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Skin clusters and canyons: New insights from old structures
P6301
P6790
Psychosomatic evaluation of patients with atopic dermatitis Manuela Boleira, MD, Policlinica Geral do Rio de Janeiro, Rio de Janeiro, Brazil; Amanda Seba, MD, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Gisele Pires, PhD, MD, Universidade Federal do Rio de Janeiro, rio de Janeiro, Brazil; Omar Lupi da Rosa Santos, PhD, MD, Policlinica Geral do Rio de Janeiro, Rio de Janeiro, Brazil
Skin clusters and canyons: New insights from old structures Manoj Misra, PhD, Unilever R&D, Trumbull, CT, United States; Dane Drutis, Unilever R&D, Trumbull, CT, United States; Eugene Pashkovski, PhD, Unilever R&D, Trumbull, CT, United States; G. Holtom, PhD, Harvard University, Cambridge, MA, United States; Thomas Hancewicz, Unilever R&D, Trumbull, CT, United States; X. Xie, PhD, Harvard University, Cambridge, MA, United States
Atopic dermatitis (AD) is defined as a genetic inflammatory skin disease, with recurrent episodes of itching associated with eczema, often intense. Very common worldwide, with prevalence around 2% to 7% in adults. Few studies are focused on adults with AD and its impact on quality of life. Patients with AD are more anxious and depressed. Studies evaluating the impact of psychotherapy on the disease showed improvement in anxiety levels and also in the cutaneous symptoms. We conducted a qualitative and descriptive study to validate the Portuguese version of a questionnaire for psychosomatic evaluation of adult patients with AD, originally in Japanese, in the outpatients of the Immunology Service of the Hospital Clementino Fraga Filho, Rio de Janeiro. In a first stage of the study, the linguistic and cultural translation was made, followed by the application of a pretest on a sample of eight patients. After the final version of the Psychosomatic Scale for Atopic Dermatitis in Portuguese, which has 12 questions divided into 3 areas, the questionnaire was administered from November 2011 to March 2012 in our clinic patients. We applied 40 questionnaires, 64.86% women and 35.14% men, the mean age was 31.03 years; 51.35% used oral medication for AD treatment. The total Cronbach index was found to be 0.8647 (by domains: 0.9679, 0.9801, 1.0099). The linguistic and cultural translation of the questionnaire was satisfactory. This test is a fast, simple questionnaire, with easy compression and there was no cultural barriers that prevented the translation into Portuguese. Cronbach indices, which estimates the reliability of the questionnaire in a survey, was rated on the scale of Lands and Koch, as perfect. We believe that this can be a tool for assessing patients who require adjuvant therapy when presenting psychosomatic symptoms worsen their skin condition
Unlike glyph-lines which can be readily visualized on skin surface, skin canyons are anatomic microstructures that can be visualized in vivo under special imaging conditions. We have employed ex vivo and in vivo imaging techniques to improve our understanding of structureefunctional relationship of these microstructures. Stimulated Raman scattering (SRS) microscopy is emerging as a fundamental method for simultaneously visualizing structural and chemical features of skin. Three-dimensional representation of chemical substructure throughout epidermis is achieved by acquiring images from focal planes up to 100 m below the surface of the skin. Chemical specificity for protein, lipid and water content of the skin can be obtained without requiring the introduction of external labels. SRS signals are directly proportional to molecular concentration and thus provide a high level of chemical contrast in the images. SRS imaging shows the unique organization of corneocytes and how the structure changes deeper into the skin. In the stratum corneum, cells are organized into clusters that can range from 100-250 m in width across the surface. These cell clusters are separated by intercluster spaces, which are referred to as canyons. The canyons range in width between 10 and 30 m in the stratum corneum, and often extend in depth to dermoepidermal junction. The chemical specificity of the technique allows for examination of the lipid distribution in different regions of the skin. A distinct concentration of lipid-like material is invariably seen near the surface of skin in the canyon regions. SRS was used for water mapping and water was found to be located almost exclusively within the cell clusters, with minimal water signal detected from the canyons. Analysis of the water signal through an image depth stack shows the water content increasing as a function of depth in skin clusters, with a rapid increase at the transition from stratum corneum to viable cells as also demonstrated using in vivo confocal Raman spectroscopy. The structural observations in the research presented here provides insights into the role of canyons in dry skin formation, where the ultimate aim is to provide better treatment options.
