Skin Barrier Function in Psoriasis and Atopic Dermatitis: Transepidermal Water Loss and Temperature as Useful Tools to Assess Disease Severity
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design
2.2. Study Population
- Healthy volunteers were people who attended the Dermatology Service for common conditions, such as melanocytic nevi or seborrheic keratoses, and did not have previous personal or family history of any inflammatory skin disease.
- Patients with psoriasis were patients with an established clinical diagnosis of mild to severe plaque-type psoriasis [25] and had a psoriasis plaque on their elbows.
- Patients with AD were patients with established clinical diagnosis of mild to severe AD [26] and had an eczematous lesion on their volar forearms.
- Psoriasis patients currently having non-plaque forms of psoriasis, e.g., erythrodermic, guttate, or pustular psoriasis, or a drug-induced form of psoriasis.
- Healthy volunteers who had previous personal history of any inflammatory skin disease.
- Clinical infection on the measured area.
- History of cancer, including skin cancer.
- Subjects with intense sun exposure during the study.
- Not signing the informed consent form.
2.3. Study Variables
2.4. Outcome Measures
- To assess differences in TEWL, SCH, and temperature values between healthy skin, psoriatic skin, and AD skin.
- To evaluate TEWL and temperature values’ ability to discriminate mild psoriasis versus moderate/severe psoriasis.
- To evaluate TEWL and temperature values’ ability to discriminate mild AD versus moderate/severe AD.
- To assess differences in other homeostasis parameters between healthy skin, psoriatic skin, and AD skin: erythema, melanin, pH, and elasticity.
- To assess differences in homeostasis parameters between mild psoriasis and moderate/severe psoriasis: TEWL, SCH, temperature, erythema, melanin, pH, and elasticity.
- To assess differences in homeostasis parameters between mild AD and moderate/severe AD: TEWL, SCH, temperature, erythema, melanin, pH, and elasticity.
2.5. Statistical Analysis
3. Results
3.1. Skin Homeostasis in Psoriatic Patients
3.2. Skin Homeostasis in Atopic Dermatitis Patients
3.3. Skin Homeostasis Analysis between Psoriatic Patients and AD Patients
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Sociodemographic Features | Psoriatic Patients (n = 92) | Healthy Participants assessed on the Elbow (n = 92) | Atopic Dermatitis Patients (n = 65) | Healthy Participants assessed on the Volar Forearm (n = 65) |
---|---|---|---|---|
Age (years) | 48.63 (15.70) | 42.06 (18.59) | 28.14 (19.59) | 35.96 (19.03) |
Sex (%) | ||||
Female | 46 (50%) | 57 (62%) | 42 (64.6%) | 48 (73.8%) |
Male | 46 (50%) | 35 (38%) | 23 (35.4%) | 17 (26.2%) |
Smoking habit (yes) | 31 (33.7%) | 12 (13%) | 7 (10.8%) | 6 (9.23%) |
Alcohol habit (yes) | 29 (31.5%) | 29 (31.5%) | 15 (23.1%) | 10 (15.4%) |
Family history of psoriasis/atopic dermatitis (yes) | 43 (46.7%) | 12 (13%) | 32 (49.2%) | 7 (10.8%) |
Emollients use (yes) | 51 (55.4%) | 35 (38%) | 51 (78.5%) | 28 (43.1%) |
Treatment | ||||
Topical treatment | 49 (53.26%) | 39 (60%) | ||
Systemic treatment | 23 (25%) | 26 (40%) | ||
Biologic drugs | 20 (21.7%) | 0 |
Skin Homeostasis Parameters | Psoriatic Patients with PASI < 7 (n = 59) | Psoriatic Patients with PASI ≥ 7 (n = 33) | p Value | p Value | ||
---|---|---|---|---|---|---|
Uninvolved Psoriatic Skin | Psoriatic Plaques | Uninvolved Psoriatic Skin | Psoriatic Plaques | p * | p ** | |
TEWL (g·m−2·h−1) | 12.18 (7.52) | 17.16 (9.58) | 11.86 (8.78) | 20.75 (11.22) | 0.855 | 0.109 |
