RESUMEN
INTRODUCTION: Atopic dermatitis (AD) is characterised by skin barrier defects often measured by biophysical tools that observe stratum corneum (SC) functional properties. OBJECTIVE: To employ in vivo infrared spectroscopy alongside biophysical measurements to analyse changes in chemical composition of the SC in relation to AD severity. METHODS: We conducted an observational cross-sectional cohort study where attenuated Total Reflection Fourier Transform Infrared (ATR-FTIR) spectroscopy measurements were collected on the forearm alongside surface pH, capacitance, erythema and transepidermal water loss (TEWL) combined with tape stripping (STS) in a cohort of 75 participants; 55 AD patients stratified by phenotypic severity, compared to 20 healthy controls. Common filaggrin (FLG) variant alleles were genotyped. RESULTS: Reduced hydration, elevated TEWL and redness all associated with greater AD severity. Spectral analysis showed a reduction in 1465cm-1 (full width half maximum) and 1340 cm-1 peak areas indicative of less orthorhombic lipid ordering and reduced carboxylate functional groups that correlated with clinical severity (lipid structure r=-0.59, carboxylate peak area r=-0.50). CONCLUSION: ATR-FTIR spectroscopy is a suitable tool for the characterisation of structural skin barrier defects in AD and has potential as a clinical tool for directing individual treatments based on chemical structural deficiencies.
RESUMEN
Living in a hard water area is associated with an increased risk of atopic dermatitis (AD). Greater skin barrier impairment after exposure to surfactants in wash products, combined with the high calcium levels of hard water and/or high chlorine levels, is a compelling mechanism for this increase. The purpose of this study was to investigate this mechanism in individuals with and without a predisposition to skin barrier impairment. We recruited 80 participants: healthy control subjects and AD patients with and without FLG mutations. The skin of each participant was washed with sodium lauryl sulfate in water of varying hardness levels and chlorine concentrations, rinsed, and covered with chambers to determine the effects of surfactant residues. Sites washed with hard water had significantly increased sodium lauryl sulfate deposits. These deposits increased transepidermal water loss and caused irritation, particularly in AD patients carrying FLG mutations. A clear effect of chlorine was not observed. Water softening by ion-exchange mitigated the negative effects of hard water. Barrier impairment resulting from the interaction between hard water and surfactants is a contributory factor to the development of AD. Installation of a water softener in early life may be able to prevent AD development. An intervention study is required to test this hypothesis.
