Jou nal o
Clinical Medicine
A icle
Skin Ba ie Func ion in Pso iasis and A opic De ma i is:
T ansepide mal Wa e Loss and Tempe a u e as Use ul Tools o
Assess Disease Se e i y
T inidad Mon e o-Vilchez 1,2 , Ma ía-Vic o ia Segu a-Fe nández-Nogue as 3, Isabel Pé ez-Rod íguez 3,
Miguel Sole -Gongo a 3, An onio Ma inez-Lopez 1,2, Ana Fe nández-González 2, Alejand o Molina-Ley a 1,2,*
and Sal ado A ias-San iago 1,2,3


Ci a ion: Mon e o-Vilchez, T.;
Segu a-Fe nández-Nogue as, M.-V.;
Pé ez-Rod íguez, I.; Sole -Gongo a,
M.; Ma inez-Lopez, A.;
Fe nández-González, A.;
Molina-Ley a, A.; A ias-San iago, S.
Skin Ba ie Func ion in Pso iasis and
A opic De ma i is: T ansepide mal
Wa e Loss and Tempe a u e as
Use ul Tools o Assess Disease
Se e i y. J. Clin. Med. 2021,10, 359.
h ps://doi.o g/10.3390/jcm10020359
Recei ed: 21 Decembe 2020
Accep ed: 16 Janua y 2021
Published: 19 Janua y 2021
Publishe ’s No e: MDPI s ays neu al
wi h ega d o ju isdic ional claims in
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Copy igh : © 2021 by he au ho s.
Licensee MDPI, Basel, Swi ze land.
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dis ibu ed unde he e ms and
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A ibu ion (CC BY) license (h ps://
c ea i ecommons.o g/licenses/by/
4.0/).
1De ma ology Depa men , Hospi al Uni e si a io Vi gen de las Nie es, A enida de Mad id, 15,
18012 G anada, Spain; mon e o @co eo.ug .es (T.M.-V.); [email p o ec ed] (A.M.-L.);
sal ado a ias@ug .es (S.A.-S.)
2Ins i u o de In es igación Biosani a ia GRANADA, 18012 G anada, Spain;
[email p o ec ed]
3De ma ology Depa men , Facul y o Medicine, Uni e si y o G anada,18001 G anada, Spain;
[email p o ec ed].es (M.-V.S.-F.-N.); isabelp @co eo.ug .es (I.P.-R.); [email p o ec ed].es (M.S.-G.)
*Co espondence: alejand [email p o ec ed]; Tel.: +34-958-023-422
Abs ac :
Mul iple diagnos ic ools a e used o e alua e pso iasis and a opic de ma i is (AD) se e i y,
bu mos o hem a e based on subjec i e componen s. T ansepide mal wa e loss (TEWL) and
empe a u e a e skin ba ie unc ion pa ame e s ha can be objec i ely measu ed and could help
clinicians o e alua e disease se e i y accu a ely. Thus, he aims o his s udy a e: (1) o compa e
skin ba ie unc ion be ween heal hy skin, pso ia ic skin and AD skin; and (2) o assess i skin
ba ie unc ion pa ame e s could p edic disease se e i y. A c oss-sec ional s udy was designed,
and epide mal ba ie unc ion pa ame e s we e measu ed. The s udy included 314 pa icipan s:
157 heal hy indi iduals, 92 pso ia ic pa ien s, and 65 a opic de ma i is pa ien s. TEWL was signi -
ican ly highe , while s a um co neum hyd a ion (SCH) (8.71 s. 38.43 s. 44.39 A bi a y Uni s
(AU)) was lowe a pso ia ic plaques han a unin ol ed pso ia ic skin and heal hy con ols. Pa-
ien s wi h bo h
TEWL > 13.85 g·m−2h−1
and empe a u e > 30.85
◦
C p esen ed a mode a e/se e e
pso iasis (pso iasis a ea se e i y index (PASI)
≥
7), wi h a speci ici y o 76.3%. TEWL (28.68 s.
13.15 s.
11.60 g·m−2h−1
) and empe a u e we e signi ican ly highe , while SCH (25.20 s. 40.95
s. 50.73 AU) was lowe a AD eczema ous lesions han unin ol ed AD skin and heal hy con ols.
Pa ien s wi h a empe a u e > 31.75
◦
C p esen ed a mode a e/se e e AD (SCORing A opic De ma i is
(SCORAD)
≥
37) wi h a sensi i i y o 81.8%. In conclusion, empe a u e and TEWL alues may help
clinicians o de e mine disease se e i y and selec pa ien s who need in ensi e ea men .
Keywo ds: a opic de ma i is; homeos asis; pso iasis; skin ba ie ; ansepide mal wa e loss
1. In oduc ion
The skin is he la ges o gan o he human body and accomplishes mul iple de ensi e
and egula o y unc ions [
1
]. The ba ie unc ion o skin esides in he epide mis, mainly
in he s a um co neum [
2
]. This epide mal ba ie main ains cu aneous homeos asis
and p o ec s he body agains nume ous ex e nal s esso s [
3
]. Assessmen o epide mal
ba ie unc ion usually in ol es measu emen s o ansepide mal wa e loss (TEWL) [
4
],
s a um co neum hyd a ion (SCH) [
5
], skin su ace pH [
6
], empe a u e [
7
], elas ici y [
8
],
melanin [9], and e y hema index [10].
Pso iasis and a opic de ma i is (AD) a e cu aneous in lamma o y diseases esul ing
om he in e ac ion be ween en i onmen al and gene ic ac o s ha may al e epide mal
ba ie unc ion [
11
]. Hype -p oli e a ion and de ec i e ke a inocy e di e en ia ion in pso-
iasis [
12
] and dec eased ilagg in exp ession [
13
] may impai epide mal ba ie unc ion.
