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。     

116例健康儿童部分皮肤屏障参数检测

目的 了解北京市健康儿童不同部位皮肤理化参数的数值及差别.方法 将北京116名健康儿童分为4组.采用皮肤水分流失测试仪TM300、皮肤水分测试仪CM825及皮肤酸碱度测试仪PH905检测前额、颊前、前臂3个部位的经表皮失水(TEWL)、水分和pH值,皮肤黑素和血红蛋白测试探头MX18测量面部的黑素值.结果 ①不同年龄及不同部位的TEWL值,差异无统计学意义(P＞0.05);②角质层含水量值(额部、面颊部和前臂):＜1岁组分别为51.53±15.70、39.88±10.48、50.33±17.54;1～3岁组分别为49.95±17.88、32.51±12.09、36.10±7.43;4～6岁组分别为51.37±10.60、31.65±9.01、34.41±8.21;7～12岁组分别为49.74±10.64、39.99±50.43、29.35±8.10;不同年龄的角质层含水量,差异无统计学意义(P＞0.05);在不同部位,差异有统计学意义(P＜0.05),颊部和前臂角质层含水量明显低于额部;③pH值(额部、面颊部和前臂):＜1岁组分别为5.27±0.60、6.12±0.51、5.48±0.45;1～3岁组分别为4.68±0.58、6.80±0.55、5.07±0.58;4～6岁组分别为4.58±0.37、5.70±0.48、5.09±0.49;7～12岁组分别为4.87±0.51、5.72±0.49、5.09±0.51;不同年龄的pH值,差异无统计学意义(P＞0.05),在不同部位,差异有统计学意义(P＜0.05),颊部pH值明显高于前臂和额部;④不同年龄的面部皮肤黑素值,差异无统计学意义(P＞0.05).结论 健康儿童皮肤理化参数在不同部位存在一定差异.     

湿疹及皮炎

20130752特应性皮炎患儿与健康儿童皮肤屏障功能的对比/刘秋慧(首都医科大学北京儿童医院皮肤科),徐子刚,李丽…∥中国皮肤性病学杂志.-2012,26(2).-109～1110～7岁的特应性皮炎(AD)患儿和健康儿童各60名,根据不同年龄段分成两组,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     

我国正常人皮肤表面皮脂和水分含量的研究

目的：了解我国不同年龄、不同性别正常人皮肤角质层含水量、皮肤表面皮脂含量及皮肤皮脂的分泌速度。方法：利用皮肤表面皮脂测量仪和皮肤水分含量测量仪对我国北方325名正常人的前额及前臂屈侧皮肤皮脂量和皮肤含水量进行测量。结果：12岁以前,男女前额皮脂量无差异;13岁以后,男性前额的皮脂量明显高于女性。除36～50岁年龄组外,女性前额的皮脂分泌快于男性。男女前臂的皮脂量无差异。除男性13～35岁组的前额皮肤含水量高于女性外,其他各年龄组各部位男、女皮肤含水量无显著差别。13～35岁组男、女性前额的含水量均高于前臂。其他各年龄组前额和前臂皮肤含水量无明显部位差异。13-35岁组男性前额皮肤含水量最高。结论：正常人皮肤表面含水量和皮脂含量因性别、年龄和部位的不同而有差异。     

寻常型银屑病患者皮肤屏障功能相关指标检测分析

目的:探讨寻常型银屑病患者皮损区与非皮损区、患者与正常人皮肤屏障功能相关指标之间的差异。方法:1.收集寻常型银屑病患者35例,健康志愿者36例,使用皮肤屏障功能测试仪测定患者皮损区、非皮损区、健康志愿者的皮肤角质层含水量、PH值及经皮水分流失(TEWL)。2.收集30例寻常型银屑病患者与34例健康志愿者的血清,分别采用压板法、分光光度法测定NO、VitE水平。结果:寻常型银屑病患者皮损区PH值为(5.69±0.61)高于非皮损区PH值和健康对照组PH值;皮损区含水量为(17.90±6.75),低于非皮损区及健康对照组;皮损区TEWL为(18.58±11.55)g/m²h,高于非皮损区和健康对照组;然而非皮损区与健康对照组的PH值、角质层含水量及TEWL无统计学差异;寻常型银屑病患者血清维生素E含量(7.27±0.96)μg/mL低于健康对照组,银屑病组血清NO含量(5.29±1.91)μg/mL高于健康对照组。结论:寻常型银屑病患者皮损区,皮肤屏障功能指标异常,表现在皮肤表面PH值升高、角质层含水量下降、TEWL值升高、血清VitE下降、血清NO升高。     

