Differences of skin irritation between Japanese and European women

BACKGROUND: After using cosmetics, Japanese women frequently complain about sensitive, stinging skin. We wondered whether Japanese women's skin is more sensitive than that of Caucasians. OBJECTIVES: To examine possible racial differences of skin irritation and subjective sensations. METHODS: We performed patch testing on the forearm with sodium lauryl sulphate (SLS) at different concentrations (0.25%, 0.5%) and 24-h exposure time. Skin reaction was evaluated by measurement of transepidermal water loss (TEWL), stratum corneum hydration, sebum secretion, laser Doppler flowmetry (LD), content of melanin and erythema. During a stinging test with 10% lactic acid (applied to one side of the cheeks) the subjects were asked to describe the present intensity of any sensation. We used a Chromameter to measure skin colour before and after application of lactic acid. This study was performed in Marburg, Germany, with healthy Japanese and German women living in Marburg. RESULTS: After SLS testing, we found no significant differences of the barrier function in the stratum corneum, but we found significant subjective sensory differences between Japanese and German women. CONCLUSIONS: Japanese women may complain about stronger sensations reflecting a different cultural behaviour rather than measurable differences in skin physiology; however, a faster penetration of SLS in Japanese cannot be excluded.     

Intra- and inter-individual variations in transepidermal water loss on the face: facial locations for bioengineering studies

The volar forearm is the favored location for bioengineering studies. However, transepidermal water loss (TEWL), which is an important indicator of the function of the epidermal barrier, shows regional variations, and for the evaluation of cosmetic formulations, facial skin would be more suitable. In this study, we have compared 10 facial locations with 1 test site on the volar forearm for absolute TEWL values, reproducibility, and correlation. Measurements were performed over 3 consecutive days. The TEWL values of the facial test sites were higher compared to forearm values and did not correlate with the forearm. On the face, there was a good correlation between the values of the right compared to the left side of the face. The sites superior to the nervus supraorbitalis, the medial borders of the musculus masseter, and the center of the chin proved to be locations with relatively stable TEWL values. There was a greater variability at the center of the forehead and at the center of the cheeks. It is recommended that TEWL measurements on facial locations with stable TEWL values are used for the evaluation of cosmetic formulations.     

特应性皮炎患儿与健康儿童皮肤屏障功能的对比

目的探讨特应性皮炎(AD)患儿与健康儿童皮肤屏障功能的差异。方法 0～7岁的AD患儿和健康儿童各60名,根据不同年龄段分成2组,0～2岁组和2～7岁组各30例。依次进行角质层含水量、pH值、经表皮水分丢失量(TEWL)的测量,使用SPSS13.0统计软件分析。结果 0～2岁、2～7岁AD患儿与健康儿童比较,角质层含水量除前臂无差异外,前额和颊前均明显低于健康对照组;皮肤表面pH值均明显高于健康对照组;0～2岁的AD患儿TEWL值除前臂无差异外,前额和颊前均明显高于健康对照组,而2～7岁AD患儿TEWL值均明显高于健康对照组。结论 AD患儿与健康儿童比较,皮肤屏障功能存在障碍。表现为角质层含水量、皮肤表面pH值、TEWL值有不同程度的差异。     

Functional properties of the surface of the vermilion border of the lips are distinct from those of the facial skin

BACKGROUND: The vermilion border of the lips (lip for short) is the only part on the face where the oral mucosa is persistently exposed to the outside. Despite its prominent presence on the face, constituting not only the target of cosmetics but also the site for various skin diseases, its functional properties remain almost unknown. OBJECTIVES: To elucidate the functional properties of the vermilion border of the lips. METHODS: We studied the biophysical properties of the lip by comparing them with those of the cheek skin in 303 healthy Japanese females aged 21-80 years, in winter. We used a closed-chamber system to measure transepithelial water loss (TEWL) of the lip to avoid the effect of breathing. Moreover, we examined the effects of oral etretinate, a drug that definitely produces dry, scaly lips, on the lips of seven male patients aged 49-89 (average 67) years. RESULTS: TEWL was significantly almost three times as high on the lips as that on the cheek which is a site that shows far higher levels than do other body areas. TEWL decreased with age more remarkably on the lip than on the cheek. High-frequency conductance, a parameter for surface hydration state, was significantly lower on the lip than on the cheek. The mean values obtained were about one-third of those on the cheek, and no age-related changes were observed either on the lip or on the cheek. The superficial epithelial cells on the lip were parakeratotic and larger than those of the cheek skin. Furthermore, we detected a significant increase in TEWL on the lip as well as on the cheek of patients treated with oral etretinate. CONCLUSIONS: It appears that the incomplete corneocyte formation of the lip surface is responsible for the poor barrier function and water-holding capacity.     

