Transepidermal Water Loss (TEWL) and Corneometry With Hydrogel Vehicle in the Treatment of Atopic Dermatitis: A Randomized, Investigator-Blind Pilot Study
February 2012 | Volume 11 | Issue 2 | Original Article | 181 | Copyright © 2012
Leon H. Kircik MD
Mount Sinai Medical Center, New York, NY Indiana University School of Medicine, Indianapolis, IN
Disruption of the epidermal barrier, as indicated by a reduction in skin hydration and an increase in transepidermal water loss (TEWL) is a feature of atopic dermatitis (AD). Novel formulations of dermatologic therapies may enhance patient satisfaction and adherence and may possibly preserve and enhance epidermal barrier function. A single-center, investigator-blinded, randomized, split-body exploratory study was undertaken to assess the hydrating and barrier preserving effects of a water-based hydrogel vehicle. Subjects (n=20) with mild to moderate disease at baseline applied hydrogel vehicle or a moisturizing lotion (Eucerin Lotion®, Beiersdorf, Inc.) in a split-body fashion for two weeks. Corneometry and TEWL measurements were taken at baseline and week 2. Hydrogel vehicle produced a statistically significant improvement in skin hydration from baseline, as compared to a moisturizing lotion control. Hydrogel produced no statistically significant change in TEWL, while comparator lotion increased TEWL. Data from this pilot study indicate that the water-based hydrogel vehicle improves skin hydration and does not further impair epidermal barrier function, suggesting that it is an appropriate vehicle choice for patients with mild-to-moderate atopic dermatitis.
J Drugs Dermatol. 2012;11(2):180-184.
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Disruption of the epidermal barrier, as indicated by a reduction in skin hydration1 and an increase in transepidermal water loss (TEWL)1,2 is characteristic of atopic dermatitis, a common inflammatory skin disease with a relapsing remitting course. Data suggest that capacitance and TEWL correlate with clinical severity of AD.1,3 Whether abnormal skin barrier function is a cause of atopic dermatitis or a consequence of the disease remains controversial.3 Increasingly, researchers and clinicians recognize that disrupted barrier function contributes not only to the xerotic and pruritic manifestations of AD, but also to the inflammatory cascade that underlies the disease.4 In light of these evolving conceptions of AD, clinicians now understand that long-advocated skin moisturization strategies may provide more than symptomatic relief.
Due to their perceived occlusive and hydrating properties, ointment-based formulations have been used for years in dermatology. However, many patients and/or their parents/caregivers dislike the difficult and messy application of ointments, especially on hairy areas or large body surfaces. Novel formulations of dermatologic therapies offer additional options for prescribers and their patients, including foams, sprays, shampoos, scalp-specific topical solutions, and non-alcohol based gels that may provide hydrating and moisturizing benefits. Among these is the hydrogel, a mostly water-based, non-irritating, non-greasy vehicle that is shown to moisturize the skin and achieve a high degree of patient satisfaction. It was found in one study to be easy to apply and spread, quickly-absorbing, and comfortable under clothing and make-up.5 However, few studies have quantified the effect of hydrogel vehicle on barrier function. The current pilot study was conducted to assess the influence of hydrogel vehicle on TEWL and skin hydration.
This was a single-center, investigator-blinded, randomized, parallel, split-body study. The study is comprised of two study visits; visit 1 (week 0, baseline) and visit 2 (week 2, follow-up).
Subjects eligible for inclusion were men or women of any race, at least 12 years of age, with a definitive diagnosis of AD, defined as 3 out of 4 major characteristics and at least 3 minor characteristics, based on Hanifin and Rajka criteria (Table 1). Each subject