Emollient Therapy and Skin Barrier Function

Chapter

Abstract

Conventional treatment of dry skin conditions involves the chronic application of emollients or moisturisers in order to replace the skin’s water content and restore barrier integrity. However, a number of studies in the literature have also highlighted the ability of specific emollient products to compromise the skin’s protective role. Two specific products (Locabase® and Aqueous Cream B.P.) are considered in this chapter. Their effects on skin barrier integrity have been studied using a combination of molecular and biophysical approaches. The changes following short-term or chronic application to human skin are reviewed, and possible reasons for their influence on skin health are also discussed.

Keywords

Stratum Corneum Sodium Lauryl Sulphate Electrical Capacitance Stratum Granulosum Skin Barrier Function 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Washington C, Washington N (1989) Drug delivery to the skin. In: Wilson CG, Washington N (eds) Physiological pharmaceutics: biological barriers to drug absorption. Ellis Horwood Limited, Chichester, pp 109–120Google Scholar
  2. 2.
    Walters KA, Roberts MS (2002) The structure and function of skin. In: Walters KA (ed) Dermatological and transdermal formulations. Marcel Dekker, Inc, New York, pp 1–39CrossRefGoogle Scholar
  3. 3.
    Scheuplein RJ (1971) Permeability of the skin. Physiol Rev 51:702–747PubMedGoogle Scholar
  4. 4.
    Egelrud T (2000) Desquamation in the stratum corneum. Acta Derm Venereol Suppl (Stockh) 208:44–45Google Scholar
  5. 5.
    Michaels AS, Chandrasekaran SK, Shaw JE (1975) Drug permeation through human skin: theory and in vitro experimental measurement. AIChE J 21:985–996CrossRefGoogle Scholar
  6. 6.
    Suhonen TM, Bouwstra JA, Urtti A (1999) Chemical enhancement of percutaneous absorption in relation to stratum corneum structural alterations. J Control Release 59:149–161CrossRefGoogle Scholar
  7. 7.
    Kalinin AE, Kajava AV, Steinert PM (2002) Epithelial barrier function: assembly and structural features of the cornified cell envelope. Bioessays 24:789–800PubMedCrossRefGoogle Scholar
  8. 8.
    Swartzendruber DC, Wertz PW, Madison KC, Downing DT (1987) Evidence that the corneocyte has a chemically bound lipid envelope. J Invest Dermatol 88:709–713PubMedCrossRefGoogle Scholar
  9. 9.
    Kalinin A, Marekov LN, Steinert PM (2001) Assembly of the epidermal cornified cell envelope. J Cell Sci 114:3069–3070PubMedGoogle Scholar
  10. 10.
    Michel S, Schmidt R, Shroot B, Reichert U (1988) Morphological and biochemical characterization of the cornified envelopes from human epidermal keratinocytes of different origin. J Invest Dermatol 91:11–15PubMedCrossRefGoogle Scholar
  11. 11.
    Hirao T, Denda M, Takahashi M (2001) Identification of immature cornified envelopes in the barrier-impaired epidermis by characterization of their hydrophobicity and antigenicities of the components. Exp Dermatol 10:35–44PubMedCrossRefGoogle Scholar
  12. 12.
    Madison KC (2003) Barrier function of the skin: “La raison d’etre” of the epidermis. J Invest Dermatol 121:231–241PubMedCrossRefGoogle Scholar
  13. 13.
    Bouwstra JA, Honeywell-Nguyen PL, Gooris GS, Ponec M (2003) Structure of the skin barrier and its modulation by vesicular formulations. Prog Lipid Res 42:1–36PubMedCrossRefGoogle Scholar
  14. 14.
    Elias PM, Feingold KR, Tsai J, Thornfeldt C, Menon G (2003) Metabolic approach to transdermal drug delivery. In: Guy RH, Hadgraft J (eds) Transdermal drug delivery, 2nd edn, Revised and expanded. Marcel Dekker, New York, pp 285–305Google Scholar
  15. 15.
    Landmann L (1986) Epidermal permeability barrier: transformation of lamellar granule-disks into intercellular sheets by a membrane-fusion process, a freeze-fracture study. J Invest Dermatol 87:202–209PubMedCrossRefGoogle Scholar
  16. 16.
    Downing DT (1992) Lipid and protein structures in the permeability barrier of mammalian epidermis. J Lipid Res 33:301–313PubMedGoogle Scholar
  17. 17.
    Katz M, Poulsen BJ (1971) Absorption of drug through the skin. In: Brodie BB, Gilette JR (eds) Handbook of experimental pharmacology. Springer, Berlin, pp 103–174Google Scholar
  18. 18.
    Sun TT, Green H (1978) Keratin filaments of cultured human epidermal cells. Formation of intermolecular disulfide bonds during terminal differentiation. J Biol Chem 253:2053–2060PubMedGoogle Scholar
  19. 19.
