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Enzo Berardesca,1 Adriana Bonfigli,2 Claudia Cartigliani,2 Delphine Kerob,3 Jerry Tan4 1Phillip Frost Department of Dermatology, University of Miami, Miami, FL, USA; 2Clinical Evaluations, ISPE, Milano, Italy; 3International Scientific Affairs, Cosmetic Active International, Levallois-Perret, France; 4Department of Medicine and Windsor Clinical Research Inc Western University, Windsor, ON, CanadaCorrespondence: Enzo Berardesca, Phillip Frost Department of Dermatology, University of Miami, Miami, FL, USA, Tel +393486962500, Email berardesca@berardesca.itPurpose: Rosacea is a common facial dermatosis, with flares induced by exposome factors. M89PF containing Vichy mineralizing water, probiotic fractions, hyaluronic acid, niacinamide and tocopherol repairs the skin barrier and reinforces skin defences against exposome factors. This study assessed the benefit of M89PF in subjects with rosacea associated with erythema and sensitive skin during the Covid-19 pandemic using protective face masks.Methods: M89PF was compared to usual skin care in a randomized, split-face study, for 30 days in subjects with rosacea associated with erythema and sensitive skin. Clinical evaluations included erythema, desquamation, skin tightness, dryness, burning sensation, itching, stinging, stinging test, and local tolerability. Instrument evaluations included erythema, skin hydration and TEWL. Subject satisfaction was also assessed.Results: Erythema significantly improved with M89PF at both time points (p< 0.01 at D15, and p< 0.001 at D30). Skin sensitivity assessed by the skin stinging test improved significantly (p< 0.01) with M89PF at D30, compared to baseline and usual skin care. Skin erythema, tightness, dryness, hydration and TEWL significantly improved (p≤ 0.05) with M89PF at D15 and D30, versus baseline and the untreated side. Subjects were highly satisfied with M89PF at D15 and D30. Tolerance was very good in all subjects.Conclusion: In subjects with rosacea, M89PF significantly reduces erythema, skin tightness, dryness and TEWL, and improves skin hydration and skin sensitivity, even when using protective masks. M89PF is well tolerated and received high satisfaction ratings.ClinicalTrials.gov. No: NCT05562661.Keywords: rosacea, skin barrier, exposome, erythema, sensitive skin

Background Silicon is an abundant element in the human body and plays an important role in the skin, taking part in the synthesis of collagen and glycosaminoglycans. The use of nanotechnology methods, which processes materials at an atomic and molecular scale, has allowed the development of nanosilicons. Aims The study evaluates the effectiveness of a food supplement and a topical solution containing nanosilicon in improving skin hydration and elasticity. Methods A total of 30 female subjects were randomized to receive the placebo (n = 15) and the active compound (n = 15). All enrolled subjects took the food supplement twice a day for 20 days and then once a day for the next 20 days, and they also had to apply the nanosilicon solution on the right forearm four times a day. Evaluation of several parameters was performed after 20 and 40 days through the use of non-invasive instrumental methods (Corneometer® CM 825, Cutometer® MPA 580, Visioscan® VC, Tewameter® TM 200). Results Both treatment groups showed a statistically significant improvement in barrier function and in skin hydration on the right forearm after 20 days; increase in skin elasticity was observed only in the group taking the active compound. Conclusions The study showed that the administration of a food supplement and a topical solution, both containing nanosilicon, improves hydration, elasticity, and skin barrier function.

