Epidermal Barrier Function May Predict Atopic Dermatitis Flares

Atopic dermatitis on arm
A novel study assesses skin barrier function (pH, TEWL and skin hydration) in healthy participants and patients with atopic dermatitis (peri-lesional and lesional skin).

Patients with atopic dermatitis (AD) have altered epidermal barrier function which may help predict flare-ups, according to an observational study published in the Journal of The European Academy of Dermatology and Venereology.

Investigators evaluated skin barrier function in healthy patients and patients with AD and compared changes in the evolution of skin barrier function with changes in the evolution of AD severity during a 6-week period. During the course of 18 clinical visits, investigators assessed predefined skin areas in all patients using the SCORing Atopic Dermatitis (SCORAD) calculator, pH, transepidermal water loss (TEWL), and skin hydration. They identified significantly worsened AD severity based on changes in local SCORAD and analyzed the discrepancy between lesional and perilesional skin within 5 visits of a flare.

There were 25 patients included in the analysis: 15 with AD and 10 healthy control participants. In the AD group there were 5 men and 10 women, and the mean age was 35.87±8.33 years. In the control group there were 9 women and 1 man participating, and the mean age was 34.20±9.47 years.

TEWL and skin pH discrepancy was significantly higher at a flare visit compared with the 2 visits before and afterward. This discrepancy decreased in the visit following the AD flare. Using skin pH and TEWL data from the 2 visits before a flare, a Support Vector Machine-machine learning classifier was able to predict flare vs nonflare periods with an average balanced accuracy of 74%, an average sensitivity of 81%, and an average specificity of 67%.

“This novel finding indicates that targeted emollients for balancing skin pH and reducing TEWL may have therapeutic potential in prevention of AD flares,” the study authors wrote.


Marini A, Aue N, Demessant AL, Salah S, Kerob D, Luger TA. Increased skin pH and transepidermal water loss may serve as predictor for atopic dermatitis flares. J Eur Acad Dermatol Venereol. Published online August 22, 2022. doi:10.1111/jdv.18558