Free residual chlorine in bathing water reduces the water-holding capacity of the stratum corneum in atopic skin

Some patients with atopic dermatitis (AD) develop dry skin or exacerbated cutaneous inflammations with frequent swimming in public pools or after bathing. We examined the effects of residual chlorine in bathing water on the function of the stratum corneum (SC) in patients with AD and determined the lowest chlorine concentration showing an effect. In addition, we investigated the relationship between the free residual chlorine concentration in bathing water and the water-holding capacity of the SC in patients with AD. Twenty patients with AD and 10 normal control (NC) subjects were included in this study. The hydration status of the SC on the flexor surface of the forearm was measured with a corneometer before and after the subject's arms were immersed in tubs filled with comfortably hot water (40 degrees C) containing residual chlorine at concentrations of 0, 0.5, 1.0 and 2.0 mg/L for 10 minutes in a room maintained at normal temperature (24 degrees C) and relative humidity (55%). The water-holding capacity of the SC after immersion was calculated by integration of the hydration status determined every 30 seconds over a period of 10 minutes. In the patients with AD, the average SC hydration status after immersion in comfortably hot water containing residual chlorine at 1.0 and 2.0 mg/L was significantly lower than that following immersion in water containing a negligible concentration of residual chlorine (i.e., less than 0.03 mg/L) (p<0.05). In the NC subjects, significant differences were observed only between the 2.0 mg/L and the negligible residual chlorine groups (p<0.05). The water-holding capacity of the SC was significantly decreased with a residual chlorine concentration of 0.5 mg/L or higher in the patients with AD (p<0.01). However, in the NC subjects, a significant decrease in water-holding capacity was observed only at a residual chlorine concentration of 2 mg/L (p<0.01). These results indicate, first, that the water-holding capacity of the SC in patients with AD is more sensitive to free residual chlorine exposure than that in NC subjects without AD. Second, these results suggest that free residual chlorine exposure in patients with AD may play a role in the development or exacerbation of AD.     

A multicentre randomized controlled trial of ion-exchange water softeners for the treatment of eczema in children: protocol for the Softened Water Eczema Trial (SWET) (ISRCTN: 71423189)

Background  There is epidemiological evidence linking increased water hardness with increased eczema prevalence. A number of plausible mechanisms can be forwarded to suggest why hard water could exacerbate eczema. The most likely explanation is increased soap usage in hard water areas, the deposits of which can cause skin irritation in individuals with eczema.
Objectives  To assess the cost and cost-effectiveness of ion-exchange water softeners for the treatment of eczema in children.
Patients/Methods  Three hundred and ten children aged 6 months to 16 years, with moderate to severe eczema. The children must live in hard water areas (≥ 200 mg L⁻¹ of calcium carbonate) and have a home that is suitable for the installation of a water softener. This is a single-blind, parallel-group, randomized controlled trial of 12 weeks duration followed by a 4-week cross-over period.
Results/Analysis Plan  Primary outcome: difference in the mean change in disease severity (Six Area, Six Sign Atopic Dermatitis score) at 12 weeks compared with baseline. Secondary outcomes: (i) proportion of time spent moving during the night; (ii) self-reported global changes in eczema severity; (iii) amount of topical treatment used; (iv) Patient Oriented Eczema Measure; (v) number of totally controlled and well controlled weeks; (vi) impact on health-related quality of life for the child (EQ-5D) and the family (Dermatitis Family Impact questionnaire); and (vii) cost-effectiveness. It is planned that recruitment will be completed by the end of 2008 and results will be available towards the end of 2009.     

Correlation of transepidermal water loss with skin barrier properties in vitro: comparison of three evaporimeters

Aim: This study investigates the relationship between transepidermal water loss (TEWL) and skin permeability to tritiated water as a rapid assessment of the integrity of the barrier properties of skin as part of in vitro skin permeation studies.
Methods: TEWL values before and during the experimental period were measured using three evaporimeters (A, B, and C) representing different measuring principles and technologies. Single application of tritiated water was dosed on dermatomed human skin samples in a flow-through diffusion cell system. Radioactivity of the absorbed dose and the removable dose residues was counted to determine percent dose and flux rate. These data were further combined with TEWL values to analyze the correlation.
Results: Evaporimeter C, a closed chamber–condenser technology, had higher measurement capacity than other instruments, evaporimeter A, an open chamber, and evaporimeter B, a closed chamber ( P <0.001). The baseline TEWL value correlated with tritiated water flux ( r =0.34, P =0.04). The pattern of tritiated water expressed as percent dose permeated into receptor fluid was similar to that of TEWL values.
Conclusion: These data indicate that TEWL can be ascribed to be a measure of skin water barrier function. Further work should be conducted to interpret the significance of measuring TEWL by evaporimetry.     

