The early phase of epidermal barrier regeneration is faster in patients with atopic eczema

Background: Altered epidermal barrier function as determined by transepidermal water loss (TEWL) is a typical feature in patients with atopic eczema (AE). Objective: The purpose of this study was to assess the kinetics of epidermal regeneration after barrier perturbation induced by two different stimuli, namely acetone treatment (removal of stratum corneum lipids) and tape stripping (removal of the nonviable stratum corneum). Methods: Fifteen patients with AE and 12 nonatopic healthy controls were investigated. An area of 9.0 cm2 of clinically normal skin of the forearm flexural side was treated by acetone or tape stripping in a way that an increase in TEWL of 3.5–4.0 times the pretreatment value was achieved. TEWL was recorded directly after perturbation (t0), after 15 min (t1), 3 h (t2), 6 h (t3), 24 h (t4), 48 h (t5), 72 h (t6) and 96 h (t7). Results: The speed of epidermal regeneration was faster after acetone treatment, both in the patient and the control groups, with no significant difference between the two. However, after tape stripping at points t2, t5 and t6, TEWL values relative to t0 were significantly lower in atopic skin as compared to normal skin (p < 0.05). Conclusions: The faster regeneration of barrier function after tape stripping in patients with AE may be the result of a persisting mild disturbance of barrier function. It may be speculated that repair mechanisms are permanently activated, and therefore barrier recovery is faster. However, a complete restoration of the epidermal barrier function is not achieved, perhaps because of the decreased content of ceramides in atopic skin.