Commercial support: None identified.
100% is sponsored by Unilever R&D.
P6808 Relative roles of surfactant interactions with proteins and lipids in cleanser-induced skin dryness K. P. Ananthapadmanabhan, PhD, Unilever R&D, Trumbull, CT, United States; Anthony Cece, MS, Unilever R&D, Trumbull, CT, United States; Carol Vincent, MS, Unilever R&D, Trumbull, CT, United States; Lin Yang, PhD, Unilever R&D, Trumbull, CT, United States Skin cleansing is an essential part of hygiene and daily skin care. Cleanser surfactants are designed to remove oily soils, dirt, sweat and sebum from skin. During cleansing surfactants can, however, interact with stratum corneum (SC), leading to skin irritation, itch, and dryness. The skin irritation potential of surfactants has been correlated with their ability to denature model proteins and cause swelling of collagen and stratum corneum. In contrast, factors that lead to skin dryness are less understood. In this paper, protein and lipid interaction tendencies of 10 commonly used surfactants are presented and the results are correlated with their in vivo skin drying potential as measured in a leg controlled application test. As expected, surfactants that showed high protein damage potential in in vitro tests caused high in vivo skin dryness. Importantly, the surfactants that showed high lipid damage potential in in vitro studies with minimal or no protein damage also caused in vivo skin dryness. The latter surfactants also showed higher tendency to solubilize skin lipids, such as cholesterol and medium chain fatty acids. Clearly these findings and correlations show the importance of surfactant interactions with skin lipids and their relevance to skin dryness. In order to develop an understanding of the relative importance of damage to proteins versus lipids in causing cleanser-induced skin dryness, a mildness map has been created in which surfactants are positioned on the map depending upon their tendency to damage proteins and lipids in in vitro tests. Ranking of the 11 surfactants on the map according to their in vivo skin dryness scores shows that surfactants with similar skin dryness scores cluster in certain regions on the map and it is possible to designate zones of increasing skin dryness with increase in either protein or lipid damage potential. The results presented also show that sodium cocoyl glycinate (SCG), an aminoacid based surfactant that is used in facial cleansing applications, is similar to sodium cocoyl isethionate (SCI) in its mildness towards both proteins and its propensity to cause minimal skin dryness. The mildness map thus offers a reliable, relevant prediction for the skin drying potential of surfactants in vivo, and establishes for the first time the relative importance of protein and lipid damage in skin dryness. 100% is sponsored by Unilever R&D.
AB78
J AM ACAD DERMATOL
P7006 Stratum corneum fatty acids: Their critical role in preserving barrier integrity during cleansing K. P. Ananthapadmanabhan, Unilever R&D, Trumbull, CT, United States; Prem Chandar, Unilever R&D, Trumbull, CT, United States; Surajit Mukherjee, Unilever R&D, Trumbull, CT, United States Stratum corneum (SC) bilayer lipids, specifically ceramides, cholesterol, and fatty acids, such as stearic acid, contribute to the permeability barrier function of the skin as part of the lipid component of the SC. Normal skin cleansing is associated with damage to the SC lipids because cleanser surfactants, in addition to providing the desired effect of solubilizing and facilitating the removal of sebum and skin soils, have a propensity to disrupt bilayer lipids by extracting endogenous skin lipids or intercalating into the bilayer. Disrupted SC lipids are associated with a variety of pathologic skin conditions, including dry skin induced by harsh cleansing. In an attempt to preserve the barrier and mitigate the damage caused by frequent normal cleansing, the incorporation of physiologically relevant lipids into skin cleansers has become common in leading cleansing products. It has been found that fatty acids are more susceptible to surfactant-induced removal than other lipids (eg, ceramides), an observation that may form the basis for a critically important strategy for replenishing SC lipids. This review will focus on the role of fatty acids in the structure and function of the SC, and the rationale for incorporation of stearic acid into moisturizing body cleansers to minimize surfactant extraction and replenish lost fatty acids in order to promote skin barrier preservation. 100% is sponsored by Unilever R&D.
