ABSTRACT
BACKGROUND: Atopic dermatitis is a chronic relapsing inflammatory skin disease characterized by dry skin, pruritus, and typical distribution of the lesions. Because an objective tool for the assessment of disease severity of atopic dermatitis has yet to be agreed upon, many dermatologists are dependent on subjective history and clinical scoring. Recently, instrumental measurements have been used for the assessment of skin barrier function. OBJECTIVE: The purpose of this study was to assess the correlation between SCORAD (scoring of atopic Dermatitis) index and the results of instrumental assessments of disease severity in atopic dermatitis. Additionally, we compared the values of instrumental measurements on normal and lesional skin. METHODS: From February to April 2007, 44 patients with atopic dermatitis were treated with topical steroids, topical calcineurine inhibitors, oral antihistamine agents and systemic steroids. At initial visit, and after 1, 2, 3, and 4 weeks of treatment, the SCORAD index was measured, and instrumental measurements of skin surface hydration (SSH), transepidermal water loss (TEWL), and pH were performed on the antecubital fossa (lesional skin) and flank (normal skin) of the patients by Corneometer(R), Tewameter(R), and skin-pH-meter(R). RESULTS: Significant correlation was found between SCORAD index and SSH (p<0.0001), TEWL (p<0.0001), and pH (p=0.1680). SSH and TEWL improved within 1 week of treatment but pH improved after 2 weeks of treatment. Instrumental assessments showed lesional skin had lower SSH, higher TEWL, and more alkaline pH than normal skin. CONCLUSION: Instrumental measurements showed correlation with SCORAD index. Therefore, we can use instrumental assessments as well as SCORAD index in the assessment of disease severity of AD.
ABSTRACT
BACKGROUND: Xerosis is commonly seen in patients in intensive care units (ICU), and is sometimes accompanied by itching sensation and dermatitis. However, xerosis in ICU patients is often missed by doctors who are trained to attend to the more serious conditions that can become life-threatening. OBJECTIVE: The purpose of this study is to evaluate xerosis of ICU patients objectively, by measuring hydration levels of the skin. METHOD: To investigate hydration levels of the skin in ICU patients, a corneometer was used to measure the skin's capacitance. The experimental group consisted of 106 ICU patients, while the control group was made up of 53 outpatients visiting the dermatology department. RESULTS: ICU patients showed decreased skin surface hydration, and its level was inversely correlated with the duration of ICU admission. However, no correlation between age and skin surface hydration was observed in either the ICU patients or the control group. The actual humidity of the ICU was 5% lower than that of the outpatient dermatologic clinic. The severity of systemic diseases can also influence the development of xerosis. CONCLUSION: The decreased skin surface hydration in ICU patients correlated with the prolonged ICU stay, which seemed to be associated with the dry environment of the ICU or the severity of the systemic diseases causing dry skin. The increased incidence of xerosis in ICU patients can be explained by the decreased skin surface hydration.