Transepidermal water loss in young and aged healthy humans: a systematic review and meta-analysis

Transepidermal water loss (TEWL) is regarded as one of the most important parameters for characterizing skin barrier function but an agreed upon definition of what a “normal” TEWL is does not exist. In order to determine generalizable TEWL values for healthy adults, a systematic review and meta-analysis was conducted. The databases MEDLINE and EMBASE and publication lists were screened. After full-text appraisal of 398 studies, 231 studies were excluded due to unclear or insufficient reporting. 167 studies providing data about 50 skin areas were included in the final data synthesis. Pooled sample sizes ranged from n = 5 for the left cheek and the left lower back to a maximum of n = 2,838 for the right midvolar forearm area. The lowest TEWL of 2.3 (95 % CI 1.9–2.7) g/m²/h was calculated for the breast skin, the highest TEWL of 44.0 (39.8–48.2) g/m²/h for the axilla. TEWL in individuals being 65 years and above was consistently lower compared to the group of 18- to 64-year-old individuals. The quality of reporting TEWL in humans should be increased in future studies.     

Biophysical measurements of human forearm skin in vivo: effects of site, gender, chirality and time

Background/aims: Measurements of transepidermal water loss (TEWL) and skin colour are biophysical techniques commonly used to measure the in vivo skin effects of cosmetics, topical medicaments and chemical irritants. The purpose of this study was to investigate the variability of TEWL and skin colour on human forearm skin as a function of regional variation, gender and preferred chirality over an 8 h period.
Methods: Biophysical measurements of TEWL and skin colour were made at five sites on both forearms of male ( n =8) and female ( n =9) human volunteers in vivo (38% relative humidity, 21°C).
Results: Rates of TEWL at the forearm midpoint were 10% lower than at the forearm extremities ( P <0.01). Skin redness ( a *) near the wrist was 5–10% higher than at other sites ( P <0.05). Rates of TEWL were 5% higher in male volunteers ( P <0.05). Red and blue ( b *) colour measurements of male forearm skin differed by 18% and 20% in comparison with female, respectively. Rates of TEWL, skin brightness ( L *) and b * decreased by 9% ( P <0.05), 1.8% ( P <0.05) and 4% ( P <0.05), respectively, with time whereas a * and skin temperature increased by 4.5% ( P <0.01) and 7.2% ( P <0.01), respectively. There was a significant correlation between the change in all measured parameters with time.
Conclusions: Significant differences in TEWL and skin colour were identified that may have relevance in the design and interpretation of multivariate analyses of human forearm skin. Diurnal variation of TEWL, skin colour and temperature may have a single underlying mechanism.     

Skin barrier function recovery after diamond microdermabrasion

Microdermabrasion is a popular method for facial rejuvenation and is performed worldwide. Despite its extensive usage, there are few publications on skin barrier change after microdermabrasion and none concerning diamond microdermabrasion. Our object was to see changes in transepidermal water loss (TEWL), hydration and erythema of the face following diamond microdermabrasion. Twenty-eight patients were included in this spilt face study. TEWL, stratum corneum hydration and the degree of erythema were measured from the right and left sides of the face (forehead and cheek) at baseline. One side of the face was treated with diamond microdermabrasion and the other side was left untreated. Measurements were taken right after the procedure and repeated at set time intervals. Diamond microdermabrasion was associated with a statistically significant increase in TEWL immediately after the procedure and at 24 h. However, on day 2, levels of TEWL were back to baseline. An increase in hydration and erythema was observed right after microdermabrasion, but both returned to baseline on day 1. The results show that skin barrier function of the forehead and cheek recovers within 2 days of diamond microdermabrasion. Diamond microdermabrasion performed on a weekly basis, as presently done, is expected to allow sufficient time for the damaged skin to recover its barrier function in most parts of the face.     