J. Clin. Med. 2021,10, 359. h ps://doi.o g/10.3390/jcm10020359 h ps://www.mdpi.com/jou nal/jcm
J. Clin. Med. 2021,10, 359 2 o 12
The e a e sca ce epo s ega ding ba ie unc ion cha ac e is ics in pso iasis and a opic
de ma i is [
14
,
15
]. Ne e heless, he assessmen o skin homeos asis and epide mal ba ie
unc ion in hese diseases could e alua e quali a i e and quan i a i e skin al e a ions o
lesioned and non-lesioned skin and help o unde s and he complex and s ill incomple e
e iopa hogenesis o hese diseases [15].
Mo eo e , mul iple diagnos ic ools ha e been used o e alua e se e i y in pa ien s
wi h pso iasis and AD [
16
,
17
]. The pso iasis a ea se e i y index (PASI) is he mos widely
used scale o assessing pso iasis se e i y [
18
]. This sco e quan i ies ex en ( he pe cen age
o in ol emen o he ou ana omical egions: head, unk, and uppe and lowe ex-
emi ies) and in ensi y o he pso ia ic plaques (e alua ing e y hema, desquama ion, and
indu a ion sepa a ely o he ou ana omical egions) [
19
]. The SCORing A opic De ma i is
(SCORAD) is he mos common index used o assess AD se e i y [
20
]. I consis s o he
e alua ion o he ex en o he diso de , he in ensi y (composed o six i ems: e y hema,
oedema/papules, e ec o sc a ching, oozing/c us o ma ion, licheni ica ion, and d yness)
and subjec i e symp oms (i ch, sleeplessness) [
21
]. In he apeu ics and ou come esea ch, i
is impo an o measu e pso iasis and AD se e i y, bu all o hese scales ha e a subjec i e
componen ha could lead o a high in a- and in e -obse e a iabili y [
22
,
23
]. In ha
way, he measu emen o skin homeos asis and epide mal ba ie unc ion in pso ia ic and
AD pa ien s could help clinicians o assess he disease se e i y objec i ely [24].
Thus, he objec i es o his s udy a e (1) o compa e cu aneous homeos asis and skin
ba ie unc ion be ween heal hy skin, pso ia ic skin, and AD skin; and (2) o assess i skin
homeos asis and skin ba ie unc ion could p edic disease se e i y.
2. Ma e ials and Me hods
2.1. Design
A c oss-sec ional s udy was unde aken o assess skin homeos asis di e ences be-
ween heal hy skin; in ol ed and unin ol ed skin in pso ia ic pa ien s; and in ol ed and
unin ol ed skin in AD pa ien s.
2.2. S udy Popula ion
Pa icipan s we e ec ui ed om Oc obe 2019 o Feb ua y 2020 in he De ma ology
Se ice o he Hospi al Uni e si a io Vi gen de las Nie es in G anada.
Inclusion C i e ia:
•
Heal hy olun ee s we e people who a ended he De ma ology Se ice o com-
mon condi ions, such as melanocy ic ne i o sebo heic ke a oses, and did no ha e
p e ious pe sonal o amily his o y o any in lamma o y skin disease.
•
Pa ien s wi h pso iasis we e pa ien s wi h an es ablished clinical diagnosis o mild o
se e e plaque- ype pso iasis [25] and had a pso iasis plaque on hei elbows.
•
Pa ien s wi h AD we e pa ien s wi h es ablished clinical diagnosis o mild o se e e
AD [26] and had an eczema ous lesion on hei ola o ea ms.
Exclusion C i e ia:
•
Pso iasis pa ien s cu en ly ha ing non-plaque o ms o pso iasis, e.g., e y h ode mic,
gu a e, o pus ula pso iasis, o a d ug-induced o m o pso iasis.
•
Heal hy olun ee s who had p e ious pe sonal his o y o any in lamma o y skin disease.
•Clinical in ec ion on he measu ed a ea.
•His o y o cance , including skin cance .
•Subjec s wi h in ense sun exposu e du ing he s udy.
•No signing he in o med consen o m.
2.3. S udy Va iables
Main a iables o in e es
Homeos asis pa ame e s ela ed o epide mal ba ie unc ion we e measu ed. SCH
(in a bi a y uni s, using Co neome e
®
CM 825, Mi ocaya, Bilbao, Spain), TEWL (in
J. Clin. Med. 2021,10, 359 3 o 12
g
·
m
−2
h
−1
, using Tewame e
®
TM 300, Mi ocaya, Bilbao, Spain), pH (using Skin-pH-
Me e
®
PH 905, Mi ocaya, Bilbao, Spain), e y hema and melanin index (in a bi a y uni s,
using Mexame e
®
MX 18, Mi ocaya, Bilbao, Spain), skin empe a u e (in
◦
C, using Skin-
The mome e ST 500, Mi ocaya, Bilbao, Spain), and elas ici y pa ame e s (including R2
alue, measu ed in %, using Cu ome e
®
Dual MPA 580, Mi ocaya, Bilbao, Spain) we e
measu ed by a Mul i P obe Adap e (MPA, Cou age + Khazaka elec onic GmbH, Mi ocaya,
Bilbao, Spain). Elas ici y pa ame e s we e measu ed ou imes and he o he a iables we e
measu ed en imes, using hei a e age o analysis. All o hese measu emen s we e aken
ollowing he same o de . All measu emen s we e aken in he same oom a a mean oom
empe a u e o 23
±
1
◦
C and ambien ai humidi y o 45% ( ange, 40–50%). All pa icipan s
unde wen an adap a ion pe iod o a leas 20 min be o e he measu emen s we e aken.
No sys emic o opical ea men s was allowed h ee hou s be o e he measu emen s
we e aken.
These a iables we e measu ed a wo body si es in pso ia ic pa ien s (on a pso ia ic
plaque and on an unin ol ed skin a ea a he elbow), a wo body si es in AD pa ien s
(on an eczema ous lesion and on an unin ol ed skin a ea a ola o ea m), a one body
si e in heal hy olun ee s (on he elbow in con ols o pso iasis o on he ola o ea m in
con ols o a opic de ma i is).
