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Xing M, Yang G, Zhang S, Gao Y. Acid-base combination principles for preparation of anti-acne dissolving microneedles loaded with azelaic acid and matrine. Eur J Pharm Sci 2021; 165:105935. [PMID: 34284096 DOI: 10.1016/j.ejps.2021.105935] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/08/2021] [Accepted: 07/04/2021] [Indexed: 11/29/2022]
Abstract
To overcome the poor solubility, skin irritation, and low permeability of azelaic acid (AZA) existed on the marketed formulations, a co-drug principle via matrine (MAT) was adopted to prepare anti-acne dissolving microneedles (DMNs). The formula was optimized according to the solubility and antibacterial activity of novel ionic salt. The results indicated solubilization of AZA could be achieved at a molar ratio between AZA and MAT was 1:1. Meanwhile, synergistic antibacterial and anti-irritative properties were acquired. The matrix materials were composed of sodium carboxymethyl cellulose (CMC), polyvinylpyrrolidone (PVP), and trehalose. And drug loadings of AZA and MAT in DMNs were 201.88 ± 4.81 µg and 259.71 ± 1.72 µg, respectively. After insertion into porcine skin for 10 h, the cumulative permeability of AZA and MAT were 68.16% ± 3.79% and 57.37 ± 5.17%, respectively, while just 4.13 ± 0.39% (p < 0.01) was detected for commercially available AZA gel. In vitro antibacterial experiment, bacteriostatic rates of DMNs were all above 95% for Staphylococcus aureus, Staphylococcus epidermidis, and Propionibacterium acnes. Besides, DMNs exhibited no cytotoxicity and skin irritation. In conclusion, combination between AZA and MAT addressed shortcomings of AZA, and made it easier, safer, and more effective in acne treatment.
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Affiliation(s)
- Mengzhen Xing
- Key Laboratory of Photochemical Conversion and Optoelectronic Materials, Technical Institute of Physics and Chemistry of Chinese Academy of Sciences, Beijing 100190, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Guozhong Yang
- Beijing CAS Microneedle Technology Ltd, Beijing 102609, China
| | - Suohui Zhang
- Key Laboratory of Photochemical Conversion and Optoelectronic Materials, Technical Institute of Physics and Chemistry of Chinese Academy of Sciences, Beijing 100190, China; Beijing CAS Microneedle Technology Ltd, Beijing 102609, China
| | - Yunhua Gao
- Key Laboratory of Photochemical Conversion and Optoelectronic Materials, Technical Institute of Physics and Chemistry of Chinese Academy of Sciences, Beijing 100190, China; University of Chinese Academy of Sciences, Beijing 100049, China; Beijing CAS Microneedle Technology Ltd, Beijing 102609, China.
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Yu LL, Wang XM, Zou Y, Fan GB, Wu PL, Zhang YH, Yang LJ, Zhu X, Cao YN, Shi HY, Wang XJ. Correlation between the capsaicin test and objective skin measurements in evaluating sensitive skin in Chinese females. J Dermatol Sci 2012; 68:108-9. [PMID: 23010530 DOI: 10.1016/j.jdermsci.2012.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 07/24/2012] [Accepted: 08/29/2012] [Indexed: 11/18/2022]
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Zha WF, Song WM, Ai JJ, Xu AE. Mobile connected dermatoscope and confocal laser scanning microscope: a useful combination applied in facial simple sensitive skin. Int J Cosmet Sci 2012; 34:318-21. [DOI: 10.1111/j.1468-2494.2012.00726.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Alstonia scholaris R. Br. Significantly Inhibits Retinoid-Induced Skin Irritation In Vitro and In Vivo. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2011; 2012:190370. [PMID: 21912567 PMCID: PMC3170789 DOI: 10.1155/2012/190370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 07/05/2011] [Indexed: 11/17/2022]
Abstract
Topical retinoids inhibit matrix metalloproteinases and accelerate collagen synthesis, thereby triggering antiaging effects in the skin. However, topical retinoids can cause severe skin reactions, including scaling, erythema, papules, and inflammation. The present study demonstrates that the ethanolic bark extract of Alstonia scholaris R. Br. can significantly inhibit all-trans retinoic acid-induced inflammation in human HaCat keratinocyte cells. Furthermore, two representative retinoid-induced proinflammatory cytokines, monocyte chemoattractant protein-1 and interleukin-8, were significantly suppressed by A. scholaris extract (by 82.1% and 26.3% at 100 ppm, and dose-dependently across the tested concentrations) in vitro. In a cumulative irritation patch test, A. scholaris extract decreased retinol-induced skin irritation, while strengthening the ability of retinoids to inhibit matrix metalloproteinase-1 expression, which is strongly associated with aging effects. These results suggest that A. scholaris is a promising compound that may increase the antiaging function of retinoids while reducing their ability to cause skin irritation.
