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Handeland K, Wakeman M, Burri L. Krill oil supplementation improves transepidermal water loss, hydration and elasticity of the skin in healthy adults: Results from two randomized, double-blind, placebo-controlled, dose-finding pilot studies. J Cosmet Dermatol 2024. [PMID: 39169540 DOI: 10.1111/jocd.16513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 07/12/2024] [Accepted: 07/25/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Dietary marine omega-3 fatty acids and phospholipids have individually shown favorable effects on skin barrier function. Krill oil offers a combination of omega-3 in phospholipid form which might enhance the efficacy in supporting skin health. AIMS The aim was to investigate the impact of two different doses of krill oil on skin transepidermal water loss (TEWL) in healthy adults. Secondary outcomes were skin hydration, elasticity and the omega-3 index. METHODS Two randomized, double-blind, placebo-controlled, pilot studies were conducted in healthy adults with a baseline TEWL of >10 and ≤24.9 g/m2/h. In study 1, 51 participants consumed 1 g of krill oil or placebo daily. In study 2, 50 participants consumed 2 g of krill oil or placebo daily. The outcomes were assessed at baseline, 6 and 12 weeks. RESULTS The krill oil supplemented groups significantly increased their omega-3 index versus placebo in both studies. Furthermore, the krill oil groups in both studies showed statistically significant beneficial reductions in TEWL (from 14.47 ± 3.65 to 13.83 ± 3.78 in study 1 and from 14.25 ± 3.21 to 13.02 ± 2.76 in study 2) and increases in hydration and elasticity when compared to placebo. There were significant linear relationships between changes in the omega-3 index and changes in TEWL, hydration and elasticity in both studies. CONCLUSIONS Daily oral supplementation with 1 and 2 g of krill oil showed significant and dose-dependent improvements in skin TEWL, hydration, and elasticity compared to placebo that correlated with changes in the omega-3 index.
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Affiliation(s)
| | - Mike Wakeman
- Faculty of Health and Wellbeing, University of Sunderland, Sunderland, UK
| | - Lena Burri
- Aker BioMarine Human Ingredients AS, Lysaker, Norway
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2
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Yang Y, Wang J, Wanasathop A, Niu M, Ghosh P, Zidan A, Gu J, Hunt R, Faustino P, Ashraf M, Xu X. Evaluation of in vitro Skin Permeation of Clascoterone From Clascoterone Topical Cream, 1% (w/w). AAPS PharmSciTech 2024; 25:186. [PMID: 39138712 DOI: 10.1208/s12249-024-02887-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/07/2024] [Indexed: 08/15/2024] Open
Abstract
Winlevi® (clascoterone) topical cream (1%, w/w) was approved by the U.S. FDA for the treatment of acne vulgaris in patients 12 years of age and older. The active ingredient, clascoterone, is not stable in physiological solutions and can hydrolyze to cortexolone at body temperature. Instability of clascoterone poses a significant challenge in accurately assessing the rate and extent of clascoterone permeation in vitro. Therefore, the purpose of this study was to develop an in vitro skin permeation test (IVPT) method, and a robust analytical method, that can minimize hydrolyzation of clascoterone during the study for quantification of clascoterone. Two IVPT methods, using either vertical diffusion cells or flow-through cells, were developed and compared to evaluate in vitro permeation of clascoterone from Winlevi. A liquid chromatography with tandem mass spectrometry (LC-MS/MS) method was developed to monitor the level of clascoterone and cortexolone in the IVPT samples. The analytical method features a 2-min high-throughput analysis with good linearity, selectivity, and showed a lower limit of quantitation (LLOQ) of 0.5 ng/mL for both clascoterone and cortexolone. The in vitro skin permeation of clascoterone and cortexolone was observed as early as 2 h in both IVPT methods. A substantive amount of clascoterone was found to hydrolyze to cortexolone when using the vertical static diffusion cells with aliquot sampling. Conversely, degradation of clascoterone was significantly minimized when using the flow-through diffusion cells with fractional sampling. The data enhanced our understanding of in vitro permeation of clascoterone following topical application of the Winlevi topical cream, 1% and underscores the importance of IVPT method development and optimization during product development.