O he a iables o in e es
Da a we e ga he ed in a clinical in e iew on he pa icipan s’ sex, age, smoking/alcohol
habi s, amily his o y o cu aneous disease, pe sonal his o y o cu aneous disease, skinca e
habi s (mois u izing o sun an lo ion use), and hou s o sun exposu e du ing he p e ious
week. Pso iasis se e i y was assessed by he PASI and body su ace a ea (BSA), and AD
se e i y was assessed by SCORAD.
2.4. Ou come Measu es
P ima y ou come measu es:
•
To assess di e ences in TEWL, SCH, and empe a u e alues be ween heal hy skin,
pso ia ic skin, and AD skin.
•
To e alua e TEWL and empe a u e alues’ abili y o disc imina e mild pso iasis
e sus mode a e/se e e pso iasis.
•
To e alua e TEWL and empe a u e alues’ abili y o disc imina e mild AD e sus
mode a e/se e e AD.
Seconda y ou come measu es:
•
To assess di e ences in o he homeos asis pa ame e s be ween heal hy skin, pso ia ic
skin, and AD skin: e y hema, melanin, pH, and elas ici y.
•
To assess di e ences in homeos asis pa ame e s be ween mild pso iasis and mode -
a e/se e e pso iasis: TEWL, SCH, empe a u e, e y hema, melanin, pH, and elas ici y.
•
To assess di e ences in homeos asis pa ame e s be ween mild AD and mode a e/se e e
AD: TEWL, SCH, empe a u e, e y hema, melanin, pH, and elas ici y.
2.5. S a is ical Analysis
In a desc ip i e analysis, con inuous a iables we e exp essed as means
±
s anda d
de ia ions (SDs) and quali a i e a iables as absolu e and ela i e equency dis ibu ions.
The S uden ’s - es o independen samples o S uden ’s - es o pai ed samples, as
app op ia e, was used o compa isons o con inuous a iables. The Pea son co ela ion
coe icien was calcula ed o es o possible co ela ions be ween con inuous a iables.
AD se e i y was analyzed o es ablish cu -o poin s using ecei e ope a ing cha ac e is ic
cu es ROC cu es o he alues o empe a u e, TEWL, and SCH. The esul s o ROC
cu es we e used o calcula e sensi i i y and speci ici y o a ious c i e ia oge he . S a is-
ical signi icance was de ined by a wo- ailed p< 0.05. SPSS e sion 24.0 (SPSS Inc, Chicago,
IL, USA) was used o s a is ical analyzes.
J. Clin. Med. 2021,10, 359 4 o 12
3. Resul s
The s udy included 314 pa icipan s, consis ing o 92 pa ien s wi h pso iasis and hei
92 con ols and 65 a opic de ma i is pa ien s and hei 65 con ols. Table 1shows he
cha ac e is ics o he sample.
Table 1.
Cha ac e is ics o he sample. This able shows sociodemog aphic ea u es in pso ia ic pa ien s, a opic de ma i is
pa ien s, and heal hy pa icipan s.
Sociodemog aphic Fea u es Pso ia ic Pa ien s
(n= 92)
Heal hy Pa icipan s
assessed on he Elbow
(n= 92)
A opic De ma i is
Pa ien s (n= 65)
Heal hy Pa icipan s
assessed on he Vola
Fo ea m (n= 65)
Age (yea s) 48.63 (15.70) 42.06 (18.59) 28.14 (19.59) 35.96 (19.03)
Sex (%)
Female 46 (50%) 57 (62%) 42 (64.6%) 48 (73.8%)
Male 46 (50%) 35 (38%) 23 (35.4%) 17 (26.2%)
Smoking habi (yes) 31 (33.7%) 12 (13%) 7 (10.8%) 6 (9.23%)
Alcohol habi (yes) 29 (31.5%) 29 (31.5%) 15 (23.1%) 10 (15.4%)
Family his o y o
pso iasis/a opic de ma i is
(yes)
43 (46.7%) 12 (13%) 32 (49.2%) 7 (10.8%)
Emollien s use (yes) 51 (55.4%) 35 (38%) 51 (78.5%) 28 (43.1%)
T ea men
Topical ea men 49 (53.26%) 39 (60%)
Sys emic ea men 23 (25%) 26 (40%)
Biologic d ugs 20 (21.7%) 0
Da a a e exp essed as ela i e (absolu e) equencies and means (s anda d de ia ions (SDs)).
3.1. Skin Homeos asis in Pso ia ic Pa ien s
Skin ba ie unc ion pa ame e s be ween heal hy, in ol ed, and unin ol ed skin in
pso ia ic pa ien s we e compa ed (Figu e 1, Table S1). TEWL was signi ican ly highe a
pso ia ic plaques (18.45 g
·
m
−2·
h
−1
) han a unin ol ed pso ia ic skin (12.06 g
·
m
−2·
h
−1
)
and heal hy skin (12.34 g
·
m
−2·
h
−1
), while no di e ences we e ound be ween unin ol ed
pso ia ic skin and heal hy skin. SCH was signi ican ly lowe a pso ia ic plaques han
unin ol ed pso ia ic skin and heal hy skin (8.71 s. 38.43 s. 44.39 AU). Tempe a u e was
highe a pso ia ic plaques han a unin ol ed pso ia ic skin (30.95 s. 30.57
◦
C,
p= 0.046
).
The e y hema index was signi ican ly highe a pso ia ic plaques han a unin ol ed
pso ia ic skin and heal hy con ols (408.44 s. 311.56 s. 285.91 AU). No di e ences in pH
o elas ici y we e ound.
This igu e shows TEWL, SCH, empe a u e, e y hema, elas ici y, and pH in pso ia ic
pa ien s, AD pa ien s, and heal hy indi iduals. The di e ences be ween heal hy skin, unin-
ol ed pso ia ic skin, and pso ia ic plaque a e obse ed in he le side o each pa ame e .