APRIL 2013
P6790
Psychosomatic evaluation of patients with atopic dermatitis Manuela Boleira, MD, Policlinica Geral do Rio de Janeiro, Rio de Janeiro, Brazil; Amanda Seba, MD, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Gisele Pires, PhD, MD, Universidade Federal do Rio de Janeiro, rio de Janeiro, Brazil; Omar Lupi da Rosa Santos, PhD, MD, Policlinica Geral do Rio de Janeiro, Rio de Janeiro, Brazil
Skin clusters and canyons: New insights from old structures Manoj Misra, PhD, Unilever R&D, Trumbull, CT, United States; Dane Drutis, Unilever R&D, Trumbull, CT, United States; Eugene Pashkovski, PhD, Unilever R&D, Trumbull, CT, United States; G. Holtom, PhD, Harvard University, Cambridge, MA, United States; Thomas Hancewicz, Unilever R&D, Trumbull, CT, United States; X. Xie, PhD, Harvard University, Cambridge, MA, United States
Atopic dermatitis (AD) is defined as a genetic inflammatory skin disease, with recurrent episodes of itching associated with eczema, often intense. Very common worldwide, with prevalence around 2% to 7% in adults. Few studies are focused on adults with AD and its impact on quality of life. Patients with AD are more anxious and depressed. Studies evaluating the impact of psychotherapy on the disease showed improvement in anxiety levels and also in the cutaneous symptoms. We conducted a qualitative and descriptive study to validate the Portuguese version of a questionnaire for psychosomatic evaluation of adult patients with AD, originally in Japanese, in the outpatients of the Immunology Service of the Hospital Clementino Fraga Filho, Rio de Janeiro. In a first stage of the study, the linguistic and cultural translation was made, followed by the application of a pretest on a sample of eight patients. After the final version of the Psychosomatic Scale for Atopic Dermatitis in Portuguese, which has 12 questions divided into 3 areas, the questionnaire was administered from November 2011 to March 2012 in our clinic patients. We applied 40 questionnaires, 64.86% women and 35.14% men, the mean age was 31.03 years; 51.35% used oral medication for AD treatment. The total Cronbach index was found to be 0.8647 (by domains: 0.9679, 0.9801, 1.0099). The linguistic and cultural translation of the questionnaire was satisfactory. This test is a fast, simple questionnaire, with easy compression and there was no cultural barriers that prevented the translation into Portuguese. Cronbach indices, which estimates the reliability of the questionnaire in a survey, was rated on the scale of Lands and Koch, as perfect. We believe that this can be a tool for assessing patients who require adjuvant therapy when presenting psychosomatic symptoms worsen their skin condition
Unlike glyph-lines which can be readily visualized on skin surface, skin canyons are anatomic microstructures that can be visualized in vivo under special imaging conditions. We have employed ex vivo and in vivo imaging techniques to improve our understanding of structureefunctional relationship of these microstructures. Stimulated Raman scattering (SRS) microscopy is emerging as a fundamental method for simultaneously visualizing structural and chemical features of skin. Three-dimensional representation of chemical substructure throughout epidermis is achieved by acquiring images from focal planes up to 100 m below the surface of the skin. Chemical specificity for protein, lipid and water content of the skin can be obtained without requiring the introduction of external labels. SRS signals are directly proportional to molecular concentration and thus provide a high level of chemical contrast in the images. SRS imaging shows the unique organization of corneocytes and how the structure changes deeper into the skin. In the stratum corneum, cells are organized into clusters that can range from 100-250 m in width across the surface. These cell clusters are separated by intercluster spaces, which are referred to as canyons. The canyons range in width between 10 and 30 m in the stratum corneum, and often extend in depth to dermoepidermal junction. The chemical specificity of the technique allows for examination of the lipid distribution in different regions of the skin. A distinct concentration of lipid-like material is invariably seen near the surface of skin in the canyon regions. SRS was used for water mapping and water was found to be located almost exclusively within the cell clusters, with minimal water signal detected from the canyons. Analysis of the water signal through an image depth stack shows the water content increasing as a function of depth in skin clusters, with a rapid increase at the transition from stratum corneum to viable cells as also demonstrated using in vivo confocal Raman spectroscopy. The structural observations in the research presented here provides insights into the role of canyons in dry skin formation, where the ultimate aim is to provide better treatment options.
