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Elias and Williams: The Inside-Out of Skin by dermatologists and skin researchers Peter M. Elias, M.D. and Mary L. Williams, M.D.

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RESEARCH FROM LABS AROUND THE WOLD

2018 IID Meeting Update: GPSkin Device, A New, Easy To Use Means To Assess The Skin’s Barrier And Hydration

September 6, 2018 By Peter M. Elias, M.D. Leave a Comment

GPSkin Barrier device by GPower, Inc., which measures trans-epidemal water loss and water hydration
GPSkin Barrier device which measures trans-epidermal water loss and water hydration

A Korean company, GPower Inc., has developed a small, hand-held device, called the GPSkin device, that can accurately and quickly measure both the barrier status and moisture content (hydration) of the stratum corneum. At the recent IID meeting, Eric Simpson and his co-worker, Erin Grinich, both from Oregon Health Science University, reported that the GPSkin apparatus is as reliable in measuring barrier function and hydration as other standard, but much more cumbersome and expensive instruments. Another useful feature is the accompanying software, which collects the information, and assists with interpretations of the data.

A big problem for investigators interested in studying the barrier status of normal humans, and in patients with diseases, like atopic dermatitis and psoriasis, has been both the cost and complexity of the devices that are currently in use to measure barrier function. When you consider both the ease of use and widespread deployment of other medical devices – such as those that measure the blood levels of oxygen or sugar across the skin – it’s rather surprising that the capability to measure water movement and water content have not kept pace. Now, simple to use but reliable devices, such as the GPSkin, promise to make this hurdle a thing of the past.

Not only could the GPSkin device be useful for dermatologic research, but dermatologists, allergists and pediatricians also could find it helpful in their clinical practices to determine how well their atopic dermatitis patients are responding to treatment. Nurses and physicians in the intensive care nursery could also find it useful in assessing the maturation of the skin barrier in their premature babies. The ease of use the GPSkin apparatus means that it could even be used by patients to assess changes in their disease activity. Practitioners in skin care salons might also employ the device to determine whether their clients need certain types of barrier repair therapy, or whether the products they are currently using are doing the job – or not. This is particularly important as there is mounting evidence that many of the products commonly used for skin care are actually harmful to skin.

With the availability of simple to use and reliable devices, such as GPSkin, that can measure water loss and skin hydration, the assessment of these epidermal functions should become routine in both the research setting and in clinical practice and is likely to lead to improvements in the care of both normal and inflamed skin.

2018 IID Meeting Update: Pollutants And The Skin

July 19, 2018 By Peter M. Elias, M.D. Leave a Comment

 

Prof. Krutmann describes how pollutants affect skin
Professor Krutmann lecturing on how pollutants affect skin at the 2018 International Investigative Dermatology Meeting in Orlando

Pollutants Affect Skin.

Environmental pollutants and how they affect skin was a hot topic at the 2018 IID meeting in Orlando. Dr. Jean Krutmann, Professor of Dermatology and Environmental Medicine at the Heinrich-Heine-University Düsseldorf, delivered a plenary presentation in a symposium devoted to this subject, where he provided a brief overview.

The extent of the problem, Krutmann noted, is alarming.

In northern India and much of China, the populace is exposed to levels of pollution comparable to smoking ~25 cigarettes a day. It is estimated that, worldwide, about 7 million people a year die from exposure to pollutants. And matters are getting worse! This  number that is projected to burgeon to 50 million by the year 2050!

[Read more…] about 2018 IID Meeting Update: Pollutants And The Skin

2018 IID Meeting Update: Even Fat Is Linked To The Skin Barrier

July 12, 2018 By Peter M. Elias, M.D. Leave a Comment

Fat is healthy for elephant seals. Could it also be good for the skin barrier as dome fat is for humans?
Resting elephant seals on San Simeon State Beach.

Fat Cells And The Skin Barrier?

What do fat cells have to do with the function of the epidermal permeability barrier? Before the recent International Investigative Dermatology Meeting in Orlando, we – although generally obsessed with all things related to the skin’s permeability barrier – would reluctantly have had to admit, “Alas, nothing.”