The di e ences be ween heal hy skin, unin ol ed AD skin, and AD eczema ous lesioned
skin a e ound in he igh side o each pa ame e .
The mean PASI was 6.57 (4.82), so pa ien s we e di ided in o wo g oups: PASI < 7
and PASI
≥
7 (Table 2). The e we e no di e ences in age, sex, o ea men dis ibu ion
be ween g oups. Rega ding cu en ea men , 27.1% (16/59) pa ien s wi h PASI < 7 and
21.2% (7/33) pa ien s wi h PASI
≥
7 we e ecei ing sys emic ea men wi hou di e ences
be ween g oups (p= 0.835); 20.3% (12/59) pa ien s wi h PASI < 7 and 24.2% (8/33) pa ien s
wi h PASI ≥7 we e ecei ing biologics, wi hou di e ences be ween g oups (p= 0.941).
J. Clin. Med. 2021,10, 359 5 o 12
J. Clin. Med. 2021, 10, x FOR PEER REVIEW 5 o 12
Figu e 1. Homeos asis pa ame e s be ween pso ia ic pa ien s and heal hy pa icipan s and homeos asis pa ame e s be-
ween a opic de ma i is pa ien s and heal hy pa icipan s. (A) T ansepide mal Wa e Loss (TEWL) be ween pso ia ic pa-
ien s and heal hy pa icipan s and TEWL be ween a opic de ma i is pa ien s and heal hy pa icipan s. (B) S a um
co neum hyd a ion (SCH) be ween pso ia ic pa ien s and heal hy pa icipan s and SCH be ween a opic de ma i is pa ien s
and heal hy pa icipan s. (C) Tempe a u e be ween pso ia ic pa ien s and heal hy pa icipan s and empe a u e be ween
a opic de ma i is pa ien s and heal hy pa icipan s. (D) E y hema be ween pso ia ic pa ien s and heal hy pa icipan s and
e y hema be ween a opic de ma i is pa ien s and heal hy pa icipan s. (E) Elas ici y be ween pso ia ic pa ien s and heal hy
pa icipan s and elas ici y be ween a opic de ma i is pa ien s and heal hy pa icipan s. (F) pH be ween pso ia ic pa ien s
and heal hy pa icipan s and pH be ween a opic de ma i is pa ien s and heal hy pa icipan s. Pho o cap ion: AD, a opic
de ma i is, AU, a bi a y uni s, SCH, s a um co neum hyd a ion, TEWL, T ansepide mal Wa e Loss. * p alue a e using
S uden ’s es o independen samples o compa e homeos asis pa ame e s be ween heal hy skin and unin ol ed pso-
ia ic skin. ** p alue a e using S uden ’s es o independen samples o compa e homeos asis pa ame e s be ween
heal hy skin and pso ia ic plaque. *** p alue a e using S uden ’s es o pai ed samples o compa e homeos asis pa-
ame e s be ween unin ol ed pso ia ic skin and pso ia ic plaque. # p alue a e using S uden ’s es o independen
samples o compa e homeos asis pa ame e s be ween heal hy skin and unin ol ed AD skin. ## p alue a e using S uden ’s
es o independen samples o compa e homeos asis pa ame e s be ween heal hy skin and eczema ous lesion. ### p alue
a e using S uden ’s es o pai ed samples o compa e homeos asis pa ame e s be ween AD skin and eczema ous le-
sion.
This igu e shows TEWL, SCH, empe a u e, e y hema, elas ici y, and pH in pso ia ic
pa ien s, AD pa ien s, and heal hy indi iduals. The di e ences be ween heal hy skin, un-
in ol ed pso ia ic skin, and pso ia ic plaque a e obse ed in he le side o each pa ame-
e . The di e ences be ween heal hy skin, unin ol ed AD skin, and AD eczema ous le-
sioned skin a e ound in he igh side o each pa ame e .
The mean PASI was 6.57 (4.82), so pa ien s we e di ided in o wo g oups: PASI < 7
and PASI ≥ 7 (Table 2). The e we e no di e ences in age, sex, o ea men dis ibu ion
be ween g oups. Rega ding cu en ea men , 27.1% (16/59) pa ien s wi h PASI < 7 and
21.2% (7/33) pa ien s wi h PASI ≥ 7 we e ecei ing sys emic ea men wi hou di e ences
Figu e 1.
Homeos asis pa ame e s be ween pso ia ic pa ien s and heal hy pa icipan s and homeos asis pa ame e s be ween
a opic de ma i is pa ien s and heal hy pa icipan s. (
A
) T ansepide mal Wa e Loss (TEWL) be ween pso ia ic pa ien s
and heal hy pa icipan s and TEWL be ween a opic de ma i is pa ien s and heal hy pa icipan s. (
B
) S a um co neum
hyd a ion (SCH) be ween pso ia ic pa ien s and heal hy pa icipan s and SCH be ween a opic de ma i is pa ien s and
heal hy pa icipan s. (
C
) Tempe a u e be ween pso ia ic pa ien s and heal hy pa icipan s and empe a u e be ween
a opic de ma i is pa ien s and heal hy pa icipan s. (
D
) E y hema be ween pso ia ic pa ien s and heal hy pa icipan s and
e y hema be ween a opic de ma i is pa ien s and heal hy pa icipan s. (
E
) Elas ici y be ween pso ia ic pa ien s and heal hy
pa icipan s and elas ici y be ween a opic de ma i is pa ien s and heal hy pa icipan s. (
F
) pH be ween pso ia ic pa ien s
and heal hy pa icipan s and pH be ween a opic de ma i is pa ien s and heal hy pa icipan s. Pho o cap ion: AD, a opic
de ma i is, AU, a bi a y uni s, SCH, s a um co neum hyd a ion, TEWL, T ansepide mal Wa e Loss. * p alue a e using
S uden ’s es o independen samples o compa e homeos asis pa ame e s be ween heal hy skin and unin ol ed pso ia ic
skin. ** p alue a e using S uden ’s es o independen samples o compa e homeos asis pa ame e s be ween heal hy
skin and pso ia ic plaque. *** p alue a e using S uden ’s es o pai ed samples o compa e homeos asis pa ame e s
be ween unin ol ed pso ia ic skin and pso ia ic plaque.
