthy skin, with the occurrence of invisible desquamation, smooth skin texture, elasticity, and resistance to shearing forces [10,11]. ...
... The intercellular lamellar lipid membrane is mainly composed of ceramides, cholesterol and fatty acids. A mixture of several small hygroscopic compounds present in corneocytes, referred to as natural moisturizing factor (NMF), plays an important role in the physiological maintenance of stratum corneum hydration (Figure 2) [10][11][12][13]. Many skin disorders are associated with the skin barrier impairment. ...
... The stratum corneum, which affects skin moisture retention, forms a lipid layer composed of ceramide, cholesterol, and free fatty acids between keratinocytes and has low permeability compared to general phospholipid biofilms, thereby inhibiting the permeation of external substances [6]. The stratum corneum produces natural moisturizing factors, such as amino acids, lactic acid, urea, citrate, and hyaluronic acid (HA), to maintain body water balance [7]. The stratum corneum of a healthy person contains approximately 10 to 30% moisture, and insufficient moisture causes abnormalities in the skin barrier and increases transdermal moisture loss, resulting in dry skin. ...
... Loss of moisture caused by abnormal skin barrier function reduces skin elasticity, thickens the epidermis, promotes wrinkle formation, causes diseases such as itching and xerosis, and worsens diseases such as psoriasis and atopic dermatitis [8]. Moisture supply and maintenance of moisture in the skin are important in terms of pathological and cosmetic aspects [7]. Active ingredients required to moisturize the skin include ceramide, hydroxy acid, glycerin, and butylene glycol, and these compounds are either applied to the skin or ingested orally [9,10]. ...
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Reactive oxygen species (ROS) generated by ultraviolet (UV) exposure cause skin barrier dysfunction, which leads to dry skin. In this study, the skin moisturizing effect of sphingomyelin-containing milk phospholipids in UV-induced hairless mice was evaluated. Hairless mice were irradiated with UVB for eight weeks, and milk phospholipids (50, 100, and 150 mg/kg) were administered daily. Milk phospholipids suppressed UV-induced increase in erythema and skin thickness, decreased transepidermal water loss, and increased skin moisture. Milk phospholipids increased the expression of filaggrin, involucrin, and aquaporin3 (AQP3), which are skin moisture-related factors. Additionally, hyaluronic acid (HA) content in the skin tissue was maintained by regulating the expression of HA synthesis- and degradation-related enzymes. Milk phospholipids alleviated UV-induced decrease in the expression of the antioxidant enzymes superoxidase dismutase1 and 2, catalase, and glutathione peroxidase1. Moreover, ROS levels were reduced by regulating heme oxygenase-1 (HO-1), an ROS regulator, through milk phospholipid-mediated activation of nuclear factor erythroid-2-related factor 2 (Nrf2). Collectively, sphingomyelin-containing milk phospholipids contributed to moisturizing the skin by maintaining HA content and reducing ROS levels in UVB-irradiated hairless mice, thereby, minimizing damage to the skin barrier caused by photoaging.
... Most epidermal cells are keratinocytes (KC). The stratum corneum, which serves as the outermost layer of the epidermis, is composed of keratin-rich corneocytes (CC: deceased cells that have relinquished their nuclei and intracellular organelles from KC) and the intercellular lipids that envelop them (Del Rosso and Levin, 2011) . Staphylococcus aureus, a microorganism implicated in atopic dermatitis (AD), releases alpha and other toxins that disrupt KC (Geoghegan et al., 2018) . ...
Article
The outer layer of the epidermis, called the stratum corneum (SC), comprises keratin-rich cells and intercorneal lipids. Staphylococcus aureus has been linked to the fragility of the stratum corneum and formation of atopic dermatitis (AD) lesions. Thus, binding of keratin to bacteria may reflect their binding to the AD-like stratum corneum. In this study, keratin films were prepared using keratin extracted from hair and their potential for bacterial removal and adhesion was investigated using chlorine dioxide, which exhibits bactericidal effects, and fucoidan, which is thought to inhibit bacterial adhesion. The results showed that chlorine dioxide was effective at the removal of S. aureus, whereas fucoidan effectively inhibited bacterial adhesion. Therefore, keratin films can be used to evaluate bacterial removal and inhibition of bacterial adhesion, and the results of this evaluation may reflect those of the AD-like stratum corneum. Using these methods, the effects of fucoidan on indigenous skin bacteria (Staphylococcus epidermidis and Cutibacterium acnes) and general bacteria (Escherichia coli) involved in moisturization were investigated. The results showed that fucoidan inhibited adhesion of S. epidermidis and S. aureus, but did not remove bacteria. Overall, the fucoidan (1700 kDa) used in this study has the potential to prevent and treat AD by inhibiting S. aureus adhesion and improving moisturization by maintaining C. acnes.
... The first layer that protects the internal environment from infection, light, and penetration is the stratum corneum [61,62]. The stratum thickness depends on its anatomical location, and has cells that are flat, highly organized, stacked, and interlocking [62]. ...
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Introduction: Women wear exterior breast support for most of the day. A female’s breast tissue and skin affect the comfort of the ADLs, exercise, health, and work environments. Understanding the breast tissue’s normal anatomy and mechanical and material properties is related to a woman’s daily health and quality of life outcomes. Considering the importance and impact of female breasts throughout one’s lifespan, additional research is needed to address the research gaps to provide solutions to improve daily lives and clinical interventions. Breast stability and behavior are dependent on its internal mechanical properties and applied external forces. Objective: To evaluate the current knowledge and research gaps on the adult female breast tissue’s anatomy, the factors that impact its growth and development, variations among racial populations, the internal and external mechanical properties of the tissue, and the factors employed to evaluate the pathology risk. Review sections: The review sections are as follows: 3. Anatomy of Breast, 4. Effects of Age and Stages of Breast Development, 5. Breast Skin, and 6. Breast Tissue Mechanics. Conclusions: Numerous research gaps have been identified within the field of female breasts.
... Conversely, αNG1, though effective in drug delivery (Table 3 and Figure 8A-C), disrupted the SC significantly (arrow i in Figure 12C), potentially compromising skin barrier function and increasing secondary infection risk. 38 Meanwhile, αNG3 maintained the skin structure but failed to sufficiently reduce fungal burden, emphasizing the need to optimize the balance between drug penetration and therapeutic effectiveness to enhance treatment outcomes. ...
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Background Adjusting thickening agent proportions in nanoemulsion gel (NG) balances its transdermal and topical delivery properties, making it more effective for dermatophytosis treatment. Methods Carbomer 940 and α-pinene were used as model thickening agent and antifungal, respectively. A series of α-pinene NGs (αNG1, αNG2, αNG3) containing 0.5%, 0.75% and 1% (w/w) Carbomer 940 were developed and evaluated for stability, rheological properties, and skin irritation; assessed for ex vivo skin permeation, deposition, and fluorescent imaging of drug distribution within skin layers; and tested in vivo for efficacy against Trichophyton rubrum infection in guinea pigs, with PAS (Periodic Acid–Schiff) staining confirming fungal clearance. Results The steady-state skin flux rates of α-pinene over 24 hours were αNG1 (46.93±2.52 μg/cm²/h) > αNG2 (26.01±2.65 μg/cm²/h) > αNG3 (11.36±1.69 μg/cm²/h). The α-pinene deposition in the epidermis/dermis for αNG1 decreased substantially from 2 h (62.74 ± 3.36 μg/cm²) to 12 h (11.7 ± 2.24 μg/cm²). In contrast, αNG2 showed relatively sustained deposition with 2 h (25.54 ± 2.67 μg/cm²), 6 h (57.32 ± 4.62 μg/cm²) and 12 h (23.69 ± 3.29 μg/cm²). αNG3 exhibited a slow increase from 2 h (18.32 ± 2.11 μg/cm²) to 12 h (36.78 ± 3.22 μg/cm²). The αNG2 exhibited the highest efficacy and fungal clearance rates (71.42%, 79.17%), followed by αNG1 (55.34% and 60.42%), and αNG3(43.21%, 52.08%). Fluorescent imaging confirmed αNG2’s higher drug deposition within the epidermis/dermis, while PAS staining showed a potent fungal clearance with αNG2. Conclusion This study demonstrates that Carbomer 940 proportions significantly impact the transdermal performance of αNG. αNG2, with a moderate proportion, optimally enhances skin drug delivery and deposition, achieving superior therapeutic outcomes. These findings highlight the importance of optimizing thickening agent proportions to improve the efficacy of topical nanoemulsion gels.
... 13 Due to these properties, alkaline cleansers have greater potential to irritate skin than neutral cleansers 12,14,15 and can adversely affect barrier repair. 16 Liquid detergents enable the creation of liquid surfactant solutions at pHs below 7 and produce less skin damage and drying. ...
... 4,5 At times posing a significant challenge that hinders the completion of a journey. Blisters form as a result of abrasion caused by friction forces directly applied to the upper epidermis, 6 transmitted from the granular layer to the spinous layer, causing micro-tears between different layers of the skin. 7 Identified risk factors include excess moisture, 8,9 temperature, 7,9 heavy load-bearing, 2,10 activity duration, 11 inappropriate footwear, 9,11,12 and socks, 13 as well as inadequate adaptation and conditioning to the undertaken route. ...
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Friction blisters are common among outdoor enthusiasts, yet their causes remain uncertain. This study aimed to compare foot hydration in long‐distance hikers with and without blisters, and to assess variability based on age and sex. An observational case–control study involving 86 hikers was conducted. Skin hydration was measured using a corneometer on various foot zones. Data on blister count, footwear, sex, age, and temperature were recorded. The most hydrated zones were the digital area, forefoot, and heel. Higher hydration was found in the blister group (61.6%) compared to the control group (38.4%). A significant relationship between hydration and blisters was observed in the left foot (p = 0.032). Total foot hydration was higher in women (p = 0.007) and inversely related to age (r = −0.333; p = 0.002). Hydration values above 30.40 a.u. in the right foot and 27.37 a.u. in the left foot were linked to blisters with 80% sensitivity. This study highlights the variability in foot hydration and its relationship with blisters. The influence of age and wet socks underscores the complexity of blister formation, emphasizing the need for future research on effective prevention.
... The condition of the skin barrier in AD sufferers appears to be directly proportional to the activity and severity of the disease, so changes in the condition of the skin barrier can be used to evaluate the level of success of therapy (Lee & Jamil, 2020). The condition of the skin barrier in AD is known to be closely related to TEWL and pH, where increasing TEWL will trigger an inflammatory cascade and play a role in causing a number of clinical abnormalities on the skin surface such as desquamation, reduced skin elasticity, and epidermal hyperplasia (Del Rosso & Levin, 2011). while an increase in pH can cause disruption in the production and composition of skin barrier lipids, causing damage to the skin barrier and triggering desquamation (Lynde et al., 2019). ...