Therefore, we were most intrigued to learn of the discovery by Dr. S. Hong, of Dankook University in Cheonan, Korea, and his colleagues that some of our fat cells are at work, fine-tuning the permeability barrier. [Read more…] about 2018 IID Meeting Update: Even Fat Is Linked To The Skin Barrier

2018 IID Meeting Update: New Insights Into Pustular Psoriasis

July 5, 2018 By Peter M. Elias, M.D. Leave a Comment

picture of pustular psoriasis
Pustular psoriasis is an uncommon and often severe form of psoriasis characterized by sheets of sterile pustules

Pustular psoriasis is a type of psoriasis in which pustules, rather than red, scaly patches, are its clinical hallmark.  These psoriasis pustules are ‘sterile’, meaning they are not produced by a bacterial or viral infection.  The pustules can be scattered over much of the skin surface, but more often are entirely localized to the palms and soles.

To develop a better understanding of this uncommon and often severe variant of psoriasis, a consortium of dermatologists from all over Europe and Asia pooled their data on 863 patients. Somewhat surprisingly, they found that many patients also had the more common, plaque-type psoriasis on other parts of their skin. Pustular psoriasis was more frequently seen in females than males and tended to occur later in life than classic plaque type psoriasis.

Many of the patients in this large cohort also had diabetes and high blood pressure. [Read more…] about 2018 IID Meeting Update: New Insights Into Pustular Psoriasis

2018 IID Meeting Report: The Skin Microbiome

May 30, 2018 By Peter M. Elias, M.D. Leave a Comment

Richard Gallo and the skin microbiome
Richard Gallo, M.D., PhD., of UC San Diego at the 2018 IID meeting. Photo by Peter M. Elias

The ‘microbiome’ is a trending concept these days – and just as the gut hosts a large population of beneficial microbes, so, too, there is a normal skin microbiome. Of course, it has been known for decades that our outer skin layer, the stratum corneum, supports the residence of certain species of bacteria, its so-called ‘normal flora’.

These normal commensals provide skin with a host of benefits. The most important of these is their ability to successfully out compete – at least most of the time – certain species of ‘bad bugs’, like Staph. aureus.

In essence the good bacteria on our skin keep the bad ones from taking up residence and causing problems.

But only a minority of the bugs that inhabit our skin could be identified by the culture methods that were the only means available to the scientists of yore. The recent revolution in microbial genetics has circumvented this need to grow out a microbial species in order to identify it. Using these new, DNA-based techniques, a vast array of additional microbes that also inhabit our skin have been identified – literally myriads of species that had gone undetected in the past.

Just as a whole host of organisms form the gut microbiome, the skin too possesses a vast microbiome. In fact, the sheer burden of these organisms is mind-boggling – it turns out that we are only about 43% human, with much of the rest of us consisting of microorganisms – an average of 39 trillion bugs in all! While we humans only possess about 20,000 genes, our resident microbes, in the gut, skin and elsewhere, display from 2 to 20 million genes!

It is now clear that the microbiome of the skin and the gut are very different – not only in their profile of species but also in their ecology.

In a plenary lecture that kicked off the recent 2018 IID meeting in Orlando, Rob Knight, Ph.D., from the Department of Pediatrics at the University of California San Diego, described how the total burden and diversity of organisms that reside on our skin differ greatly from individual to individual, and also totally differ from the organisms that inhabit the gut. The skin’s microbiome can also change within a day or two, and is influenced greatly by our lifestyles, including where we live.

For example, in rural areas, we pick up a lot of organisms from the soil, to form a kind of Earth-Soil-Skin biosystem.

Changes in external temperature and humidity also alter the skin microbiome, explaining, for example, the differences in the bugs that inhabit our moist body folds, such as our arm pits or groins, vs. the rest of our skin. And of course, oral antibiotics can drastically alter the microbiomes of both the skin and the gut, with still uncertain consequences for our health.