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Bilcha KD, Ayele A, Shibeshi D, Lovell C. Patch testing and contact allergens in Ethiopia - results of 514 contact dermatitis patients using the European baseline series. Contact Dermatitis 2010; 63:140-5. [DOI: 10.1111/j.1600-0536.2010.01740.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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7
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Ethnic groups and sensitive skin: two examples of special populations in dermatology. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.ddmec.2008.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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An S, Lee E, Kim S, Nam G, Lee H, Moon S, Chang I. Comparison and correlation between stinging responses to lactic acid and bioengineering parameters. Contact Dermatitis 2007; 57:158-62. [PMID: 17680863 DOI: 10.1111/j.1600-0536.2007.01182.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In evaluating the safety of a novel cosmetic product or a new chemical, it is important to assess susceptible population. One group of subjects is known to stingers who are more likely to experience sensory effects such as stinging and burning after contacting with cosmetics. The purpose of the study is to measure skin biophysical parameters noninvasively in stingers and non-stingers and to see their correlations with stinging responses. 298 women were evaluated by modified lactic acid stinging test with 5% lactic acid solution rather than classic 10% solution because of strong reaction in Asian populations. Transepidermal water loss (TEWL), skin hydration, sebum content, and pH were measured using the bioengineering instruments in an environment-controlled room. Correlations between stinging responses and skin biophysical parameters were statistically analysed. There was a positive correlation between stinging responses and TEWL evaluation. However, no correlations was observed between stinging responses and other parameters such as skin hydration, sebum content, and pH. Our data indicate that there is a relationship between the degree of stinging and the skin barrier function. However, we believe that various additional studies are necessary to characterize skin of stingers and the pathogenesis.
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Affiliation(s)
- Susun An
- Skin Research Institute, AmorePacific Corporation R&D Center, Yongin-si, Gyeonggi-do 446-729, Korea.
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Peters L, Marriott M, Mukerji B, Indra P, Iyer JV, Roy A, Rowson M, Ahmed S, Cooper K, Basketter D. The effect of population diversity on skin irritation. Contact Dermatitis 2006; 55:357-63. [PMID: 17101012 DOI: 10.1111/j.1600-0536.2006.00975.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The impact of many human variables on the response to skin irritating substances has been studied to varying degrees, including the impact of age, sex, and atopic status. However, the importance of ethnic origin has been more difficult to investigate, leading to a relative paucity of compelling data, either for or against the existence of differences. A primary reason for this lack is that studies on different ethnic groups often have to be undertaken in different locations thus introducing variables, e.g. time, environmental conditions that confound interpretations. In the present work, an attempt has been made to eliminate all variables except ethnicity by conducting a study on 2 distinct populations (Punjabis and Tamils) at the same location on the same day with a single assessor of the skin reactions, using sodium lauryl sulfate as the skin irritant. The skin reactions were assessed visually, and it was demonstrated that the modality of the reactions in these 2 populations had clear differences, but that the dose-response profiles were very similar. Thus, although the irritant response was expressed differently (e.g. erythema was much less evident in the darker Tamil population), the overall outcome was that the populations reacted in an equivalent manner.