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Repairing the skin barrier with moisturizers is one of the five main pillars of treating atopic dermatitis. Petrolatum is considered the gold standard, but its consistency is too thick and oily making it less comfortable to use. Moisturizers containing pomegranate extract (Punica granatum) can be an alternative choice that is more comfortable to use. The effectiveness of this pomegranate extract can be eval__uated using TEWL and pH examinations which are considered accurate indicators for changes in skin barrier conditions. Effectiveness of topical administration of 0.1% pomegranate extract in reducing TEWL and skin pH in sufferers with a history of AD.Single blind randomized clinical trial with two parallel group pre and post design. 34 sufferers with a history of AD were randomly divided into treatment groups (topical 0.1% pomegranate extract, 17 subjects) and control group (topical 100% petrolatum, 17 subjects). Moisturizer was applied twice daily to the volar area of the forearm for 4 weeks. Both groups showed a significant decrease in TEWL after 4 weeks with a TEWL delta of -5.2±2.31g/m2/hour (p<0.001) in the pomegranate extract group and-7.0±7.95g/m2/hour(p=0.003) in the petrolatum group. There was no significant difference in TEWL reduction between the two study groups.The pomegranate extract group showed a significant decrease in pH after 4 weeks with a pH delta of -0.5±0.10(p<0.001), while the petrolatum group actually showed a slight increase with a pH delta of0.0±0.59 (p=0.6). The pomegranate extract group showed a significantly greater decrease in pH (p<0.001).Topical 0.1% pomegranate extract is as effective as 100% petrolatum in reducing TEWL, but more effective in lowering skin pH.
... The stratum corneum cells are primarily composed of insoluble keratins (70%) and lipids (20%). Water in the stratum corneum is associated with keratin in corneocytes [65]. ...
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This article discusses the use of nanotechnology in the development of transdermal delivery systems for herbal extracts for dermatological therapeutics and skin care. Nanotechnology involves manipulating nanoscale materials to create nanoparticles that can penetrate the skin and deliver active ingredients more effectively. Natural products are commonly used in cosmetics because of their therapeutic properties and minimal side effects; however, the safety of nanoparticles in cosmetic products is a concern that requires further research. Chronic and nonhealing wounds pose a significant threat to patients' lives, and there is a pressing need for novel materials and approaches to wound healing. Nanomaterials exhibit unique physicochemical properties owing to their distinct structures, resulting in small size, surface, and macroscopic quantum tunnelling effects, making them ideal for use in wound dressings. Herbal transdermal patches offer advantages such as better patient tolerance, minimal side effects, renewable sources of medication, extensive availability, and cost-effectiveness; however, they also have disadvantages such as slower growth in demand, testing difficulties, and limited availability. This article concludes that by following a regimen that includes both natural ingredients and over-the-counter treatments, consumers can improve their skin health and appearance.
... They contribute to the strengthening of the hair structure. Fig. 8 shows the test subjects who continued to use only the cosmetic masses, in whom no major changes in the hair structure were observed [29,30]. ...
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The aim of the articles was to popularize the upcycling trend in the production of sustainable cosmetics and to confirm their effectiveness. For thousands of years, people have been looking for new ways to improve their appearance. To take care of their beauty, women and men around the world, in addition to using the best cosmetics and treatments, want to introduce sustainable care to alleviate the negative impact of consumerism on the environment. One of the most noticeable trends is the development of pro-ecological solutions used in everyday life, but also in industry. Manufacturers emphasize the production of more environmentally friendly raw materials. Conscious consumers choose cosmetics whose production is based on sustainable development. Instead of using waste from various industries, we used it to produce active substances used in hair cosmetics. We created the production of the collagen series in accordance with the assumptions of upcycling, obtaining collagen water that is waste generated during the production of supplements. The main aim of the work was to create cosmetic recipes for styling, washing and conditioning hair based on collagen waste, as well as to compare the results of subjects using the product in question.
... The epidermis is a stratified, keratinized epithelium, the outermost layer of which consists of corneocytes that are cemented together by intercorneocyte lipids. This layer serves as a physical barrier, preventing the entry of chemicals and pathogens [19]. The dermis is a highly vascularized tissue containing hair follicles, nerve endings, and secretory glands. ...
Article
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Wound healing is a dynamic and complex process, characterized by the coordinated activities of multiple cell types, each with distinct roles in the stages of hemostasis, inflammation, proliferation, and remodeling. The cells of the immune system not only act as sentinels to monitor the skin and promote homeostasis, but they also play an important role in the process of skin wound repair. Skin-resident and recruited immune cells release cytokines and growth factors that promote the amplification of the inflammatory process. They also work with non-immune cells to remove invading pathogens and debris, as well as guide the regeneration of damaged host tissues. Dysregulation of the immune system at any stage of the process may lead to a prolongation of the inflammatory phase and the development of a pathological condition, such as a chronic wound. The present review aims to summarize the roles of different immune cells, with special emphasis on the different stages of the wound healing process.
... The outermost layer of the skin, known as the stratum corneum, serves as a robust barrier, preventing the entry of various substances, including drugs. Enhancing the permeability of simvastatin through the skin presents a significant challenge [11]. Solubility is the measure of a solute's capacity to dissolve in a set volume of solvent under specific temperature conditions. ...
... Acne can be treated topically with agents such as benzoyl peroxide, retinoids, and oral isotretinoin, as well as with photodynamic therapy, chemical exfoliation therapy, and laser therapy. However, such treatments, and acne itself, can increase the rate of water loss from the epidermis, resulting in skin dryness and inflammation and greater skin sensitivity [19]. Acne skin samples were found to demonstrate an altered expression of epidermal molecules with a key role in maintaining barrier function [8], and acne patients demonstrated higher TEWL and lower hydration compared to a healthy group [20]. ...
Article
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Colostrum, the first secretion of mammalian breasts after giving birth, contains a wealth of components believed to have a beneficial effect on human skin, including lactoferrin, immunoglobulin (Ig)A, beta-carotene, fat-soluble vitamins, and zinc. The present study examines the effect of a cosmetic preparation containing 15% lyophilisate of sheep colostrum on acne skin. A group of 27 volunteers with mild or moderate acne applied the cream twice a day for eight weeks. Before and after using the cream, the level of skin hydration, sebum level, and TEWL were measured using a standardized Courage–Khazaka Multi Probe Adapter. The participants also completed a survey rating the effects of using the cosmetic preparation. Regular application of the cream with sheep colostrum resulted in an objective improvement in hydration and TEWL and a reduction in sebum; this is extremely desirable for acne-prone skin. Three-quarters of the participants reported that the tested cream reduced acne lesions (blackheads, papules, pustules, and erythema) by around 40%. Moreover, the cosmetic preparation improved hydration by 40% and reduced seborrhea by 29% in 82% of subjects and kept the skin in good condition in 90%. As the cream improves the hydrobarrier and overall condition of the skin, it could serve as an addition to local acne treatment, e.g., with retinoids.
... An individualized phenotypic approach to rosacea treatment is essential to improve the overall effectiveness of therapy; additional research and real-world data collection can help us understand how to optimize treatment outcomes by combining available treatments in the rosacea armamentarium. Various combination treatments have been explored: oral and topical therapies for faster control of papulopustular rosacea; alphaagonist and topical therapies for specific unresponsive manifestations of papulopustular rosacea; and alpha-agonist treatment with a selective physical modality to address PFE and telangiectasias [30][31][32][33]. ...
Article
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Rosacea is a common, chronic inflammatory disease characterized by both fluctuating and fixed heterogeneous signs such as facial erythema, papules/pustules, telangiectasia, acute vasodilation (flushing), and phymatous changes, and symptoms such as cutaneous stinging and burning. The shift to a phenotype-based approach to rosacea management has improved the consistency of recommendations across recent published guidelines. Consistent and thorough guidance for the classification, diagnosis, and management of the disease is difficult, as the mechanisms underlying the development of rosacea are still not completely understood nor universally accepted. Here, we provide a critical review of current published guidance, and gaps in the knowledge and management of rosacea. We present the recently approved microencapsulated benzoyl peroxide as an effective topical treatment option for papulopustular rosacea. Benzoyl peroxide (BPO) has been used in acne management for many years; however, many clinicians perceive treatment of rosacea with any BPO formulation to be counterintuitive because of concerns of potential skin irritation, while the lack of an accepted mechanism of action on rosacea pathophysiology means that others may be hesitant to use BPO as a treatment. Minocycline foam 1.5% is also an option for the treatment of inflammatory lesions in rosacea, with a decreased risk of systemic adverse events compared with oral minocycline.
... Dehydration disturbs cell metabolism and wound healing. Moreover, adequate fluid intake is necessary to support blood flow to wounded tissues and prevent breakdown of skin components such as the stratum corenum [42,43]. The therapeutic potential of cannabinoids for integumentary wound healing [44] and the isoflavonoid, equol has estrogenic actions such as skin hydration, cellular/tissue repair and wound healing [23,27] have been reported elsewhere. ...
Article
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Background While cannabidiol (CBD) and 4’,7-isoflavandiol (Equol) have been examined individually in various skin studies, the present investigation tested whether topically applied CBD with Equol may yield enhanced effects on human skin biomarkers. Methods After 24 hours exposure human skin gene expression was measured by quantitative polymerase chain reaction-messenger ribonucleic acid (qPCR-mRNA) analysis across 9 functional skin categories covering 97 biomarkers. Results In general, among the biomarkers analyzed the CBD with Equol treatment displayed greater efficacy compared to CBD only or the Equol treatment alone (e.g., 4 out 5 for anti-acne, 15 out of 17 for anti-aging [e.g., collagen, elastin, calcium binding protein A7, tissue inhibitor of matrix metalloproteinase 1 (TIMP 1), etc.], 19 out of 21 for anti-inflammatory (pain), 10 out of 11 for antioxidants to protect against oxidative stress, 6 out of 6 for circadian rhythm regulation for cell repair/restoration, 10 out of 15 for anti-pigmentation properties, 4 out of 5 for skin hydration, 6 out of 6 for tissue integrity, and 11 out of 12 for wound healing properties). Conclusions CBD with Equol displayed synergistic effects that may be an effective topical treatment for dermatology and cosmetic applications to improve human skin health and reduce photo-aging.
... The skin is the largest and most diverse organ of the human body with the epidermis being the first line of defence against the skin exposome which includes ultraviolet radiation (UV) and pollution. [1][2][3][4][5] The effect of pollutants, such as Ozone (O 3 ) and UV on human skin has been investigated over the past decades. Ferrara et al have studied the combination of UV and pollution, confirming their impact on both the skin barrier and skin defence system through oxidative stress and activation of inflammatory cytokines. ...