Functional analysis of the stratum corneum of scalp skin: studies in patients with alopecia areata and androgenetic alopecia

Abstract Because of the presence of thick long hairs on the scalp, little information is available concerning the functional characteristics of the stratum corneum (SC) of scalp skin. We therefore conducted a functional study of the SC of lesional scalp skin of patients with alopecia areata and of patients with androgenetic alopecia. We compared the scalp with the cheek and the flexor surface of the forearm (volar forearm). The water barrier function of the scalp SC of both patient groups, in terms of transepidermal water loss (TEWL), was almost comparable to that of the volar forearm, and was far better than that of facial skin. However, hydration of the scalp skin surface, as evaluated by measurement of high-frequency conductance, was markedly higher than that of facial skin, and showed significantly higher values than the volar forearm. These characteristics seem to be dependent, at least to some extent, on the amount of sebum-derived skin surface lipids because these were abundant on the scalp skin. Moreover, removal of skin surface lipids led to a significant decrease in skin surface hydration. The superficial corneocytes, the size of which reflects the proliferative activity of the epidermis, were substantially smaller on the scalp than on the volar forearm but significantly larger than on the cheek. These findings suggest that the rate of turnover of the scalp epidermis is intermediate between that of the facial and volar forearm epidermis. We conclude that the SC of the scalp skin in humans is functionally distinct from that of the face and extremities. Received: 6 January 2000 / Revised: 11 August 2000 / Accepted: 25 September 2000     

Biophysical parameters of skin: map of human face, regional, and age-related differences

The face showed anatomical variation on reaction to chemicals, which could be related to differences in biophysical specificities of the skin. The aim of this study was to establish a map of the face for 6 biophysical parameters.10 young human volunteers (24-34 years) and 10 old volunteers (66-83 years) were studied to prepare a map of the human face based on regional variations and age-related differences by measuring various biophysical parameters. 7 locations on the face, neck, and forearm were investigated. Skin blood flow, transepidermal water loss (TEWL), stratum corneum hydration (capacitance), temperature, pH, and sebum content of the skin surface were measured. In both groups, skin blood flow in the nose showed the highest value. Perioral and nasolabial areas showed the highest TEWL values. The neck showed the highest capacitance value. The highest skin temperature was detected in the neck in the young group and in the nasolabial area in the old group. The chin showed the most alkaline pH in both groups. Nasolabial area showed the highest sebum content in the young group, as did the chin in the old group. These baseline values provide a framework to build on for ascertaining disease and intervention-related effects.     

Does massage postapplication improve moisturizer’s efficacy? A 2‐week regression study

Background Combining massage with moisturizer application is a popular technique in beauty spa sessions. The subjective positive psychological effects of massage with moisturizer application in hand and face beauty treatment are documented by many people attending spa sessions. The aim of this study was to objectively evaluate the effect of local effleurage massage as an external intervention on moisturizer efficacy. Methods In a regression‐type study of 2‐week, twice‐daily application followed by 1 week of regression, 13 female subjects applied “off the shelf” moisturizer twice daily on both forearms followed by 1 min superficial massage for one forearm randomized among subjects. The influence of massage after moisturizer application on skin barrier properties was evaluated by noninvasive measurements of transepidermal water loss (TEWL), skin capacitance, and skin elasticity at baseline, day 7, and day 14 during the treatment phase, and day 21 following a 1‐week regression period, in which no moisturizer and no massage were performed on forearms. Results The tested “off the shelf” moisturizer in both “massage” and “no‐massage” application protocols caused a comparable progressive improvement in skin hydration level and barrier permeability over the 2‐week treatment period, which was maintained during the 1‐week regression (no moisturizer) period. In addition, skin elasticity was similarly improved by both application protocols. Conclusion In this long‐term study, the daily performance of massage after moisturizer application was not an effective external intervention for enhancing moisturizer efficacy.     