Enzo Berardesca,1 Adriana Bonfigli,2 Bernard Cribier,3 Frederic Flament,4 Marco Vicic,4 Delphine Kerob,5 Jerry Tan6 1Phillip Frost Department of Dermatology, University of Miami, Miami, FL, USA; 2ISPE, Milano, Italy; 3Clinique Dermatologique, University Hospital, Strasbourg, France; 4L’Oréal Research and Innovation, Chevilly-Larue, France; 5Laboratoires Vichy International, Levallois-Perret, France; 6Western University, Department of Medicine and Windsor Clinical Research Inc, Windsor, ON, CanadaCorrespondence: Enzo BerardescaPhillip Frost Department of Dermatology, University of Miami, Miami, FL, USATel +1 393486962500Email berardesca@berardesca.itObjective: This study assessed the efficacy and tolerability of M89 in patients with rosacea associated with erythema and sensitive skin.Methods: Intra-individual study in a split-face design comparing after 30 days M89 twice daily and usual skin care in 20 adult subjects with rosacea and sensitive skin. M89 contains 89% Vichy volcanic mineralizing water (VVMW) and 0.4% hyaluronic acid. It is hypoallergenic and contains no perfume and this convenes in rosacea. Contained minerals reinforce the natural defences of the skin in restoring the natural skin barrier, stimulating antioxidant activity and reducing inflammation, commonly observed in subjects with rosacea. Clinical evaluations included assessment of erythema, desquamation, papules and pustules, skin tightness, dryness, burning sensation, itching, stinging and stinging test as well as local tolerability. Instrumental evaluations included skin hydration and TEWL. Subject satisfaction was assessed at Days 15 and 30. Demodex density was assessed at Day 30.Results: A significant superiority of M89 over the standard skin care was observed for erythema, skin tightness and dryness (all P≤ 0.05) as early as Day 15, the skin stinging test was significantly in favour of M89 (P< 0.05 at Day 15 and P< 0.01 at Day 30) and for skin hydration (P< 0.0001) at Day 15 and 30 with no difference in mean Demodex density between M89 and usual skin care after 30 days. Tolerance was excellent and subject satisfaction very high.Conclusion: Study results concerning M89 are encouraging for its use either alone or as an adjuvant daily skin care to topical medication in patients with persistent centrofacial erythema of rosacea with no more than 3 papules and pustules.Keywords: rosacea, sensitive skin, Vichy volcanic mineralizing water, M89, split face

Vitamin E is a powerful lipophilic antioxidant that protects membranes from lipid peroxidation, and consequently, oxidative damage. Oxidative stress plays a role in the development of neurodegenerative diseases. Vitamin E supplementation is recommended in patients with vitamin E deficiency due to fat malabsorption. The addition of vitamin E to the diet slows Alzheimer's disease progression and protects older patients against respiratory infections. Recent studies also point to the involvement of oxidative stress in the pathology of immune-mediated skin diseases, such as atopic dermatitis and psoriasis. We reviewed the available clinical trials that investigated the role of vitamin E supplementation in preventing and treating atopic dermatitis and psoriasis. Data from these studies point to a positive role of vitamin E supplementation in these diseases. Still, due to limitations in study design, further evidence is needed to reach a definite conclusion. This article is protected by copyright. All rights reserved.

Lichen sclerosus (LS) is an autoimmune chronic inflammatory disease usually involving the anogenital skin of both sexes; more rarely LS exclusively involves extragenital areas. As a chronic inflammatory disease, in most cases, LS evolves and progresses causing scleroatrophy of the skin or scars which may cause stenosis in the affected areas. A few LS patients are at risk of developing squamous cell carcinoma in their lifetime, but appropriate long-term treatment diminishes the possibility of a malignant evolution. Oxidative stress (OS) has been proven to play a role not only in the pathogenesis of LS, but also in the development and progression of the disease. OS, by causing DNA damage and lipid peroxidation, contributes directly to the possible malignant transformation of LS. Moreover, the increase in oxidative DNA damage is associated with mutations in tumor suppressor genes. Considering the role that OS plays in LS, therapeutic use of antioxidants appears to be rational and possible, in association with other treatments. Antioxidants would counteract the oxidative DNA damage, which is the most important factor for the progression of LS and its malignant transformation.