皮肤生理功能检测在慢性湿疹治疗中的指导意义

目的探讨慢性湿疹皮肤屏障功能受损的变化,指导临床对慢性湿疹的预防和治疗。方法选取慢性湿疹受试者136例,均为男性,运用无创性皮肤生理功能测试仪测量受试者皮肤pH、角质层含水量和经表皮水分丢失(TEWL),同时检测同1部位未受损皮肤。结果与未受损处皮肤比较,慢性湿疹处TEWL值明显升高(P0.05),与未受损处皮肤比较,慢性湿疹处角质层含水量显著降低(P0.05),而TEWL值较高,与未受损处皮肤比较,慢性湿疹处p H明显高(P0.05),其余参数比较差异无统计学意义。结论未受损处皮肤和慢性湿疹处皮肤屏障功能在pH、TEWL、角质层含水量有显著差异,应根据测试结果及时恢复或重建皮肤屏障功能,减少或阻止慢性湿疹的再复发。     

健康儿童皮肤透皮失水率与角质层含水量的相关性研究

目的探讨角质层含水量与透皮失水率的相关性。方法 2021年10月至2022年6月在普宁市公共健康医疗中心、2所幼儿园及2所小学招募≤ 17岁健康儿童。用皮肤生理功能测量仪测量健康儿童左前臂屈侧和右胫前部位的透皮失水率和角质层含水量, 采用Pearson相关分析法分析不同年龄、性别儿童的透皮失水率与角质层含水量的相关性。结果共招募1 396例健康儿童, 年龄1个月至17岁, 男783例、女613例。在1 ～ < 12个月组, 除男童前臂部位的皮肤透皮失水率与角质层含水量无显著相关性外, 男童胫前和女童前臂及胫前部位的透皮失水率与角质层含水量均呈正相关(r值为0.283、0.404、0.420, 均P < 0.05);在1 ～ 2岁组, 男童前臂和女童胫前部位的皮肤透皮失水率与角质层含水量无显著相关性, 而男童胫前和女童前臂部位的透皮失水率与角质层含水量均呈正相关(r值为0.370、0.419, 均P < 0.01);在3 ～ 5岁组和6 ～ 11岁组, 除6 ～ 11岁组男童胫前的透皮失水率与角质层含水量无显著相关性外, 两组男女性其他部位的透皮失水率与角质层含水量均呈...     

单次强脉冲光照射对豚鼠皮肤屏障功能和表皮组织学的影响

目的研究强脉冲光(intense pulsed light,IPL)照射对豚鼠皮肤屏障功能和表皮组织学的影响,探讨其在IPL嫩肤过程中的作用和机制。方法采用临床光子嫩肤剂量的IPL照射豚鼠背部皮肤,分别检测对照组未照射皮肤、照射后1、7、15 d皮肤的经皮水分丢失(transepidermal water loss,TEWL)、角质层含水量、皮肤弹性和表皮组织学变化。结果照射后1 d较对照组TEWL增加,角质层含水量减少。照射后7 d较照射后1 d TEWL减少的同时,角质层含水量开始增加。照射后15 d较照射后7 d TEWL减少,角质层含水量进一步增加,且照射后15 d TEWL低于对照组,角质层含水量高于对照组。皮肤弹性至照射后15 d较对照组开始增加。与对照组相比,照射后1 d角质层变薄,层数减少,角质层发生了皱缩、融合。照射后7 d较照射后1 d角质层增厚,角质层层数增多,但角质层排列松散,呈席纹状。照射后15 d与照射后7 d相比角质层厚度和层数差异无统计学意义,但角质层排列趋于规整、致密,呈网篮状。IPL照射各组与对照组间表皮层形态及厚度差异无统计学意义。结论 IPL照射可引起表皮组织学的损伤-修复过程和豚鼠皮肤屏障功能变化,表现为照射后短暂的角质层变薄和皮肤屏障功能受损,随后角质增厚、结构重排、皮肤屏障功能增强参与IPL嫩肤机制。     