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Affiliation(s)
- Yang Yang
- Office of Pharmaceutical Quality Research, CDER, U.S. FDA, 10903 New Hampshire Avenue, WO64-Rm1032, Silver Spring, MD, 20993, USA.
| | - Jiang Wang
- Office of Pharmaceutical Quality Research, CDER, U.S. FDA, 10903 New Hampshire Avenue, WO64-Rm1032, Silver Spring, MD, 20993, USA
- Division of Bioequivalence III, Office of Bioequivalence, Office of Generic Drugs, CDER, U.S. FDA, Silver Spring, MD, USA
| | - Apipa Wanasathop
- Office of Pharmaceutical Quality Research, CDER, U.S. FDA, 10903 New Hampshire Avenue, WO64-Rm1032, Silver Spring, MD, 20993, USA
| | - Mengmeng Niu
- Division of Therapeutic Performance I, Office of Research and Standards, Office of Generic Drugs, CDER, U.S. FDA, Silver Spring, MD, USA
| | - Priyanka Ghosh
- Division of Therapeutic Performance I, Office of Research and Standards, Office of Generic Drugs, CDER, U.S. FDA, Silver Spring, MD, USA
| | - Ahmed Zidan
- Office of Pharmaceutical Quality Research, CDER, U.S. FDA, 10903 New Hampshire Avenue, WO64-Rm1032, Silver Spring, MD, 20993, USA
| | - Jianghong Gu
- Office of Pharmaceutical Quality Research, CDER, U.S. FDA, 10903 New Hampshire Avenue, WO64-Rm1032, Silver Spring, MD, 20993, USA
| | - Robert Hunt
- Office of Pharmaceutical Quality Research, CDER, U.S. FDA, 10903 New Hampshire Avenue, WO64-Rm1032, Silver Spring, MD, 20993, USA
| | - Patrick Faustino
- Office of Pharmaceutical Quality Research, CDER, U.S. FDA, 10903 New Hampshire Avenue, WO64-Rm1032, Silver Spring, MD, 20993, USA
| | - Muhammad Ashraf
- Office of Pharmaceutical Quality Research, CDER, U.S. FDA, 10903 New Hampshire Avenue, WO64-Rm1032, Silver Spring, MD, 20993, USA
| | - Xiaoming Xu
- Office of Pharmaceutical Quality Research, CDER, U.S. FDA, 10903 New Hampshire Avenue, WO64-Rm1032, Silver Spring, MD, 20993, USA
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3
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Chaturvedi P, Kroon W, Zanelli G, Worsley PR. An exploratory study of structural and microvascular changes in the skin following electrical shaving using optical coherence topography. Skin Res Technol 2024; 30:e13830. [PMID: 38951871 PMCID: PMC11217022 DOI: 10.1111/srt.13830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/11/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Consumer products such as electrical shavers exert a combination of dynamic loading in the form of pressure and shear on the skin. This mechanical stimulus can lead to discomfort and skin tissue responses characterised as "Skin Sensitivity". To minimise discomfort following shaving, there is a need to establish specific stimulus-response relationships using advanced tools such as optical coherence tomography (OCT). OBJECTIVE To explore the spatial and temporal changes in skin morphology and microvascular function following an electrical shaving stimulus. METHODS Ten healthy male volunteers were recruited. The study included a 60-s electrical shaving stimulus on the forearm, cheek and neck. Skin parameters were recorded at baseline, 20 min post stimulus and 24 h post stimulus. Structural and dynamic skin parameters were estimated using OCT, while transepidermal water loss (TEWL) was recorded to provide reference values for skin barrier function. RESULTS At baseline, six of the eight parameters revealed statistically significant differences between the forearm and the facial sites, while only surface roughness (Rq) and reflectivity were statistically different (p < 0.05) between the cheek and neck. At 20 min post shaving, there was a significant increase in the TEWL values accompanied by increased blood perfusion, with varying magnitude of change dependent on the anatomical site. Recovery characteristics were observed 24 h post stimulus with most parameters returning to basal values, highlighting the transient influence of the stimulus. CONCLUSIONS OCT parameters revealed spatial and temporal differences in the skin tissue response to electrical shaving. This approach could inform shaver design and prevent skin sensitivity.