Indoor and outdoor airborne pollutants modify our environment and represent a growing threat to human health worldwide. Airborne pollution effects on respiratory and cardiac health and diseases have been well established, but its impact on skin remains poorly described. Nonetheless, the skin is one of the main targets of pollutants, which reach the superficial and deeper skin layers by transcutaneous and systemic routes. In this review, we report the outcomes of basic and clinical research studies monitoring pollutant levels in human tissues including the skin and hair. We present a current understanding of the biochemical and biophysical effects of pollutants on skin metabolism, inflammatory processes and oxidative stress, with a focus on polyaromatic hydrocarbons and ground‐level ozone that are widespread outdoor pollutants whose effects are mostly studied. We reviewed the literature to report the clinical effects of pollutants on skin health and skin ageing and their impact on some chronic inflammatory skin diseases. We also discuss the potential interactions of airborne pollutants with either ultraviolet radiation or human skin microbiota and their specific impact on skin health.

Ein durchgängig saurer pH-Wert im Stratum corneum ist ein wesentlicher Bestandteil des Schutzsystems der Haut, der eine feindliche Umgebung für die Besiedelung durch pathogene Mikroorganismen schafft. Doch diese Barriere kann bei gesunder und umso mehr bei geschädigter Haut durchbrochen werden. Mykosen, Windel-/Inkontinenz-assoziierte Dermatitis und Wundheilung sind Beispiele für Situationen, in denen durch veränderte Haut- oder Umgebungsbedingungen eine mikrobielle Infektion begünstigt wird. Pilze verfügen über ein komplexes System, mit dem sie den pH-Wert ihrer Umgebung erfassen, um durch entsprechende Stoffwechselreaktionen ihre Adhäsion, Vermehrung und Invasion zu gewährleisten, indem mikrobielle Metaboliten den pH-Wert der Haut weiter erhöhen, bis schließlich eine klinisch manifeste Infektion (Mykose) vorliegt. Menschen mit Diabetes, bei denen der pH-Wert der Haut in intertriginösen Bereichen erhöht ist, sind besonders anfällig für Candidosen. Bei Windeldermatitis und Inkontinenz-assoziierter Dermatitis ist die Ursache für den erhöhten pH-Wert der Haut und die Schädigung der Hautbarrierefunktion der Kontakt mit Urin und Fäzes, ob unter Okklusion oder nicht, und durch Wirts- und mikrobielle Enzyme und Metaboliten wird dieser Zustand aufrechterhalten. Das führt zur Dezimierung der schützenden residenten Mikroflora und ihrer Überwucherung durch Pilze, meist Candida albicans. Die Hautpflege mit leicht sauren Produkten kann helfen, diese Form von Dermatitis zu verhindern und zu behandeln. Der Prozess der Wundheilung ist eine komplexe Abfolge biologischer Ereignisse, die mit dem pH-Wert der Umgebung korrelieren, welcher die verschiedenen Phasen der Wundheilung beeinflusst. Der pH-Wert ist für die adäquate Aktivität von Immunzellen und wichtigen Enzymen ebenso bestimmend wie für die Biofilmbildung. Wenn der Heilungsprozess gestört wird, können Wunden chronisch werden und sind dann durch einen neutralen bis leicht alkalischen pH-Wert gekennzeichnet. Vor diesem Hintergrund könnten die Überwachung des pH-Wertes und die Herstellung eines sauren Milieus als Wundbehandlungsmaßnahme sinnvoll sein.

Ethnic differences in skin barrier function have been described even though data can be influenced by several variables related to environmental, cultural, and social factors. Stratum corneum physiology and sensitive skin can have different impact in Asians compared to Caucasian. Some diseases also might have a higher incidence in ethnic groups due mainly to genetic predisposition or in case of contact and irritant dermatitis to increased exposure to relevant triggering factors.