    Kurihara-Bergstrom T, Good WR (1987) Skin development and permeability. J Control Release 6:51–58CrossRefGoogle Scholar
  20. 20.
    Rawlings N, Barrett A (1999) MEROPS: the peptidase database. Nucleic Acids Res 27:325–331PubMedCrossRefGoogle Scholar
  21. 21.
    Milstone LM (2004) Epidermal desquamation. J Dermatol Sci 36(3):131–140PubMedCrossRefGoogle Scholar
  22. 22.
    Yousef GM, Diamandis EP (2001) The new human tissue kallikrein gene family: structure, function, and association to disease. Endocr Rev 22:184–204PubMedCrossRefGoogle Scholar
  23. 23.
    Yousef GM, Diamandis EP (2002) Human tissue kallikreins: a new enzymatic cascade pathway? Biol Chem 383:1045–1057PubMedCrossRefGoogle Scholar
  24. 24.
    Brattsand M, Stefansson K, Lundh C, Haasum Y, Egelrud T (2004) A proteolytic cascade of kallikreins in the stratum corneum. J Invest Dermatol 124:198–203CrossRefGoogle Scholar
  25. 25.
    Borgono CA, Michael IP, Diamandis EP (2004) Human tissue kallikreins: physiologic roles and applications in cancer. Mol Cancer Res 2:257–280PubMedGoogle Scholar
  26. 26.
    Komatsu N, Saijoh K, Toyama T, Ohka R, Otsuki N, Hussack G, Takehara K, Diamandis EP (2005) Multiple tissue kallikrein mRNA and protein expression in normal skin and skin diseases. Br J Dermatol 153:274–281PubMedCrossRefGoogle Scholar
  27. 27.
    Suzuki Y, Nomura J, Hori J, Koyama J, Takahashi M, Horii I (1993) Detection and characterization of endogenous protease associated with desquamation of stratum corneum. Arch Dermatol Res 285:372–377PubMedCrossRefGoogle Scholar
  28. 28.
    Hachem J-P, Man M-Q, Crumrine D, Uchida Y, Brown BE, Rogiers V, Roseeuw D, Feingold KR, Elias PM (2005) Sustained serine proteases activity by prolonged increase in pH leads to degradation of lipid processing enzymes and profound alterations of barrier function and stratum corneum integrity. J Invest Dermatol 125:510–520PubMedCrossRefGoogle Scholar
  29. 29.
    Overloop LV, Declercq L, Maes D (2001) Visual scaliness of human skin correlates to decreased ceramide levels and decreased stratum corneum protease activity. J Invest Dermatol 117:811Google Scholar
  30. 30.
    Voegeli R, Rawlings AV, Breternitz M, Doppler S, Schreier T, Fluhr JW (2009) Increased stratum corneum serine protease activity in acute eczematous atopic skin. Br J Dermatol 161:70–77PubMedCrossRefGoogle Scholar
  31. 31.
    Egelrud T, Brattsand M, Kreutzmann P, Walden M, Vitzithum K, Marx UC, Forssmann WG, Mägert HJ (2005) hK5 and hK7, two serine proteinases abundant in human skin, are inhibited by LEKTI domain 6. Br J Dermatol 153:1200–1203PubMedCrossRefGoogle Scholar
  32. 32.
    Hansson L, Stromqvist M, Backman A, Wallbrandt P, Carlstein A, Egelrud T (1994) Cloning, expression, and characterization of stratum corneum chymotryptic enzyme. A skin-specific human serine proteinase. J Biol Chem 269:19420–19426PubMedGoogle Scholar
  33. 33.
    Brattsand M, Egelrud T (1999) Purification, molecular cloning, and expression of a human stratum corneum trypsin-like serine protease with possible function in desquamation. J Biol Chem 274:30033–30040PubMedCrossRefGoogle Scholar
  34. 34.
    Harding CR, Watkinson A, Rawlings AV, Scott IR (2000) Dry skin, moisturization and corneodesmolysis. Int J Cosmet Sci 22:21–52PubMedCrossRefGoogle Scholar
  35. 35.
    Voegeli R, Rawlings AV, Doppler S, Heiland J, Schreier T (2007) Profiling of serine protease activities in human stratum corneum and detection of a stratum corneum tryptase-like enzyme. Int J Cosmet Sci 29:191–200PubMedCrossRefGoogle Scholar
  36. 36.
    Denda M, Kitamura K, Elias PM, Feingold KK (1997) Trans-4-(aminomethyl)cyclohexane carboxylic acid (T-AMCHA), an anti-fibrinolytic agent, accelerates barrier recovery and prevents the epidermal hyperplasia induced by epidermal injury in hairless mice and humans. J Invest Dermatol 109:84–90PubMedCrossRefGoogle Scholar
  37. 37.
