Br J Dermatol:增强角质层脂质结构可改善成人干燥、易患湿疹皮肤的皮肤屏障功能并保护其免受刺激

2022-01-05 医路坦克 MedSci原创

特应性皮炎(AD)患者的皮肤以角质层(SC)脂质水平异常为特征。因此,板层基质被破坏,皮肤屏障功能减弱,增加了皮肤对刺激物和过敏原的敏感性。

    特应性皮炎(AD)患者的皮肤以角质层(SC)脂质水平异常为特征。因此,板层基质被破坏,皮肤屏障功能减弱,增加了皮肤对刺激物和过敏原的敏感性。

    皮肤屏障(SB)是一种物理渗透屏障,可以防止水分流失,保护身体免受外部环境的影响。它是由角质层(SC)形成的,角质层是一种防御结构,由交织在内部的角质细胞组成复杂的脂质混合物(脂层)。这些脂质包括等摩尔浓度的胆固醇、神经酰胺和游离脂肪酸,排列在多层膜中。脂膜的组成和结构对通透性屏障功能至关重要。

    在特应性皮炎/湿疹(AD)中,SC的脂质组成发生了显著的变化,包括神经酰胺EOS、EOH和NP的水平降低,物种水平的神经酰胺增加,亚种水平的神经酰胺普遍转向短链神经酰胺。这些变化导致脂层和角质细胞脂质包膜的缺陷形成,并被发现与干燥症有关。皮肤表面脂质的减少,特别是关键神经酰胺的减少,这些变化导致脂层和角质细胞脂质包膜的缺陷形成,并被发现与干燥症有关。皮肤表面脂质的减少,特别是关键神经酰胺的减少。这些变化导致脂质层和角质细胞脂质包膜的缺陷形成,并被发现与干燥有关。皮肤表面脂质的减少,特别是关键神经酰胺,而且可能与皮肤干燥的发病率增加有关。

     局部补充生理脂质是支持健康皮肤的潜在重要机制。然而,目前还不清楚局部使用的脂质是否能够进入脂质基质,并带来改变通透性屏障功能的结构变化。这项研究的目的是比较在多泡乳液中含有皮肤脂质(神经酰胺、甘油三酯和胆固醇)和保湿剂的保湿霜(测试霜)与参考润肤霜(不含这些添加剂)对干燥、易患湿疹的皮肤的SB结构的影响。在此之前,我们曾证明测试霜可在24小时内提供持续保湿。我们假设,皮肤脂质和保湿剂的受控释放将支持最佳的SB结构和功能,从而防止干燥和刺激。

     确定多泡乳剂中含有神经酰胺、甘油三酯和胆固醇的乳膏是否能增强皮肤屏障,防止皮肤刺激。

     对34例干燥、易患湿疹的成人进行了一项随机观察者盲法受试者内对照研究。每个参与者都接受了4周的治疗,一边是前臂和小腿上的测试膏,另一边是参考润肤膏。治疗前后分别测定皮肤性质。使用一种新的界面,用FTIR光谱分析了脂质结构。

     试验乳膏处理部位的皮肤屏障完整性更强(效果尺寸-161.9,95%CI-205.5,-118.3),皮肤对十二烷基硫酸钠的敏感度降低(-0.5点[97.57%CI-1.00,-0.25%]视觉红度和-15.34g/m2/h[95%CI-20.28,10.40]TEWL)与参照物相比,皮肤对月桂基硫酸钠的敏感度降低(-0.5点[97.57%CI-1.00,-0.25%]视觉红度和-15.34g/m2/h[95%CI-20.28,10.40]TEWL)。用测试乳膏处理的部位显示脂链有序性增强,这与皮肤屏障完整性显著相关(r0.606)。与对照相比,使用测试乳膏的治疗增加了水合作用(8.61电容单位,95%可信区间6.61到10.60),并减少了干燥的迹象。

   通过增强SC的脂质结构,4周的测试霜治疗促进了SB功能的改善,从而提供了对皮肤刺激的保护。与通常处方的润肤剂相比,测试霜带来了更好的皮肤保湿水平,更有效地减少了皮肤干燥的迹象。这一结果对临床实践具有重要的意义,因为简单的润肤霜非常普遍地用于干燥性皮肤状况的管理。研究表明,目前很少有患者和照顾者认为他们可以充分管理AD症状,包括慢性皮肤干燥和炎性病变的倾向。

   考虑到像SLS这样的刺激物是AD皮损的重要诱因,测试霜对SB的影响可能有助于保持皮肤健康,并减轻管理这种情况的负担。在局部皮质类固醇治疗的基础上添加测试乳膏可以帮助改善轻中度AD的预后。

 

文献来源: Danby SG,  Andrew PV,  Kay LJ,Enhancement of stratum corneum lipid structure improves skin barrier function and protects against irritation in adults with dry, eczema-prone, skin,Br J Dermatol 2021 Dec 18;

 

 

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    2022-01-05 默拜岐黄

    卖药来了

    0

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    2022-01-05 ms1000000413528422

    学习

    0

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    2022-01-05 奔袭

    明了

    0

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