BACKGROUND Treatment of unwanted body hair is a challenging area in cosmetic dermatology. Topical soy isoflavones and derivatives or eflornithine have been utilized in dermatocosmetology for their estrogenic and antiandrogenic activity. AIMS To evaluate the efficacy of a formulation containing capryloyl glycine 4% in decreasing hair growth on the forearms after topical application for 120 days vs placebo. METHODS A total of 69 female patients entered the study (age 37 ± 6). Hair growth was quantified using TrichoScan software on both forearms at 20-fold magnification (analyzed area 0.651 cm2). Hair density (number of hairs/cm2 ), density vellus hair, density terminal hair, and median length of hairs were evaluated. The data were analyzed using ANOVA for repeated measures to evaluate changes during the treatment (T0, T60, and T120) and Student's t test (placebo vs active). RESULTS There was a significant decrease on hair density, median, and terminal hair at the end of the treatment in the active-treated site (P

Laser-Doppler flowmetry (LDF) is a method able to provide continuous noninvasive measurements related to changes in microvascular perfusion, in terms of relative changes of blood volume and velocity. The method is based on the effect of the light on moving (mainly erythrocytes) and nonmoving components of a limited volume of tissue. Unlike ultrasound Doppler, for which one might establish the velocity of the blood and its flow within a single vessel if a relatively limited number of factors related to the structure to be investigated are known (incidence angle, vessel diameter, velocity profile), in LDF methodology the extraction of red blood cell velocity and volume cannot be obtained directly. The backscattered light is detected and transformed into an electric signal by solid-state miniature devices, photodiodes, or phototransistors.

Rosacea is a very common chronic facial dermatosis characterized by a multiphase evolution. Inflammation is an important reaction in rosacea not only due to inflammatory reactions to cutaneous microorganisms, such as Demodex follicolorum, but also to ultraviolet damage that generates reactive oxygen species. This study evaluated the efficacy and tolerability of a nonsteroidal anti-inflammatory 18-beta glycyrrhetinic acid cream for the treatment of mild rosacea by means of noninvasive methods. A total of 24 subjects suffering from erythemato-telangiectatic or mild papulo-pustular rosacea were recruited in the trial. Twelve patients applied an anti-inflammatory cream with 18-beta glycyrrhetinic acid twice daily for 20 days and 12 patients, recruited as control, applied the same formulation without 18-beta glycyrrhetinic acid. After 10 days of treatment, a significant reduction of erythema was recorded in the patient sample who applied the 18-beta glycyrrhetinic acid cream, the mean change from baseline showed an increase in hydration level of the skin surface but it was not statistically significant. The use of 18-beta glycyrrhetinic acid cream can be helpful in managing symptoms and condition of rosacea skin, especially in the management of erythema.

Urea is an emollient widely used in clinical dermatology to moisturise and protect the skin. Non-invasive techniques can be useful in evaluating and quantifying the moisturising and hydrating properties of topically applied urea. Amongst these, transepidermal water loss, skin conductance and capacitance are the most widely used. Dynamic tests and mapping of skin moisturisation are additional features that can be used to evaluate the dynamics of water into the stratum corneum. Ultrasound and mechanical properties can be used to investigate the effects on skin smoothness and tone. In conclusion, urea is a fundamental ingredient of cosmetic and dermatological formulations and can have several positive effects on skin function. These can be easily investigated and monitored using non-invasive techniques measuring the stratum corneum function.

BACKGROUND Noninvasive quantification of stratum corneum water content is widely used in skin research and topical product development. METHODS The original EEMCO guidelines on measurements of skin hydration by electrical methods and transepidermal water loss (TEWL) by evaporimeter published in 1997 and 2001 have been revisited and updated with the incorporation of recently available technologies. RESULTS Electrical methods and open-chamber evaporimeters for measurement of TEWL are still the preferred techniques to measure the water balance in the stratum corneum. The background technology and biophysics of these instruments remain relevant and valid. However, new methods that can image surface hydration and measure depth profiles of dermal water content now available. Open-chamber measurement of TEWL has been supplemented with semiopen and closed chamber probes, which are more robust to environmental influence and therefore convenient to use and more applicable to field studies. However, closed chamber methods interfere with the evaporation of water, and the methods cannot be used for continuous monitoring. Validation of methods with respect to intra- and inter-instrument variation remains challenging. No validation standard or test phantom is available. RESULTS AND CONCLUSIONS The established methods for measurement of epidermal water content and TEWL have been supplemented with important new technologies including methods that allow imaging of epidermal water distribution and water depth profiles. A much more complete and sophisticated characterization of the various aspects of the dermal water barrier has been accomplished by means of today's noninvasive techniques; however, instrument standardization and validation remain a challenge.