    McConnell RM, York JL, Frizzell D, Ezell C (1993) Inhibition studies of some serine and thiol proteinases by new leupeptin analogs. J Med Chem 36:1084–1089PubMedCrossRefGoogle Scholar
  38. 38.
    Brockow K, Abeck D, Hermann K, Ring J (1996) Tryptase concentration in skin blister fluid from patients with bullous skin conditions. Arch Dermatol Res 288:771–773PubMedCrossRefGoogle Scholar
  39. 39.
    Endo K, Suzuki N, Yoshida O, Sato H, Fujikura Y (2007) The barrier component and the driving force component of transepidermal water loss and their application to skin irritant tests. Skin Res Technol 13:425–435PubMedCrossRefGoogle Scholar
  40. 40.
    Farahmand S, Tien L, Hui X, Maibach HI (2009) Measuring transepidermal water loss: a comparative in vivo study of condenser-chamber, unventilated-chamber and open-chamber systems. Skin Res Technol 15:392–398PubMedCrossRefGoogle Scholar
  41. 41.
    Kawai E, Kohno Y, Ogawa K, Sakuma K, Yoshikawa N, Aso D (2002) Can inorganic powders provide any biological benefit in stratum corneum, while residing on skin surface? IFSCC Mag 5(4):269–275Google Scholar
  42. 42.
    Voegeli R, Rawlings AV, Doppler S, Schreier T (2008) Increased basal transepidermal water loss leads to elevation of some but not all stratum corneum serine proteases. Int J Cosmet Sci 30:435–442PubMedCrossRefGoogle Scholar
  43. 43.
    Imhof RE, De Jesus MEP, Xiao P, Ciortea LI, Berg EP (2009) New developments in skin barrier measurements. In: Rawlings AV, Leyden JJ (eds) Skin moisturization, 2nd edn, Cosmetic science and technology series. Informa Healthcare, New York, pp 463–479CrossRefGoogle Scholar
  44. 44.
    Frödin T, Helander P, Molin L, Skogh M (1988) Hydration of human stratum corneum studied in vivo by optothermal infrared spectrometry, electrical capacitance measurement, and evaporimetry. Acta Derm Venereol 68(6):461–467PubMedGoogle Scholar
  45. 45.
    Bodor ET, Offermanns S (2008) Nicotinic acid: an old drug with a promising future. Br J Pharmacol 153(S1):S68–S75PubMedCrossRefGoogle Scholar
  46. 46.
    Cronin E, Stoughton RB (1962) Percutaneous absorption. Regional variations and the effect of hydration and epidermal stripping. Br J Dermatol 74:265–272PubMedCrossRefGoogle Scholar
  47. 47.
    Barrett CW, Hadgraft JW, Sarkany I (1964) The influence of vehicles on skin penetration. J Pharm Pharmacol 16(Suppl):104T–107TCrossRefGoogle Scholar
  48. 48.
    Tur E, Guy RH, Tur M, Maibach HI (1983) Noninvasive assessment of local nicotinate pharmacodynamics by photoplethysmography. J Invest Dermatol 80:499–503PubMedCrossRefGoogle Scholar
  49. 49.
    Leopold CS, Maibach HI (1996) Effect of lipophilic vehicles on in vivo skin penetration of methyl nicotinate in different races. Int J Pharm 139:161–167CrossRefGoogle Scholar
  50. 50.
    Bonina FP, Montenegro L, Scrofani N, Esposito E, Cortesi R, Menegatti E, Nastruzzi C (1995) Effects of phospholipid based formulations on in vitro and in vivo percutaneous absorption of methyl nicotinate. J Control Release 34:53–63CrossRefGoogle Scholar
  51. 51.
    Duval C, Lindberg M, Boman A, Johnsson S, Edlund F, Loden M (2003) Differences among moisturizers in affecting skin susceptibility to hexyl nicotinate measured as time to increase skin blood flow. Skin Res Technol 9:59–63PubMedCrossRefGoogle Scholar
  52. 52.
    Thune P, Nilsen T, Hanstad IK, Gustavsen T, Lövig Dahl H, Thune P, Nilsen T, Hanstad IK, Gustavsen T, Lövig Dahl H (1988) The water barrier function of the skin in relation to the water content of stratum corneum, pH and skin lipids. The effect of alkaline soap and syndet on dry skin in elderly, non-atopic patients. Acta Derm Venereol 68(4):277–283PubMedGoogle Scholar
  53. 53.
    Lodén M (1995) Biophysical properties of dry atopic and normal skin with special reference to effects of skin care products. Acta Derm Venereol Suppl (Stockh) 192:1–48Google Scholar
  54. 54.
    Di Nardo A, Wertz P, Giannetti A, Seidenari S (1998) Ceramide and cholesterol composition of the skin of patients with atopic dermatitis. Acta Derm Venereol 78(1):27–30PubMedCrossRefGoogle Scholar
  55. 55.