Epithelial barrier function and atopic diathesis in rosacea and perioral dermatitis

BACKGROUND: Rosacea and perioral dermatitis (PD) are common dermatoses, the aetiology and pathogenesis of which remain speculative. Objectives To investigate skin barrier function and features of atopy in both diseases. METHODS: We studied 75 patients with rosacea and 75 with PD. Transepidermal water loss (TEWL) was measured in three regions of the face (lateral chin, perinasal cheek, side of the nose) and the patients were assessed for atopy by clinical criteria, prick tests and specific IgE against a mixture of aeroallergens (CAP SX1). The control group consisted of 125 individuals with no history of rosacea, PD or active atopic disease. RESULTS: In patients with PD, TEWL was significantly increased (P < 0.001) at all measurement points in comparison with the rosacea and control groups. Significantly (P < 0.001) higher values were also found regarding history and clinical signs of an atopic diathesis, prick test reactivity and specific IgE against aeroallergens. CONCLUSIONS: PD is characterized by a skin barrier disorder of facial skin. It differs from rosacea in that it involves a significantly increased TEWL and features of an atopic diathesis. However, it remains disputed as to whether PD is an individual skin disease or a subtype of rosacea in atopic patients.     

Correlation of clinical features and skin barrier function in adolescent and adult patients with atopic dermatitis

BACKGROUND: Xerotic changes in atopic skin are considered to be related to a decrease in the water permeability barrier. Whether abnormal skin barrier function is the main cause of atopic dermatitis (AD) or a secondary change of the disease is still controversial. Noninvasive bioengineering methods, including the measurement of the transepidermal water loss (TEWL) and water capacitance, have been commonly used to evaluate skin barrier function. AIM: To evaluate the correlation between the clinical features of each evaluation site (severity of AD) and skin barrier function. METHODS: TEWL, capacitance, and pH were checked on five evaluation sites: postauricle, forearm, abdomen, thigh, and popliteal fossa. The subjects included 25 patients, both adolescents and adults, with AD and 25 age-matched normal controls. The clinical severity, from 0 (no clinical manifestation) to 3 (severe), was also scored for erythema, induration/papulation, lichenification, and xerosis on each evaluation site of the AD patients. RESULTS: Based on the data, we found that the clinical severity score was correlated with TEWL and capacitance in more than one-half of the evaluation sites. Erythema and induration/papulation showed a statistically significant correlation with TEWL in most cases (P < 0.05, four sites). Lichenification and xerosis showed a significant correlation with capacitance in most cases (P < 0.05, four sites). In most cases, severity scoring of the clinical features did not show a significant correlation with skin pH. The patients showed higher TEWL and lower capacitance than normal controls (P < 0.05, all five sites). CONCLUSIONS: The results of our study suggest that skin barrier function, measured by TEWL and capacitance, and clinical severity show a statistically significant correlation in patients with AD.     

Monitoring of skin response to sodium lauryl sulphate: clinical scores versus bioengineering methods

The present trial was designed to evaluate clinical scores (single observer) of sodium lauryl sulphate (SLS)-induced skin irritation in a group of subjects (n = 10) over a 10-day period along with various skin function parameters. In order to avoid significant variations due to secondary phenomena, the following parameters were recorded with non-invasive instruments in this order: skin capacitance (C1; arbitrary units; CM420 Corneometer), transepidermal water loss (TEWL; g/m2.h; Evaporimeter) and laser Doppler flowmetry (CBFV: cutaneous blood flow values; Periflux). All examinations were performed during winter on reclined relaxed subjects present for at least 10 min in a test room with controlled temperature and relative humidity (t degrees: 19.5-20.7 degrees C and RH: 47.3-60.3%). The analysis of differential data (delta = value at tx-value before test; 2-way ANOVA) was made on single parameters as a function of site (volar forearm versus neck) and time (from 24 h after 48-h occlusion with 5% SLS up to 10 days later). The profile of erythema scores over time differed between neck and forearm, but the delta CBFV readings with the laser Doppler instrument did not detect significant site-time interactions. Roughness (blind evaluation with palpating finger) and capacitance readings (delta C1) showed significant differences between sites, but the profile over time was similar in both locations. delta TEWL did not differ according to anatomical location. The reason for different erythema scores on neck and forearm might be related to inherent regional variation of optical properties of the skin or to a substantial contribution of SLS-induced roughness to the readings of erythema.(ABSTRACT TRUNCATED AT 250 WORDS)     