One of the most common micronutrient deficiencies with cutaneous findings is the vitamin B, also known as biotin, deficiency. Biotin deficiency may be due to congenital lack of biotinidase, or acquired following some conditions that interfere with its absorption, such as inflammatory bowel disorders, a diet too rich in avidin, magnesium deficiency, smoking habit and treatment with broad-spectrum antibiotics, anticonvulsants and sulfonamides. This review highlights the role of biotin in the most common skin disorders such associated with biotin deficiency and an approach to their treatment. Biotin administration may improve the treatment of hair loss when deficiency is detected on the basis of a careful patient history, clinical examination and the determination of serum biotin levels. the use of biotin is rationale in seborrheic dermatitis as the vitamin intercepts the main metabolic pathways underlying the pathogenesis of the disease. treatment with biotin could also be useful in comedonal acne characterized by a high rate of seborrhea, and may be helpful for acne treated with topical retinoids, contributing to the control of flaking and irritation. The tolerability of biotin is excellent and there is no risk of hypervitaminosis even in the case of high doses. It is important that administration is controlled by physicians and follows a medical diagnosis and prescription. Correct doses used in dermatological conditions are safe and are not at risk of interference with laboratory tests.

The aim of this study is showing the filming and skin barrier protective properties of a new ingredient based on ceramides and trehalose and carried in lipophilic vesicles composed of lecithin and cholesterol (or phytosterols). Through an in vivo study, the restructuring and hydrating properties of this trehalose and ceramides compound have been evaluated. Furthermore, this new ingredient has been used in a topical formulation for atopic dermatitis, proving to be effective in the alterations of skin barrier. This evidence makes it an interesting ingredient for topical dermatological compositions in the treatment of dermatitis and all manifestations correlated to these skin disorders, such as edema, swelling, rash, redness, and itching. Its soothing and protective action against the painful and annoying symptoms like those given by dermatitis makes this trehalose and ceramides based ingredient for topical use.

Dry skin is a common condition that is attributed to a lack of water in the stratum corneum. With the availability of new technologies, light has been shed on the pathophysiology of dry skin at the molecular level. With the aim to discuss implications of this latest research for the optimal formulation of emollients designed to treat dry skin, five specialists met in November 2017. Research on three topics thereby provided particularly detailed new insights on how to manage dry skin: research on the lipid composition and organization of the stratum corneum, research on natural moisturizing factors, and research on the peripheral nervous system. There was consensus that latest research expands the rationale to include physiological lipids in an emollient used for dry skin, as they were found to be essential for an adequate composition and organization in the stratum corneum but are reduced in dry skin. Latest findings also confirmed the incorporation of carefully selected humectants into a topical emollient for dry skin, given the reduced activity of enzymes involved in the synthesis of moisturizing factors when skin is dry. Overall, the group of specialists concluded that the previous concept of the five components for an ideal emollient for dry skin is well in accordance with latest research.

Lichen sclerosus (LS) is an autoimmune chronic inflammatory disease usually involving the anogenital skin of both sexes; more rarely LS exclusively involves extragenital areas. As a chronic inflammatory disease, in most cases, LS evolves and progresses causing scleroatrophy of the skin or scars which may cause stenosis in the affected areas. A few LS patients are at risk of developing squamous cell carcinoma in their lifetime, but appropriate long-term treatment diminishes the possibility of a malignant evolution. Oxidative stress (OS) has been proven to play a role not only in the pathogenesis of LS, but also in the development and progression of the disease. OS, by causing DNA damage and lipid peroxidation, contributes directly to the possible malignant transformation of LS. Moreover, the increase in oxidative DNA damage is associated with mutations in tumor suppressor genes. Considering the role that OS plays in LS, therapeutic use of antioxidants appears to be rational and possible, in association with other treatments. Antioxidants would counteract the oxidative DNA damage, which is the most important factor for the progression of LS and its malignant transformation.