    Flohr C, England K, Radulovic S, McLean WH, Campbel LE, Barker J, Perkin M, Lack G (2010) Filaggrin loss-of-function mutations are associated with early-onset eczema, eczema severity and transepidermal water loss at 3 months of age. Br J Dermatol 163(6):1333–1336PubMedCrossRefGoogle Scholar
  56. 56.
    Agner T, Held E, West W, Gray J (2000) Evaluation of an experimental patch test model for the detection of irritant skin reactions to moisturisers. Skin Res Technol 6:250–254PubMedCrossRefGoogle Scholar
  57. 57.
    Halkier-Sørensen L, Thestrup-Pedersen K (1993) The efficacy of a moisturizer (Locobase) among cleaners and kitchen assistants during everyday exposure to water and detergents. Contact Dermatitis 29(5):266–271PubMedCrossRefGoogle Scholar
  58. 58.
    Ramsing DW, Agner T (1997) Preventive and therapeutic effects of a moisturizer. An experimental study of human skin. Acta Derm Venereol 77(5):335–337PubMedGoogle Scholar
  59. 59.
    Held E, Sveinsdóttir S, Agner T (1999) Effect of long-term use of moisturizer on skin hydration, barrier function and susceptibility to irritants. Acta Derm Venereol 79(1):49–51PubMedCrossRefGoogle Scholar
  60. 60.
    Held E, Agner T (2001) Effect of moisturizers on skin susceptibility to irritants. Acta Derm Venereol 81(2):104–107PubMedCrossRefGoogle Scholar
  61. 61.
    Zachariae C, Held E, Johansen JD, Menné T, Agner T (2003) Effect of a moisturizer on skin susceptibility to NiCl2. Acta Derm Venereol 83(2):93–97, ++PubMedCrossRefGoogle Scholar
  62. 62.
    General Medical Council (Great Britain) (1958) British pharmacopoeia. The Pharmaceutical Press, London, pp 245–246, 1012 ppGoogle Scholar
  63. 63.
    British National Formulary 60. British Medical Association, Royal Pharmaceutical Society. Sept 2010:689–690Google Scholar
  64. 64.
    Gloor M, Hauth A, Gehring W (2003) O/W emulsions compromise the stratum corneum barrier and improve drug penetration. Pharmazie 58(10):709–715PubMedGoogle Scholar
  65. 65.
    Lapsley P (2000) Emollients – ADR concern (letter). Pharm J 265:555Google Scholar
  66. 66.
    Cork MJ, Timmins J, Holden C, Carr J, Berry V, Tazi-Ahnini R, Ward SJ (2003) An audit of adverse drug reactions to aqueous cream in children with atopic eczema. Pharm J 271:747–748Google Scholar
  67. 67.
    Tsang M, Guy RH (2010) Effect of Aqueous Cream BP on human stratum corneum in vivo. Br J Dermatol 163(5):954–958PubMedCrossRefGoogle Scholar
  68. 68.
    Kalia YN, Pirot F, Guy RH (1996) Homogeneous transport in a heterogeneous membrane: water diffusion across human stratum corneum in vivo. Biophys J 71:2692–2700PubMedCrossRefGoogle Scholar
  69. 69.
    Mohammed D, Matts PJ, Hadgraft J, Lane ME (2011) Influence of Aqueous Cream BP on corneocyte size, maturity, skin protease activity, protein content and transepidermal water loss. Br J Dermatol 164(6):1304–1310PubMedCrossRefGoogle Scholar
  70. 70.
    Danby SG, Al-Enezi T, Sultan A, Chittock J, Kennedy K, Cork MJ (2011) The effect of aqueous cream BP on the skin barrier in volunteers with a previous history of atopic dermatitis. Br J Dermatol 165(2):329–334PubMedCrossRefGoogle Scholar
  71. 71.
    Pecegueiro M, Brandão M, Pinto J, Conçalo S (1987) Contact dermatitis to Hirudoid cream. Contact Dermatitis 17(5):290–293PubMedCrossRefGoogle Scholar
  72. 72.
    Hannuksela M (1988) Skin contact allergy to emulsifiers. Int J Cosmet Sci 10:9–14PubMedCrossRefGoogle Scholar
  73. 73.
    Wilson CL, Cameron J, Powell SM, Cherry G, Ryan TJ (1991) High incidence of contact dermatitis in leg-ulcer patients-implications for management. Clin Exp Dermatol 16(4):250–253PubMedCrossRefGoogle Scholar
  74. 74.
    Plötz SG, Ring J (2010) What’s new in atopic eczema? Expert Opin Emerg Drugs 15(2):249–267PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Department of PharmaceuticsSchool of PharmacyLondonUK

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