Impact of Different Spa Waters on Inflammation Parameters in Human Keratinocyte HaCaT Cells

BackgroundThe treatment of different skin conditions with spa waters is a long tradition dating back to at least late Hellenism. Interestingly, independent scientific examinations studying the effect of spa waters are scarce.ObjectiveIn the present in vitro study, we compared the effect of culture media supplemented with (a) thermal spa waters (La Roche-Posay, Avène) and (b) two natural mineral drinking waters (Heppinger, Adelholzener) on physiological parameters in HaCaT keratinocytes.MethodsThe different medium preparations were investigated with regard to cell proliferation and cell damage. Moreover, the impact on inflammation parameters with and without ultraviolet B (UVB) irradiation was examined.ResultsTwo popular thermal spring waters were found to suppress cell proliferation and cell damage. Moreover, these waters reversed the induction of interleukin-6, as measured using enzyme-linked immunosorbent assay and promoter transactivation, and the formation of reactive oxygen species after UVB stimulation. Of note, the two natural mineral waters, which are distributed as drinking waters, had some effect on the above-mentioned parameters but to a lesser extent.ConclusionIn summary, our results show that spa waters, and particularly those derived from thermal springs, reduce parameters associated with inflammation. It seems likely that trace elements such as selenium and zinc are critical for the observed effects.     

Skin function parameters in intensive-care patients

BACKGROUND/PURPOSE: The study was performed to investigate the transepidermal water loss (TEWL) and pH-value in patients in intensive care. METHODS: Forty intensive-care patients (22 men, 18 women) were included in the study. TEWL and pH-values were measured at admission, and after 24, 96 and 168 h. The areas of measurement were the forehead, the volar forearm, paraumbilical and the ventral thigh. The measurements were made under standardized environmental conditions according to the recommendations of the EMCO Group. RESULTS: Elevated values were found on the forehead compared with the other skin areas examined. There was no significant change in mean TEWL-values in any patient in the course of the study. There was also no significant influence of TEWL at the time of admission on the prognosis. The course analysis of the mean pH-values, however, showed that patients who developed a systemic inflammatory response syndrome (SIRS) or sepsis during the further course had a higher pH-value over the entire study period. CONCLUSION: TEWL and the pH of the skin surface could be measured at bedside in the intensive-care unit and delivered reproducible results. These parameters appear, however, to be relevant only for subgroups of patients under intensive care.     

Local tissue water assessed by measuring forearm skin dielectric constant: dependence on measurement depth, age and body mass index

Background: Tissue dielectric constant (TDC) measured at 300 MHz via the coaxial line reflection method is useful to evaluate local tissue water (LTW) and its change. Because excitation field penetration depth depends on size and geometry of the coaxial probe in contact with the skin, TDC values reflect skin and subcutaneous fat to varying depths depending on the probe used. Because tissue changes that occur with age or body mass index (BMI) may affect tissue water content and its depth distribution, our goal was to use TDC measurements to characterize depth patterns of LTW in normal tissue and to investigate the possible impact of age and BMI.
Methods: TDC was measured to depths of 0.5, 1.5, 2.5 and 5.0 mm on both forearms of 69 healthy women (age: 22–82 years, BMI: 18.7–46.1 kg/m²).
Results: Independent of age or BMI, TDC values decreased significantly with increasing measurement depth (33.7±5.8 at 0.5 mm to 21.8±3.7 at 5.0 mm) but at all depths dominant and non-dominant TDC values were similar to each other with ratios ranging from 1.025±0.081 at 0.5 mm to 1.017±0.097 at 5.0 mm. TDC values only at 2.5 and 5.0 mm decreased significantly with increasing BMI whereas TDC values only at 0.5 and 1.5 mm increased significantly with age.
Conclusion: The findings indicate that normal TDC values are affected differentially by BMI and age in a depth-dependent manner. Possible explanations are discussed.     