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Affiliation(s)
- Pakhi Chaturvedi
- Skin Sensing Research GroupSchool of Health Sciences, University of SouthamptonSouthamptonUK
- Philips Consumer Lifestyle B.V.DrachtenThe Netherlands
| | - Wilco Kroon
- Philips Consumer Lifestyle B.V.DrachtenThe Netherlands
| | | | - Peter R. Worsley
- Skin Sensing Research GroupSchool of Health Sciences, University of SouthamptonSouthamptonUK
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4
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van den Brink NJM, Pardow F, Meesters LD, van Vlijmen-Willems I, Rodijk-Olthuis D, Niehues H, Jansen PAM, Roelofs SH, Brewer MG, van den Bogaard EH, Smits JPH. Electrical Impedance Spectroscopy Quantifies Skin Barrier Function in Organotypic In Vitro Epidermis Models. J Invest Dermatol 2024:S0022-202X(24)00293-8. [PMID: 38642800 DOI: 10.1016/j.jid.2024.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/16/2024] [Accepted: 03/02/2024] [Indexed: 04/22/2024]
Abstract
Three-dimensional human epidermal equivalents (HEEs) are a state-of-the-art organotypic culture model in preclinical investigative dermatology and regulatory toxicology. In this study, we investigated the utility of electrical impedance spectroscopy (EIS) for noninvasive measurement of HEE epidermal barrier function. Our setup comprised a custom-made lid fit with 12 electrode pairs aligned on the standard 24-transwell cell culture system. Serial EIS measurements for 7 consecutive days did not impact epidermal morphology, and readouts showed comparable trends with HEEs measured only once. We determined 2 frequency ranges in the resulting impedance spectra: a lower frequency range termed EISdiff correlated with keratinocyte terminal differentiation independent of epidermal thickness and a higher frequency range termed EISSC correlated with stratum corneum thickness. HEEs generated from CRISPR/Cas9-engineered keratinocytes that lack key differentiation genes FLG, TFAP2A, AHR, or CLDN1 confirmed that keratinocyte terminal differentiation is the major parameter defining EISdiff. Exposure to proinflammatory psoriasis- or atopic dermatitis-associated cytokine cocktails lowered the expression of keratinocyte differentiation markers and reduced EISdiff. This cytokine-associated decrease in EISdiff was normalized after stimulation with therapeutic molecules. In conclusion, EIS provides a noninvasive system to consecutively and quantitatively assess HEE barrier function and to sensitively and objectively measure barrier development, defects, and repair.
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Affiliation(s)
| | - Felicitas Pardow
- Department of Dermatology, Radboudumc, Nijmegen, The Netherlands; Department of Molecular Developmental Biology, Faculty of Science, Radboud University, Nijmegen, The Netherlands
| | - Luca D Meesters
- Department of Dermatology, Radboudumc, Nijmegen, The Netherlands; Department of Molecular Developmental Biology, Faculty of Science, Radboud University, Nijmegen, The Netherlands
| | | | | | - Hanna Niehues
- Department of Dermatology, Radboudumc, Nijmegen, The Netherlands
| | | | | | - Matthew G Brewer
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Jos P H Smits
- Department of Dermatology, Radboudumc, Nijmegen, The Netherlands; Department of Dermatology, Heinrich Heine University, University Hospital Düsseldorf, Düsseldorf, Germany
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5
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Dyson E, Sikkink S, Nocita D, Twigg P, Westgate G, Swift T. Evaluating the Irritant Factors of Silicone and Hydrocolloid Skin Contact Adhesives Using Trans-Epidermal Water Loss, Protein Stripping, Erythema, and Ease of Removal. ACS APPLIED BIO MATERIALS 2024; 7:284-296. [PMID: 38150300 PMCID: PMC10792606 DOI: 10.1021/acsabm.3c00874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 12/28/2023]
Abstract
A composite silicone skin adhesive material was designed to improve its water vapor permeability to offer advantages to wearer comfort compared to existing skin adhesive dressings available (including perforated silicone and hydrocolloid products). The chemical and mechanical properties of this novel dressing were analyzed to show that it has a high creep compliance, offering anisotropic elasticity that is likely to place less stress on the skin. A participant study was carried out in which 31 participants wore a novel silicone skin adhesive (Sil2) and a hydrocolloid competitor and were monitored for physiological response to the dressings. Trans-epidermal water loss (TEWL) was measured pre- and postwear to determine impairment of skin barrier function. Sil2 exhibited a higher vapor permeability than the hydrocolloid dressings during wear. Peel strength measurements and dye counter staining of the removed dressings showed that the hydrocolloid had a higher adhesion to the participants' skin, resulting in a greater removal of proteins from the stratum corneum and a higher pain rating from participants on removal. Once the dressings were removed, TEWL of the participants skin beneath the Sil2 was close to normal in comparison to the hydrocolloid dressings that showed an increase in skin TEWL, indicating that the skin had been highly occluded. Analysis of the skin immediately after removal showed a higher incidence of erythema following application of hydrocolloid dressings (>60%) compared to Sil2, (<30%). In summary, this modified silicone formulation demonstrates superior skin protection properties compared to hydrocolloid dressings and is more suitable for use as a skin adhesive.