Article
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Purpose Exposure of the skin to ultraviolet radiation (UV) or ozone (O3) results in stressed skin, leading to the alteration of the skin physical barrier and defence functions. In this work, the preventive benefit of a dermocosmetic, M89PF, containing Vichy mineralising water, probiotic fractions, antioxidant vitamins and hyaluronic acid, in the alteration of skin physical barrier and skin defence functions after exposure to O3 and UV, alone or combined, was assessed. Methods Untreated and treated (M89PF) skin explants were exposed to O3, to UV rays or to O3+UV. Immunofluorescence was performed for skin barrier, oxidative stress, and inflammatory markers after one and four days of exposure to the pollutants. Results M89PF significantly (p≤0.05) prevented the decrease of the expression level of different skin barrier markers, and significantly (p≤0.05) prevented the induction of OxInflammatory markers and inflammasome components by UV, O3, or both combined. Conclusion M89PF prevents skin barrier damage, as well as oxidative stress and inflammatory markers induced by exposome factors, such as UV, O3, or both combined.
... If you feel you have obtained this copy illegally, please contact JDD immediately at support@jddonline.com JO06022 inflammatory substance, producing concentration-dependent irritation, while topical retinoids such as second-generation adapalene is comedolytic, disrupting the stratum corneum and inducing acanthosis, epidermal dysadhesion, and desmosomal shedding. 7 This results in irritation that decreases patient compliance and slows down acne resolution. Therefore, there is a need for a regimen that is effective but will not induce side effects that contribute to low adherence. ...
Article
Barrier damage caused by facial acne vulgaris can be magnified by topical medication, such as adapalene (0.3%) and benzoyl peroxide (2.5%)(A/BPO), which utilizes a retinoid to normalize follicular keratinization and BPO to decrease the C. acnes population. Disease-induced irritation combined with topical medication-induced irritation results in dryness and enhanced inflammation leading to lower compliance and increased skin healing time. Ceramide-based moisturizers have documented barrier repair benefits for eczema but have not been studied for acne. The objective of this double-blind study was to measure the impact of acne treatment on skin barrier function and tolerance when paired with a ceramide routine. Participants were prescribed an A/BPO gel once daily. The treatment group received a ceramide-containing foaming facial cleanser and facial lotion, and the control group received basic foaming face wash for twice-daily use. Participant and investigator tolerability and efficacy were evaluated by both ordinal and clinical measures. Acne lesion counts and Investigator’s Global Assessments (IGA) of acne were obtained along with transepidermal water loss (TEWL) measurements for barrier function. TEWL for the treatment group remained significantly lower than the control at all timepoints and significantly improved from baseline by week 12. The treatment group had statistically lower mean investigator scores for dryness at all timepoints. Inflammatory lesion counts were significantly lower for the treatment group. A/BPO damaged the skin barrier, demonstrated by elevated TEWL, contributing to dryness, redness, and scaling. Use of a ceramide-containing cleanser and moisturizer significantly reduced severity and incidence of dryness, erythema, and scaling while more quickly resolving barrier damage and restoring function. Draelos ZD, Baalbaki N, Colon G, et al. Ceramide-containing adjunctive skin care for skin barrier restoration during acne vulgaris treatment. J Drugs Dermatol. 2023;22(6):554-558. doi:10.36849/JDD.7142&nbsp.
... Deep to the stratum corneum is the stratum lucidum [17], which is a thin layer made of flattened corneocytes that is present on palms and soles [18]. Beneath the stratum lucidum, is the stratum granulosum, which consists of keratinocytes preparing to become flattened corneocytes [19]. Stratum spinosum lays down to the stratum granulosum and contains mature keratinocytes with visible granules that adhere to each other by desmosomes and produce keratin, a protein that helps form hair and nails [20,21]. ...
Article
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Zinc is an important trace mineral in the human body and a daily intake of zinc is required to maintain a healthy status. Over the past decades, zinc has been used in formulating topical and systemic therapies for various skin disorders owing to its wound healing and antimicrobial properties. Zinc transporters play a major role in maintaining the integrity of the integumentary system by controlling zinc homeostasis within dermal layers. Mutations and abnormal function of zinc-transporting proteins can lead to disease development, such as spondylocheirodysplastic Ehlers–Danlos syndrome (SCD-EDS) and acrodermatitis enteropathica (AE) which can be fatal if left untreated. This review discusses the layers of the skin, the importance of zinc and zinc transporters in each layer, and the various skin disorders caused by zinc deficiency, in addition to zinc-containing compounds used for treating different skin disorders and skin protection.
... It is having significant role in regulation of water balance, prevents the entry of pathogens into the body. Earlier stratum corneum was believed to be made up of dead cells called corneocytes which is having no physiological role [4,5]. Consistent research over past decades have shown up the role of stratum corneum in the physiological homeostasis's. ...
Article
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Patient compliance and the total reduction in the adverse drug reactions is the most important criteria in front of the formulation scientists while developing a dosage form. In this context external delivery of drugs for systemic action is an important approach. i.e., the non-invasive delivery of drugs. This approach focusses on delivering the drug through skin. This will reduce the overall side effects and major adverse reactions, problems with overdosing can be avoided to a certain extent. This review extensively describes the different vesicular carriers that can be employed for the delivery of drugs non-invasively such as transferosomes, Ethosomes etc. with their mechanism of transport and applications. Keywords: Non-invasive drug delivery, transferosomes, Ethosomes
... Epidermal barrier impairment is the main pathology of HE. Restoration of the structural and functional integrity of the stratum corneum is essential to reverse the clinical signs and symptoms of the disorder [7]. TCS is a mainstay treatment that aims to reduce inflammation; however, prolonged TCS use affects stratum corneum lipids and increases skin barrier permeability, resulting in delayed healing [8]. ...
Article
Background: Hand Eczema (HE) is the most common skin problem during SARS-CoV-2 pandemic which has impaired quality of life, impact work ability and cause hand dysfunction. The use of Topical Corticosteroid (TCS) alone can delay HE healing. Objective: To determine the efficacy of a semi-occlusive ointment containing panthenol, glycerol and bisabolol as an adjuvant therapy to TCS in mild-to-moderate HE. Methods: An open-label prospective study was conducted of 60 patients with mild-to-moderate HE. The tested product was applied to both hands, two or three times a day every 4 to 6 hours for 8 weeks. There was then a 4-week cessation period. Disease severity was assessed by physician/patient scoring systems, Corneometer, Tewameter and Visioscan that were collected at week 0, 2, 4, 8 and 12. Results: Fifty-six patients completed the study. The patients had a mean age of 42.8 years and were mostly female. The median duration of HE was 12.0 years. The physician and patient global assessment scores of clinical severity; erythema, dryness, itching and functional impairment, were significantly reduced starting at week 2 compared with baseline. After the 4-week cessation of the tested product, patient loosed the product efficacies. The proportion of patients who used TCS tended to decrease during the study period. Skin hydration was significantly improved at week 4. No unwanted effects found. Conclusion: A semi-occlusive healing ointment with panthenol, glycerol and bisabolol was effective and safe for treating mild-to-moderate HE. Our study identified an adjuvant ointment choice for HE treatment other than TCS.
... Furthermore, frequent washing changes the skin-lipid structure [3], [4]. Thus the combination of allergens, irritants and skin pathogens is eased by skin barrier disrupter and leads to altered immunoregulatory process [5]. This study explores the possible correlation or predomination of changes in skin barrier function and characteristic of LSH disease. ...
Article
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Background: The primary role of the skin is to protect the body from environmental factors. The intact skin is a barrier to the uncontrolled water loss, proteins and plasma components from the organism. Frequent hand and body wash has a negative impact on skin ecosystem by removing lipids which naturally preserve and protect it. Objective: The purpose of this study is to evaluate changes in barrier functions of skin in the condition of repeated body and hand wash in Lichen Simplex Chronicus (LSH) patients. Materials and Methods: Transepidermal Water Loss (TEWL) and Hydratation (H) of epidermis in healthy and damaged skin were measured in 36 non-hospitalized LSH patients. The results were compared with those from a similar study but in patients before the COVID pandemic recommended hygiene regimen. Results: The results reported in the present study showed significantly more pronounced skin barrier disorders compared to those announced in LSH patients before the COVID pandemic. Conclusion: All the reported and analyzed results indicate that disorders of skin barrier are connected with severity and duration of LSH. The frequent washing regime act as an additional reduction of the barrier function of the skin and thus worsens the parameters of the disease.
... The physiological properties, relative composition, and the specialized intercellular physiological lipids within the intercellular lamellar lipid membrane serve to sustain stratum corneum water content, and modify the rate and magnitude of TEWL. [23] The progression from normal skin to clinically evident xerosis and subsequent eczematous changes occur in a stepwise fashion so the epidermal abnormality is not just a secondary phenomenon but a critical trigger of inflammatory skin disease such as atopic dermatitis. [24] Based on our results and as well as Davoudi et al. it can be concluded that the clinical appearance of dry skin in patients with SM-exposure and their major symptoms, pruritus, could not simply explain by a change in hydro-lipid film of the stratum corneum. ...
Article
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Background: Despite almost the three decades passed since the chemical attacks of Iraqi’s army against the Iranian troops, some veterans are still suffering from long-term complications of sulfur mustard (SM) poisoning, including certain skin complaints specially dryness, burning, and pruritus. We thus aimed to evaluate the skin’s water and lipid content in patients with a disability of >25% due to complications of SM poisoning and compare them with a matched control group. Materials and Methods: Sixty-nine male participants were included in this study; 43 SM-exposed patients, and 26 normal controls from their close relatives. The water and lipid content was measured in four different locations: Extensor and flexor sides of forearms and lateral and medial sides of legs by the Corneometer CM 820/Sebumeter SM 810. Collected data was analyzed and P ≤ 0.05 was considered as statistically significant. Results: The mean age of the patients and controls was 49.53 ± 11.34 (ranges: 40-71) and 29.08 ± 8.836 (ranges: 15-49 years), respectively. In the veterans group, the main cutaneous complaint was itching and skin dryness. Cherry angioma, dry skin, and pruritus were significantly more common in the SM-exposed cases than in the controls. (P = 0.01, 0.05, and 0.04, respectively). The moisture and lipid content of all areas were lower in the SM-exposed group, but it was only significant in skin sebum of lateral sides of legs (P = 0.02). Conclusion: Exposure to SM could decrease the function of stratum corneum and lipid production as a barrier, even after several years of its exposure.
... Dry skin is formed due to the reduction of ceramides, which is a part of the stratum corneum lipid layer and functions as one of the compounds which play a part in skin barrier homeostasis [74]. Simple administration of ceramides is not advisable because they are insoluble and result in formation of water impermeable barrier. ...
Research
a r t i c l e i n f o Applications of nanotechnology in various spheres have increased manifold as it offers solutions to unsolved problems with higher effectiveness. Nanoemulsions are one such system that is widely studied and have a very promising potential in solving various issues such as those encountered in the delivery of drugs, pesticides, or any other biologically potent substance. Apart from this, nanoemulsions have wide applications in the field of food, cosmetics, skincare, and agriculture. In this review, we have discussed and compared the methods of nanoemulsion preparation and various methods of synthesis, along with a few major applications in various fields of science and technology. We sincerely hope that this review will help to understand the different aspects of nanoemulsions and help us to explore their potent applications in various fields.