上海两社区特应性皮炎患儿的皮肤屏障功能研究

【摘要】 目的 探讨上海两个社区特应性皮炎（AD）患儿及健康对照儿童皮肤屏障功能及AD皮损严重程度与皮肤屏障功能的相关性。方法 3 ~ 12岁AD患儿169例和健康对照儿童142例来自上海长宁新泾社区和嘉定菊园社区,检测前臂伸侧、屈侧及脸颊、胫前4个部位非皮损区的角质层含水量和经皮失水量（TEWL）。并用欧洲AD评分标准（SCORAD）对AD患儿临床严重程度进行评分。结果 AD患儿前臂伸侧、屈侧及脸颊、胫前四个部位的TEWL值均高于健康对照儿童（P ＜ 0.05）,角质层含水量在前臂伸侧和胫前均显著低于健康对照儿童（P ＜ 0.05）。AD患儿SCORAD与TEWL均值呈正相关,与角质层含水量均值呈负相关。结论 皮肤屏障功能可以作为评价AD临床严重程度的指标之一。     

EIectrical impedance and transepidermal water loss of healthy human skin under different conditions

Background/aims: The skin barrier function is a multidimensional quality, which can be defined by a combination of noninvasive measurements, including EIectrical impedance (EI) and transepidermal water loss (TEWL). Methods: TEWL and EI were determined on in five different areas of the body in 25 healthy volunteers. The effects of hydration (a 15 min water bath, a 1 h occlusion and application of an oil-in-water emulsion combined with occlusion) were measured on the volar forearm. Results: EI was highest in the axillary region, followed by the cheek, spinal region, presternal area and upper arm. TEWL was highest in the axillary region, followed by the cheek. Lowest levels were detected in the spinal region, the presternal region and the upper arm. The water bath increased EI but not TEWL. After 1 h occlusion TEWL was not increased and EI decreased, which corresponds to stratum corneum hydration. After a single application of an oil-in-water emulsion, we observed a reduction of EI and an increase of TEWL. The simultaneous use of occlusion and application of an emulsion led to the most significant reduction of EI. TEWL was increased during the following 30 min. Conclusions: EI and TEWL show a topological variability. Acute hydration increased EI but occlusion and/or moisturizing decreased EI. Acute hydration and occlusion alone did not significantly affect TEWL, but moisturizing in combination caused a longer lasting TEWL increase. To examine the stratum corneum function, the use of different noninvasive techniques seem to provide more complex information.     

Acute irritant threshold correlates with barrier function,skin hydration and contact hypersensitivity in atopic dermatitis and rosacea

The aim of the study was to disclose interactions between epidermal barrier, skin irritation and sensitization in healthy and diseased skin. Transepidermal water loss (TEWL) and stratum corneum hydration (SCH) were assessed in adult patients with atopic dermatitis (AD), rosacea and healthy controls. A 4‐h patch test with seven concentrations of sodium lauryl sulphate was performed to determine the irritant threshold (IT). Contact sensitization pattern was revealed by patch testing with European baseline series. Subjects with a lower IT had higher TEWL values and lower SCH. Subjects with positive allergic reactions had significantly lower IT. In AD, epidermal barrier deterioration was detected on both volar forearm and nasolabial fold, while in rosacea, impeded skin physiology parameters were observed on the facial skin only, suggesting that barrier impediment is restricted to the face in rosacea, in contrast with AD where the abnormal skin physiology is generalized.     