The skin is a complex barrier organ made of a symbiotic relationship between microbial communities and host tissue via complex signals provided by the innate and the adaptive immune systems. It is constantly exposed to various endogenous and exogenous factors which impact this balanced system potentially leading to inflammatory skin conditions comprising infections, allergies or autoimmune diseases. Unlike the gut and stool microbiome which has been studied and described for many years, investigations on the skin or scalp microbiome only started recently. Researchers in microbiology and dermatology started using modern methods such as pyrosequencing assays of bacterial 16S rRNA genes to identify and characterize the different microorganisms present on the skin, to evaluate the bacterial diversity and their relative abundance and to understand how microbial diversity may contribute to skin health and dermatological conditions. This article aims to provide an overview on the knowledge about the skin microbiota, the microbiome and their importance in dermatology.

Clinical management of alopecia represents one of the major issues in dermatology. Scalp biopsies are not easily accepted because of the high bleeding and sensitive anatomical area. Trichoscopy is routinely used for diagnosis of alopecia, but in several cases lack to provide sufficient information on the status of the disease. Recently, reflectance confocal microscopy demonstrated its usefulness for the evaluation of several inflammatory skin condition and preliminary reports about alopecia have been proposed in the literature. The aim was to identify the confocal features characterizing scarring and non-scarring alopecia. Reflectance confocal microscopy from 86 patients affected by scarring (28 lichen planopilaris and 9 lupus erythematosus) and non-scarring alopecia (30 androgenic alopecia and 19 alopecia areata), were retrospectively, blinded evaluated. Good concordance between different readers on the confocal criteria has been assessed. Statistical significant features, specific for scarring alopecia and non-scarring alopecia have been identified. In this study, data on reflectance confocal microscopy features useful for the differential diagnosis between scarring and non-scarring alopecia have been identified. Further studies focusing on the use of this non-invasive technique in the therapeutic follow-up and distinction of sub-entities of alopecia are still required.

Acne is a very common skin disease affecting 90% of 16–17-year-old boys and 80% of 16–17-year-old girls. Scarring occurs early in acne and may affect some 95% of patients with this disease. Inflammation in acne is a two-stage process, with lymphocytes and neutrophils affecting the attenuated follicular wall of the closed comedone and, if this wall is breached, the extravasation of irritating follicular contents into the dermis leads to a variety of lesions. Innate immunity seems to play a role in acne scars. Clinically normal epidermis of acne patients prone to scars is associated with a profile of activation of innate immunity that is different from patients not prone to scars. Collagen and other tissue damage from the inflammation of acne leads to permanent skin texture changes and fibrosis. From a histopathological point of view, scars demonstrate thicker, abundant collagen that is stretched and aligned in the same plane as the epidermis.

The body skin pH can usually vary from 4.0 to 7.0 depending on location. The presence of natural acidic compounds on the skin surface helps maintain the skin's physicochemical properties as well as its protective functions. Since the slightly acidic pH of the skin is extremely important for the skin's protective function, the skin is widely known as "acid mantel." Factors such as age, race, gender, body sites, biochemical differences, and even washing affect the pH of the stratum corneum. Recent clinical studies using an emollient-base finish product using the traditional way of measuring skin pH produced results that indicated an apparent increase in skin pH. The apparent pH increase with these products is most probably an artifact of the skin pH measurement technique. Our findings show that certain petrolatum-based emollients and components could create a protective barrier and help maintain the healthy acidity of the skin. Our work provides new evidence of emollients helping to stabilize skin pH in its natural balanced state rather than affecting it. This new learning should be taken into consideration by other researchers in the area of skin pH as well as in clinical studies to avoid misleading results.