... 3,4 The unique biochemical and biophysical properties of the APP preparation support the concept that the plant-based skin cream actively increases hydration via multiple functional mechanisms in contrast to the MHB skin preparation which passively increases hydration by preventing dehydration. The properties of APP's chemical structure appear to explain mechanisms for how APP molecules can act as humectants that hydrate viable skin tissues via 3 mechanisms that employ their polarity: (1) facilitates permeation of the epidermis accompanied by water, [20][21][22] (2) ability to repair the skin's lamellar system formed by phospholipid bilayers, [26][27][28] and (3) organizing the waters of hydration into a structured (ice-like) configuration. The first mechanism for increasing skin hydration using APP skin cream technology is the enhancement and improvement of tissue permeability. ...
Article
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Purpose This study compares and contrasts a skin cream containing plant-based anionic polar phospholipid (APP) technology with a mineral oil hydrocarbon (petrolatum)-based (MHB) skin cream technology in the treatment of skin xerosis (dryness) in diabetic feet. Skin cream with APP technology promotes phospholipid absorption, reparation of intercellular lamellae, and organization of water promoting hydration; whereas skin cream with mineral hydrocarbon-based (MHB) technology principally covers skin, preventing dehydration. Methods Subjects (n = 54) with diagnoses of diabetes mellitus and foot skin dryness were studied using a multicenter, double-blind, masked-study design. An emulsion cream containing 0.05% APP in triglycerides (APP preparation) was compared to MHB skin cream, Eucerin® (MHB preparation) applied topically to skin of the feet. Graded measurements were recorded on 4 efficacy variables including dryness, erythema, fissures, and itching and neurovascular assessments. Implications of the plant-based and mineral-based skin creams in the context of skin xerosis are contrasted. Results APP and MHB preparations were similar in effectiveness and safety. There was no significant difference among any of the 4 efficacy variables (P < .5) including neurovascular measurements. The APP preparation is absorbed into the skin, whereas the MHB skin cream leaves detectable residues after each application. Conclusion Although the APP and MHB preparations were not significantly different in effectiveness and safety, distinctively, application of the APP skin cream preparation absorbed into the skin leaving no discernible residue in contrast to the MHB preparation leaving residues potentiating textile damage. Both of these technologies function in the hydration of skin; however, they differ in their modes of action. The plant-based APP preparation functions actively by phospholipid and triglyceride absorption, reparation of skin lamellae, and in the consequent delivery and organization of waters of hydration in skin. The MHB preparation functions passively, hydrating the skin it covers by sealing the skin against dehydration.
Article
The aim of the research problem of the article was to try to popularize the upcycling trend in the production of sustainable cosmetics and to confirm their effectiveness. The development of recycled raw materials is a new discovery in the chemical industry. Manufacturers emphasize the production of more environmentally friendly raw materials. Conscious consumers choose cosmetics whose production is based on sustainable development. Instead of throwing away waste from various industries, let us use it to produce active substances used in hair cosmetics. The production of the collagen series was created in accordance with the principles of upcycling, which involves obtaining collagen water, which is waste generated during the production of supplements. The main goal of the work was to learn cosmetic recipes for styling, washing and conditioning hair based on collagen waste, as well as to compare the results of people using the product in question. The aim of the study was also to demonstrate the effectiveness of the treatment in preventing split ends and hair breakage, usually caused by mechanical stress (brushing), as well as to confirm the effectiveness of other tests. The article presents procedures and parameters confirming the effectiveness of treatment with the tested hair products. The following tests were carried out: hair thickness and density, colour uniformity, shine factor and scalp hydration. All parameters numerically confirmed the beneficial effects of products containing collagen water used in hair care.
Article
Background: Acne vulgaris is a complex, multifactorial, inflammatory skin condition. Although frequently presented at dermatology clinics, the literature on adult acne is scarce, particularly concerning skin barrier function and management. We aimed to provide insights into the role of skin barrier integrity in adult acne patients and the role of cleansers and moisturizers as adjunctive to treating and maintaining adult acne. Methods: A panel of eight dermatologists who treat adult patients with acne developed a consensus paper on the role of skin barrier function and skin care in adult acne management. The modified Delphi method comprised a face-to-face meeting and online follow-up to discuss the results of a scoping literature review. Drawing from their experience and opinions, they agreed on seven consensus statements. Results: Epidermal barrier dysfunction plays a vital role in acne pathogenesis and asymmetrically impacts adult female acne. Erythema, pruritus, peeling, and xerosis are common adverse effects of first-line acne treatment options and, if not appropriately counseled and managed, can exacerbate, leading to regimen nonadherence and poor patient experience and outcomes. Conclusion: Improving patient knowledge of comprehensive acne treatments, including quality adjunctive cleansers and moisturizers, may maximize regimen efficacy and provide patients with personalized and successful acne treatment and maintenance tools. J Drugs Dermatol. 2024;23(8):674-679. doi:10.36849/JDD.8471.
Article
Background: The normally acidic skin pH changes in atopic dermatitis (AD) to alkaline, which contributes to the associated skin-barrier dysfunction. Hence, acidic cleansers would be preferred, but such information is scarce. Objective: Guiding health-care providers and patients on selecting skin cleansers with a pH optimal for AD. Methods: A total of 250 products were tested: 37 soaps (32 bars, 5 liquid) and 213 syndets (14 bars, 199 liquid); 10% solutions were tested for pH by using a pH meter; pH values 6.65‐7.35 were considered neutral. Results: The pH of the tested skin cleansers varied widely (3.59‐10.83). All 37 soaps were highly alkaline. In the 14 syndet bars, the pH was neutral in 6, alkaline in 8, and acidic in none. In the 199 syndet liquids, the pH was acidic in 84.9%, neutral in 11.1%, and alkaline in 4.0%. The product’s pH was disclosed in none of the 37 soaps and in only 32 syndets (15%) , of which 9 bars were labeled “balanced,” whose measured pH was neutral in 6 and alkaline in 3. Of the other 23 syndets, the labeled pH was referred to as “balanced” in 20 whose measured pH was neutral in 2 (6.80, 6.88) and acidic in 18 (3.59‐6.59). The pH in the other three syndets was 4.25‐6.00. Conclusion: All tested soaps had undesirable pH, whereas 84.9% of the liquid syndets were acidic (which is desirable) and 11.1% were neutral (which could be acceptable). Only 12.8% of the products disclosed the pH, an issue in need of improvement.
Article
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Cosmeceuticals, a fusion of cosmetics and pharmaceuticals, have emerged as powerful tools in addressing a myriad of skin concerns, ranging from combating signs of aging to managing acne. These advanced skincare products are distinguished by their enriched formulations, featuring active ingredients that go beyond traditional cosmetic offerings. The key to unlocking their full potential lies in a nuanced understanding of individual skin types and specific needs. One of the primary advantages of cosmeceuticals is their ability to deliver tailored solutions for diverse skincare issues. Whether someone is seeking to diminish fine lines and wrinkles, control acne breakouts, or address hyperpigmentation, these products are designed to provide targeted benefits. The incorporation of potent ingredients, such as retinoids, hyaluronic acid, and antioxidants, allows for a more sophisticated and effective approach to skincare. To harness the maximum benefits of cosmeceuticals, it is crucial to comprehend the unique characteristics of one's skin. Different skin types, whether oily, dry, sensitive, or combination, necessitate specific formulations to achieve optimal results. Tailoring the skincare routine to individual needs ensures that active ingredients address concerns without causing unnecessary irritation or imbalance. Moreover, the synergy between cosmeceuticals and professional cosmetic treatments can elevate skincare outcomes. Combining the benefits of at-home products with in-office procedures, such as chemical peels or laser treatments, can enhance and prolong the effectiveness of the overall skincare regimen. Professional guidance becomes invaluable in navigating the intricate landscape of cosmeceuticals, helping individuals customize their routines for optimal results. However, the transformative potential of cosmeceuticals comes with a responsibility for cautious application. Ingredient compatibility is a critical consideration to avoid adverse reactions and maximize efficacy.
Article
Background Moisturizers are designed to maintain skin health and treat dermatological conditions associated with impaired skin barrier function. However, differences in their composition account for the differences in their effect. Aims This narrative review aims to discuss the role of barrier repair moisturizers, highlight the role of different components in a moisturizer and their role in impaired skin conditions (e.g., dry, itchy, inflamed, sensitive skin, atopic eczema), and thereby empower dermatologists and pediatricians in selecting the right moisturizer. Methods PubMed, Embase, and Scopus electronic databases were searched from January 2000 to June 2023 for publications on skin barrier repair and use of barrier repair moisturizers for the treatment of dry, itchy, inflamed, sensitive skin, or atopic eczema. Studies conducted in humans, published in English for which full texts were freely available were included. Results The structure and composition of lipid lamellae within the stratum corneum play an important role in maintaining an effective skin barrier and protecting the body from various external assaults. Endocannabinoid mediators play an active role in maintaining skin barrier function. Moisturizers containing physiological lipids and functional ingredients (e.g., endocannabinoids such as palmitoylethanolamide [PEA]) and based on the principles of biomimic technology are demonstrated to be beneficial for the management of conditions associated with a disrupted skin barrier. Conclusions Moisturizer based on the innovative biomimic formulation has good cosmetic efficacy and is generally well tolerated, and the addition of PEA might represent a new generation of compounds that may be beneficial for long‐term management of impaired skin conditions.
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Introduction Improvement of skin barrier strength could lead to healthy and youthful appearance. “Beauty inside‐out” approach using nutraceuticals such as tomato derived carotenoids to support skin barrier strength could be of benefit to the ageing population. Method A panel of 60 female subjects were provided with the Lumenato capsules (containing carotenoids) or placebo capsules as nutritional supplements for 3 months. Skin health and barrier function were observed using evaporimeter which measures trans epidermal water loss (TEWL). Barrier strength was determined by study of the number of strippings required to disrupt skin barrier and barrier repair was observed in terms of TEWL a few hours after barrier disruption. Cutometer was used to observe skin firmness and elasticity. Measurements were obtained before treatment and after 4 and 12 weeks of use. Results Results indicated a statistically significant improvement (p < 0.05) in skin barrier strength; a higher number of strippings were required to disrupt skin barrier after 12 weeks of supplement use. There was also a significant improvement in skin firmness and elasticity as observed with a cutometer. Conclusion Based on the confines and conditions of this study, oral supplementation with Lumenato resulted in significant improvement in skin barrier as well as skin firmness and elasticity.