SCH (AU) | 37.76 (13.13) | 10.91 (9.76) | 39.63 (14.69) | 4.78 (5.24) | 0.531 | <0.001 ** |
Temperature (°C) | 30.51 (2.00) | 30.62 (1.65) | 30.66 (1.09) | 31.56 (1.13) | 0.639 | 0.005 ** |
Erythema (AU) | 311.78 (73.15) | 404.37 (73.76) | 311.34 (69.90) | 412.79 (67.91) | 0.981 | 0.648 |
Melanin (AU) | 246.49 (81.63) | 193.65 (69.98) | 230.05 (75.64) | 188.36 (69.30) | 0.422 | 0.770 |
pH | 6.01 (0.64) | 6.06 (1.01) | 6.12 (0.56) | 5.90 (0.87) | 0.422 | 0.468 |
Elasticity (%) | 0.74 (0.13) | 0.77 (0.20) | 0.69 (0.15) | 0.72 (0.17) | 0.110 | 0.251 |
Skin Homeostasis Parameters | Cut-off Value | Sensitivity | Specificity | OR | p |
---|---|---|---|---|---|
Temperature (°C) | 30.85 | 72.7% | 55.9% | 3.39 | 0.010 * |
TEWL (g·m−2 h−1) | 13.85 | 81.8% | 50.8% | 4.66 | 0.003 * |
SCH (AU) | 2.07 | 39.4% | 84.7% | 0.28 | 0.011 * |
Two criteria (temperature > 30.85 + TEWL > 13.85) | - | 60.6% | 76.3% | 4.95 | 0.001 * |
Skin Homeostasis Parameters | AD Patients with SCORAD < 37 (n = 26) | AD Patients with SCORAD ≥ 37 (n = 34) | p Value | p Value | ||
---|---|---|---|---|---|---|
Uninvolved AD Skin | AD Eczematous Lesion | Uninvolved AD Skin | AD Eczematous Lesion | p * | p ** | |
TEWL (g·m−2 h−1) | 10.88 (8.04) | 26.33 (15.34) | 13.75 (6.62) | 31.67 (13.74) | 0.135 | 0.161 |
SCH (AU) | 47.10 (17.01) | 30.68 (24.23) | 34.78 (13.55) | 19.90 (11.40) | 0.003 * | 0.044 ** |
Temperature (°C) | 31.30 (1.04) | 31.74 (1.00) | 31.35 (1.46) | 32.45 (1.15) | 0.891 | 0.015 ** |
Erythema (AU) | 201.05 (17.30) | 351.78 (102.64) | 254.93 (78.78) | 395.71 (77.71) | 0.004 * | 0.361 |
Melanin (AU) | 168.91 (37.39) | 1990.04 (23.33) | 212.55 (82.57) | 215.24 (88.88) | 0.221 | 0.298 |
pH | 5.79 (0.62) | 5.87 (0.61) | 6.04 (0.41) | 6.03 (0.47) | 0.97 | 0.274 |
Elasticity (%) | 0.79 (0.11) | 0.75 (0.12) | 0.67 (0.16) | 0.63 (0.20) | 0.003 * | 0.01 ** |
Skin Homeostasis Parameters | Cut-off Value | Sensitivity | Specificity | OR | p |
---|---|---|---|---|---|
Temperature (°C) | 31.75 | 81.8% | 57.7% | 6.14 | 0.003 * |
TEWL (g·m−2 h−1) | 23.19 | 73.5% | 53.8% | 3.24 | 0.034 * |
SCH (AU) | 14.54 | 71.9% | 23.1% | 0.77 | 0.663 |
Two criteria (temperature > 31.75 + TEWL > 23.19) | - | 69.2% | 61.8% | 3.64 | 0.19 |
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Montero-Vilchez, T.; Segura-Fernández-Nogueras, M.-V.; Pérez-Rodríguez, I.; Soler-Gongora, M.; Martinez-Lopez, A.; Fernández-González, A.; Molina-Leyva, A.; Arias-Santiago, S. Skin Barrier Function in Psoriasis and Atopic Dermatitis: Transepidermal Water Loss and Temperature as Useful Tools to Assess Disease Severity. J. Clin. Med. 2021, 10, 359. https://doi.org/10.3390/jcm10020359
Montero-Vilchez T, Segura-Fernández-Nogueras M-V, Pérez-Rodríguez I, Soler-Gongora M, Martinez-Lopez A, Fernández-González A, Molina-Leyva A, Arias-Santiago S. Skin Barrier Function in Psoriasis and Atopic Dermatitis: Transepidermal Water Loss and Temperature as Useful Tools to Assess Disease Severity. Journal of Clinical Medicine. 2021; 10(2):359. https://doi.org/10.3390/jcm10020359
Chicago/Turabian StyleMontero-Vilchez, Trinidad, María-Victoria Segura-Fernández-Nogueras, Isabel Pérez-Rodríguez, Miguel Soler-Gongora, Antonio Martinez-Lopez, Ana Fernández-González, Alejandro Molina-Leyva, and Salvador Arias-Santiago. 2021. "Skin Barrier Function in Psoriasis and Atopic Dermatitis: Transepidermal Water Loss and Temperature as Useful Tools to Assess Disease Severity" Journal of Clinical Medicine 10, no. 2: 359. https://doi.org/10.3390/jcm10020359