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Affiliation(s)
- Lisa Peters
- Safety and Environmental Assurance Centre, Unilever, Colworth Laboratory, Sharnbrook, Bedfordshire, MK44 1LQ, UK
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Draelos ZD. The combination of 2% 4-hydroxyanisole (mequinol) and 0.01% tretinoin effectively improves the appearance of solar lentigines in ethnic groups. J Cosmet Dermatol 2006; 5:239-44. [PMID: 17177746 DOI: 10.1111/j.1473-2165.2006.00260.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
While the efficacy and safety of topical 4-hydroxyanisole (mequinol) 2%/tretinoin 0.01% therapy has been established in Caucasian populations, those with skin types I-II, little research has focused on individuals with darker skin types. The purpose of this open-label study was to evaluate the efficacy and safety of mequinol 2%/tretinoin 0.01% solution in the treatment of solar lentigines in Asian, Latin/Hispanic, and African American ethnic groups with skin types II-V. Subjects were required to have >or= 10 solar lentigines on the dorsal forearms/hands and >or= 3 on the face. One lesion was designated the target lesion, however, all lesions were treated. Patients were treated with topical mequinol 2%/tretinoin 0.01% and clinically evaluated at 4, 8, 12, 16, 20, and 24 weeks as well as 4 weeks following treatment cessation. At each visit, lesions were evaluated using Target and Overall Lesion Pigmentation Index scores ranging from 0 (lightest) to 8 (darkest), where 4 indicated equal pigment with surrounding skin. Efficacy was determined based on pigmentation index scores, and safety was assessed using laboratory monitoring and adverse event (AE) reporting. Over 80% of the 259 subjects completing this study responded to mequinol 2%/tretinoin 0.01% therapy, with a majority of subjects maintaining clinical benefit at 4 weeks post-treatment. Most AEs reported were tolerable and overall mequinol 2%/tretinoin 0.01% therapy had a favorable benefit-to-risk ratio. This study therefore supports the theory that topical mequinol 2%/tretinoin 0.01% is an effective and safe treatment of solar lentigines in ethnic populations, and in those with dark skin types.
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Abstract
Transdermal clonidine was approved by the US Food and Drug Administration in 1984 for the treatment of mild-to-moderate hypertension alone or in combination with a diuretic. Clonidine is released from the patch at a constant rate and thus displays a pharmacokinetic pattern not dissimilar to that of infusion therapy. Transdermal clonidine, like oral clonidine, is effective first- or second-line therapy for most forms of hypertension. More recently, transdermal clonidine has found alternative uses in the areas of smoking cessation, posttraumatic stress disorder, menopausal hot flashes, and alcohol and opiate withdrawal syndromes. The not infrequent development of a dermatitis, together with a substantially greater cost than oral clonidine, have been the major undoings for transdermal clonidine.
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Affiliation(s)
- Domenic A Sica
- Section of Clinical Pharmacology and Hypertension, Division of Nephrology, Medical College of Virginia of Virginia Commonwealth University, Richmond, VA 23298, USA.
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Bornkessel A, Flach M, Arens-Corell M, Elsner P, Fluhr JW. Functional assessment of a washing emulsion for sensitive skin: mild impairment of stratum corneum hydration, pH, barrier function, lipid content, integrity and cohesion in a controlled washing test. Skin Res Technol 2005; 11:53-60. [PMID: 15691260 DOI: 10.1111/j.1600-0846.2005.00091.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/PURPOSE Sensitive skin has been described as a skin type with higher reactivity than normal skin and exaggerated reactions to external irritants. Washing with soaps is harmful for barrier-related parameters. Cutaneous irritation induced by cleansing products under exaggerated test conditions, e.g. patch testing, is not necessarily predictive of the irritation occurring under standardized daily use conditions. The purpose of the study was to assess the effect of an improved washing solution for sensitive skin in a half-site comparison on barrier-related parameters. METHODS Thirty healthy volunteers with self-reported sensitive and so-called problematic skin performed standardized washings with a soap-free washing emulsion with mild acidity (pH 5.5) for 3 weeks. Test areas were both forearms and the cheek. Non-invasive biophysical measurements of the following skin parameters, epidermal permeability barrier function measured as transepidermal water loss (TEWL), stratum corneum (SC) hydration, pH value, skin surface lipids, skin temperature and SC integrity/cohesion, were assessed prior to the first washing, on days 7, 14 and 21 after beginning the washing procedure. SC cohesion was quantified using two independent methods on D-Squame tapes: optical spectroscopy measuring the absorbance and a protein assay assessing the total protein (Bradford). Both methods showed a good correlation. SC integrity was quantified by measuring TEWL after sequential stripping with D-Squame tapes. RESULTS The use of the washing emulsion led to a mild damage of the epidermal permeability barrier function with no marked difference to water application. Furthermore, a mild but significant dehydration was assessed after 21 days vs. baseline without any differences between the water-treated and the washing emulsion-treated forearm. On the cheek no dehydration was detectable but the lipid content was reduced under the washing emulsion. The pH value increased in all three test areas after 21 days, again without significant differences between water and the washing solution. SC cohesion was quantified using two independent methods on D-Squame tapes: optical spectroscopy measuring the absorbance and a protein assay assessing the total protein (Bradford). Both methods showed a good correlation. The SC cohesion decreased after 21 days on the water-treated as well as on the washing emulsion-treated arm. The decrease over time was significant when used the optical spectroscopy measuring. A standardized questionnaire revealed positive characteristics of the washing emulsion and good acceptance. CONCLUSION The investigated standardized washing model with the endpoints epidermal barrier function, SC hydration, surface pH, skin surface lipids, skin temperature and SC integrity/cohesion showed only mild damage comparable to washing with water.