Role of organic osmolytes in water homoeostasis in skin

The ability to conserve water is fundamental to terrestrial life. A number of organs such as the kidney and the bladder have important roles in the regulation of body water balance. The epidermis of skin is also fundamental to this process, and it is in a constant battle to prevent loss of water to the external, dry environment. Given this important role of the epidermis as a barrier to water loss, it is perhaps surprising that many of the cellular mechanisms by which human keratinocytes achieve cell volume homoeostasis, maintain epidermal hydration and adapt to biological effects from environmental stressors such as ultraviolet radiation are poorly understood. This article reviews what is known thus far and speculates about other potential mechanisms through which skin conducts water homoeostasis, with a particular emphasis on the putative role of organic osmolytes.     

Comparing the rates of absorption and weight loss during a desorption test using near infrared spectroscopy

The importance of determining skin hydration has over the years prompt the development of many instruments and methods, specifically designed to assess this parameter or water contents especially in the stratum corneum, and have greatly matured to suit different anatomical sites and measure multiple attributes. Of those, Near Infrared Spectroscopy (NIRS) has gained wide interest as a precise, safe, fast and noninvasive technique for determining skin hydration due to its high sensitivity to hydrogen bonding and ability to measure the amount of water in skin directly using the intensities of overtone and combination bands of OH and HOH water bonds occurring in the NIR region, that are good indicators of the state of skin hydration. This paper reports near infrared spectrophotometric measurements using a highly sophisticated spectrophotometer in the region of 1000‐2500 nm to study the water uptake and dehydration properties of skin in vitro using samples of porcine skin. Initial results of pure liquid water and skin samples have clearly displayed the prominent bands associated with water content, and desorption tests have been able to verify changes in these bands associated with water content, although a clear correlation between the rates of weight loss and absorbance loss at various hydration periods has not yet been established. These preliminary results are expected to further explain the relationship between water and skin, and its role within, in hope to aid the future development of a portable instrument based on near infrared spectroscopy that would be capable of directly measuring skin hydration and/or water content in a fast and noninvasive manner.     

Nickel in tap water

Nickel analyses of tap water from several sources in Copenhagen gave up to 490 + 10^-4 g + 1^-1 in the first 250 ml portions. Hot water gave higher values than cold water. After flushing for 5 min, low values were found. Considerable variation from time to time and from tap to tap was found. Drinking of only the first portion in the morning might have an influence on nickel hand eczema.     

A case of allergic contact dermatitis due to nickel in underground water

A 26-year-old Korean woman with nickel allergy continued to have recurrent facial lesions even after avoiding the usual sources of nickel. As another possible source of nickel, underground water at her house, which had been used by her for 3 years, was analyzed by atomic absorption spectrophotometry. Nickel contents in 8 different domestic tap waters and another underground water sample were also measured by plasma scan. Nickel contents in the patient's underground water were 9 times higher on average than those in domestic tap water. Patch tests with 2 concentrated underground water samples gave positive results. The other underground water sample also contained a higher amount of nickel than tap water. Therefore, we suggest that the underground water was a source of our patient's nickel contact dermatitis, and should be considered as a rare but possible source of nickel contact dermatitis.     

特应性皮炎动物模型表皮分化蛋白表达的改变

目的观察特应性皮炎(AD)除真皮T细胞浸润和皮肤增厚外,是否有表皮细胞的分化和增生异常。方法利用反复外涂半抗原的方法制作AD动物模型。在观察该模型皮肤生理学改变的同时,利用免疫组化的方法对表皮分化蛋白的表达和角质形成细胞的增生进行观察。结果AD组角质层的水分含量明显降低;皮肤水分丢失量及pH明显增高。与对照组相比,AD组表皮兜甲蛋白(loricrin)的表达明显减少;在角质层,中间丝相关蛋白(Filaggrin)和外皮蛋白(involucrin)的表达强度稍微减低,但表达部位有明显地改变。正常时仅表达在角质层,而在AD组其颗粒层和棘细胞层均有较强的染色。抗增生细胞核抗体染色显示,AD的表皮增生极其活跃。HE染色显示AD的表皮明显增厚。结论利用反复外涂半抗原的方法可成功制作AD动物模型,AD除皮肤生理的异常外,还伴有表皮增生和分化的异常。     

Effects of water temperature on photosensitization in bath-PUVA therapy with 8-methoxypsoralen

The pharmacokinetic aspects of bath-PUVA are not completely clarified. Therefore, we determined the phototoxic response of human skin following psoralen baths at temperatures ranging from 32°C to 42°C (71.6–107.6°F) and UVA doses ranging from 0.5 to 5.5 J/cm². The highest therapeutical photosensitization (i.e., lowest minimal phototoxic dose) was assessed at temperatures of 37°C (98.6°F) and above. Photosensitization was significantly decreased at lower temperatures. These data indicate that a bath temperature of 37°C (98.6°F) should be used to gain optimal therapeutic efficiency in a clinical setting. Furthermore, in order to minimize the risk of adverse phototoxic effects in bath-PUVA, it is important to use a constant temperature during the psoralen bath.     