Article
Molluscum contagiosum (MC) is a viral infection that affects primarily pediatric patients, sexually active young adults, and immunocompromised people of all ages. MC occurs all over the world, making up about one percent of skin disorders and appears to be increasing in prevalence. This cutaneous infection is often associated with atopic dermatitis and is typically self-limiting, although spontaneous resolution can take months to years. Many treatments exist, but only one-a drug-device product using topical cantharidin- is approved by the United States (US) Food and Drug Administration (FDA) for treatment of MC. For many years, there was a lack of an established or FDA-approved first-line treatment for MC, which might have contributed to the common "benign neglect" attitude of physicians regarding treatment of MC. Unfortunately, this noninterventional approach can increase risk of spreading infection and result in longer duration of infection, physical discomfort, and psychosocial issues due to persistence of the MC lesions. This article reviews available epidemiology data and explores treatment options and therapeutic gaps in MC management.
Article
Introduction: Acne is a common, complex, multifactorial inflammatory skin disease associated with epidermal barrier dysfunction. Beginning in childhood, acne affects many adolescents and adults. Acne is associated with lower self-esteem, anxiety, and depression and may cause scars and pigmentary sequelae. The review explores the relationships between acne and the skin barrier function and discusses nuances in the prevention, treatment, and maintenance of acne and its impact on the skin barrier. Methods: The advisors' previous publications addressed prescription and nonprescription pediatric acne treatment and skincare using cleansers, moisturizers, and a practical algorithm for treatment and maintenance, including skincare recommendations for pediatric acne patients and an algorithm for skin of color patients with acne. Before the meeting, literature was culled on the relationship between the skin barrier and acne and current best practices in acne, addressing prescription and nonprescription acne products and skincare as monotherapy, adjunctive, and maintenance treatment. Results: After discussing 13 draft statements, the advisors applied the selected literature and drew from their clinical knowledge and experience, and agreed on five statements. The follicular epithelial barrier is directly involved with changes that occur during both comedogenesis and in stages of inflammation, especially with follicular rupture compromising the barrier's integrity. In acne-affected skin, sebaceous glands are larger, sebum excretion and filaggrin expression higher, and stratum corneum lipids are reduced. Educating patients and clinicians about inflammation's central role in acne and measures to reduce inflammation is essential. Skin irritation and xerosis from acne and treatments lead to poor treatment adherence. A skincare regimen should be included in the acne prevention, treatment, and maintenance care regimen and should be ongoing. Maintenance treatment with topical agents and skincare using gentle ceramide-containing cleansers and moisturizers is a recommended strategy after successfully controlling the disease. Conclusions: Epidermal barrier dysfunction contributes to acne exacerbation. Using the appropriate treatment and skincare helps to minimize irritation and inflammation, enhance treatment adherence, and improve patient outcomes.
Article
Leptospira enters humans and animals through injured skin or mucous membranes by direct or indirect contact with urine excreted from infected reservoirs. Individuals with cut or scratched skin are at high risk of infection and are recommended to be protected from contact with Leptospira, but the risk of infection via skin without apparent wounds is unknown. We hypothesized that the stratum corneum of the epidermis might prevent percutaneous invasion of leptospires. We established a stratum corneum deficient model of hamsters using the tape stripping method. The mortality rate of hamsters lacking stratum corneum that were exposed to Leptospira was higher than that of controls with shaved skin, and was not significantly different from an epidermal wound group. These results indicated that the stratum corneum plays a critical role in protecting the host against leptospiral entry. We also examined the migration of leptospires through the monolayer of HaCaT cells (human keratinocyte cell line) using Transwell. The number of pathogenic leptospires penetrating the HaCaT cell monolayers was higher than that of non-pathogenic leptospires. Furthermore, scanning and transmission electron microscopic observations revealed that the bacteria penetrated the cell monolayers through both intracellular and intercellular routes. This suggested that pathogenic Leptospira can migrate easily through keratinocyte layers and is associated with virulence. Our study further highlights the importance of the stratum corneum as a critical barrier against the invasion of Leptospira found in contaminated soil and water. Hence, preventative measures against contact infection should be taken, even without visible skin wounds.
Article
Purpose: Echinacea angustifolia (E. angustifolia ) extract’s usefulness as a cosmetic ingredient was examined. This study confirmed its skin improvement effects through a moisturizing and elasticity test and clinical trials.Methods: Cell ability of E. angustifolia on HaCaT and CCD986sk cells was measured by MTT assay respectively. And hyaluronic acid in HaCaT cells and pro-collagen acid productions in CCD986sk cells were measured.Results: As a result of the cytotoxicity test on CCD986sk and HaCaT cells, it was confirmed that there was no cytotoxicity at a concentration of 200 μg/mL or less. At a concentration of 200 μg/mL, both hyaluronic acid and collagen productions showed statistically significant differences. Meanwhile, the skin improvement test performed in the clinical trials revealed high scores compared to a control group and a significant difference was observed especially in moisturizing and wrinkle-care effects ( p <0.001, p <0.01).Conclusion: With the potential of E. angustifolia extract, this study confirmed its promise as a cosmeceutical cosmetics ingredient.
Article
Reversing or slowing down the skin aging process is one of the most intriguing areas of focus across the social and scientific communities around the world. While aging is considered a universal and inevitable natural process of physiological decline, the aging of the skin is the most apparent visual representation of an individual’s health. Aging skin may be objectively defined by epidermal thinning; increased transepidermal water loss; decreased cutaneous barrier function; loss of elasticity, laxity, and textured appearance; and gradual deterioration of the epidermal immune environment. As the largest structure of the immune system and of the body as a whole, the skin is the most vulnerable barrier of defense against the environment. The skin reflects an individual’s exposures, lifestyle habits, and overall health. From an immunological perspective, cytokines and chemokines act as a central character in the communicating of the immunity in skin aging. These cell signaling proteins serve as the intercellular communication link. This review aims to elucidate how cell-cell crosstalk through cytokines and chemokines, and the interplay between host cells, infiltrating immune cells, and exogenous factors contribute to the overall aging skin.
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Background Prolonged face mask usage, a daily practice for the public due to the COVID‐19 pandemic, creates high levels of humidity underneath the mask, which may cause unexpected skin concerns. Objective To investigate the impact of repeated mask usage on the face by comparing skin properties inside and outside of the mask‐covered areas. Methods A double‐blinded, randomized, split‐face clinical study was conducted with 21 healthy female participants who wore face masks at least 6 h every day for 1 week, with one side of their face treated with a moisturizer three times daily. On day 8, after 5 h of wearing the mask, skin properties (sebum, hydration, and trans‐epidermal water loss [TEWL]) were evaluated at 15, 60, and 120 min post‐mask removal, followed by barrier disruption and recovery assessment. Results Mask usage weakened stratum corneum (SC) on facial skin compared to uncovered areas, including reduced SC hydration (p < 0.02 at 15 min) and increased TEWL in response to tape stripping challenge (p < 0.03 after stripping). In addition, sebum production also increased after mask removal (p < 0.01 at 15 min). Notably, a daily moisturizer mitigated these effects by increasing SC hydration (p < 0.001) and improving SC resilience against barrier disruption. Conclusion Daily prolonged usage of a facial mask, essential due to the COVID‐19 situation, generated a high‐humidity microenvironment and led to compromised SC, which was revealed by a barrier challenge technique. Moreover, proper facial moisturization may help to maintain skin homeostasis and prevent the barrier impairment caused by repeated mask usage.
Chapter
Colloidal nanocarriers can be produced using nanotechnological approaches in which the material is reengineered to the nanoscale to bestow unique attributes in terms of physicochemical facets and bioavailability. The use of colloidal nanocarriers in cosmetics provides additional benefits in terms of higher efficacy which leads to exceptionally improved cosmetic performance. Organic nanocarriers like liposomes, niosomes, solid lipid nanoparticles, nanoemulsions, etc. are marketed by leading cosmetic companies, whereas titanium dioxide- and zinc oxide-based inorganic colloidal nanocarriers that exhibit enhanced ultraviolet blocking action perceive vast scope in formulation of sunscreen products. The nanotechnology-abled colloidal nanocarriers are being seen as great boon in modern cosmetic industry that was worth 1055.1millionin2018,andisforecastedtoexpandataCompoundAnnualGrowthRateof10.51055.1 million in 2018, and is forecasted to expand at a Compound Annual Growth Rate of 10.5% to reach 2231.4 million by 2025. In this chapter, various colloidal carriers and their suitability for nanocosmeceutical applications along with their commercial status are explored. Besides, the routes of exposure of nanocosmeceuticals including their toxicity, safety, and regulatory concerns are addressed.
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A comparative analysis of surface and ultrastructural changes in stratum corneum (SC) with transepidermal water loss (TEWL) was conducted to develop a better understanding of the surfactant-induced damage to human skin. Treatments comprised a synthetic anionic surfactant (A), a composition of soap, glycerin, and petrolatum (B), a pure soap (C), and water (control). An increase in water loss is shown to correlate with increased perturbation of lipid barrier and damage to multiple layers of corneocytes. Transmission electron microscopy (TEM) revealed that, in general, one to two layers of lipid lamellae enveloped the outer layers of SC throughout the tissue. A significantly larger number of lamellae (approximately six to eight) appeared only in the lower layers. Surface topology, obtained using environmental scanning electron microscopy (ESEM), displayed a normal unperturbed structure. Treatment with A did not result in significant changes in SC. B caused regional variations in corneocytes and an increase in TEWL. Treatment with C exhibited significant variation in TEWL numbers: lipid lamellae were disordered and corneocytes appeared damaged and swollen. Intercorneocyte damage ranged from one to two (for TEWL ∼ 11 g/m2 hr) to up to six cell layers (for TEWL ∼ 34 g/m2 hr) of the SC. The presence or absence of the outermost layers of disjunctum did not appear to be critical for water loss, presumably due to a decrease in lipid lamellae.
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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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It is difficult for rosacea patients to discern which products and ingredients will be beneficial to their skin and which products will lead to an exacerbation of the signs and symptoms of rosacea. In this paper, the authors provide a brief overview of rosacea, its pathogenesis, signs and symptoms, and the management of the two major rosacea subtypes-erythematotelangiectatic rosacea and papular pustular rosacea. Reviewed in greater detail are the common ingredients used in over-the-counter cleansers and moisturizers with discussion of how these ingredients potentially benefit or harm the skin of patients with rosacea. Clinical studies investigating the benefits of using certain over-the-counter cleansers and moisturizers in patients with erythematotelangiectatic rosacea and papular pustular rosacea with or without topical prescription therapy are also reviewed. The specific formulas used in the clinical studies include a sensitive skin synthetic detergent bar, a nonalkaline cleanser and moisturizer, polyhydroxy acid containing cleanser and moisturizer, and a ceramide-based cleanser and moisturizer formulated in a multivesicular emulsion. Based on review of available data, the authors conclude that the use of mild over-the-counter cleansers and moisturizers is beneficial for patients with erythematotelangiectatic rosacea and papular pustular rosacea. The properties of over-the-counter cleansers and moisturizers that contribute to their mildness include an acidic-neutral pH to minimize the flux in skin pH; surfactants or emulsifiers that will not strip the skin of its moisture or strip the lipids and proteins of the stratum corneum; moisturizing ingredients such as emollients, humectants, and occlusives; and formulas without potential irritants and allergens. The most consistent clinical benefits demonstrated in the reviewed studies were a subjectively perceived improvement in subjective symptoms of dryness and irritation as well as an objective improvement in dryness.