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Affiliation(s)
- A Bornkessel
- Skin Physiology Laboratory, Department of Dermatology, Friedrich-Schiller-University, Jena, Germany
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Sultana B, Cimiotti J, Aiello AE, Sloan D, Larson E. Effects of age and race on skin condition and bacterial counts on hands of neonatal ICU nurses. Heart Lung 2003; 32:283-9. [PMID: 12891170 DOI: 10.1016/s0147-9563(03)00095-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the relationship between demographic factors such as age and race and skin condition and bacterial counts on hands of nurses. METHODS Nurses (n = 111) working in 1 of 2 neonatal ICUs in New York City were surveyed regarding reported hand care practices and demographics, the condition of their hands was assessed by a trained observer and by themselves using validated instruments, and a hand culture was obtained. RESULTS There were no significant differences in any skin care practices by race, but nurses who wore powder-free gloves were significantly younger than those who did not (P =.004). There were no significant differences in bacterial counts on hands of black or white nurses (mean log colony-forming units 3.49 and 3.61 respectively, P =.63) and no significant correlation between age and microbial counts (r = 0.04, P =.72). In a logistic regression analysis, race, but not age, was a significant predictor of skin health. By both observer (P =.02) and self-assessment (P =.004) black nurses had healthier skin. CONCLUSION Physiochemical differences in skin associated with demographic factors such as age and race may be exacerbated among those in disciplines such as nursing, for whom the skin of the hands is continually stressed by occupational practices such as frequent hand hygiene. Such demographic factors need be considered when assessing skin condition and when advocating for appropriate strategies to maximize skin health. The recommendations of the new CDC Hand Hygiene Guideline for Healthcare Settings(23) regarding maintaining skin health and providing moisturizers and products that are milder to the skin are timely and should be followed.
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Abstract
The clonidine transdermal therapeutic system is being used as a therapy for blood pressure treatment. Systemic side effects seem to be fewer than with oral clonidine. However, localized skin reactions occur frequently and the incidence increases with the dose and duration of use. Common signs include erythema, scaling, vesiculation, excoriation, and induration. Allergic contact dermatitis is less frequent but common. Hyperpigmentation and depigmentation also occur. Pretreatment with 0.5% hydrocortisone is associated with less skin irritation and higher blood levels. Although oral clonidine is no longer widely used in the management of hypertension, awareness of these reactions to the transdermal delivery of this agent is important.
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Affiliation(s)
- L Michael Prisant
- Department of Medicine, Section of Cardiology, Hypertension Unit, Medical College of Georgia, 1120 15th Street, Augusta, GA 30912, USA
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Taylor SC. Skin of color: biology, structure, function, and implications for dermatologic disease. J Am Acad Dermatol 2002; 46:S41-62. [PMID: 11807469 DOI: 10.1067/mjd.2002.120790] [Citation(s) in RCA: 214] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
People with skin of color constitute a wide range of racial and ethnic groups-including Africans, African Americans, African Caribbeans, Chinese and Japanese, Native American Navajo Indians, and certain groups of fair-skinned persons (eg, Indians, Pakistanis, Arabs), and Hispanics. It has been predicted that people with skin of color will constitute a majority of the United States and international populations in the 21st century. There is not a wealth of data on racial and ethnic differences in skin and hair structure, physiology, and function. What studies do exist involve small patient populations and often have methodologic flaws. Consequently, few definitive conclusions can be made. The literature does support a racial differential in epidermal melanin content and melanosome dispersion in people of color compared with fair-skinned persons. Other studies have demonstrated differences in hair structure and fibroblast size and structure between black and fair-skinned persons. These differences could at least in part account for the lower incidence of skin cancer in certain people of color compared with fair-skinned persons; a lower incidence and different presentation of photo aging; pigmentation disorders in people with skin of color; and a higher incidence of certain types of alopecia in Africans and African Americans compared with those of other ancestry. However, biologic or genetic factors are not the only ones impacting on these differences in dermatologic disorders. Cultural practices also can have a significant impact. Further studies are needed to help dermatologists optimally treat people with skin of color.
