Sakurai Kensei, Sugiura Hisashi, Matsumoto Motonobu, Uehara Masami
Department of Dermatology, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, 520-2192, Japan.
J Dermatol Sci. 2002 Oct;30(1):37-42. doi: 10.1016/s0923-1811(02)00047-6.
It remains unclear whether an impaired barrier function often seen in areas of normal-appearing skin in patients with active atopic dermatitis (AD) is primary event in nature or secondary to subclinical eczematous change. We then attempted to evaluate the barrier function of normal-appearing skin in both active and healed AD patients, and as well as see whether a subclinical eczematous change exists or not in the normal-appearing skin using a non-invasive method. Transepidermal water loss (TEWL) measurement and exfoliative cytology method for corneal layer were applied in 153 AD patients who have active skin lesions and 29 individuals with completely healed AD for at least 5 years and 40 normal individuals. The TEWL of normal-appearing skin in severe, moderate and mild AD cases was 10.5+/-2.9, 8.3+/-2.4 and 7.3+/-2.1 g/m2 per h, respectively. The TEWL values in severe and moderate cases were significantly higher than the normal controls (6.2+/-1.6 g/m2 per h). However, the TEWL was not deranged in patients with completely healed AD. An exfoliative cytology examination of corneal layer disclosed that patchy parakeratosis appeared in normal-appearing skin in severe, moderate and mild AD cases at a rate of 42, 29 and 19%, respectively. However, no patchy parakeratosis was recognized in patients with completely healed AD. The occurrence of patchy parakeratosis in normal-appearing skin in patients with active AD suggests that an impaired barrier function often seen in normal-appearing skin in AD patients is secondary to subclinical eczematous change in the area.
目前尚不清楚，在患有活动性特应性皮炎（AD）的患者中，常出现在外观正常皮肤区域的屏障功能受损，本质上是原发性事件还是继发于亚临床湿疹样改变。然后，我们试图评估活动性和已治愈的AD患者外观正常皮肤的屏障功能，并使用非侵入性方法查看外观正常的皮肤中是否存在亚临床湿疹样改变。对153例有活动性皮肤病变的AD患者、29例AD完全愈合至少5年的个体以及40名正常个体，应用经表皮水分流失（TEWL）测量和角质层剥脱细胞学方法。重度、中度和轻度AD病例外观正常皮肤的TEWL分别为每小时10.5±2.9、8.3±2.4和7.3±2.1g/m²。重度和中度病例的TEWL值显著高于正常对照组（每小时6.2±1.6g/m²）。然而，AD完全愈合的患者TEWL并未紊乱。角质层剥脱细胞学检查显示，重度、中度和轻度AD病例外观正常皮肤中出现斑片状角化不全的比例分别为42%、29%和19%。然而，AD完全愈合的患者未发现斑片状角化不全。活动性AD患者外观正常皮肤中出现斑片状角化不全，提示AD患者外观正常皮肤中常见的屏障功能受损继发于该区域的亚临床湿疹样改变。