Commercial support: None identified.
100% is sponsored by Unilever R&D.
P6808 Relative roles of surfactant interactions with proteins and lipids in cleanser-induced skin dryness K. P. Ananthapadmanabhan, PhD, Unilever R&D, Trumbull, CT, United States; Anthony Cece, MS, Unilever R&D, Trumbull, CT, United States; Carol Vincent, MS, Unilever R&D, Trumbull, CT, United States; Lin Yang, PhD, Unilever R&D, Trumbull, CT, United States Skin cleansing is an essential part of hygiene and daily skin care. Cleanser surfactants are designed to remove oily soils, dirt, sweat and sebum from skin. During cleansing surfactants can, however, interact with stratum corneum (SC), leading to skin irritation, itch, and dryness. The skin irritation potential of surfactants has been correlated with their ability to denature model proteins and cause swelling of collagen and stratum corneum. In contrast, factors that lead to skin dryness are less understood. In this paper, protein and lipid interaction tendencies of 10 commonly used surfactants are presented and the results are correlated with their in vivo skin drying potential as measured in a leg controlled application test. As expected, surfactants that showed high protein damage potential in in vitro tests caused high in vivo skin dryness. Importantly, the surfactants that showed high lipid damage potential in in vitro studies with minimal or no protein damage also caused in vivo skin dryness. The latter surfactants also showed higher tendency to solubilize skin lipids, such as cholesterol and medium chain fatty acids. Clearly these findings and correlations show the importance of surfactant interactions with skin lipids and their relevance to skin dryness. In order to develop an understanding of the relative importance of damage to proteins versus lipids in causing cleanser-induced skin dryness, a mildness map has been created in which surfactants are positioned on the map depending upon their tendency to damage proteins and lipids in in vitro tests. Ranking of the 11 surfactants on the map according to their in vivo skin dryness scores shows that surfactants with similar skin dryness scores cluster in certain regions on the map and it is possible to designate zones of increasing skin dryness with increase in either protein or lipid damage potential. The results presented also show that sodium cocoyl glycinate (SCG), an aminoacid based surfactant that is used in facial cleansing applications, is similar to sodium cocoyl isethionate (SCI) in its mildness towards both proteins and its propensity to cause minimal skin dryness. The mildness map thus offers a reliable, relevant prediction for the skin drying potential of surfactants in vivo, and establishes for the first time the relative importance of protein and lipid damage in skin dryness. 100% is sponsored by Unilever R&D.
AB78
J AM ACAD DERMATOL
P7006 Stratum corneum fatty acids: Their critical role in preserving barrier integrity during cleansing K. P. Ananthapadmanabhan, Unilever R&D, Trumbull, CT, United States; Prem Chandar, Unilever R&D, Trumbull, CT, United States; Surajit Mukherjee, Unilever R&D, Trumbull, CT, United States Stratum corneum (SC) bilayer lipids, specifically ceramides, cholesterol, and fatty acids, such as stearic acid, contribute to the permeability barrier function of the skin as part of the lipid component of the SC. Normal skin cleansing is associated with damage to the SC lipids because cleanser surfactants, in addition to providing the desired effect of solubilizing and facilitating the removal of sebum and skin soils, have a propensity to disrupt bilayer lipids by extracting endogenous skin lipids or intercalating into the bilayer. Disrupted SC lipids are associated with a variety of pathologic skin conditions, including dry skin induced by harsh cleansing. In an attempt to preserve the barrier and mitigate the damage caused by frequent normal cleansing, the incorporation of physiologically relevant lipids into skin cleansers has become common in leading cleansing products. It has been found that fatty acids are more susceptible to surfactant-induced removal than other lipids (eg, ceramides), an observation that may form the basis for a critically important strategy for replenishing SC lipids. This review will focus on the role of fatty acids in the structure and function of the SC, and the rationale for incorporation of stearic acid into moisturizing body cleansers to minimize surfactant extraction and replenish lost fatty acids in order to promote skin barrier preservation. 100% is sponsored by Unilever R&D.
APRIL 2013