Maintenance of an acidic stratum corneum pH is a major component of the skin's protective system and creates a hostile environment for colonization with pathogenic microorganisms. This barrier can however be overcome on healthy and in particular on compromised skin. Mycosis, diaper/incontinence dermatitis and wound healing are examples of cases where microbial infection is promoted by the altered skin conditions or environment. Fungi have a complex system that senses ambient pH that leads to metabolic responses allowing adhesion, growth and invasion, as microbial metabolites further increase skin pH resulting in a clinically manifest infection (mycosis). Diabetic patients with a higher pH in intertriginous areas are particularly vulnerable to candidiasis. In diaper and incontinence dermatitis, the increase in skin pH and damage to the skin barrier function is triggered by the contact with urine and faeces with or without occlusion and maintained by host and microbial enzymes and metabolites. This leads to the reduction of the protective resident microflora and fungal overgrowth, mostly with Candida albicans. Skin care with slightly acidic products may help to prevent and treat this kind of dermatitis. Wound healing is a complex sequence of biologic events correlated with ambient pH, which influences the different phases of the healing process. The pH determines the appropriate activity of immune cells and key enzymes as well as biofilm formation. Chronic wounds emerging from the disruption of the healing process are characterized by a neutral to slightly alkaline pH and may benefit from wound pH monitoring and therapeutic acidification.

Background Atopic dermatitis is a chronic, pruritic inflammatory skin disease that adversely affects quality of life. Aims The current study evaluates the efficacy of a shower cream and a lotion, each with skin-identical lipids and emollients, in the treatment of atopic dry skin of subjects with a history of atopic condition. Methods In all, 40 healthy females with clinically dry skin on the lower legs were enrolled in the study and underwent 4 weeks of daily use of the shower cream and 2 additional weeks of both the shower cream and the body lotion. Subjects were evaluated at day 0, week 4, and week 6. Skin barrier function was assessed by Tewameter® , skin hydration by Corneometer® , smoothness and desquamation by Visioscan® , and stratum corneum architecture by reflectance confocal microscopy (RCM). The investigator assessed the degree of dryness, roughness, redness, cracks, tingling and itch, and subjective self-assessment evaluated the perception of skin soothing, smoothness, and softness. Results Skin barrier function and skin moisture maintenance were significantly improved using the shower cream. The lotion with physiological lipids, together with the shower cream, also improved skin barrier function and moisture. Both the shower cream and the body lotion reduced clinical dryness, roughness, redness, cracks, tingling and itch, according to the dermatologist, and increased soothing, smoothness, and softness, according to the subjects of the study. Conclusion The combination of a shower cream and a lotion with physiological lipids efficiently restores skin barrier function and increases skin hydration, becoming an effective skin-care option for patients with atopic dry skin.

Maintenance of an acidic stratum corneum pH is a major component of the skin's protective system and creates a hostile environment for colonization with pathogenic microorganisms. This barrier can however be overcome on healthy and in particular on compromised skin. Mycosis, diaper/incontinence dermatitis and wound healing are examples of cases where microbial infection is promoted by the altered skin conditions or environment. Fungi have a complex system that senses ambient pH that leads to metabolic responses allowing adhesion, growth and invasion, as microbial metabolites further increase skin pH resulting in a clinically manifest infection (mycosis). Diabetic patients with a higher pH in intertriginous areas are particularly vulnerable to candidiasis. In diaper and incontinence dermatitis, the increase in skin pH and damage to the skin barrier function is triggered by the contact with urine and faeces with or without occlusion and maintained by host and microbial enzymes and metabolites. This leads to the reduction of the protective resident microflora and fungal overgrowth, mostly with Candida albicans. Skin care with slightly acidic products may help to prevent and treat this kind of dermatitis. Wound healing is a complex sequence of biologic events correlated with ambient pH, which influences the different phases of the healing process. The pH determines the appropriate activity of immune cells and key enzymes as well as biofilm formation. Chronic wounds emerging from the disruption of the healing process are characterized by a neutral to slightly alkaline pH and may benefit from wound pH monitoring and therapeutic acidification.

