Are transepidermal water loss and clinical signs correlated in canine atopic dermatitis? A compilation of studies

Fluctuations in equine cutaneous pH and transepidermal water loss with time of day and ambient conditions

Cutaneous pH and transepidermal water loss (TEWL) are commonly utilized measures in dermatological research as they provide information concerning barrier function. The importance of dermal health has become more evident in recent years. Accordingly, the aim of this work was to identify natural fluctuations in the biophysical parameters of healthy equine skin. Cutaneous pH and TEWL was collected on nine mares at 6:00 AM, 12:00 PM, and 6:00 PM daily for five days on the nose, withers, girth area, mid-back, and base of tail. Ambient temperature and humidity were measured at each collection. Statistical analysis was completed using SAS On Demand. Tests included repeated measures, ANOVA, and regression analysis. Mean cutaneous pH significantly differed by day (P = 0.0052) and time (P = 0.0073) but was unaffected by anatomical location (P = 0.2841). Interestingly, cutaneous pH had a significant interaction of day and location (P = 0.0004). Mean TEWL measures significantly differed by day (P < 0.0001), time (P < 0.0001), and anatomical location (P = 0.0231). Interaction of day and time had a significant effect on TEWL (P < 0.0001) and also resulted in a three-way interaction of day, time, and location (P = 0.0167). There were no significant associations of pH with temperature and humidity. All measures of TEWL across all locations were significantly correlated with temperature and humidity (P < 0.0001). Cutaneous pH and TEWL measures are affected by environmental conditions which should be considered in future models and work using dermal characteristics of horses.

Establishing an experimental model for canine atopic dermatitis through epicutaneous application of Dermatophagoides farinae

There is no established protocol for the development of an experimental canine atopic dermatitis model in laboratory beagles. This study aimed to establish an experimental model that mimics spontaneous canine atopic dermatitis (CAD) clinically, immunologically, and microbiologically, by repeated epicutaneous applications of mite antigens and to describe the entire process including sensitization and provocation in detail for reproducibility. Six intact male laboratory beagle dogs aged 14 months were included in this study. During the sensitization and provocation phase, the house dust mite (HDM) paste consisted of Dermatophagoides farinae (Der f ) and mineral oil, which was applied focally to the 10 × 10 cm area of the right groin as evenly as possible. Further, 120 mg of Der f was applied to each dog twice a week for 12 weeks during the sensitization phase and 25 mg and 120 mg was applied to each dog for the first 2 weeks and subsequent 2 weeks, respectively, during the provocation phase. Thereafter, the applied area was covered with a dressing. Skin lesions including erythema, hyperpigmentation, excoriation, and lichenification were induced and exacerbated gradually through the experimental time course in all six dogs. The canine atopic dermatitis extent and severity index (CADESI) score and transepidermal water loss (TEWL) significantly increased after sensitization and provocation. IL-13 and IL-31 levels increased significantly after provocation as a result of the activation of the T helper-2 (Th2) response. On the contrary, the IL-10 levels decreased significantly after sensitization, which suggested a suppression of Tregs activity. After the completion of provocation, skin microbiome analysis showed that Firmicutes was the most abundant phylum, which indicated bacterial dysbiosis. This study demonstrated that epicutaneous application of HDM in beagle dogs resulted in the elevation of serum HDM-specific IgE levels and clinical atopic scores, a high TEWL, and microbiome dysbiosis resembling spontaneous CAD. These results suggest that this tailored protocol of epicutaneous exposure to Der f may provide support for the development of the experimental CAD model in laboratory beagles.

A comparison of canine decontamination cleansers: Implications for water use, dermal pH, and contaminant reduction

Environmental contamination is commonly experienced by working canines deployed in the field. Unfortunately, data regarding safety and efficacy of cleansers recommended for decontamination is lacking. Client-owned canines recruited from the community (n = 43) were randomly assigned to one of four treatment groups: povidone-iodine scrub [60mL Betadine® 7.5% povidone-iodine surgical scrub (Avrio Health L.P, Stamford, CT)], chlorhexidine scrub [60 mL Nolvasan® 2% chlorohexidine surgical scrub (Zoetis, Kalamazoo, MI)], dish detergent [60mL Dawn® dish detergent (Proctor & Gamble, Cincinnati, OH)], or water alone (control). A visual score assessing removal of a fluorescent marker (GloGerm, Moab, UT) applied between the shoulder blades was used to rate effectiveness of decontamination. Cleanser effect on canine dermal barrier function was determined by measuring pre- and post-decontamination dermal pH and trans-epidermal water loss (TEWL). Analysis of visual scores was performed using PROC FREQ and Chi Square. Significance was set a priori at 0.05 for all tests. Efficacy of fluorescent marker removal was significantly affected by cleanser (P<0.0001). Dermal pH was also highly affected by cleanser (P < 0.0001). In contrast, TEWL was unchanged across cleansers (P = 0.2686). Common veterinary cleansers utilized for canine decontamination demonstrate similarity in effectiveness for removal of a simulated contaminant and negative impact on dermal barrier function.