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Atopic dermatitis skin tends to be easily irritated and appears dry. These clinical peculiarities correspond to impaired barrier function and to increased transepidermal water loss (TEWL) values. A few studies suggest that a reduced amount of total ceramides (especially of ceramide 1) is responsible for functional abnormalities of the skin of atopic dermatitis patients. The aim of this study was to analyze the relationship between epidermal lipids and barrier impairment in the skin of patients with atopic dermatitis. The quantity of ceramides, cholesterol sulphate and free cholesterol of 47 patients with atopic dermatitis and 20 age- and sex-matched healthy subjects was assessed by cyanoacrylate stripping and thin layer chromatography. Capacitance and TEWL were recorded at the same site of the lipid sample. In patients with atopic dermatitis, the levels of ceramide 1 and 3 were significantly lower and values of cholesterol significantly higher with respect to healthy subjects. Moreover, the CER/CH ratio was significantly lower with respect to normal skin. Patients with active signs of eczema also had higher TEWL values and lower capacitance values. By contrast, patients with no active signs of atopic dermatitis had a normal barrier function and intermediate values of ceramides and cholesterols, when compared to patients with atopic dermatitis with active lesions and normal subjects. The quantity of ceramide 3 was significantly correlated with TEWL impairment. These findings suggest that a decrease in ceramides in the stratum corneum is involved in barrier impairment in atopic dermatitis skin. Our data confirm those of other authors and support the view that impaired metabolism of ceramides may be the cause of dry skin and impaired barrier function in atopic dermatitis.
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Atopic dermatitis (AD) is an inflammatory disease characterized by pruritic skin lesions, immunodysregulation, disrupted epidermal barrier function and IgE-mediated sensitization to food and environmental allergens. Identification of the aetiology of AD has become increasingly a priority, as it is clear that the disease burden exceeds AD alone, with many children suffering severe, multi-system and occasionally life-threatening allergic disease. Previous approaches to understanding AD have centred on mechanisms in the adaptive immune system, often with an emphasis on the Th1–Th2 paradigm. Recently, the conceptual focus has increasingly shifted to include a primary defect in the epithelial barrier as a threshold event in moderate-to-severe AD. Familial aggregation of the disease is well established through many family studies of AD, asthma and allergic rhinitis, suggesting a significant heritable component. The identification of loss-of-function mutations in the filaggrin (FLG) gene, whose product is a key structural protein in the outermost layer of the epidermis in up to 50% of patients with AD, provides a significant insight into explaining disease initiation and points to a complex secondary interplay of environmental and immunological sequelae once barrier disruption is established. The elucidation of the environmental, genetic and immunobiological modifiers of this structural molecule may also direct our understanding of the pathomechanisms and endotypes central to the atopic diathesis. The recent identification of a murine model for FLG-AD, with the detection of a homozygous frame-shift mutation in the Flg gene in flaky-tail (ft/ft) mice, stands to rapidly accelerate our understanding of mechanisms and therapeutic intervention points in AD. Refining the molecular understanding of AD and its subtypes will allow for specific diagnostic, treatment and ultimately, preventative algorithms, and has opened an exciting new world of investigative challenges and collaborations. Cite this as: G. M. O'Regan and A. D. Irvine, Clinical & Experimental Allergy, 2010 (40) 965–972.
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Atopic dermatitis (AD) is a multifactorial, heterogenous disease that arises as a result of the interaction between both environmental and genetic factors. Changes in at least three groups of genes encoding structural proteins, epidermal proteases, and protease inhibitors predispose to a defective epidermal barrier and increase the risk of developing AD. Loss-of-function mutations found within the FLG gene encoding the structural protein, filaggrin, represent the most significant genetic factor predisposing to AD identified to date. Enhanced protease activity and decreased synthesis of the lipid lamellae lead to exacerbated breakdown of the epidermal barrier. Environmental factors, including the use of soap and detergents, exacerbate epidermal barrier breakdown, attributed to the elevation of stratum corneum pH. A sustained increase in pH enhances the activity of degradatory proteases and decreases the activity of the lipid synthesis enzymes. The strong association between both genetic barrier defects and environmental insults to the barrier with AD suggests that epidermal barrier dysfunction is a primary event in the development of this disease. Our understanding of gene-environment interactions should lead to a better use of some topical products, avoidance of others, and the increased use and development of products that can repair the skin barrier.
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Loss-of-function mutations in the FLG (filaggrin) gene cause the semidominant keratinizing disorder ichthyosis vulgaris and convey major genetic risk for atopic dermatitis (eczema), eczema-associated asthma and other allergic phenotypes. Several low-frequency FLG null alleles occur in Europeans and Asians, with a cumulative frequency of approximately 9% in Europe. Here we report a 1-bp deletion mutation, 5303delA, analogous to common human FLG mutations, within the murine Flg gene in the spontaneous mouse mutant flaky tail (ft). We demonstrate that topical application of allergen to mice homozygous for this mutation results in cutaneous inflammatory infiltrates and enhanced cutaneous allergen priming with development of allergen-specific antibody responses. These data validate flaky tail as a useful model of filaggrin deficiency and provide experimental evidence for the hypothesis that antigen transfer through a defective epidermal barrier is a key mechanism underlying elevated IgE sensitization and initiation of cutaneous inflammation in humans with filaggrin-related atopic disease.
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In a prospective computerized study on atopic dermatitis (AD) several basic and minor clinical features in patients with AD (n = 110) and a sample of the normal population (n = 527) was studied systematically and analysed statistically with regard to their diagnostic importance. On basis of chi-square values a diagnostic score system was constructed which might help to establish a firm diagnosis of AD in patients with ambiguous cutaneous inflammatory disease. Based on this score system patients with more than 10 points should be considered atopic, patients with 6 to 10 points are suspected to be atopics. An association between serum IgE and the amount of atopic points was found. Seven percent of the normal population sample proved to be obviously atopic, another 19% were suspected to be atopics.
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Although encompassing a multitude of attributes, in its most widely appreciated context the skin barrier function refers to the epidermal barrier to water permeability. Indeed, this is one of the most crucial of integumentary functions that make terrestrial life possible. Large-scale damage to this barrier, as in third-degree burns, results in death by dehydration (due to unchecked water loss). An intact impermeable barrier allows the organism to soak in water without flooding its internal organs and keeps out many xenobiotics. The stratum corneum (SC), a tough, paper-thin superficial layer of skin, has evolved to meet this primary requirement. Compared to the rest of the skin, which weighs around 16% of the total body weight, the mass of SC is rather insignificant. However, its average surface area (1.6 to 1.9 m2 in an adult person) is a clear indication of its functional significance to the integumentary system. The skin serves as a primary defense, a sensory and an excretory organ, a key to temperature regulation, and a visual signal for intraspecific communication. Its barrier function extends to UV, oxidants, and immune barriers, as well as barriers in interracial relations that have shaped human destiny. Functions and dysfunctions of skin affect not only the physical health, but also the self-esteem of the person. The latter aspect, once trivialized as vanity, is being increasingly recognized as important to emotional well being. This scientific attitude also has made the cosmetic and personal care industries focus on truly functional ingredients and products that perform, with an objective means of measuring the functional efficacy. As a result, research in skin biology has taken a truly interdisciplinary approach to encompass polymer sciences, measurement sciences (analytical), bio-and tissue-engineering and instrumentation, controlled-release and transdermal delivery of actives, in addition to the classic dermatological sciences, which have added molecular biology and genome sciences to its armamentarium of diagnosis and treatment.
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Dramatic changes in epidermal differentiation and stratum corneum structure and function occur in psoriasis and in the ichthyoses. In this chapter the differences in epidermal structure, composition, and function will be discussed, together with a summary of relevant topical technologies to improve the skin conditions discussed.
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The flexibility of the stratum corneum (SC) plays an important role in keeping the skin supple and in giving it a radiant appearance. Water present within the SC is essential for maintaining the flexibility of the SC, and is constitutively regulated by the water-holding capacity of the SC. Much evidence suggests that water-soluble materials, such as free amino acids, organic acids, urea, and inorganic ions determine the water-holding properties of the SC; these materials have been termed natural moisturizing factors [1]. Based upon this theory, many moisturizers have been designed and developed in the cosmetic field. Well-known removers of lipids, such as organic solvents, despite their poor ability to remove water-soluble materials, induce dry skin, which is characterized by a reduction in the water-holding function of the SC. Thus, we hypothesized that structural lipids, mainly comprised of ceramides, play a significant role in the water-holding potential of the SC. In this chapter, we introduce a new mechanism underlying the water-holding properties of the SC and elucidate the role of ceramides as natural moisturizing factors and their ef?cacy in the clinical treatment of dry skin.
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Widespread regions of dry itchy skin is one of the prominent clinical features of atopic dermatitis [1]. The intense itch is the most characteristic feature of this disease, and the consequences include scratching and eczematous lesions, as illustrated in Figure 1. Scratching can lead to disruption of the stratum corneum and infection. This disease is generally associated with asthma, allergic rhinitis, and elevated levels of IgE. There is frequently a family history of atopic dermatitis, indicating a genetic component in the etiology of the disease. All of these factors are taken into account in arriving at a clinical diagnosis.
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Winter itch was first described in 1874 by Duhring [3], and its seasonal nature was confirmed in later studies. Decades later, Gaul [4] related the problem to the presence of dry air as measured by dew points, and the early work of Irwin Blank in the 1950s proved that the low moisture content of the skin is a prime factor in precipitating this condition [5]. Low temperature and humidity are not the only factors that induce a dry skin condition; dry skin also occurs after excessive sun exposure or after the use of soaps and surfactants. Indeed, dry scaly skin is a characteristic feature in a wide range of more serious pathological conditions that affect the underlying epidermis.
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Atopic dermatitis (AD) is a chronic relapsing, pruritic skin disease frequently seen in patients with a history of respiratory allergy (1). Skin lesions evolve as the result of complex interactions between IgE-bearing antigen-presenting cells, T-cell activation, mast cell degranulation, keratinocytes, eosinophils, and a combination of immediate and cellular immune responses (see Chapters 8-16 for further discussion). Population studies indicate that the prevalence of AD in children has been steadily increasing since World War II and that it now affects more than 10% of children in most parts of the world (2). The rapid rise in prevalence of AD is thought to be primarily related to changes in our environment. A number of factors can trigger AD, including irritants, foods, aeroallergens, and infection. The relative contribution of allergens to the course of this illness is reviewed in Chapters 17, 18, and 20.
