Stratum corneum maturation. A review of neonatal skin function

The importance of the stratum corneum and its barrier function for infants, especially for newborns, is clinically evident. Research regarding the maturation of the stratum corneum in neonates, i.e. when full barrier function is obtained, has produced varying results. Based on transepidermal water loss and percutaneous absorption studies, term infants seem to possess stratum corneum with adult barrier properties. Additionally, postnatal life is thought to accelerate stratum corneum maturation, so that even preterm infants have barrier function similar to term infants at 2-3 weeks of gestational age. However, a look at other parameters, such as skin thickness, skin pH and stratum corneum hydration, shows that neonatal skin is always adjusting to the extrauterine environment in contrast to the steady state of adult skin. This suggests that barrier stabilization may be dependent on achieving a balance between different parameters. However, it is still in question, which parameters, what balance and what timing. This paper provides an up-to-date overview on the neonatal skin barrier based on the review of current literature.     

Strategies for overcoming the stratum corneum

Transdermal drug delivery has many advantages over the oral administration of drugs. This is the reason why many researchers have extensively investigated the transdermal absorption of drugs. However, a much smaller number of drugs are marketed using this route of delivery, compared to oral dosage forms, because drug absorption across the skin is very low due to the stratum corneum (the main barrier for drug absorption across the skin). Overcoming the penetration barrier would significantly improve the development of an efficient transdermal drug delivery system. Several techniques have been developed, or are under development, to bypass the stratum corneum. Approaches that have been made to overcome the stratum corneum fit into five different categories: (i) device and formulation; (ii) modification of stratum corneum by chemical enhancers; (iii) ablation; (iv) bypassing the stratum corneum via appendages; and (v) electrically assisted methods such as iontophoresis and electroporation. Furthermore, possible combinatorial uses of several approaches have been studied. Although the safety issues of these synergistic approaches still require clarification, several combinations could be promising. Finally, there is a necessity to regulate the intradermal disposition of drugs to develop a more efficient transdermal drug delivery system after overcoming the skin barrier.     

醇传递体在透皮给药系统中的研究进展

由于角质层的限速屏障作用,大部分药物透过皮肤的能力较差。醇传递体因能够将药物传递到皮肤深层和全身循环,且制备方法简单,使用安全而受到关注,为药物的经皮渗透提供了新的传递载体。醇传递体具有高度变形性、促进药物经皮渗透、缓释、防止药物代谢降解等优点,在药物的经皮吸收方面具有广阔的应用价值和开发前景。本文通过查阅国内外文献对醇传递体在透皮给药系统中的研究和应用等方面进行综述,为其今后在透皮领域的进一步发展提供借鉴。     

Transdermal delivery of drugs and enhancement of percutaneous absorption

This paper describes 1) the drug delivery through the skin to produce systemic effects, 2) the enhancement of percutaneous absorption by absorption enhancers, heating and complex formation, 3) the mechanism for the enhancement effect by enhancers, 4) the percutaneous absorption of peptides, and 5) the pharmacokinetic analysis for percutaneous absorption. 1,3-Dinitroglycerin, indomethacin (IND) and many drugs were efficiently absorbed via rat and rabbit skins in the presence of some enhancers, and using a microporous membrane therapeutic plasma concentrations were maintained for a long time. Enhancement of percutaneous absorption by the complex formation with fatty acid was observed for propranolol (PL) in vitro and in vivo. Heating at 42-45 degrees C also enhanced the percutaneous absorption dramatically, with decreased activation energies. The following mechanisms for the enhancement effect by enhancers were found: a) an increase in the fluidity of the stratum corneum lipids and reduction in the diffusional resistance to permeants, b) the removal of intercellular lipids and dilation between adherent cornified cells, c) an increase in the thermodynamic activity of drugs in vehicles, d) the exfoliation of stratum corneum cell membranes, the dissociation of adherent cornified cells and elimination of the barrier function. Peptides such as enkephalin, elcatonin and insulin were effectively absorbed through the skin in the presence of some enhancers and specific inhibitors, with no proteolytic degradation. The pharmacokinetic model with two parallel absorption processes, lipidic and aqueous pore transport pathways, in skin could adequately describe the percutaneous absorption of IND, PL and valproic acid. With peptides, a kinetic model including zero-order input rate, first-order permeation rate and first-order degradation rate was able to describe well the steady-state flux of peptides.     

Random brick model for drug transport across stratum corneum

A model for drug permeation across the stratum corneum is developed to predict the effect of the physical configuration and chemical composition of the stratum corneum on the skin permeability of drugs. The experimental data of percutaneous absorption across different skin specimens are well interpreted by the present model.     