#
p alue a e using S uden ’s es o independen samples o
compa e homeos asis pa ame e s be ween heal hy skin and unin ol ed AD skin.
##
p alue a e using S uden ’s es o
independen samples o compa e homeos asis pa ame e s be ween heal hy skin and eczema ous lesion.
###
p alue a e
using S uden ’s es o pai ed samples o compa e homeos asis pa ame e s be ween AD skin and eczema ous lesion.

J. Clin. Med. 2021,10, 359 6 o 12
Table 2.
Homeos asis pa ame e s in pso ia ic pa ien s depending on disease se e i y. This able shows di e ences in TEWL,
SCH, empe a u e, e y hema, melanin, pH, and elas ici y be ween pa ien s wi h mild pso iasis (PASI < 7) and pa ien s wi h
mode a e/se e e pso iasis (PASI ≥7).
Skin Homeos asis
Pa ame e s
Pso ia ic Pa ien s wi h PASI < 7
(n= 59)
Pso ia ic Pa ien s wi h PASI ≥7
(n= 33) pValue pValue
Unin ol ed
Pso ia ic Skin Pso ia ic Plaques Unin ol ed Pso ia ic
Skin Pso ia ic Plaques p*p**
TEWL (g·m−2·h−1)12.18 (7.52) 17.16 (9.58) 11.86 (8.78) 20.75 (11.22) 0.855 0.109
SCH (AU) 37.76 (13.13) 10.91 (9.76) 39.63 (14.69) 4.78 (5.24) 0.531 <0.001 **
Tempe a u e (◦C) 30.51 (2.00) 30.62 (1.65) 30.66 (1.09) 31.56 (1.13) 0.639 0.005 **
E y hema (AU) 311.78 (73.15) 404.37 (73.76) 311.34 (69.90) 412.79 (67.91) 0.981 0.648
Melanin (AU) 246.49 (81.63) 193.65 (69.98) 230.05 (75.64) 188.36 (69.30) 0.422 0.770
pH 6.01 (0.64) 6.06 (1.01) 6.12 (0.56) 5.90 (0.87) 0.422 0.468
Elas ici y (%) 0.74 (0.13) 0.77 (0.20) 0.69 (0.15) 0.72 (0.17) 0.110 0.251
AU, a bi a y uni s; PASI, pso iasis a ea and se e i y index; SCH, s a um co neum hyd a ion; TEWL, ansepide mal wa e loss; * p- alue
a e using S uden ’s - es o independen samples o compa e homeos asis pa ame e s be ween unin ol ed pso ia ic skin in pso ia ic
pa ien s wi h PASI < 7 and unin ol ed pso ia ic skin in pso ia ic pa ien s wi h PASI
≥
7; ** p- alue a e using S uden ’s - es o
independen samples o compa e homeos asis pa ame e s be ween pso ia ic plaques in pso ia ic pa ien s wi h PASI < 7 and pso ia ic
plaques in pso ia ic pa ien s wi h PASI ≥7.
SCH was signi ican ly lowe in pa ien s wi h PASI
≥
7 han in pa ien s wi h
PASI < 7
on pso ia ic plaques (4.78 s. 10.91 AU, p< 0.001). Tempe a u e was highe in pa ien s wi h
PASI
≥
7 han in pa ien s wi h PASI < 7 on pso ia ic plaques (31.56 s. 30.62
◦
C,
p= 0.005
).
Mo eo e , i was obse ed ha pa ien s wi h PASI
≥
7 had nea ly signi ican ly highe TEWL
on pso ia ic plaques han pa ien s wi h PASI < 7 (20.75 s.
17.16 g·m−2h−1
,
p= 0.109
).
The e was a nega i e co ela ion be ween SCH on he plaque and PASI (
=−0.292
,
p= 0.005
), and a nea ly signi ican posi i e co ela ion be ween empe a u e on he plaque
and PASI ( = 0.187, p= 0.074).
As pa ien s wi h mode a e/se e e pso iasis (PASI
≥
7) exhibi ed highe empe a u e
alues on pso ia ic plaques, an ROC cu e was gene a ed o de e mine an op imum cu -o
alue o empe a u e ha allowed o suspec isk o mode a e/se e e pso iasis (a ea
unde he cu e = 0.68, p= 0.004). A alue o empe a u e exceeding 30.85
◦
C indica es,
wi h a sensi i i y o 72.7% and a speci ici y o 55.9%, ha a pa ien had mode a e/se e e
pso iasis. TEWL was also highe in pso ia ic pa ien s wi h mode a e/se e e PASI; hus,
when gene a ing he ROC cu e o es ablish an op imum cu -o poin o suspicion o
mode a e/se e e pso iasis (a ea unde he cu e = 0.636, p= 0.031), i was no ed ha a
TEWL alue highe han 13.85 g
·
m
−2
h
−1
indica ed ha a pa ien had mode a e/se e e
pso iasis, wi h a sensi i i y o 81.8% and a speci ici y o 50.8%. SCH was lowe in pa ien s
wi h high PASI, so a hi d ROC cu e was gene a ed o es ablish an op imum cu -o poin
o his pa ame e o iden i y possible pa ien s wi h a isk o mode a e/se e e pso iasis
(a ea unde he cu e = 0.285, p= 0.001). A alue o SCH lowe han 2.07 indica ed, wi h a
sensi i i y o 60.6% and a speci ici y o 15.3%, ha a pa ien had mode a e/se e e pso iasis.
