Comparison of Skin Hydration Evaluation Sites and Correlations among Skin Hydration, Transepidermal Water Loss, SCORAD Index, Nottingham Eczema Severity Score, and Quality of Life in Patients with Atopic Dermatitis
Background:Atopic dermatitis (AD) is characterized by dryness of the skin, pruritus and involvement of the skin flexures. Skin hydration (SH) and integrity, as measured by transepidermal water loss (TEWL), are important parameters for objectively quantifying AD research.
Objectives:To evaluate if sites in the forearm are equivalent to the antecubital fossa for standard SH and TEWL measurements; and to determine the correlations among these measurements and scores of disease severity and quality of life.
Methods:We evaluated SH and TEWL under standardized conditions at three common measurement sites in the forearm (antecubital flexure, 2 cm below the antecubital flexure, mid-forearm), and determined the SCORing Atopic Dermatitis (SCORAD) score, Nottingham Eczema Severity Score (NESS), and Children’s Dermatology Life Quality Index (CDLQI).
Results:Significant correlations between clinical scores, SH, and TEWL were obtained at a site 2 cm below the antecubital fossa (r = -0.553, p < 0.001 for SH and SCORAD; r = 0.596, p <0.001 for TEWL and SCORAD). SH and TEWL were also correlated with long-term severity of AD as measured by NESS (r = -0.494, p = 0.001 for SH; r = 0.430, p = 0.004 for TEWL), while TEWL was significantly correlated with CDLQI (r = 0.323, p = 0.035). Overall, similar significant correlations were obtained at the mid-forearm, but less so at the antecubital fossa.
Conclusion:In AD research, three sites on the forearm appear to be convenient for determination of SH and TEWL. This is the first report to demonstrate that significant correlations are obtained among acute and chronic scores of AD disease severity, quality of life, and the bioengineering parameters
Atopic Dermatitis Antecubital Fossa Skin Hydration Transepidermal Water Loss Stratum Corneum Hydration
This is a preview of subscription content, log in to check access
No sources of funding were used to assist in the preparation of this study. The authors have no conflicts of interest that are directly relevant to the content of this study.
Leung DY. Atopic dermatitis: the skin as a window into the pathogenesis of chronic allergic diseases. J Allergy Clin Immunol 1995; 96: 302–18PubMedCrossRefGoogle Scholar
Severity scoring of atopic dermatitis: the SCORAD index. Consensus report of the European Task Force on Atopic Dermatitis. Dermatology 1993; 186: 23–31Google Scholar
Hon KL, Leung TF, Wong Y, et al. Lesson from performing SCORADs in children with atopic dermatitis: subjective symptoms do not correlate well with disease extent or intensity. Int J Dermatol 2006; 45: 728–30PubMedCrossRefGoogle Scholar
Hon KL, Lam MC, Leung TF, et al. Nocturnal wrist movements are correlated with objective clinical scores and plasma chemokine levels in children with atopic dermatitis. Br J Dermatol 2006; 154: 629–35PubMedCrossRefGoogle Scholar
Pinnagoda J, Tupker RA, Agner T, et al. Guidelines for transepidermal water loss (TEWL) measurement: a report from the Standardization Group of the European Society of Contact Dermatitis. Contact Derm 1990; 22: 164–78PubMedCrossRefGoogle Scholar
Serup J. Characterization of contact dermatitis and atopy using bioengineering techniques: a survey. Acta Derm Venereol Suppl (Stockh) 1992; 177: 14–25Google Scholar
Seidenari S, Giusti G. Objective assessment of the skin of children affected by atopic dermatitis: a study of pH, capacitance and TEWL in eczematous and clinically uninvolved skin. Acta Derm Venereol 1995; 75: 429–33PubMedGoogle Scholar
Choi SJ, Song MG, Sung WT, et al. Comparison of transepidermal water loss, capacitance and pH values in the skin between intrinsic and extrinsic atopic dermatitis patients. J Korean Med Sci 2003; 18: 93–6PubMedGoogle Scholar
O’goshi K, Serup J. Inter-instrumental variation of skin capacitance measured with the Corneometer. Skin Res Technol 2005; 11: 107–9PubMedCrossRefGoogle Scholar
Kim DW, Park JY, Na GY, et al. Correlation of clinical features and skin barrier function in adolescent and adult patients with atopic dermatitis. Int J Dermatol 2006; 45: 698–701PubMedCrossRefGoogle Scholar
Proksch E, Nissen HP, Bremgartner M, et al. Bathing in a magnesium-rich Dead Sea salt solution improves skin barrier function, enhances skin hydration, and reduces inflammation in atopic dry skin. Int J Dermatol 2005; 44: 151–7PubMedCrossRefGoogle Scholar
Son SW, Park SY, Ha SH, et al. Objective evaluation for severity of atopic dermatitis by morphologic study of skin surface contours. Skin Res Technol 2005; 11: 272–80PubMedCrossRefGoogle Scholar
Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venereol (Stockh) 1980; 2: 44–7Google Scholar
Emerson RM, Charman CR, Williams HC. The Nottingham Eczema Severity Score: preliminary refinement of the Rajka and Langeland grading. Br J Dermatol 2000; 142: 288–97PubMedCrossRefGoogle Scholar
Ho KL, Ma KC, Wong E, et al. Validation of a self-administered questionnaire in Chinese in the assessment of eczema severity. Pediatr Dermatol 2003; 20: 465–9CrossRefGoogle Scholar
Chuh AA. Validation of a Cantonese version of the Children’s Dermatology Life Quality Index. Pediatr Dermatol 2003; 20: 479–81PubMedCrossRefGoogle Scholar
Loden M, Olsson H, Axell T, et al. Friction, capacitance and transepidermal water loss (TEWL) in dry atopic and normal skin. Br J Dermatol 1992; 126: 137–41PubMedCrossRefGoogle Scholar
Sakurai K, Sugiura H, Matsumoto M, et al. Occurrence of patchy parakeratosis in normal-appearing skin in patients with active atopic dermatitis and in patients with healed atopic dermatitis: a cause of impaired barrier function of the atopic skin. J Dermatol Sci 2002; 30: 37–42PubMedCrossRefGoogle Scholar
Matsumoto M, Sugiura H, Uehara M. Skin barrier function in patients with completely healed atopic dermatitis. J Dermatol Sci 2000; 23: 178–82PubMedCrossRefGoogle Scholar
Shahidullah M, Raffle EJ, Rimmer AR, et al. Transepidermal water loss in patients with dermatitis. Br J Dermatol 1969; 81: 722–30PubMedCrossRefGoogle Scholar
Mohrenschlager M, Schafer T, Huss-Marp J, et al. The course of eczema in children aged 5-7 years and its relation to atopy: differences between boys and girls. Br J Dermatol 2006; 154: 505–13PubMedCrossRefGoogle Scholar
Palmer CN, Irvine AD, Terron-Kwiatkowski A, et al. Common loss-of-function variants of the epidermal barrier protein filaggrin are a major predisposing factor for atopic dermatitis. Nat Genet 2006; 38: 441–6PubMedCrossRefGoogle Scholar