Skin Structure and Metabolism: Relevance to the Design of Cutaneous Therapeutics

The outer layer of the epidermis or stratum corneum is the major barrier to percutaneous absorption. It has been shown that there are numerous enzyme systems beneath the stratum corneum in the viable epidermis capable of metabolizing drugs. A number of prodrug and soft drug topical therapeutic agents have been designed. After these agents penetrate the stratum corneum, they are metabolized by the cutaneous esterase systems to the desired metabolites.     

派瑞松乳膏中3种药物透皮特性的研究

目的:评价派瑞松乳膏中曲安奈德(TACA)、苯甲酸(BEN)、硝酸益康唑(ECN)3种药物的透皮特性.方法:采用Franz扩散池法,考察药物经完整皮肤和去角质层皮肤的体外透皮能力,并采用了胶带剥离、皮肤萃取法分别获取了皮肤角质层、去角质层皮肤样本,用HPLC法测定了样本中的药物含量.结果:经过24 h透皮吸收,TACA和BEN的去角质层皮肤渗透量分别为完整皮肤的1.5和1.3倍,ECN的渗透量基本为零.8h透皮实验,TACA高、中、低3个浓度角质层中药物含量基本相同,真皮层则存在浓度依赖现象;ECN在皮肤各层和接受室均检测不到;BEN在角质层和真皮层中的分布与TACA相似,但透过量比TACA大.结论:角质层是皮肤渗透的重要屏障,派瑞松乳膏应用于皮肤溃疡、受损或者婴幼儿皮肤仍需谨慎.     

Penetration enhancing effect of Azone on the transport of 5-fluorouracil across the hairless rat skin

The effect of the penetration enhancer, Azone, on drug transport across skin was investigated using an in vitro permeation technique involving diffusion cells, hairless rat skin and 5-fluorouracil. The permeability of 5-fluorouracil across full-thickness skin (stratum corneum to dermis transport) was enhanced by Azone about 100-fold although a lag time of approximately 10 h was observed. This long lag time was not found after in vitro and in vivo pretreatments with Azone. Azone had no effect on the epidermis-to-dermis transport (across stripped skin) or dermis-to-stratum corneum transport (across reversed full-thickness skin). These results suggest that the amount of Azone in the skin, especially in the stratum corneum, may be related to its penetration enhancing effect. The results also suggest that incorporation of Azone into transdermal dosage forms could be useful in enhancing the transport of drugs for which the rate-limiting step for percutaneous absorption is penetration of the stratum corneum.     

Influence of nanosized delivery systems with benzyl nicotinate and penetration enhancers on skin oxygenation

Many novel nanosized delivery systems have been designed for topical application of drugs since they can overcome the skin barrier and improve drug bioavailability. The increased absorption is often a consequence of a reversibly disrupted barrier function of the skin by the vehicle itself or by specific ingredients that act as penetration enhancers. This paper reports the effects of two nanosized systems (microemulsion and liposomes), in the presence and absence of penetration enhancers (PE), on the topical delivery of a lipophilic drug in vivo and compares that to classical hydrogel formulation. A vasodilator benzyl nicotinate (BN), which increases the blood flow of the skin, was incorporated into the formulations, and skin oxygenation was followed by electron paramagnetic resonance oximetry. It was found that microemulsions and liposomes (with or without PE) accelerate the rate of BN action when compared to hydrogel. However, incorporation of PE in microemulsion also improves the effectiveness of BN action. To understand why PE enhances the action of BN, its effect on the structure of the stratum corneum was investigated in vitro. The increased fluidity of the stratum corneum lipids provides an explanation for the greater penetration of BN into the skin when the drug and PE are together incorporated into the appropriate formulation.     

Transdermal drug delivery: penetration enhancement techniques

There is considerable interest in the skin as a site of drug application both for local and systemic effect. However, the skin, in particular the stratum corneum, poses a formidable barrier to drug penetration thereby limiting topical and transdermal bioavailability. Skin penetration enhancement techniques have been developed to improve bioavailability and increase the range of drugs for which topical and transdermal delivery is a viable option. This review describes enhancement techniques based on drug/vehicle optimisation such as drug selection, prodrugs and ion-pairs, supersaturated drug solutions, eutectic systems, complexation, liposomes, vesicles and particles. Enhancement via modification of the stratum corneum by hydration, chemical enhancers acting on the structure of the stratum corneum lipids and keratin, partitioning and solubility effects are also discussed. The mechanism of action of penetration enhancers and retarders and their potential for clinical application is described.     