Changes in the depth profile of water in the stratum corneum treated with water

Background/purpose: Water in the stratum corneum (SC) plays an important role in keeping the skin surface soft and smooth. Information regarding the depth profile of the molecular composition of the skin, such as water and free amino acids, can be obtained non‐invasively using the recently developed confocal Raman spectrometer. In this study, we investigated changes in the depth profile of water in the SC treated with water. We also unveil a relationship between the depth profile patterns of water content in the SC and cutaneous sensation. Methods: Depth profiles of Raman spectra in the region 2600–4000 cm^?1 were obtained using a 671‐nm laser at 2 μm intervals from the skin surface toward the interior with a confocal Raman spectrometer. Water content (mass%), expressed in grams of water per 100 g wet tissue, was calculated from the water‐to‐protein ratio of the Raman band. Skin surface temperature was measured by an infrared irradiation thermometer. Changes in the depth profile of water and skin temperature were measured at 1, 5, and 10 min after the application of water to the skin surface. In addition, questionnaires regarding cutaneous sensation were administered. Results: Water content in the middle to lower part of the SC increased with increased water‐application time. Warming of the skin during water application increased the water‐penetration amount, depth, and holding time in the SC. Steamer application increased water content particularly in the upper part of the SC. Increasing water content in the upper part of the SC was associated with cutaneous sensations, such as hydrate and water‐rich feelings. On the other hand, the increasing water content in the middle and lower part of the SC was associated with water penetration and tension feelings. Conclusion: The water content in the upper part of the SC changed easily. When water was applied externally, the water content in both the upper and middle/lower part of the SC increased with increasing water‐application time. In addition, warming of the skin during water application increased the water‐penetration depth, amount, and holding time of water in the SC. Thus, we were able to control the depth profile of water in the SC by externally applying water. The location of water in the SC also affected cutaneous sensations.     

Alternative evaluation method in vitro for the water-resistant effect of sunscreen products

Background/purpose: Sunscreen products today represent a trend of providing not only simple sun protection factor (SPF)/protection of UVA (PFA) but also other additional benefits. For example, as popularized by seasonless use of sunscreens, the special function of water resistance or sand proof is added to sunscreens as well as for leisure. Because a human in vivo test is time consuming and expensive, a screening process has been tried using an accurate in vitro system. In this study, we suggest the development of an in vitro test that can predict the result of in vivo water resistance of sunscreens. Methods: Water resistance is presented as a comparison of initial SPF and water‐exposed SPF by immersion and washing. In order to be comparable with the in vivo test, water immersion and flow were defined as the basic statements. Also, substrate, revolutions per minute (r.p.m.) – rotative velocity – of propeller inducing water flow, and time of immersion were defined as controlled factors. Considering the strength, separation of test material and adhesive texture, a PMMA plate was selected as suitable among commercial substrates: Transpore tape?, VITRO SKIN, and PMMA plate. Also, when the PMMA plate was adhered on the wall of a water bath, the water turbulence of the rotational propeller alone was not strong enough to wash off the test material from the substrate. Therefore, PMMA plates were fixed on the axis. In this experiment, the most important thing is whether this in vitro system can predict correctly. Hence, we tried to match the in vitro water resistance following from our control factors and water resistance value of the in vivo test. Results: We found the immersion time and r.p.m. of controlled factors to obtain the target water resistance using design of experiment, MiniTab statistical package. Response optimization yielded the optimal in vitro conditions of 150 r.p.m./60 min. The repeatability and reproducibility of this in vitro system were also good in validation studies. Conclusions: This study enables to modify an in vivo water resistance test and predict the result of in vivo water resistance by the manufacture of effective equipment and choosing a suitable substrate. Compared with in vivo results, our in vitro system is more time and cost effective, and provides reliable results.