Kundu Dibyasankha, Jayaraman Anant, Sen Chandan K
Department of Surgery, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Adv Wound Care (New Rochelle). 2025 Jun 5. doi: 10.1089/wound.2024.0148.
Recent reports recognize transepidermal water loss (TEWL) as a critical objective parameter measuring clinical wound healing endpoint. At the site of wound repair, TEWL measures functional wound closure as marked by re-establishment of barrier function at the wound site. This review article addresses recent developments in clinical TEWL measurement in the context of human skin health and wound care. To that end, emphasis is placed on the review of registered clinical studies reported in ClinicalTrials.gov for which TEWL results have been posted or published. The U.S. Food and Drug Administration (FDA) defines complete wound closure as the achievement of 100% re-epithelialization of the wound surface, with no detectable exudate, drainage, or need for wound dressing, as verified during two sequential clinical assessments conducted at least 14 days apart. Clinically, wounds may meet this current FDA-recommended clinical criteria for wound closure, yet not achieve functional wound closure which requires the re-establishment of barrier function at the site of repair. Such wounds are likely to recur. High TEWL posthealing predicts wound recurrence. Thus, TEWL measurement at the site of repair posthealing is emerging as a significant measurement of wound healing endpoint. Appropriate clinical measurement of TEWL requires a basic understanding of the related technologies and their appropriate use. Such understanding will help achieve the necessary rigor and reproducibility in clinical measurement. Recent reports on the critical significance of TEWL in wound care open new horizons wherein TEWL is likely to have broader applications involving altered skin barrier functions, such as during aging and other factors that determine skin health. Evidence to support revisiting the FDA definition of wound closure to include restoration of barrier function at the site of closure is strong. Widespread adoption of TEWL in wound care practices to determine functional wound closure is anticipated.
近期报告将经表皮水分流失（TEWL）视为衡量临床伤口愈合终点的关键客观参数。在伤口修复部位，TEWL测量功能性伤口闭合情况，其标志是伤口部位屏障功能的重新建立。这篇综述文章探讨了在人类皮肤健康和伤口护理背景下临床TEWL测量的最新进展。为此，重点回顾了ClinicalTrials.gov上报告的已公布或发表TEWL结果的注册临床研究。美国食品药品监督管理局（FDA）将完全伤口闭合定义为伤口表面实现100%的再上皮化，无可检测到的渗出物、引流液或无需伤口敷料，这在至少相隔14天进行的两次连续临床评估中得到验证。临床上，伤口可能符合当前FDA推荐的伤口闭合临床标准，但未实现功能性伤口闭合，而功能性伤口闭合需要在修复部位重新建立屏障功能。此类伤口很可能复发。愈合后TEWL值高预示着伤口复发。因此，愈合后在修复部位测量TEWL正成为伤口愈合终点的一项重要测量指标。对TEWL进行适当的临床测量需要对相关技术及其正确使用有基本的了解。这种了解将有助于在临床测量中实现必要的严谨性和可重复性。近期关于TEWL在伤口护理中关键意义的报告开辟了新的视野，其中TEWL可能有更广泛的应用，涉及改变的皮肤屏障功能，如在衰老过程以及其他决定皮肤健康的因素中。有充分证据支持重新审视FDA对伤口闭合的定义，将闭合部位屏障功能的恢复纳入其中。预计TEWL将在伤口护理实践中广泛应用以确定功能性伤口闭合情况。