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Affiliation(s)
- Edward Dyson
- School
of Chemistry and Biosciences, University
of Bradford, Bradford BD7 1DP, U.K.
| | - Stephen Sikkink
- School
of Chemistry and Biosciences, University
of Bradford, Bradford BD7 1DP, U.K.
| | - Davide Nocita
- Faculty
of Engineering and Informatics, University
of Bradford, Bradford BD7 1DP, U.K.
| | - Peter Twigg
- Faculty
of Engineering and Informatics, University
of Bradford, Bradford BD7 1DP, U.K.
| | - Gill Westgate
- School
of Chemistry and Biosciences, University
of Bradford, Bradford BD7 1DP, U.K.
| | - Thomas Swift
- School
of Chemistry and Biosciences, University
of Bradford, Bradford BD7 1DP, U.K.
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Serrano-Castañeda P, Ochoa Loyo MA, Tinoco Hernández CE, Anaya-Ortega BM, Guadarrama-Escobar OR, Anguiano-Almazán E, Rodríguez-Pérez B, Peña-Juárez MC, Vázquez-Durán A, Méndez-Albores A, Rodríguez-Cruz IM, Morales-Florido MI, Escobar-Chávez JJ. Ceftriaxone-Loaded Polymeric Microneedles, Dressings, and Microfibers for Wound Treatment. Polymers (Basel) 2023; 15:2610. [PMID: 37376256 DOI: 10.3390/polym15122610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
The objective of this study was to create polymeric dressings, microfibers, and microneedles (MN) loaded with ceftriaxone, using PMVA (Poly (Methyl vinyl ether-alt-maleic acid), Kollicoat® 100P, and Kollicoat® Protect as polymers to treat diabetic wounds and accelerate their recovery. These formulations were optimized through a series of experiments and were subsequently subjected to physicochemical tests. The results of the characterization of the dressings, microfibers, and microneedles (PMVA and 100P) were, respectively, a bioadhesion of 281.34, 720, 720, 2487, and 510.5 gf; a post-humectation bioadhesion of 186.34, 831.5, 2380, and 630.5 gf, tear strength of 2200, 1233, 1562, and 385 gf, erythema of 358, 8.4, 227, and 188; transepidermal water loss (TEWL) of 2.6, 4.7, 1.9, and 5.2 g/h·m2; hydration of 76.1, 89.9, 73.5, and 83.5%; pH of 4.85, 5.40, 5.85, and 4.85; and drug release (Peppas kinetics release) of n: 0.53, n: 0.62, n: 0.62, and n: 0.66). In vitro studies were performed on Franz-type diffusion cells and indicated flux of 57.1, 145.4, 718.7, and 2.7 µg/cm2; permeation coefficient (Kp) of 13.2, 19.56, 42, and 0.00015 cm2/h; and time lag (tL) of 6.29, 17.61, 27. 49, and 22.3 h, respectively, in wounded skin. There was no passage of ceftriaxone from dressings and microfibers to healthy skin, but that was not the case for PMVA/100P and Kollicoat® 100P microneedles, which exhibited flux of 194 and 0.4 µg/cm2, Kp of 11.3 and 0.00002 cm2/h, and tL of 5.2 and 9.7 h, respectively. The healing time of the formulations in vivo (tests carried out using diabetic Wistar rats) was under 14 days. In summary, polymeric dressings, microfibers, and microneedles loaded with ceftriaxone were developed. These formulations have the potential to address the challenges associated with chronic wounds, such as diabetic foot, improving the outcomes.