Skin structure and mode of action of vesicles

The natural function of the skin is to protect the body for unwanted influences from the environment. The main barrier of the skin is located in the outermost layer of the skin, the stratum corneum. Since the lipids regions in the stratum corneum form the only continuous structure, substances applied onto the skin always have to pass these regions. Therefore, in the first part of this paper, the barrier function has been explained, focusing on the lipid composition and organisation. The major obstacle for topical drug delivery is the low diffusion rate of drugs across the stratum corneum. Several methods have been assessed to increase the permeation rate of drugs temporarily. One of the approaches is the application of drugs in formulations containing vesicles. In order to unravel the mechanisms involved in increasing the drug transport across the skin, information on the effect of vesicles on drug permeation rate, the permeation pathway and perturbations of the skin ultrastructure is of importance. In the second part of this paper, the possible interactions between vesicles and skin are described, focusing on differences between the effects of gel-state, liquid-state, and elastic vesicles.     

New insights into skin structure: scratching the surface

The formation, structural organization, and barrier functions of stratum corneum (SC) are reviewed. Stratum corneum is considered as a composite material and a biopolymer with properties so unique as to consider it a 'smart material'. SC, together with stratum granulosum (SG) responds (as an actively smart material) to environmental signals with appropriate modulations in its barrier properties. Current theories on the mode of barrier formation, validity of use of animal models and ex vivo human skin in studies of percutaneous absorption, as well as its implications in development of transdermal systems (TDS) are discussed. Potential pitfalls in extrapolating from animal data and the use of cadaver skin/epidermal membranes in evaluations of TDS are also stressed.     

盐酸丁螺环酮透皮促渗剂选择及其透皮机制的研究

目的研究透皮促渗剂对盐酸丁螺环酮体外经皮渗透的影响以及盐酸丁螺环酮的透皮机制。方法采用改良Franz扩散池,比较不同促渗剂种类、浓度、配比对盐酸丁螺环酮的促渗效果,同时通过改变扩散池的介质pH及皮肤的状态,研究药物的透皮机制。结果采用3%氮酮为透皮促渗剂时药物透过量最大。盐酸丁螺环酮随着分子型浓度的升高透过量也随之增加,皮肤去除角质层后,药物的透过量显著大于完整皮肤,而完整皮肤的贮库效应大于去角质皮肤。结论药物透皮以3%氮酮为透皮促进剂促渗效果最佳。盐酸丁螺环酮主要是以分子型透过皮肤,药物的透皮屏障与贮库效应发生的主要部位是皮肤的角质层。     

Proteolytic enzyme conjugated to SC-glucan as an enzymatic transdermal drug penetration enhancer

The objective of this study was to investigate the effect of papain, a proteolytic enzyme, on the percutaneous absorption of drugs. To guarantee the enzyme stability during the skin penetration, papain was modified by the conjugation to SC-glucan. The enhancing activity of drug penetration was evaluated using antipyrine and indomethacin as hydrophilic and hydrophobic model drugs, respectively. The SC-glucan-papain conjugate was found to be very effective for facilitating the percutaneous absorption of antipyrine. Microscopic observations showed that the thickness of stratum corneum and viable epidermis was increased by the treatment of the SC-glucan-papain conjugate. Moreover, it induced phase separation, lacuna formation, and lamellar disruption within the stratum corneum interstices. These structural changes by the SC-glucan-papain conjugate are likely to be induced from hydrolysis of extensive crosslinking of corneocyte envelopes and intracellular proteins. However, the SC-glucan-papain conjugate showed no skin irritation according to the Draize test, which may be due to the difficulty of the SC-glucan-papain conjugate in penetrating into the skin.     

Status of terpenes as skin penetration enhancers

Since its introduction, transdermal drug delivery has promised much but, in some respects has still to deliver on that initial promise, due to inherent limitations imposed by the percutaneous route. The greatest obstacle for transdermal delivery is the barrier property of the stratum corneum. Many approaches have been employed to breach the skin barrier, of which, the most widely used one is that of chemical penetration enhancers. Of the penetration enhancers, terpenes are arguably the most highly advanced and proven category and are classified as generally regarded as safe (GRAS) by the Food and Drug Administration. This paper presents an overview of the investigations on the feasibility and application of terpenes as sorption promoters for improved delivery of drugs through skin.     

皮肤性状改变后薄荷醇对甲硝唑透皮吸收作用的影响

目的：通过改变皮肤的性状，观察薄荷醇对甲硝唑透皮吸收的影响。方法：采用两室扩散池体外实验装置，以性状不同的兔皮作为屏障，使用薄荷醇作为促透剂，测定甲硝唑的吸光度，并计算人渗透系数，结果：当去除角质层后，薄荷醇对甲硝唑透皮吸收作用发生明显变化，与不含促透剂的完整皮肤组相比透皮作用非常显，但与本身不含促透剂组相比透皮作用不明显，同时薄荷醇和氮酮均能增加在完整皮肤中甲硝唑的贮存效应，对去角质层皮肤中甲硝唑的贮库效应无影响，结果还表明在两种不同性状的皮肤中，薄荷醇和氮酮对甲硝唑的透皮作用和贮库效应均无显差异。结论：薄荷醇能促进甲硝唑的透皮吸收，作用主要在角质层，角质层具贮库效应。     

Transdermal iontophoresis: combination strategies to improve transdermal iontophoretic drug delivery.