Mo eo e , i was obse ed ha pa ien s wi h bo h empe a u e > 30.85 and TEWL > 13.85
p esen ed mode a e/se e e pso iasis, wi h a sensi i i y o 60.6% and a speci ici y o 76.3%
(Table 3).
J. Clin. Med. 2021,10, 359 7 o 12
Table 3.
Odds a ios o main pa ame e s analyzed in he s udy o p edic mode a e/se e e pso iasis (PASI
≥
7). Sensi i i y
and speci ici y alues o p edic mode a e/se e e pso iasis based on skin homeos asis pa ame e s, cu -o alues, and
odds a ios.
Skin Homeos asis Pa ame e s Cu -o Value Sensi i i y Speci ici y OR p
Tempe a u e (◦C) 30.85 72.7% 55.9% 3.39 0.010 *
TEWL (g·m−2h−1)13.85 81.8% 50.8% 4.66 0.003 *
SCH (AU) 2.07 39.4% 84.7% 0.28 0.011 *
Two c i e ia ( empe a u e > 30.85 + TEWL > 13.85)
- 60.6% 76.3% 4.95 0.001 *
AU, a bi a y uni s; OR, odds a io; PASI, pso iasis a ea and se e i y index; SCH, s a um co neum hyd a ion; TEWL, ansepide mal wa e
loss. * p alue a e using a logis ic eg ession o e alua e he associa ion be ween disease se e i y (independen a iable), as a ca ego ic
a iable (PASI < 7 o PASI
≥
7) and each skin homeos asis pa ame e cu -o poin (dependen a iable), conside ed as a ca ego ic a iable
(lowe o equal han he cu -o poin o highe han he cu -o poin ).
3.2. Skin Homeos asis in A opic De ma i is Pa ien s
Skin ba ie unc ion pa ame e s be ween heal hy, in ol ed, and unin ol ed skin
in AD pa ien s we e compa ed (Figu e 1, Table S2). TEWL was signi ican ly highe a
AD eczema ous lesions han a unin ol ed AD skin and heal hy skin (28.68 s. 13.15
s.
11.60 g·m−2·h−1
). SCH was signi ican ly lowe a AD eczema ous lesions han a
unin ol ed AD skin and heal hy skin (20.20 s. 40.95 s. 50.73 AU). Tempe a u e was
signi ican ly highe a AD eczema ous lesions han a unin ol ed AD skin and heal hy skin
(32.05 s. 31.35 s. 31.37
◦
C), while no di e ences we e ound be ween unin ol ed AD skin
and heal hy skin. The e y hema index was signi ican ly highe a AD eczema ous lesions
han heal hy skin (387.21 s. 244.44 AU). No di e ences in pH we e ound. Elas ici y was
signi ican ly lowe a AD eczema ous lesions han heal hy skin (69% s. 74% s. 76%),
while no di e ences we e ound be ween unin ol ed AD skin and heal hy skin.
The mean SCORAD was 36.96 (21.65), so pa ien s we e di ided in o wo g oups: SCO-
RAD < 37 and SOCRAD
≥
37 (Table 4). The e we e no di e ences in age, sex, o ea men
dis ibu ion be ween g oups. Rega ding cu en ea men , 30.8% (8/26) pa ien s wi h
SCORAD < 37 and 52.9% (18/34) we e ecei ing sys emic ea men wi hou di e ences
be ween g oups (p= 0.132). No pa ien was being ea ed wi h biologics.
Table 4.
Homeos asis pa ame e s in a opic de ma i is pa ien s depending on disease se e i y. This able shows di e ences
in TEWL, SCH, empe a u e, e y hema, melanin, pH, and elas ici y be ween pa ien s wi h mild AD (SCORAD < 37) and
pa ien s wi h mode a e/se e e (SCORADI ≥37).
Skin Homeos asis
Pa ame e s.
AD Pa ien s wi h SCORAD < 37
(n= 26)
AD Pa ien s wi h SCORAD ≥37
(n= 34) pValue pValue
Unin ol ed AD
Skin
AD Eczema ous
Lesion
Unin ol ed AD
Skin
AD Eczema ous
Lesion p*p**
TEWL (g·m−2h−1)10.88 (8.04) 26.33 (15.34) 13.75 (6.62) 31.67 (13.74) 0.135 0.161
SCH (AU) 47.10 (17.01) 30.68 (24.23) 34.78 (13.55) 19.90 (11.40) 0.003 * 0.044 **
Tempe a u e (◦C) 31.30 (1.04) 31.74 (1.00) 31.35 (1.46) 32.45 (1.15) 0.891 0.015 **
E y hema (AU) 201.05 (17.30) 351.78 (102.64) 254.93 (78.78) 395.71 (77.71) 0.004 * 0.361
Melanin (AU) 168.91 (37.39) 1990.04 (23.33) 212.55 (82.57) 215.24 (88.88) 0.221 0.298
pH 5.79 (0.62) 5.87 (0.61) 6.04 (0.41) 6.03 (0.47) 0.97 0.274
Elas ici y (%) 0.79 (0.11) 0.75 (0.12) 0.67 (0.16) 0.63 (0.20) 0.003 * 0.01 **
AD, a opic de ma i is; AU, a bi a y uni s; PASI, pso iasis a ea and se e i y index; SCH, s a um co neum hyd a ion; TEWL, ansepide mal
wa e loss; * p- alue a e using S uden ’s - es o independen samples o compa e homeos asis pa ame e s be ween unin ol ed AD skin
in AD pa ien s wi h SCORAD < 37 and unin ol ed AD skin in AD pa ien s wi h SCORAD
≥
37; ** p- alue a e using S uden ’s - es o
independen samples o compa e homeos asis pa ame e s be ween AD eczema ous lesion in AD pa ien s wi h SCORAD < 37 and AD
eczema ous lesion in AD pa ien s wi h SCORAD ≥37.