Skin Barrier Reinforcement Effect Assessment of a Spot-on Based on Natural Ingredients in a Dog Model of Tape Stripping

Simple Summary

Canine atopic dermatitis is a disease of dogs in which the skin becomes permeable. Part of treating canine atopic dermatitis involves restoring the skin barrier function; however, few effective therapeutic options exist. The goal of this study was to evaluate the effect of a spot-on containing fatty acids, ceramides and essential oils on two parameters to evaluate the skin barrier function of dogs. We found that this spot-on had a protective effect on the skin barrier function for both parameters. This study suggests that the investigated product may be useful as an adjunctive treatment for canine atopic dermatitis.

Abstract

Skin barrier restoration is an important part of atopic dermatitis therapy. We investigated the effect of a spot-on containing plant-based essential fatty acids and essential oils on skin barrier parameters in a dog model of acute skin barrier disruption, using five healthy beagle dogs maintained in a laboratory setting. Four test sites on the dorsum and a control site on the abdomen were defined on each dog. Transepidermal water loss (TEWL) and skin surface hydration (SSH) were measured before and after tape stripping on the first day and then for three consecutive days, over four consecutive weeks. The spot-on was applied at the end of each of the first three weeks. The increase in TEWL after tape stripping was reduced after the spot-on application and reached control values in Weeks 3 and 4. SSH after tape stripping was reduced in Week 4 compared with the baseline. Thus, the ATOP 7^® spot-on significantly reduced acute skin barrier impairment in a dog model. The use of this product should be further evaluated as a potential treatment for skin barrier defects such as canine atopic dermatitis.

Advances in our understanding of canine atopic dermatitis

Canine atopic dermatitis (cAD) is a genetically inherited clinical syndrome that encompasses a diversity of mechanisms and can have a variety of triggers. Development of clinical disease is the result of genetic factors and environmental conditions, which shape the resulting immunological response. Clinical disease becomes evident once a threshold of inflammatory response is achieved. Skin barrier impairment plays a role in promoting cutaneous dysbiosis and increased allergen penetration. Keratinocytes shape the response of dendritic cells and subsequent lymphocytic response. Thymic stromal lymphopoietin is one of the links between the damaged skin barrier and the modulation of a T-helper (Th)2 response. It is still unclear whether mutations in skin barrier genes exist in atopic dogs, as they do in humans, or whether the observed alterations are purely secondary to inflammation. A dysregulated immune response with increased Th2, Th17 and CD4+ CD25+ regulatory T cells has been reported. A variety of cytokines [interleukin(IL)-31, IL-34, Macrophage migration inhibitory factor] are proposed as potential biomarkers and treatment targets because they are increased in the serum of atopic dogs when compared to controls, although a correlation between serum levels of these factors and severity of disease is not always present. The main issue with many published studies is that atopic dogs are always only compared to normal controls. Thus, it is unclear whether the changes that we find are truly a signature of cAD or merely a manifestation of nonspecific broad inflammatory responses. Studies considering comparison with other inflammatory diseases different from cAD are urgently needed to correctly identify what is specific to this complicated syndrome.

The influence of treatment with lokivetmab on transepidermal water loss (TEWL) in dogs with spontaneously occurring atopic dermatitis

BACKGROUND

Atopic dermatitis (AD) is one of the most common skin diseases in dogs. Monitoring the progress of treatment may include assessment of lesion severity by use of Canine Atopic Dermatitis Extent and Severity Index (CADESI), assessment of pruritus and measurement of biophysical parameters of the skin.

HYPOTHESIS

This study aimed to assess changes in transepidermal water loss (TEWL) during 12 weeks of treatment with lokivetmab and its correlation with the CADESI-04 and the severity of pruritus.

ANIMALS

Ten client-owned dogs with canine AD.

METHODS AND MATERIALS

The animals were administered lokivetmab three times at four week intervals. Pruritus and CADESI-04 were assessed, and TEWL was measured at six body regions, on Day 0 and repeated at weeks 4, 8 and 12.

RESULTS

There was a significant decrease in the CADESI-04 score, the severity of pruritus and the mean TEWL between baseline and each of the time points. TEWL also decreased in the majority of body sites examined. Significant correlations between the CADESI-04 and mean TEWL (r = 0.519, P = 0.0003), and between pruritus severity and mean TEWL (r = 0.517, P = 0.0003), were found.