This Italian multicenter retrospective study compared the drug survival and efficacy of different anti-TNF agents in psoriasis (PsO) and psoriatic arthritis (PsA) patients. A database of PsO/PsA patients treated with adalimumab, etanercept, and infliximab from May 2013 to May 2014 was analyzed. PASI 75, 90, and 100 was calculated at each time point to evaluate efficacy. Drug survival rate and probability of maintaining PASI response were evaluated. The impact of dependent variables on probability of PASI 75 loss was evaluated by logistic regression. 1,235 patients were included, 577 with PsO and 658 with PsA. Highest survival rates were observed with adalimumab followed by etanercept and infliximab in PsO and PsA patients. The probability of maintaining PASI response was significantly higher for adalimumab followed by infliximab. For PsO patients, the odds of losing PASI 75 was higher in etanercept-treated patients (OR: 8.1; 95% CI: 4.2-15.6, p

Skin aging is the progressive skin loss of function due to intrinsic and extrinsic factors which have effects on both epidermis and dermis. Epidermal thinning and increased catabolic activity due to MMP expression cause loss of collagen and wrinkle formation. UV light and other factors such as pollution play a fundamental role in photoaging. In women, menopause and oestrogen decay can further increase the dermal decay of collagen and hyaluronic acid aging worsening the aging process.

Background Psoriasis is a chronic recurrent inflammatory skin disease that affects 2–3% of the world population. Biologics are relatively new systemic treatments that block molecular steps important in the pathogenesis of psoriasis. In vivo Reflectance confocal microscopy (RCM) is a non-invasive, imaging technique already reported to be useful in the evaluation of the follow-up of PP under treatment with topical actives and phototherapy. No reports on systemic treatments have been proposed in literature so far. Objective The aim of this study was to evaluate the feasibility of RCM in the monitoring of microscopic response to a subcutaneous anti-TNF treatment, Adalimumab. Methods One target lesion with typical clinical aspect, from 48 psoriatic patients, was evaluated using RCM at baseline, after 4 and 8 weeks of treatment. Results Microscopic confocal changes were followed up during treatment. Results disclosed identification of early microscopic evidence of the anti-inflammatory activity of Adalimumab not detected at clinical examination. Confocal feature related to the effect of TNF-α on melanocytes activity has been also identified. Conclusion Early detected RCM parameters related to Adalimumab activity could be used to identify an early response to the treatment. RCM seems to be able to give useful and practical information about follow-up in patients with PP under treatment with Adalimumab.

SummaryObjective To instrumentally evaluate the efficacy and the safety of a new ternary system chemo exfoliating formulation (water-dimethyl isosorbide-acid) vs traditional binary systems (water and acid) where the acid is maintained in both the systems at the same concentration. Methods Different peelings (binary system pyruvic acid and trichloroacetic acid—TCA, and ternary system pyruvic acid and TCA) were tested on the volar forearm of 20 volunteers of both sexes between 28 and 50 years old. The outcomes were evaluated at the baseline, 10 minutes, 24 hours, and 1 week after the peeling by means of noninvasive skin diagnosis techniques. In vivo reflectance confocal microscopy was used for stratum corneum evaluation, transepidermal waterloss, and Corneometry for skin barrier and hydration, Laser Doppler velocimetry in association with colorimetry for irritation and erythema analysis. Results The instrumental data obtained showed that the efficacy and safety of the new ternary system peel compounds were significantly higher compared with the binary system formulations tested. The new formulation peels improved chemexfoliation and reduced complications such as irritation, redness, and postinflammatory pigmentation compared to the traditional aqueous solutions. Conclusion The study showed that ternary system chemexfoliation, using a controlled delivery technology, was able to provide the same clinical effects in term of stratum corneum reduction with a significantly reduced barrier alteration, water loss, and irritation/erythema compared to traditional binary system peels.

Stratum corneum barrier is commonly described according to the “brick and mortar” model constituted respectively by corneocytes and intercellular lipids; the former are composed mainly of insoluble bundled keratins surrounded by a cell envelope stabilized by cross-linked proteins and covalently bound lipids. Polar structures, such as corneodesmosomes, interconnect corneocytes determining stratum corneum cohesion. Intercorneocytic lipids are primarily generated from exocytosis of lamellar bodies during the keratinocytes’ terminal differentiation and secondarily generated by sebaceous output. Lipids are required for a competent skin barrier and homeostatic control of transcutaneous penetration. 1