SCH was signi ican ly lowe in pa ien s wi h SCORAD
≥
37 han in pa ien s wi h
SCORAD < 37 bo h a unin ol ed AD skin (34.78 s. 47.10 AU, p= 0.003) and AD
eczema ous lesion (19.90 s. 30.68 AU, p= 0.044). Tempe a u e was highe in pa ien s wi h
SCORAD
≥
37 han in pa ien s wi h SCORAD < 37 a AD eczema ous lesion (32.45 s.
31.74, p= 0.015). Mo eo e , i was obse ed ha pa ien s wi h SOCRAD
≥
37 had nea ly
J. Clin. Med. 2021,10, 359 8 o 12
signi ican ly highe TEWL a he AD eczema ous lesion han pa ien s wi h SCORAD < 37
(31.67 s. 26.33 g
·
m
−2·
h
−1
,p= 0.161). No di e ences in pH o melanin we e ound.
Elas ici y was signi ican ly lowe in pa ien s wi h SCORAD
≥
37 han in pa ien s wi h
SCORAD < 37, bo h a unin ol ed AD skin (67% s. 79%, p= 0.003) and AD eczema ous
lesion (63% s. 75%, p= 0.01). Fu he mo e, a posi i e co ela ion be ween empe a u e and
SCORAD a he AD eczema ous lesions ( = 0.39, p= 0.002) was ound, and be ween TEWL
and SCORAD, bo h a he AD eczema ous lesions ( = 0.27, p= 0.036) and a unin ol ed
AD skin ( = 0.27, p= 0.038). A nega i e co ela ion be ween SCH and SCORAD bo h a
he AD eczema ous lesions ( =−0.364, p= 0.005) and a unin ol ed AD skin ( =−0.519,
p< 0.001
) was obse ed. Mo eo e , a nega i e co ela ion be ween elas ici y and SCORAD,
bo h a he AD eczema ous lesions ( =
−
0.421, p= 0.003) and a unin ol ed AD skin
( =−0.542, p< 0.001) was ound.
As pa ien s wi h mode a e/se e e AD (SCORAD
≥
37) exhibi ed highe empe a u e
alues a AD eczema ous lesions, an ROC cu e was gene a ed o de e mine an op imum
cu -o alue o empe a u e ha allowed o de e mine he isk o mode a e/se e e AD
(a ea unde he cu e = 0.71, p= 0.006). A alue o empe a u e exceeding 31.75
◦
C
indica ed, wi h a sensi i i y o 81.8% and a speci ici y o 57.7%, ha a pa ien had mode -
a e/se e e AD. TEWL was also highe in AD pa ien s wi h mode a e/se e e SCORAD;
hus, when gene a ing he ROC cu e o es ablish an op imum cu -o poin o suspicion
o mode a e/se e e AD (a ea unde he cu e = 0.633, p= 0.078), i was no ed ha a
TEWL alue highe han 23.19 g
·
m
−2·
h
−1
indica ed ha a pa ien had mode a e/se e e
AD, wi h a sensi i i y o 73.5% and a speci ici y o 53.8%. SCH was lowe in pa ien s
wi h high SCORAD, so a hi d ROC cu e was gene a ed o es ablish an op imum cu -o
poin o his pa ame e o iden i y possible pa ien s wi h a isk o mode a e/se e e AD
(a ea unde he cu e = 0.367, p= 0.083). A alue o SCH lowe han 14.54 AU indica ed,
wi h a sensi i i y o 71.9% and a speci ici y o 23.1%, ha a pa ien had mode a e/se e e
AD. Mo eo e , i was obse ed ha pa ien s wi h bo h empe a u e > 31.75
◦
C and TEWL
> 23.19 g
·
m
−2·
h
−1
p esen ed a mode a e/se e e AD, wi h a sensi i i y o 69.2% and a
speci ici y o 61.8% (Table 5).
Table 5.
Odds a ios o main pa ame e s analyzed in he s udy o p edic mode a e/se e e AD (SCORAD > 37). Sensi i i y
and speci ici y alues o p edic mode a e/se e e AD based on skin homeos asis pa ame e s, cu -o alues, and odds a io.
Skin Homeos asis Pa ame e s Cu -o Value Sensi i i y Speci ici y OR p
Tempe a u e (◦C) 31.75 81.8% 57.7% 6.14 0.003 *
TEWL (g·m−2h−1)23.19 73.5% 53.8% 3.24 0.034 *
SCH (AU) 14.54 71.9% 23.1% 0.77 0.663
Two c i e ia ( empe a u e > 31.75 + TEWL > 23.19)
- 69.2% 61.8% 3.64 0.19
AU, a bi a y uni s; OR, odds a io; SCH, s a um co neum hyd a ion; SCORAD, SCORing A opic De ma i is; TEWL, ansepide mal
wa e loss. * p alue a e using a logis ic eg ession o e alua e he associa ion be ween disease se e i y (independen a iable), as a
ca ego ic a iable (SCORAD < 37 o SCORAD
≥
37) and each skin homeos asis pa ame e cu -o poin (dependen a iable), conside ed as
a ca ego ic a iable (lowe o equal han he cu -o poin o highe han he cu -o poin ).
3.3. Skin Homeos asis Analysis be ween Pso ia ic Pa ien s and AD Pa ien s
I was obse ed ha empe a u e was highe in AD pa ien s han in pso ia ic pa ien s
bo h a unin ol ed skin (31.35 s. 30.56
◦
C, p= 0.001) and in ol ed skin (32.05 s. 30.95,
p< 0.001
). Mo eo e , TEWL was highe a eczema ous lesions han a pso ia ic plaques
(28.69 s. 18.48 g
·
m
−2·
h
−1
,p< 0.001). E y hema was lowe a eczema ous lesions han
a pso ia ic plaques (244.50 s. 311.56, p< 0.001). No di e ences in pH o elas ici y
we e ound.