For several decades, there has been interest in using the skin as a port of entry into the body for the systemic delivery of therapeutic agents. However, the upper layer of the skin, the stratum corneum, poses a barrier to the entry of many therapeutic entities. Given a compound, passive delivery rate is often dependent on two major physicochemical properties: the partition coefficient and solubility. The use of chemical enhancers and modifications of the thermodynamic activity of the applied drug are two frequently employed strategies to improve transdermal permeation. Chemical enhancers are known to enhance drug permeation by several mechanisms which include disrupting the organized intercellular lipid structure of the stratum corneum , 'fluidizing' the stratum corneum lipids , altering cellular proteins, and in some cases, extracting intercellular lipids . However, the resulting increase in drug permeation using these techniques is rather modest especially for hydrophilic drugs. A number of other physical approaches such as iontophoresis, sonophoresis, ultrasound and the use of microneedles are now being studied to improve permeation of hydrophilic as well as lipophilic drugs. This article presents an overview of the use of iontophoresis alone and in conjunction with other approaches such as chemical enhancement, electroporation, sonophoresis, and use of microneedles and ion-exchange materials.     

Percutaneous absorptoin-enhancing activity of urea derivatives

The effect of urea and urea derivatives on the percutaneous absorption of salicylic acid and sodium salicylate through the skin of rabbit from petrolatum ointment was investigated. It was found that addition of urea or urea derivatives to the ointment base significantly increased the percutaneous absorption of the drugs in proportion to the concentration of the additive. The percutaneous absorption-enhancing activities of these compounds were that urea derivatives with the more and longer alkyl substituents showed the stronger activities. These activities of urea and urea derivatives were ascribed to the binding of these compounds with the lipids and proteins of the stratum corneum of the skin and the swelling of the tissues, which leads to the reduction of the barrier property of the layer. The preliminary skin irritation test showed that urea and urea derivatives were quite non-irritating to the skin. These results suggest that urea derivatives have a strong possibility to be developed as a percutaneous absorption enhancer.     

氢醌经不同皮肤层的吸收差异

目的 :评价皮肤角质层和真皮层对药物经皮吸收的差异。方法 :选择氢醌 (HQ)为模型药物 ,采用Franz吸收池法 ,考察药物经完整皮肤和剥离角质层皮肤的体外透皮能力Kp ,并比较吸收促进剂肉豆蔻酸异丙酯(IPM)共存时的促透能力大小。结果 :HQ经剥离角质层皮肤的Kp 是经完整皮肤的3 29倍 ,加入IPM后HQ的Kp 分别提高到原来的4 95倍 (经完整皮肤 )和7 49倍 (经剥离角质层皮肤 )。结论 :本实验为皮肤病态条件 ,如皮肤受伤或溃疡等时的药物经皮吸收规律研究提供了一种新的方法。     

Bicellar systems as vehicle for the treatment of impaired skin

This study assesses the potential usefulness of bicellar systems to retard the penetration of drugs into damaged skin. The active compound used in this study was diclofenac diethylamine (DDEA). Initially, physicochemical characterisation of the DDEA bicellar systems was performed at different temperatures by small-angle X-ray scattering (SAXS), wide-angle X-ray scattering (WAXS) and differential scanning calorimetry (DSC) techniques. Subsequently, in vitro percutaneous absorption of bicellar systems into in vitro damaged skin was studied.SAXS results indicated a slight decrease in the width of their bilayers with increasing temperature, with no apparent stacking in those systems. WAXS patterns were compatible with an orthorhombic lateral packing of the nanoaggregates. The thermogram obtained by DSC indicated a decrease in gel-to-liquid crystalline transition temperature (T_m) when the drug was included into bicellar systems. A retardation effect for DDEA was detected by in vitro percutaneous absorption studies when DDEA was vehiculised in the bicellar systems with respect to an aqueous solution of the drug. It seems that the use of bicellar systems as a vehicle for topical application of DDEA on skin with an impaired barrier function may inhibit the penetration of DDEA to the systemic level. Such systems may consequently repair stratum corneum barrier function to some extent. The use of these systems could be considered a new alternative strategy to treat topically pathological skin with different drugs.