Article
It is generally assumed that dermatitis, whether of allergic or irritant origin, is primarily an immunological/ inflammatory disorder. In this article, we review recent information that supports an epidermal contribution to these disorders, as well as several other dermatoses. We first review new concepts of the epidermal barrier, with recent evidence that the stratum corneum is a biosensor that regulates the epidermal lipid and DNA-metabolic responses to a variety of exogenous insults. Various signaling mechanisms, including changes in levels of epidermal cytokines and growth factors, are potential candidates to mediate these metabolic responses. Our results show that these signaling molecules may be generated not in response to permeability barrier requirements, but as an avoidable consequence of the epidermal injury that accompanies all types of acute barrier abrogation. Although the role of cytokines/growth factors as regulators of metabolic events leading to barrier recovery is still unknown, their role in initiating a cytokine cascade leading to cutaneous pathology seems more certain. We conclude that signaling molecules, released following injury to the stratum corneum, initiate a cytokine cascade that induces inflammation, which is responsible for the clinical features of specific dermatoses. Thus, ‘outside-to-inside’ signaling may contribute to the pathogenesis of a variety of dermatoses characterized by abnormal barrier function.
Article
Prolonged exposure of human epidermis to excess endogenous or exogenous glucocorticoids can result in well-recognized cutaneous abnormalities. Here, we determined whether short-term glucocorticoid treatment would also display adverse effects, specifically on two key epidermal functions, permeability barrier homeostasis and stratum corneum integrity and cohesion, and the basis for such changes. In humans 3 d of treatment with a potent, commonly employed topical glucocorticoid (clobetasol), applied topically, produced a deterioration in barrier homeostasis, characterized by delayed barrier recovery and abnormal stratum corneum integrity (rate of barrier disruption with tape strippings) and stratum corneum cohesion (mug protein removed per stripping). Short-term systemic and topical glucocorticoid produced similar functional defects in mice, where the basis for these abnormalities was explored further. Both the production and secretion of lamellar bodies were profoundly decreased in topical glucocorticoid-treated mice resulting in decreased extracellular lamellar bilayers. These structural changes, in turn, were attributable to a profound global inhibition of lipid synthesis, demonstrated both in epidermis and in cultured human keratinocytes. The basis for the abnormality in stratum corneum integrity and cohesion was a diminution in the density of corneodesmosomes in the lower stratum corneum. We next performed topical replacement studies to determine whether lipid deficiency accounts for the glucocorticoid-induced functional abnormalities. The abnormalities in both permeability barrier homeostasis and stratum corneum integrity were corrected by topical applications of an equimolar distribution of free fatty acids, cholesterol, and ceramides, indicating that glucocorticoid-induced inhibition of epidermal lipid synthesis accounts for the derangements in both cutaneous barrier function and stratum corneum integrity/cohesion. These studies indicate that even short-term exposure to potent glucocorticosteroids can exert profound negative effects on cutaneous structure and function. Finally, topical replenishment with epidermal physiologic lipids could represent a potential method to reduce the adverse cutaneous effects of both topical glucocorticoid treatment and Cushing's syndrome.
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In 1923 Coca and Cooke (1) introduced the term “atopy” to designate phenomena of hypersensitivity in humans. Atopy was adapted from the Greek word meaning “out of place” or “strange disease.” Atopy in the concept of Coca and Cooke is (1) hereditary, (2) limited to a small group of human beings, (3) different from anaphylaxis, referring to a lack of protection, and allergy, meaning an altered reactivity, both of which can also be induced experimentally in humans and in animals, (4) qualitatively an abnormal response occurring only in particular individuals (atopics), (5) clinically characterized by hay fever and bronchial asthma, and (6) associated with immediate-type (flare-and-wheal) skin reactions. The authors wanted to describe a familial or hereditary tendency-which does not occur in normals-to become sensitized in a natural way to certain substances in the environment, e.g., house dust, pollen, or food, and to develop hypersensitivity reactions such as hay fever and asthma, which are associated with immediatetype (flare-and-wheal) skin reactions. At this time Coca and Cooke were evidently unaware of the work of Prausnitz and Küstner (2), published in 1921, about the passive transfer of immediate hypersensitivity in humans by serum. However, 2 years later Coca and Grove (3) defined the “atopic reagins” as the specifically 2 Wüthrich and Schmid-Grendelmeier reacting substances in the serum of atopic individuals that can be demonstrated by the Prausnitz-Küstner test. In their original definition of atopy, Coca and Cooke included only allergic rhinitis and bronchial asthma. Wise and Sulzberger (4) discussed in the 1933 Year Book of Dermatology and Syphilogy the conditions of eczema, neurodermatitis, lichenification, and “prurigo diathe’siques” described by the French dermatologists Besnier (5) and Brocq (6) and stated in a footnote that: Of all these forms of more or less confused and confusing types of localized and generalized lichenification, at least one is emerging as a fairly distinct and clear-cut entity. This is probably best called atopic dermatitis, but is generally known as generalized neurodermitis or diffuse pruritus with lichenification. This is characterized by the following cardinal qualities: (1) atopic family history; (2) antecedent infantile eczema; (3) localization in antecubital and popliteal spaces, the anterior portions of the neck and chest and the face, particularly the eye-lids; (4) the presence of a grayish or brownish coloration of the skin; (5) the absence of true vesicles, clinically and histologically; 6) vasomotor instability or irritability; (7) the usual negative patch test with many contact allergens; (8) many positive reactions of immediate wheal type to scratch or intradermal testing and (9) the presence of many reagins in the blood serum.
Chapter
The epidermal permeability barrier resides in the stratum corneum (SC), a heterogeneous, two-compartment tissue. Whereas the cells (corneocytes) of the SC are lipid-depleted, they are embedded in a continuous, lipid-enriched extracellular matrix organized into characteristic, multilamellar membrane unit structures, which mediate barrier function (22). The formation of the permeability barrier is the goal of epidermal proliferation and differentiation, processes that begin in the basal layer. The quantitatively most important cell type of the epidermis, the keratinocyte, derives from stem cells, and en route to the SC it synthesizes specific basal (K5 and K14) and suprabasal (K1 and K10) keratins, as well as cornified envelope (CE)-associated proteins (20). The CE begins to form with the deposition and cross-linking of involucrin and envoplakin on the intracellular surface of the plasma membrane in the upper spinous and granular cell layers of the epidermis. The process begins at or near desmosomal sites, followed by the subjacent addition of elafin, small prolin-rich proteins, and loricrin. With cornification, the phospholipid-enriched plasma membrane disappears, followed by the formation of a ceramide-containing membrane bilayer (see below), which is covalently attached to involucrin, envoplakin, and periplakin moieties on the extracellular surface of the CE by ω-hydroxyester bonds (57).
Article
General skin care is a significant component of patient education, especially when treating patients with common dermatoses, such as acne, rosacea, eczematous dermatoses, and photodamage. A better understanding of epidermal barrier function and formulation science has resulted in improved cleanser and moisturizer formulations. The maintenance of skin barrier function may be overlooked if clinicians focus solely on the appropriate selection of pharmacologic agents. Patients welcome specific recommendations for basic skin care products from their dermatologist.
Chapter
The epidermis has a powerful innate immune system. Keratinocytes are immunologically active cells, able to identify and kill invading microbes. Keratinocytes recognize highly conserved structures of the pathogens, called pathogenassociated molecular patterns (PAMPs), via pattern recognition receptors (PRRs), which results in the secretion of antimicrobial and proinflammatory mediators. Antimicrobial peptides and proinflammatory chemokines/cytokines, effector molecules of innate immunity, also act as regulators of acquired immune responses, inflammation and wound repair. Keratinocyte-derived effector molecules are critical in the recruitment of dendritic cells, T cells and neutrophils into sites of infection, linking innate and acquired immune responses in the skin.
Article
Skin accomplishes the protection of the mammalian organism against exogenous physical, chemical, and biological agents, as well as sustaining the organism's homeostasis. The majority of the barrier mechanisms of the skin are attributed to the stratum corneum. The concept of ‘bricks-and-mortar’ organisation of the stratum corneum comprises the corneocytes with their cornified envelope and the intercellular bilamellar lipids. The regulation of the skin barrier homeostasis involves different mechanisms: skin surface pH, hydration of the stratum corneum, calcium ion gradient in the epidermis, nuclear hormone receptors and their ligands, and immune-cell mediators. The cutaneous barrier is perturbed in skin diseases such as atopic dermatitis, irritant dermatitis, and psoriasis, as well as in certain lifethreatening dermatoses, e.g. toxic epidermal necrolysis, staphylococcal scalded skin syndrome, and Netherton syndrome. Skin barrier function can be assessed by noninvasive methods in vivo, e.g. transepidermal water loss, stratum corneum hydration, and skin surface pH measurement.
Article
Atopic dermatitis is a very common skin condition, estimated to affect 15% to 30% of children and 2% to 10% of adults. There are distinct morphologic variants of atopic dermatitis that evolve during the maturation of an individual with atopic dermatitis. This is a complex disease process that involves polygenic inheritance as well as gene-environment interactions. Because this condition is so common in industrialized nations, it has been hypothesized that the avoidance of common childhood diseases (because of hygienic conditions and vaccination) interferes with the normal development of the immune system. A variety of factors play a role in atopic dermatitis: abnormal barrier function, neuroimmunepsychiatric factors, impaired innate immunity, and abnormal acquired immunity. Bacterial products, and the aberrant immune response to such products, are important pathogenic flare factors for eczema. Treatment involves management of flare factors, topical and systemic glucocorticosteroids, topical calcineurin inhibitors, topical and oral antibiotics, oral antihistamines, and, in severe cases, phototherapy, cytotoxic drugs, and cyclosporine.
Article
Psoriasis is a common, immune-mediated inflammatory papulosquamous skin disease that results in recurring scaly, erythematous plaques, typically in a symmetrical distribution. There is strong evidence that psoriasis is determined by genetic predisposition. It is thought that there is not a single disease gene, but rather a complex set of gene variants that results in an abnormal response to environmental factors. Psoriasis is now considered to be a disease caused by the infiltration of effector immunocytes in the epidermis and dermis. Important effector cells are CD4 and CD8 conventional T-lymphocytes, as well as natural killer (NK) T cells, plasmacytoid dendritic cells (PDCs), TIP-DCs. Other cell types that participate in this pathologic process include keratinocytes, endothelial cells, fibroblasts, monocytes/macrophages, and neutrophils. Pathologic cytokines include inflammatory cytokines such as tumor necrosis factor-α (TNF-α), interferon-α (IFN-α), T-helper-1 (Th1) cytokines such as IFN-γ, Th17 cytokines such as interleukin-17 (IL-17) and IL-22, and antigenpresenting cell (APC)-derived cytokines such as IL-12 and IL-23. Biologic agents have emerged as effective treatments for psoriasis. They include anti-T-cell agents (efalizumab and alefecept), and anti-TNF-α agents (etanercept, infliximab, and adalimumab).
