Homeostasis and epidermal barrier analysis in psoriatic patients: the impact of emollients
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BACKGROUND: Skin diseases may modify epidermal barrier function. Psoriasis is a
chronic multi-systemic inflammatory disease that may affects the epidermal barrier.
Emollients are an option as a coadjutant therapy for psoriasis management, but little is
known about how epidermal barrier function is modified by moisturizers administration
in psoriatic patients.
HYPOTHESIS AND OBJECTIVES: The objective of this before-and-after study is to analyse
skin homeostasis and epidermal barrier function differences between psoriatic plaque,
non-affected skin in psoriatic patients and control skin; also, to evaluate the effect of
two types of moisturizers on psoriatic and healthy participants.
METHODS: Thirty-one patients with plaque-type psoriasis and thirty-one gender and
age-matched healthy controls were enrolled. Temperature, Transepidermal water loss
(TEWL), stratum corneum hydration (SCH), pH, elasticity and erythema index were
measured using non-invasive tools in the healthy control and involved and uninvolved
psoriatic skin before and after the use of two determined moisturizers
RESULTS: Healthy controls had lower TEWL, temperature, and higher pH levels than
psoriatic patients. SCH levels were found lower in psoriatic plaques than in uninvolved
and healthy skin (13,44 vs 30,55 vs 30,90 Arbitrary Units (AU); p<0,001). TEWL was
significantly higher in plaques than in psoriatic uninvolved skin (13,23 vs 8,54 g/h/m2;
p<0,001)., which was also higher than in control healthy skin (8,54 vs 6,41 g/h/m2;
p=0,023).
After emollients application on psoriatic plaques, SCH experimented a significant
increment after the application of water-based formula (13,44 vs 22,89 AU; p=0,003).
However, TEWL showed a decrease of 5,59 g/h/m2 (5,68 SD, p<0,001) after use of
Vaseline jelly; and the contrary effect after the water-formula application (increment of
3,60 g/h/m2 (6,86 SD, p=0,006).
CONCLUSION: Uninvolved psoriatic skin showed epidermal barrier dysfunction
compared to healthy controls; in addition, psoriatic plaques barrier impairment was
significantly higher than not-affected skin. Use of emollients may improve epidermal
barrier function in psoriatic patients. SCH and TEWL parameters were the most changed
after moisturizers application