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Affiliation(s)
- Susan C Taylor
- Skin of Color Center, Department of Dermatology, St. Luke's-Roosevelt Hospital, New York, NY 10025, USA.
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Deleo VA, Taylor SC, Belsito DV, Fowler JF, Fransway AF, Maibach HI, Marks JG, Mathias CGT, Nethercott JR, Pratt MD, Reitschel RR, Sherertz EF, Storrs FJ, Taylor JS. The effect of race and ethnicity on patch test results. J Am Acad Dermatol 2002; 46:S107-12. [PMID: 11807472 DOI: 10.1067/mjd.2002.120792] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Allergic contact dermatitis is a condition that may be affected by differences in genetic and environmental factors. Race and ethnicity are possible examples of the former. OBJECTIVE The objective of this study was to examine the differences in patch test results between white and black individuals tested by the members of the North American Contact Dermatitis Group from July 1, 1992, to June 30, 1998. METHODS Patients evaluated in our patch test clinics were exposed to a standardized patch testing technique involving a standard series of 41 allergens in total. The standard series we used varied over the 6 years of the study in 2-year cycles. The series was the same at all centers during each of these 2-year cycles: 1992-94, 1994-96, and 1996-98. Over a 6-year period, our group tested 9624 patients. Of those individuals, 8610 (89.5%) were white and 1014 (10.5%) were black. RESULTS Allergic contact dermatitis and irritant contact dermatitis were the final diagnoses assigned by the investigators to individuals of the 2 races: 49% and 16%, respectively, for the white patients and 46% and 15%, respectively, for the black patients. In at least one of the three 2-year periods, testing in white patients revealed higher rates of sensitization to formaldehyde, glutaraldehyde, and a number of the formaldehyde-releasing preservatives, as well as lanolin, epoxy resin, thioureas, and balsam of Peru. Black patients exhibited higher rates of sensitization to para-phenylenediamine, cobalt chloride, thioureas, and p-tert-butylphenol formaldehyde resin in at least one of the 2-year periods. CONCLUSION In this test population, we found no differences in the overall response rate to allergens. There were some differences between white and black patients in their response to specific allergens. These differences, although possibly related to genetic factors based on race, are more likely related to differences in allergen exposure determined by ethnicity.
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Affiliation(s)
- Vincent A Deleo
- St Luke's-Roosevelt Hospital Center, New York, NY 10025, USA
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Seidenari S, Francomano M, Mantovani L. Baseline biophysical parameters in subjects with sensitive skin. Contact Dermatitis 1998; 38:311-5. [PMID: 9687028 DOI: 10.1111/j.1600-0536.1998.tb05764.x] [Citation(s) in RCA: 127] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sensitive skin has been described as a skin type showing higher reactivity than normal skin and developing exaggerated reactions when exposed to external factors. The stinging test, performed by applying lactic acid to the nasolabial fold and evaluating the intensity of subjective symptoms, is widely accepted as a marker of sensitivity and employed for the selection of subjects experiencing invisible cutaneous irritation. However, this test is based on self-perceived assessment and lacks objectivity. In order to contribute to the finding of objective descriptors, we assessed baseline biophysical parameters in subjects with sensitive skin by means of transepidermal water loss (TEWL), capacitance, pH, sebum and skin colour measurements, and compared the data with those obtained in normal subjects, also correlating the results with those of clinical assessments and functional tests. Subjects with sensitive skin showed a trend towards higher scores at all assessment times both for the stinging and the washing test. The skin of sensitive subjects was described as less supple, less hydrated and more erythematous and telangiectatic with respect to the skin of normal subjects. A trend towards an increase in TEWL, pH and colorimetric a* values, and a decrease in capacitance, sebum and colorimetric L* values on the face of subjects with sensitive skin was observable. However, significances were only present for capacitance and a* values. Thus, alterations of baseline capacitance values indicate the tendency to barrier impairment and support the view that skin hyperreactivity to water-soluble irritants is induced by a greater amount of irritants absorbed, whereas the increase in the erythema parameter shows that cutaneous vascular hyperreactivity in subjects with sensitive skin also corresponds to baseline vasodilation.
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Affiliation(s)
- S Seidenari
- Department of Dermatology, University of Modena, Italy
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