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It is known that elderly skin has an increased pH and decreased buffering capacity. These two changes in the physiochemical nature of elderly skin arguably contribute to the fragility of elderly skin by influencing barrier homeostasis, skin integrity/cohesion, susceptibility to infection, and skin sensitivity to topical acids and alkalis. This chapter briefly reviews the basic science of pH, the buffering capacity, and the changes seen in the epidermis of aging skin before presenting a more in-depth review of experimentation investigating the source and characteristics of human skin buffering capacity. These studies are reviewed in an attempt to illuminate the source of the diminished buffering capacity of aged skin. Experimentation reviewed here suggests that AAs are primarily responsible for the neutralization capacity of the skin. The exact sources of the amino acids as well as the types of AA that are primarily responsible for the neutralization capacity remain still rather speculative. From what is known to date, filaggrin breakdown products may play an important role in skin buffering capacity, and the decrease in filaggrin as we age may explain, at least in part, why the skin buffering capacity decreases with age. Additional components of the epidermis such as sebum and CO2 seem not to significantly participate as buffering agents of the epidermis, yet they still may play a role in the protection of skin from the harm of acids and bases.
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Skin cleansers have evolved from merely cleansing to providing mildness and moisturizing benefits as well. Alkyl carboxylate, commonly known as soap, is the prototypical surfactant used in skin-cleansing soap bars; however, the superior mildness of syndet bars over soap bars is well documented in the literature. Harsh surfactants in cleansers can cause damage to skin lipids and proteins, leading to after-wash tightness, dryness, barrier damage, irritation, and even itch. The structure of synthetic surfactants is often tailored to minimize damage to the stratum corneum. A significant breakthrough in cleansing came with the introduction of syndet bars containing sodium cocoyl isethionate as the cleanser and long-chain fatty acids as the moisturizing agents. Current liquid cleansers use a combination of anionic and amphoteric surfactants to reduce protein damage and skin irritation potential of anionic surfactants. These combinations can still cause skin dryness, and this article indicates that this may be due to the interaction of surfactants with skin lipids. The combination of anionic and amphoteric surfactants can result in increased damage to lipids, even though their skin irritation potential is reduced considerably. Skin dryness is addressed in current moisturizing cleanser systems with the use of emollients, such as petrolatum and triglyceride oils. Typically, higher levels of petrolatum are used to increase moisturization by occlusion, with some moisturizers having a petrolatum content as high as 50% to 60% by weight. A novel approach to skin moisturization involves using a combination of lipids, natural oils, and humectants, supplemented with occlusives. In this article, we describe the efficacy of a new moisturizing body wash technology, with sodium cocoyl isethionate as the primary surfactant and fatty acids and triglyceride oils as the emollients.
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The pool of free amino acids, urocanic and pyrrolidone carboxylic acid in a mammalian stratum corneum has been shown to be derived principally or totally from the histidine-rich protein of the ketatohyalin granules. The time course of appearance of free amino acids and breakdown of the histidine-rich protein are similar, as are the analyses of the free amino and the histidine-rich protein. Quantitative studies show that between 70 and 100% of the total stratum corneum-free amino acids are derived from the histidine-rich protein.
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Treatment goals for atopic dermatitis consist of attempting to eliminate inflammation and infection, hydrating the skin, controlling pruritus, and avoiding exacerbative factors. The aim of this study was to evaluate the effects of adding a moisturizing regimen to a low-potency topical corticosteroid lotion regimen in the treatment of atopic dermatitis. This controlled, randomized, investigator-masked 3-week study was undertaken to compare twice-daily applications of desonide lotion 0.05% alone with twice-daily applications of desonide lotion 0.05% plus three-times-daily applications of a moisturizing cream. The efficacy variables assessed included erythema, dryness or scaling, pruritus, excoriations, lichenification, oozing or crusting, and induration or papules. Administration of desonide lotion alone created statistically significant improvement in total sign and symptom scores. The addition of a moisturizer to the treatment regimen produced additional statistically significant improvement in total sign and symptom scores, physicians' global assessments of improvement, and most of the individual efficacy variables. Results of this study suggest that the addition of a moisturizer to a low-potency corticosteroid lotion in separate regimens was effective in treating the signs and symptoms of mild-to-moderate atopic dermatitis.
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in the lower stratum comeurn but underwent degradation towards the upper surface of the stratum corneum. These observations contrasted with xerotic skin, which had disorganized lipid bilayers in the upper stratum corneum, although apparently normal lipid bilayers in the deeper tissue regions. Also, desmosomes remained undegraded in the upper layers of the xerotic stratum corneum, a finding corrobo- rated by western blotting showing increased levels of desmoglein 1. Chromatographic analysis of stratum comeurn lipids showed decreased ceramide and increased fatty acid levels in subjects with xerosis compared with normal individuals, particularly in the outer stratum corneum layers. Although ceramides were lost from the stratum comeurn, the increased levels of fatty acids may be due in part to the deposition of soap fatty acids. Our results support previous studies demonstrating the importance of desmosomal degradation in desquamation. Furthermore, we have been able to show changes in the normal membrane structure of intracellular lipids in the desquamating layers of the stratum comeurn. These studies also provide new insights into soap-induced winter xerosis, revealing abnormalities in stratum comeurn lipid composition and organization together with reduced desmosomal degradation.
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Toll-like receptors (TLRs) are part of the innate immune response. TLRs work through two pathways: Adaptor protein myeloid differentiation factor 88 (MyD88) to activate transcription factor nuclear factor B (NF- B) or activating protein-1 (AP-1) A lipopolysaccharide (LPS)-triggered MyD88- independent pathway that produces inflammatory cytokines Multiple dermatologic diseases are found to involve TLRs, including TLR-1 (psoriasis, tuberculoid leprosy), TLR2 (acne, retinoids, lepromatous leprosy, syphilis, atopic dermatitis, Lyme disease, herpes simplex virus, candidiasis), TLR4 (Kawasaki’s disease, syphilis, candidiasis, melanoma), TLR5 (syphilis), and TLR9 (herpes simplex virus). Current and future therapies and vaccines will target TLRs.
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Antimicrobial peptides (AMPs) are low-molecularweight proteins with a wide spectrum of activity against microbial pathogens. Antimicrobial peptides are amphipathic. Antimicrobial peptides include defensins, cathelicidins, granulysin, S-100 proteins, and a variety of other antimicrobial proteins. Antimicrobial peptides play a role in acne, wound healing, psoriasis, and atopic dermatitis.
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Topical corticosteroids have been the mainstay of treatment for atopic dermatitis (AD) over the last decade, especially in the setting of acute flares. However, heavy and prolonged use of topical corticosteroid is undesirable as it is associated with side effects such as, skin atrophy, telangiectasia, striae, steroid-induced dermatoses, rosacea, acne exacerbation, and in some severe and rare cases, systemic effects such as hypothalamic-pituitary-adrenal axis suppression, growth retardation and ocular problems. Non-steroidal ant-inflammatory agents specific for the treatment of AD (topical calcineurin inhibitors, or TCIs) are now available and they are a viable alternative to topical corticosteroids in treating dermatitis of the face, neck, eyelids, and intertriginous areas where there is a greater risk of the steroid-induced side effects. More recently, medical device emollients have entered the marketplace. These medical devices provide, but are not limited to, anti-oxidant, anti-protease, anti-inflammatory activity, and aid in restoring the natural balance of lipids, which is one of the causes of the epidermal abnormalities seen with AD. The present study evaluated the short-term effectiveness and appeal of a non-steroidal medicated device foam as compared to pimecrolimus cream 1% in the treatment of AD within a wide age group of subjects with active disease at baseline. In this study, both pimecrolimus and the medical device foam exhibited efficacy in mild-to-moderate AD. Primary efficacy was measured by IGA. After four weeks of treatment with the medical device foam, 82% of target lesions were scored "clear" (0) or "almost clear" (1) compared to 71% of target lesions under the pimecrolimus arm. This study confirmed that pimecrolimus cream 1% and the medical device foam work well in the treatment of AD in both adults and children with no associated adverse effects.
Article
Rosacea is a common inflammatory facial dermatosis seen in adults that exhibits considerable variety in clinical presentation. Multiple medical therapeutic options are available including topical and oral treatments. Optimal medical management of rosacea includes assessment of subtype and disease severity and use of appropriate skin care to reduce epidermal barrier dysfunction. This article provides an overall discussion of the medical management of rosacea and reviews interim results from a study evaluating the role of designated skin care in rosacea treatment.
Article
The barrier function of the skin is dependent on an optimal composition of the stratum corneum lipids, exemplified by the altered lipid profile in patients with atopic eczema (AE). Differences in the global prevalence of AE point to the environment as an important factor in AE. Studies on filaggrin point to a genetic aspect in AE. The influence of environment and genes needs to be explored. To investigate possible differences in stratum corneum lipids between different healthy ethnicities living in the same environment. Healthy participants without any major skin diseases were enrolled in the study. Twenty-five participants of Asian origin (Asians), 18 of African origin (Africans) and 28 of Danish origin (white-skinned), all students at universities in the Copenhagen area of Denmark, had the ceramide profile of their stratum corneum examined using the cyanoacrylate method and analysed using high-performance thin layer chromatography. For the ceramide/cholesterol ratio we found statistically significant differences between groups, with Asians having the highest ratio (P < 0·001 as compared with both white-skinned individuals and Africans), white-skinned individuals having intermediate values, and Africans having the lowest values. No statistically significant differences were found between any of the ceramide subgroups. We found different ceramide/cholesterol ratios in comparable groups of different ethnicity, pointing to unknown genetic differences.
Article
The active form of vitamin D(3) , calcitriol, is widely used for the treatment of psoriasis, with or without topical corticosteroids. Topical corticosteroids are known to disrupt permeability and antimicrobial barriers, even with short-term use. Yet, the effect of topical calcitriol on epidermal permeability and antimicrobial barriers disrupted by topical corticosteroids has not been determined. To examine the effect of calcitriol on epidermal permeability and antimicrobial barrier function that has been impaired by corticosteroids, as well as to elucidate the mechanism of improvement. Topical calcitriol or the control vehicle was applied to each flank of hairless mice 20 min after treatment with topical clobetasol propionate and repeated every 12 h for 3·5 days. Barrier function assessment, Nile red staining, electron microscopy, immunohistochemistry, Western blotting, and real-time reverse transcriptase-polymerase chain reaction studies were performed 24 h after the last application. Epidermis co-treated with topical calcitriol showed an improvement of stratum corneum integrity and barrier recovery, more intense fluorescence staining with Nile red, and an increase in lamellar body (LB) maturation and density, as well as upregulation of major epidermal lipid synthesis-related enzymes (3-hydroxy-3-methylglutaryl-CoA, serine-palmitoyl transferase and fatty acid synthase), mouse beta-defensin 3, cathelin-related antimicrobial peptide and vitamin D receptor. We found that topical calcitriol restored both the epidermal permeability and antimicrobial barrier that had been impaired by corticosteroids. This restoration was mediated by both an activation of the cutaneous vitamin D pathway and an increase of epidermal lipids and antimicrobial peptides, promoted by the formation of the LB and the activity of epidermal lipid synthesis-related enzymes.