女性颈部皮肤生理学特性与年龄、季节相关性研究

目的:采用无创性评价技术量化检测女性颈部皮肤生理学特性,分析其与年龄和季节的关系.方法:检测62名女性健康志愿者颈部皮肤(曝光部位)的弹性﹑水分﹑经皮水分丢失(trans-epidermal water loss,TEWL)、皮肤颜色[包括黑素(M)值及血红素(E)值],并选取前臂内侧(非曝光部位)作为对照组,于春夏秋冬4个季节进行随访,每次随访均对志愿者颈部皮肤拍照.结果:①皮肤弹性、角质层含水量与年龄呈负相关.60岁以上年龄组TEWL明显低于其他年龄组.皮肤M值和E值随年龄增加变化有波动.②颈部皮肤弹性与季节相关,夏季、秋季较低.颈部和前臂内侧皮肤角质层含水量夏季最高,颈部角质层含水量高于前臂内侧.两部位在夏秋季皮肤TEWL值较高.颈部M值在秋季最高,E值在夏季最高,前臂内侧M值和E值在季节间无统计学差异.曝光部位颈部皮肤生理特性相较于非曝光部位前臂内侧更易受季节因素影响.结论:利用无创性评价可以量化地揭示不同季节、不同年龄皮肤表面生理学特性,了解皮肤的生理状态,并可以通过监测这些参数的变化了解健康皮肤或疾病的发展,采取干预措施改善皮肤表面特征.     

主观皮肤类型与皮肤屏障功能的关系

目的:比较不同主观皮肤类型(油性、中性和干性皮肤)屏障功能指标的差异。方法:利用无创性方法对自评为油性、中性和干性皮肤的20~25岁北京城市女性(各30例)进行皮脂分泌率(SER)、角质层含水量、p H值和经皮肤水分丢失(TEWL)值的检测,并采用胶带连续粘脱后监测TEWL值变化的方法评价角质层完整性,采用角质层取样蛋白定量的方法评价角质层黏合力和丝氨酸蛋白酶活性。结果:主观皮肤类型为中性皮肤者具有最佳的屏障功能;干性皮肤和油性皮肤者面颊部的屏障功能均有不同程度的受损,表现为TEWL值明显升高、p H值升高、丝氨酸蛋白酶活性增加;但二者也有区别,油性皮肤者角质层完整性下降更明显,而干性皮肤主要是角质层黏合力明显减弱。结论:自评为油性和干性皮肤者与中性皮肤者相比,屏障功能均存在一定程度的缺陷,油性皮肤与干性皮肤均具有不同特点,且与其屏障受损的机制不同有关。     

Biophysical characteristics of skin in diabetes: a controlled study

Background  Cutaneous complications are common in diabetes. Previous assays suggest that hyperglycemia and decreased insulin signal are involved in the impairment of skin function. The aim of this study was to evaluate the biophysical characteristics of skin in patients with diabetes mellitus and compares them with healthy non-diabetic controls.
Objective  To measure biophysical characteristic of skin including transepidermal water loss (TEWL), water content, sebum and skin elasticity in patients with diabetes mellitus and compare them with healthy non-diabetic controls.
Methods  This case-control study was conducted on 38 patients with diabetes and 40 age- and sex-matched healthy people. The biophysical properties of skin including stratum corneum (SC) hydration, sebum content, TEWL and skin elasticity were measured and compared between the two groups at three different locations of the body.
Results  The measurement of SC hydration and TEWL showed no significant difference between diabetics and controls. The skin surface lipids on the forehead but not other sites were significantly lower in the diabetics than in the controls. Acoustic wave propagation speed, a measurement related to skin elasticity, was significantly lower in forearm and forehead of diabetics.
Conclusion  Diabetes affects some functional properties of epidermis and dermis that may responsible for many cutaneous manifestations of diabetes. These results suggest that patients with diabetes mellitus tend to show a normal hydration state of the SC together with decreased sebaceous gland activity and impaired skin elasticity, without any impairment of the SC barrier function.