CONCLUSIONS AND CLINICAL SIGNIFICANCE

Overall TEWL decreased during lokivetmab treatment but not at all body sites. If TEWL is used to assess the effectiveness of a treatment, a mean TEWL score should be calculated from several areas of the body.

Evidence for an interaction between linoleic acid intake and skin barrier properties in healthy dogs – a pilot study

Dogs suffer from skin associated issues with a disproportionate frequency, with consequent interest in providing nutrition to optimize their skin's natural defences. Linoleic acid (LA) is known as an essential nutrient in dogs and plays a critical part in the lipid component of skin barrier formation. Minimum requirements have been defined, primarily based on eliminating signs of deficiencies such as dry, flaky skin and inflammation. Zn has been shown as an important nutrient for maintaining epidermal health. This pilot study investigated whether there are skin barrier benefits from feeding both linoleic acid and Zn at levels significantly in excess of published minimum requirements. Eight Labrador retrievers were fed a diet containing 3.8 g/Mcal LA, 21 mg/Mcal Zn for 12 weeks to establish baseline conditions for all dogs (basal diet). After this period, for a further 12 weeks, the dogs were switched onto a diet containing 7.9 g/Mcal LA and 50 mg/Mcal Zn (test diet). Transepidermal water loss (TEWL measurements) were used as a measure of skin quality and integrity and were taken at the end of the initial feeding period, and at 6 and 12 weeks of the test feeding period. TEWL was reduced by 8.11 g/m2/h (P < 0.001) six weeks after instigation of the test diet, and by 7.52 g/m2/h (P < 0.005) at 12 weeks, compared to the levels (14.73 g/m2/h) at the end of the basal feeding trial period. The results showed evidence of improved barrier properties as TEWL when feeding higher levels of LA and Zn for six and 12 weeks.

Influence of horse breed on transepidermal water loss

Non-invasive methods of skin condition assessment include, among others, the evaluation of transepidermal water loss (TEWL). The aim of the study was to examine whether TEWL values depend on horse breed. The study was conducted on four breeds: "Felin" ponies (FP) (n=16), Polish koniks (PK) (n=15), Polish cold-blooded horses (PcbH) (n=11) and Wielkopolska horses (WH) (n=12). It was found that horse breed influences TEWL values. In the neck region, statistically significant differences were found between PK and FP (p=0.006), and PK and WH (p=0.0005). In the lumbar region, there were statistically significant differences between FP and PK (p=0.0009), FP and PcbH (p=0.0016) as well as between PK and WH (p=0.000037), and PcbH and WH (p=0.0006). In the inguinal region statistically significant differences were found between FP and PK (p=0.0003), FP and PcbH (p=0.0005), PK and WH (p=0.009) and PcbH and WH (p=0.006). In the lip region statistically significant differences were observed between FP and PK (p=0.013) as well as between PK and PcbH (p=0.029) and PK and WH (p=0.009). In the examination of TEWL animal breed should be taken into consideration. The non-significant differences found in three of the examined body regions may suggest that these regions are the most adequate for TEWL assessment.

The influence of non-specific anti-pruritus treatment with cyclosporine A on transepidermal water loss (TEWL) in natural atopic dermatitis in dogs

Atopic dermatitis is a common allergic skin disease in dogs. Monitoring the progress of treatment and the assessment of the severity of disease symptoms are crucial elements of the treatment procedure. One of the common means of assessing the severity of the clinical signs of the disease is the CADESI 03. Research studies have pointed to a possibility of assessing the severity of skin lesions by means of measuring biophysical skin parameters such as TEWL, skin hydration and erythema intensity. The aim of the study was the assessment of changes in TEWL and CADESI values measured in ten different body regions during non-specific anti-pruritus treatment. The examination was performed on ten dogs with atopic dermatitis (age from 2.5 years to 7 years, mean age 3.8 years). The measurements were performed in the following body regions: the lumbar region, the right axillary fossa, the right inguinal region, the ventral abdominal region, the right lateral thorax region, the internal surface of the auricle, interdigital region of the right forelimb, cheek, bridge of nose and the lateral site of antebrachum. A statistically significant decrease in CADESI values was reported starting from the second week of treatment. In the case of the mean TEWL values, a fall was observed after one week of treatment in the ventral abdominal region and the interdigital region, after two weeks of treatment in the axillary fossa and the inguinal region, and after three weeks in the cheek and the lateral thorax region. There was no statistically significant decrease in TEWL values in the course of treatment in four other regions.