4. Discussion
Skin homeos asis analysis showed di e ences be ween heal hy skin, pso ia ic skin,
and AD skin. In pso ia ic pa ien s, SCH was lowe a pso ia ic plaques han unin ol ed
pso ia ic skin and heal hy con ols. Pso ia ic plaques showed highe TEWL, empe a u e,
J. Clin. Med. 2021,10, 359 9 o 12
and e y hema alues han unin ol ed pso ia ic skin. Tempe a u e and TEWL a pso ia ic
plaques could help o iden i y mode a e/se e e pso ia ic pa ien s. In AD pa ien s, TEWL
was highe a eczema ous lesions han a unin ol ed AD skin and heal hy con ols, while
SCH was lowe . Eczema ous lesions showed highe empe a u e han unin ol ed AD skin.
Mo eo e , AD pa ien s wi h a mo e se e e disease showed highe empe a u e, highe
TEWL, and lowe SCH a hei eczema ous lesions. Tempe a u e and TEWL a eczema ous
lesions in AD pa ien s could help o iden i y AD mode a e/se e e pa ien s.
This epo shows ha he whole epide mal ba ie is a ec ed in pso ia ic pa ien s, no
only a pso ia ic plaques. Some homeos asis pa ame e s ha e p e iously been e alua ed
in pso ia ic pa ien s. O he esea ch showed highe TEWL a pso ia ic plaques han a
unin ol ed pso ia ic skin and heal hy con ols [
27
,
28
]. Ne e heless, di e ences in TEWL
alues be ween unin ol ed pso ia ic skin and heal hy con ols a e con o e sial [
27
,
28
].
Lowe SCH alues ha e been ound a pso ia ic plaques han a unin ol ed pso ia ic skin
and heal hy con ols, in ag eemen wi h ou esul s [
15
,
27
]. The di e ences in TEWL and
SCH be ween pso ia ic plaques and unin ol ed skin in he same pa ien could be explained
by a dec ease in AQP3 exp ession in plaques and pe ilesional skin [
29
]. Con o e sial
esul s ha e been epo ed o pH alues. Canna o e al. ound lowe pH alues o
pso ia ic skin [
15
], while Del ino e al. epo ed no change [
30
]. Tempe a u e and e y hema
we e also highe a pso ia ic skin, explained by i s in lamma o y pa hogenesis [
31
]. The e is
a need o eliable assessmen o pso iasis se e i y [
32
] and, o ou knowledge, he e is no
in o ma ion ega ding a cu aneous homeos asis pa ame e o assess pso iasis se e i y.
We obse ed ha a alue o empe a u e on pso ia ic plaques highe han 30.85
◦
C
indica es, wi h a sensi i i y o 72.7%, ha pso iasis is mode a e/se e e, and ha a alue
o TEWL highe han 13.85 g
·
m
−2·
h
−1
indica es, wi h a sensi i i y o 81.8%, ha pso iasis
is mode a e/se e e. This may help clinicians o objec i ely measu e pso iasis se e i y.
Fu he mo e, his s udy shows ha he whole epide mal ba ie is a ec ed in AD
pa ien s. TEWL is he mos s udied pa ame e in AD pa ien s. Like p e ious epo s,
his s udy shows ha TEWL is highe a eczema ous AD lesions han a unin ol ed AD
lesions and heal hy skin [
33
–
35
]. The inc eased TEWL alues e eal an epide mal ba ie
dys unc ion ha could be explain by ilagg in mu a ions [
14
]. Junge s ed e al. also showed
ha e y hema was inc eases a AD lesions compa ed o heal hy con ol skin, while SCH
was lowe and pH was simila a bo h loca ions in 49 pa icipan s [
14
]. Mo eo e , o he
p e ious epo s, e alua ing a smalle numbe o pa icipan s, showed ha SCH was
highe in heal hy con ols han a unin ol ed AD skin and a eczema ous lesions [
36
]. In
ag eemen wi h ou esul s, his epo shows ha he skin ba ie unc ion is deg aded in
AD pa ien s, which is speci ically exp essed in lesioned skin [
36
]. This could be explained
by a ilagg in de iciency, as his p o ein is a majo cons i uen o he s a um co neum
and con ibu es o ke a in ilamen agg ega ion [
37
]. Tempe a u e and e y hema we e
also highe a eczema ous lesions han a unin ol ed AD skin and heal hy skin, showing
in lamma o y changes in his disease [
38
]. To ou knowledge, only one p e ious epo has
e alua ed elas ici y pa ame e s in AD pa ien s [
39
]. Like ou esul s, hey obse ed a mo e
dec eased elas ici y a AD eczema ous lesions han a unin ol ed AD skin in 22 pa ien s,
wi hou including a heal hy con ol g oup. Di e ences in elas ici y may e eal ha collagen
o elas in, he main p o eins esponsible o skin elas ici y [
40
], a e o he p o eins al e ed in
AD pa ien s.
The e is sca ce in o ma ion ega ding cu aneous homeos asis pa ame e s and AD
se e i y. Co ela ions be ween skin hyd a ion and SCORAD [
22
,
41
], and be ween TEWL
and SCORAD [
42
], ha e been p e iously obse ed. Mo eo e , i has been shown ha TEWL
alues a non-in ol ed AD skin p edic s he de elopmen o AD [
43
,
44
]. Ne e heless,
cu -o poin s ha e no been es ablished o assess disease se e i y. We obse ed ha a
alue o empe a u e on he eczema ous lesion highe han 31.75
◦
C indica es, wi h a
sensi i i y o 81.8%, ha AD is mode a e/se e e, and ha a alue o TEWL highe han
23.19 g
·
m
−2·
h
−1
indica es, wi h a sensi i i y o 73.5%, ha AD is mode a e/se e e. This
esea ch could help clinicians o selec AD pa ien s ha need o be ea ed in ensi ely.