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Affiliation(s)
- Pablo Serrano-Castañeda
- Unidad de Investigación Multidisciplinaria-Lab 12, Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Carretera Cuautitlán-Teoloyucan, km 2.5 San Sebastián Xhala, Cuautitlán Izcalli 54714, Mexico
| | - Miguel Alejandro Ochoa Loyo
- Unidad de Investigación Multidisciplinaria-Lab 12, Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Carretera Cuautitlán-Teoloyucan, km 2.5 San Sebastián Xhala, Cuautitlán Izcalli 54714, Mexico
| | - Cristian Ezequiel Tinoco Hernández
- Unidad de Investigación Multidisciplinaria-Lab 12, Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Carretera Cuautitlán-Teoloyucan, km 2.5 San Sebastián Xhala, Cuautitlán Izcalli 54714, Mexico
| | - Brian Miguel Anaya-Ortega
- Unidad de Investigación Multidisciplinaria-Lab 12, Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Carretera Cuautitlán-Teoloyucan, km 2.5 San Sebastián Xhala, Cuautitlán Izcalli 54714, Mexico
| | - Omar Rodrigo Guadarrama-Escobar
- Unidad de Investigación Multidisciplinaria-Lab 12, Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Carretera Cuautitlán-Teoloyucan, km 2.5 San Sebastián Xhala, Cuautitlán Izcalli 54714, Mexico
| | - Ericka Anguiano-Almazán
- Unidad de Investigación Multidisciplinaria-Lab 12, Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Carretera Cuautitlán-Teoloyucan, km 2.5 San Sebastián Xhala, Cuautitlán Izcalli 54714, Mexico
| | - Betsabé Rodríguez-Pérez
- Laboratorio de Servicio de Análisis de Propóleos (LASAP), Unidad de Investigación Multidisciplinaria (UIM), Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Cuautitlán Izcalli 54714, Mexico
| | - Ma Concepción Peña-Juárez
- Unidad de Investigación Multidisciplinaria-Lab 12, Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Carretera Cuautitlán-Teoloyucan, km 2.5 San Sebastián Xhala, Cuautitlán Izcalli 54714, Mexico
| | - Alma Vázquez-Durán
- Unidad de Investigación Multidisciplinaria L14 (Ciencia y Tecnología de los Materiales), Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Cuautitlán Izcalli 54714, Mexico
| | - Abraham Méndez-Albores
- Unidad de Investigación Multidisciplinaria L14 (Ciencia y Tecnología de los Materiales), Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Cuautitlán Izcalli 54714, Mexico
| | - Isabel Marlen Rodríguez-Cruz
- Unidad de Enseñanza e Investigación, Hospital Regional de Alta Especialidad de Zumpango, Carretera Zumpango-Jilotzingo #400, Barrio de Santiago, 2ª Sección, Zumpango 55600, Mexico
| | - Miriam Isabel Morales-Florido
- Unidad de Investigación Multidisciplinaria-Lab 12, Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Carretera Cuautitlán-Teoloyucan, km 2.5 San Sebastián Xhala, Cuautitlán Izcalli 54714, Mexico
| | - José Juan Escobar-Chávez
- Unidad de Investigación Multidisciplinaria-Lab 12, Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Carretera Cuautitlán-Teoloyucan, km 2.5 San Sebastián Xhala, Cuautitlán Izcalli 54714, Mexico
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Fluhr JW, Wiora G, Nikolaeva DG, Miséry L, Darlenski R. In vivo transepidermal water loss: Validation of a new multi-sensor open chamber water evaporation system Tewameter TM Hex. Skin Res Technol 2023; 29:e13307. [PMID: 37113085 PMCID: PMC10234168 DOI: 10.1111/srt.13307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/02/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Instrumentation technology for transepidermal water loss measurements has not been substantially modified since its introduction by Nilsson in 1977. Recent progress in sensor development allowed a new sensor arrangement using a matrix of 30 sensors. Raw measurement values are processed with spatial statistical analysis. We aimed to compare the new, multi-sensor probe (Tewameter TM Hex) with the established Tewameter TM 300 probe and to gain reference data for the new parameters of transepidermal energy loss and water vapor concentration on skin. MATERIAL AND METHODS Baseline measurements and repeated measurements on the volar forearm and assessment on eight different anatomical locations were performed on 24 healthy volunteers (both gender) with the TM Hex and the TM 300. RESULTS A significant correlation (p < 0.001; R-coefficient = 0.9) between TM Hex and the TM 300 with a low coefficient of variance (CV) 11% for TM Hex and 19% for TM 300, could be assessed. The CV ranged between 7% (right inner upper arm) and 14% (palms). Average transepidermal heat loss ranged from 12 W/m2 on the lower leg to 38.8 W/m2 on the palm. CONCLUSION The correlation between TM Hex and TM 300 along with the robustness of the measurements with the TM Hex shows that the new probe for assessment of epidermal barrier function is comparable to the TM 300. In most conditions, TM Hex provides more accurate measurements than TM 300. New parameters open the field to studying skin's water and energy balance.
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Affiliation(s)
- Joachim W. Fluhr
- Charité – Universitätsmedizin BerlinInstitute of AllergologyBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and ImmunologyGermany
| | - Georg Wiora
- Courage + Khazaka electronic GmbHCologneGermany
| | - Dessyslava G. Nikolaeva
- Department of Dermatology and VenereologyAcibadem City Clinic Tokuda Hospital, SofiaBulgaria
- EuroDerma ClinicSofiaBulgaria
| | | | - Razvigor Darlenski
- Department of Dermatology and VenereologyAcibadem City Clinic Tokuda Hospital, SofiaBulgaria
- Department of Dermatology and VenereologyMedical FacultyTrakia University, Stara ZagoraBulgaria
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