Conflicts of interest

None declared     

面部糖皮质激素依赖性皮炎患者经皮水分丢失和皮肤含水量分析

目的 分析面部糖皮质激素依赖性皮炎患者的皮肤屏障功能。方法 将面部分为额部、鼻尖、下颌、双面颊、双侧口角的皮损区及左耳后无皮损区共8个点，分别测量95例面部糖皮质激素依赖性皮炎患者及25例健康对照者的经皮水分丢失（TEWL）和皮肤含水量。结果 与健康组相比，面部糖皮质激素依赖性皮炎组下颌、双侧口角、双面颊TEWL值均显著升高（t值分别为4.90，2.60，2.57，2.54，3.77，P < 0.01）；双侧口角、右面颊及额部的皮肤含水量均显著降低（t值分别为3.27，3.81，2.02，2.78，P < 0.05）。在8个测量点中，面部糖皮质激素依赖性皮炎组与健康组TEWL值均为下颌及双侧口角 > 双面颊及额部 > 耳后无皮损区；皮肤含水量降低均为下颌及双侧口角 > 双面颊及额部 > 耳后无皮损区。结论 面部糖皮质激素依赖性皮炎患者下颌、双侧口角、双面颊区域皮肤屏障功能受损，口周区域TEWL值较高，而面颊皮肤水分含量较少。     

Measurement of electrical current perception threshold of sensory nerves for pruritus in atopic dermatitis patients and normal individuals with various degrees of mild damage to the stratum corneum

BACKGROUND: Patients with atopic dermatitis (AD) are well known to be sensitive to irritation from the environment due to the impaired function of the stratum corneum (SC). Electrical current perception threshold (CPT) evaluation quantifies the sensory threshold to transcutaneous electrical stimulation of the sensory nerves. OBJECTIVE: To study the CPT in a noninvasive fashion using Neurometer CPT/C, together with measurements of various functions of the SC. METHODS: We measured the CPT on the flexor forearm and cheek of AD patients and normal individuals. Subsequently, we evaluated the CPT and skin sensitivity to a 30% aqueous solution of lactic acid after the infliction of various mildly disruptive measures on the SC on the flexor forearm of healthy individuals by the following three methods: (1) removal of the superficial sebum with acetone/ether, (2) scarification with a needle and (3) tape stripping of the SC. Finally, we examined the effect of topical applications of emollients such as petrolatum or a moisturizing cream to the scratched skin. RESULTS: AD patients showed a lower barrier function and lower CPT than normal individuals. In subsequent studies conducted in normal individuals, the CPT was found to be inversely correlated with transepidermal water loss (TEWL) levels after tape stripping. However, most of all, the partial superficial scarification with a needle decreased the CPT and increased the lactic acid stinging response. Prolonged removal of lipids from the SC with acetone/ether for 30 min that increased the TEWL levels for only 1 day decreased the high-frequency conductance value for 2 days and the CPT only on the 2nd day after treatment. Topical applications of emollients were effective to prevent the increased sensitivity caused by scratching. CONCLUSIONS: AD patients showed functional abnormalities of the SC and tended to have more sensitive skin on the cheek and flexor forearm than healthy controls. Even focal SC damage caused by superficial cracking may lead to further disruption of the already damaged SC in AD patients, by eliciting scratching and facilitating the permeation of various environmental allergens and also the induction of hypersensitive skin.     