Returning to the gut, Knight then described how the gut microbiome is now implicated in a host of diseases, including obesity, inflammatory bowel diseases, and, increasingly, with disorders of the nervous system, like autism. It is now envisioned that vaccines, prepared from the gut microbiome, could be used to treat or prevent obesity, anxiety disorders, and even the consequences of excessive stress.

Few scientists know more about the skin’s microbiome than Richard L. Gallo, Chairman of the Department of Dermatology at the University of California San Diego. Gallo has discovered certain strains of Staphyloccos aureus in the normal skin flora (another term for our microbiome) that are not bad actors like the rest of their family. Instead, these good strains of Staph. produce antimicrobial peptides, which can fend off the bad bugs – most importantly, they inhibit growth of those bad kinds of Staph. aureus, which can trigger recurrent episodes of atopic dermatitis.

One cardinal feature of atopic dermatitis is that it is deficient in a key antimicrobial peptide, which may explain why the disease is often flares when the skin becomes colonized by harmful strains of Staph.

At the recent IID meeting, Gallo described initial studies with topical applications of a ‘soup’ prepared from organisms that had been isolated from the skin of patients with atopic dermatitis while their disease was in remission. First in mice, and then in a small group of patients with atopic dermatitis, his group showed that this soup, which he terms ‘extended biotherapy’, displaces the bad bugs, and improves the inflammatory component of the disease.

Also of importance is that this form of therapy appears to be safe – no side effects were observed in the 41 patients who participated in this study. This raises hope that this form of therapy could be safely used in infants and young children. Because our prior studies have shown that the permeability and antimicrobial barriers are intimately linked (i.e., change one function for the better or worse, and the other will change in parallel), we suspect that this microbial soup will also improve barrier function in patients with atopic dermatitis – a possibility that we hope Dr. Gallo and his coworkers will explore in their future studies.

As a result of these favorable initial studies, larger trials already are underway at both UCSD and National Jewish Medical Center in Denver. Indeed, a ‘biosoup’ for the topical therapy of atopic dermatitis is presently under development by MatrySis Bioscience. Stay tuned for further developments on this promising front!

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INSIDE THE SKIN BARRIER

The Skin Microbiome: Good Bugs And The Bugs That Bug Us

January 7, 2020 By Peter M. Elias, M.D.

We hear a lot about the multitude and diversity the micro-organisms – especially the bacteria - that … Read More...

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SKIN DISORDERS

Dry Skin: Who Is At Risk and What Can Be Done About It?

December 1, 2019 By Peter M. Elias, M.D. Leave a Comment

Who is at risk? Many people are prone to develop dry skin. Examples include those who have or … Read More...

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REPAIRING THE SKIN BARRIER

The How and Why of Sensitive Skin

November 1, 2018 By Peter M. Elias, M.D. 1 Comment

An alarming percentage (about 60%) of normal adults, mostly women, self-report that they regularly … Read More...

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CLIMATE AND THE SKIN

The Skin’s Many Barriers and Climate Change

October 9, 2020 By Mary L Williams, M.D.

Skin's Many Barriers And How Climate Change May Affect Them Skin has many barriers: it keeps us … Read More...

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Q & A

Q& A: Preventing Dry Skin From COVID-19 Hand Washing And Toxic Hand Sanitizers

December 1, 2020 By Peter M. Elias, M.D. & Mary L. Williams, M.D. Leave a Comment

Q: I have developed dry skin from COVID-19 because I have to wash my hands so often. Hand sanitizers … Read More...

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Research: From The Elias Lab

Top 5 Scientific Discoveries About Skin Of The Decade

December 26, 2019 By Peter M. Elias, M.D. & Mary L. Williams, M.D. Leave a Comment

We have learned a lot about skin and its permeability barrier in recent years.  Here are our … Read More...

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Research: From Labs Around the World

Top 5 Scientific Discoveries About Skin Of The Decade

December 26, 2019 By Peter M. Elias, M.D. & Mary L. Williams, M.D. Leave a Comment

We have learned a lot about skin and its permeability barrier in recent years.  Here are our … Read More...

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