The examination of biophysical skin parameters (transepidermal water loss, skin hydration and pH value) in different body regions in Polish ponies

The purpose of this study was to evaluate transepidermal water loss, skin hydration and skin pH in normal polish ponies. Twelve ponies of both sexes were examined in the study. Measurements were taken from seven different sites: the neck region, the shoulder, thorax, lumbar, inguinal, lip region and the pinna. In each of the regions transepidermal water loss (TEWL), skin hydration and skin pH were measured. For transepidermal water loss, the lowest values were observed in the pinna (10.54 g/hm(2)), while the highest values were observed in the lip region (30.98 g/hm(2)). In the case of skin hydration the lowest values were observed for the thorax region (1.96 CU), and the highest for the lip region (48.28 CU). For skin pH, the lowest results were obtained in the pinna (7.03), and the highest in the lumbar region (8.05).

Fixing the skin barrier: past, present and future--man and dog compared

Skin barrier dysfunction exists in both human and canine atopic dermatitis, leading to increased water loss and potentially facilitating allergen penetration and sensitization. Both lipid (e.g. ceramides) and protein (e.g. filaggrin) abnormalities have been described. Some are genetically inherited (e.g. filaggrin mutations are one of the major risk factors in humans) and some are secondary and linked to inflammation. In humans, numerous studies have shown efficacy of emollients and moisturizers in barrier restoration, and this approach has been for years the mainstay of therapy. Recently, this strategy has shown promise as a preventative function. In veterinary medicine, evidence regarding skin barrier impairment is rapidly building. Decreased ceramides and filaggrin (in some subsets of dogs) have been described. Altered metabolism of ceramides has also been proposed. Despite these preliminary data and the availability of products marketed to improve the skin barrier, evidence regarding the clinical benefit of skin repair intervention is still limited. Preliminary studies have demonstrated that topical application of fatty acids and ceramides and systemic administration of fatty acids improve lipid deficiencies in the skin of dogs with atopic dermatitis, but limited clinical evidence exists. Disease remission in humans is paralleled by an improved skin barrier, both with calcineurin inhibitors and glucocorticoids. In veterinary medicine, a preliminary study on ciclosporin and prednisone failed to detect significant improvement of water loss, while successful immunotherapy correlated with an improved skin barrier. Controlled, large studies are needed to address the question of which skin repair approach is clinically most effective and whether this can be used as a preventative strategy.

Pilot study to evaluate the effect of topical dimethicone on clinical signs and skin barrier function in dogs with naturally occurring atopic dermatitis

This study investigated the effects of a skin protectant solution (dimethicone 2%) on clinical signs and skin barrier function in canine atopic dermatitis (AD). Eighteen dogs with AD were randomly divided into two groups, one received dimethicone and the other received the vehicle (cyclomethicone) on selected areas (pinnae, groin, and axillae) daily for 4 weeks. Owners and investigators were blinded regarding group allocation. Clinical efficacy was evaluated using a scoring system and skin barrier by measuring the transepidermal water loss. Twelve dogs completed the study (50% drop rate in the vehicle and 20% in the dimethicone). For clinical signs, analysis of variance showed an effect of time (P < 0.005; day 0 > day 28) and region (axillae < groin < pinnae) but no effect of group or group × time interaction. For transepidermal water loss, analysis of variance showed only a main effect of region (axillae > pinnae > groin). Pearson found no correlation between transepidermal water loss and clinical scores. In this pilot study dimethicone had no significant effect on clinical signs and transepidermal water loss in canine atopic dermatitis.

An update on the treatment of canine atopic dermatitis

Remarkable progress has been made in recent years concerning our understanding of the pathogenesis of canine atopic dermatitis (AD). As our understanding improves, the therapeutic approach evolves. Of utmost importance is the documentation of skin barrier impairment in canine AD: ceramides deficiency leads to increased permeability and increased allergen penetration and sensitization. It is currently unknown whether this dysfunction is primary and genetically inherited or secondary to inflammation but it is accepted that skin barrier deficiency plays an important role in either starting or minimally exacerbating canine AD. Thus, the therapeutic approach has changed from focusing on the control of the inflammation to a combined approach that includes therapies aimed at skin barrier repair. The issue of skin barrier repair has been addressed both with oral administration of essential fatty acids and the topical application of products containing a combination of ceramides and fatty acids. These strategies are most helpful as adjunctive treatments and would be best used in young patients that have not developed chronic skin changes. Importantly, treatment for canine AD is multimodal and tailored to the individual patient, the age, and the duration of the disease. Client education plays an important role in explaining the importance of a long-term approach to minimize flare-ups and, in this context, topical therapy to correct skin barrier can be of great benefit. This is an area still in infancy and much work is needed to identify the best formulation. In human medicine, long-term use of moisturizers can have a profound effect on skin barrier and gene expression of proteins involved in skin barrier. This effect is variable depending on the formulation used. It is reasonable to speculate that the same may be true in dogs; thus, it is very important to identify the correct ingredients and formulation to use.