Functional properties of the stratum corneum in patients with diabetes mellitus: similarities to senile xerosis

BACKGROUND: Although diabetes mellitus is known to induce many pathophysiological changes in the skin, none of the earlier studies has focused on the state of the stratum corneum (SC) in patients with diabetes. In our previous report on a diabetic mouse model, we described a decreased SC hydration state and abnormalities in the function of the sebaceous gland together with a normally retained barrier function of the SC. OBJECTIVES: To examine the functional changes of the SC in patients with diabetes. METHODS: The following values were measured in 49 patients with diabetes: fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c); skin surface lipid level on the forehead; and high-frequency conductance (HFC) and transepidermal water loss (TEWL) of the SC of the volar forearm and extensor surface of the lower leg. These functions of the SC were compared in two pairs of patient groups, i.e. between groups with high and low FPG, and between groups with high and low HbA1c. RESULTS: The HFC levels on the extensor leg and volar forearm were significantly lower in the group with high FPG (FPG > 110 mg dL(-1)) than in the group with low FPG (FPG < 110 mg dL(-1)), although TEWL values were almost the same in these two groups. The skin surface lipids on the forehead were significantly lower in the former than in the latter. The HFC did not differ significantly between the group with high HbA1c (HbA1c > 5.8%) and the group with low HbA1c (HbA1c < 5.8%), whereas the TEWL of the volar forearm was slightly lower in the former than in the latter. CONCLUSIONS: These new results as well as our earlier results with diabetic mice suggest that patients with diabetes mellitus tend to show a reduced hydration state of the SC together with decreased sebaceous gland activity, without any impairment of the SC barrier function.     

Clinical severity correlates with impaired barrier in filaggrin-related eczema

Mutations in the gene-encoding filaggrin (FLG), a key molecule involved in skin barrier function, have been shown to be a major predisposing factor for atopic dermatitis (AD; eczema). To elucidate the pathomechanisms underlying filaggrin-related AD, we investigated stratum corneum (SC) hydration and transepidermal water loss (TEWL) as parameters of barrier function in AD patients harboring FLG mutations compared to AD patients without any FLG mutation. In filaggrin-related AD, SC hydration was both significantly reduced (P<0.01-0.05) and thicker (P<0.01-0.05) than that in healthy controls. TEWL was demonstrably increased in non-filaggrin AD compared to healthy controls (P<0.01-0.05). The objective score of atopic dermatitis (OSCORAD), a disease clinical severity index, significantly correlated with TEWL (r=0.81, P<0.005), SC hydration (r=-0.65, P<0.05), and SC thickness (r=0.59, P<0.05) in filaggrin-related AD. On the contrary, there was no correlation between these parameters and the OSCORAD in non-filaggrin AD. Furthermore, a significant correlation was obtained between the OSCORAD and specific IgE for house dust (r=0.66, P<0.05), mite allergen (r=0.53, P<0.05), and cat dander (r=0.64, P<0.05) in filaggrin-related AD, but not in non-filaggrin AD. All these data suggest that experimentally demonstrable skin barrier defects due to FLG mutations may play a crucial role in the pathogenesis of AD.     

Noninvasive bioengineering assessment of the skin barrier function in patients with chronic venous insufficiency

Background  Chronic venous insufficiency (CVI) comprises all symptoms caused by permanent venous and capillary hypertension. While the clinical manifestations of the disease have been well characterized, there is little knowledge on the skin barrier function in the affected patients. Objectives  The aim of the study was to assess noninvasively the barrier function in patients with CVI stage C2 and stage C4 according to the CEAP classification in comparison with healthy controls (stage C0). Methods  Thirty patients with CVI without concomitant diseases and 15 healthy, aged‐matched controls were recruited for the study. The skin barrier function was assessed by measuring transepidermal water loss (TEWL), capacitance and skin colour symmetrically on the calf, medial and lateral malleolus, posterior arch (arcus venosus) and volar forearm. Results  Compared with the forearm, there was a tendency for increased TEWL and significant reduction of capacitance on all measurement sites on the lower limb. Compared with the control group, the patients with CVI had significantly higher TEWL values on all measurement sites on the lower extremities while no difference in capacitance between patients and controls was observed. Conclusions  Changes in the epidermal barrier function in patients with CVI are readily detectable by bioengineering methods as early as stage C2 and are manifested by significantly increased TEWL. Our results suggest that the reduced stratum corneum hydration in patients with CVI is due to anatomical differences rather than venous disease. These findings may help better understand the factors contributing to disease progression and its complications.     

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     

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.