Normal recovery of the stratum corneum barrier function following damage induced by tape stripping in patients with atopic dermatitis

Patients with atopic dermatitis (AD) constantly inflict mechanical damage to their skin by scratching induced by pruritus. On excoriated lesions of the cheek we found exceedingly high levels of transepidermal water loss (TEWL) as compared to those in the normal skin of healthy subjects. However, it is not clear whether the skin of patients with AD also shows an abnormally slow recovery after mechanical damage. We compared the recovery of the barrier function of the stratum corneum (SC). after its complete removal by tape stripping, in patients with AD and age-matched healthy control subjects. On the normal-looking skin of the flexor forearm, we found no difference in the recovery process of the water barrier function of the SC between the two groups. This suggests that ability to reconstruct SC barrier function after mechanical damage is not impaired in AD patients.     

Skin barrier function and dermal inflammation. An experimental study of transepidermal water loss after dermal tuberculin injection compared with SLS patch testing

The reaction of the skin water barrier to dermal inflammation was studied in 15 healthy volunteers. Dermal inflammation was induced either by injection of tuberculin (Mantoux test) or by a 24-h sodium lauryl sulphate (SLS) patch test on the volar forearm. Measurement of transepidermal water loss (TEWL) was used for evaluation of the skin barrier function. Inflammation was quantified by assessment of blood flow by laser-Doppler flowmetry. Measurement from uninvolved skin in the test region > 7 cm distant from the test sites served as control. Measurements were performed twice, separated by an interval of 6 days. Throughout the study. TEWL values were higher in the SLS test sites than in the Mantoux reactions, although the blood flow was significantly increased in Mantoux reactions compared with SLS test sites. This indicates that the impaired skin barrier function caused by SLS is due to a direct cytotoxic effect, and TEWL were significantly higher on the arm with the Mantoux test than the arm with SLS patch test. The significant inflammation caused by the Mantoux reaction may cause functional alterations in the clinically normal skin > 7 cm distant from the test area.     

EEMCO guidance for the assessment of transepidermal water loss in cosmetic sciences

Measurement of transepidermal water loss (TEWL), based on the estimation of the water vapour gradient in an open chamber, is being used to support claims of cosmetics including product mildness, reduction in irritative skin reactions, skin hydration, skin repair, protective effect against UV damage and others. TEWL measurement can also screen ingredients that have a beneficial effect on the barrier function and offer the possibility to monitor in vivo, on human skin, the effect of topical treatment in an objective and non-invasive way. A high number of variables affecting TEWL measurements have been identified. These should be rigorously taken into consideration. To work under standardised conditions is of the utmost importance to obtain reliable and reproducible results.     

Functional map and age-related differences in the human face: nonimmunologic contact urticaria induced by hexyl nicotinate

Variation in human skin reactivity to various irritants in association with age and body region has been reported. Hexyl nicotinate (HN), a lipophilic nicotinate ester, was used to induce nonimmunologic contact urticaria in human volunteers of 2 age groups: 10 young subjects [24-34 years, mean +/- standard deviation (SD) 29.8 +/- 3.9 years] and 10 older volunteers (66-83 years, mean +/- SD 73.6 +/- 17.4 years); and to define skin function and potential age-related differences in various facial areas. About 5 mM of HN in ethanol was applied to 8 locations on the face, neck, and volar forearm. A laser Doppler flowmeter was used to determine baseline blood flow and to monitor the skin blood flow changes after HN application. In the contralateral areas, stratum corneum turnover was determined using 5% dansyl chloride in petrolatum. In the young group, the perioral area exhibited the strongest reaction to HN. In the older group, the chin was the most sensitive site. In both the groups, the forearm was the least responsive. The older group demonstrated a stronger reaction than the younger group in 3 sites (forehead, cheek, and nasolabial area). Stratum corneum turnover was slower in the nasolabial area and in the forearm in both age groups, whereas the fastest was in the perioral area and the chin in the younger group and in the chin and the forehead in the older group. Compared to the older group, the younger group showed a slower stratum corneum turnover in the nose and the neck. This study demonstrates the regional and the age-related variability of the stratum corneum turnover and the skin reactions to HN. These observations may help explain some aspects of the cutaneous intolerance in skin care of the face.