Journal of Clinical and Aesthetic Dermatology

Epidermal Barrier Supplement 2016

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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S2 SUPPLEMENT TO THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY [APRIL 2016 • VOLUME 9 • NUMBER 4 • SUPPLEMENT 1] Introduction The role of the stratum corneum (SC) and several associated epidermal barrier (EB) functions in both healthy and compromised skin have gained increased recognition over more recent years. This is most evident based on the work of research that has defined correlations between EB impairments and compromised skin, including those related to specific skin disorders. 1–3 Although atopic skin and eczematous dermatitis have been the primary focus, the importance of SC impairments and EB dysfunction in other skin diseases has also gained increased recognition. 3–7 In addition, the importance of developing topical vehicle formulations that are "barrier friendly" is well recognized. The main goal of this supplement is to encourage clinicians to understand the importance of addressing EB function in maintaining healthy skin and to appreciate its role in the overall management of many skin disorders. Objectives to support this goal are to provide summaries of physiologic SC and EB barrier functions, outline SC self- repair mechanisms, define compromised skin and SC impairments, evaluate potential differences in the EB among different skin types and ethnicities, and review the roles of moisturization and barrier repair in the management of specific skin disorders. What is the Epidermal Barrier? It is important to recognize that the EB represents a collection of specific diverse functions, many of which occur primarily within the SC. These include maintenance of water content and balance (permeability barrier), prevention and responses to invasion by microbial organisms and antigens (antimicrobial barrier and immune response barrier), reduction of the effects of ultraviolet (UV) light exposure (photoprotection barrier), and mitigation of the effects of oxidative stresses (antioxidant barrier). 3 Many of the activities of the EB occur within the SC, which is why the terms SC impairment and EB impairment are often used interchangeably. In fact, the entire epidermis contributes to the EB, although many of the major activities of barrier maintenance and repair occur within the SC. The major components of the SC and EB function are depicted in Table 1. These EB functions are dynamic and work collectively to maintain healthy skin, characterized by invisible desquamation, smooth texture, elasticity, and ability to respond to shearing forces without rigidity and microfissuring. 3 The structural and functional activities of the SC have been well described in the literature and will only be summarized in this supplement in order to elucidate clinical relevance. 1–3,7–9 Overall, the EB functions to Understanding the Epidermal Barrier in Healthy and Compromised Skin: Clinically Relevant Information for the Dermatology Practitioner Proceedings of an Expert Panel Roundtable Meeting a James Del Rosso, DO; b Joshua Zeichner, MD; c Andrew Alexis, MD; d David Cohen, MD; e Diane Berson, MD a Dermatology Adjunct Faculty, Touro University Nevada, Henderson, Nevada; b Assistant Professor, Dermatology, Icahn School of Medicine, Mount Sinai, New York, New York; c Associate Professor, Dermatology, Icahn School of Medicine, Mount Sinai; d Professor and Vice Chairman for Clinical Affairs; Director of Allergic, Occupational, and Environmental Dermatology, New York University School of Medicine, The Ronald O. Perelman Department of Dermatology, New York, New York; e Associate Professor, Department of Dermatology, Weill Medical College of Cornell University Supplement disclosure: This supplement was supported by educational grants from Valeant and PuraCap. The content and preparation of this supplement was completed solely by the authors. No individuals from any company or agency was involved in content development, preparation, review, or submission of this manuscript. © 2016 Matrix Medical Communications • 1595 Paoli Pike • Suite 201 • West Chester, PA 19380; Toll-free: (866) 325-9907 • Phone: (484) 266-0702

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