Seborrheic dermatitis: topical therapeutics and formulation design

Stratum corneum lipids play a predominant role in maintaining the water barrier of the skin. In order to understand the biological variation in the levels and composition of ceramides, ceramide 1 subtypes, cholesterol and fatty acids, stratum corneum lipids collected from tape strippings from three body sites (face, hand, leg) of female Caucasians of different age groups were analysed. In addition, we studied the influence of seasonal variation on the lipid composition of stratum corneum from the same body sites. The main lipid species were quantified using high-performance thin-layer chromatography and individual fatty acids using gas chromatography. Our findings demonstrated significantly decreased levels of all major lipid species, in particular ceramides, with increasing age. Similarly, the stratum corneum lipid levels of all the body sites examined were dramatically depleted in winter compared with spring and summer. The relative levels of ceramide 1 linoleate were also depleted in winter and in aged skin whereas ceramide 1 oleate levels increased. The other fatty acid levels remained fairly constant with both season and age, apart from lignoceric and heptadecanoic acid which showed a decrease in winter compared with summer. The decrease in the mass levels of intercellular lipids and the altered ratios of fatty acids esterified to ceramide 1, are likely to contribute to the increased susceptibility of aged skin to perturbation of barrier function and xerosis, particularly during the winter months.

Since the publication of the last US national burden of skin disease report in 2006, there have been substantial changes in the practice of dermatology and the US health care system. These include the development of new treatment modalities, marked increases in the cost of medications, increasingly complex payer rules and regulations, and an aging of the US population. Recognizing the need for up-to-date data to inform researchers, policy makers, public stakeholders, and health care providers about the impact of skin disease on patients and US society, the American Academy of Dermatology produced a new national burden of skin disease report. Using 2013 claims data from private and governmental insurance providers, this report analyzed the prevalence, cost, and mortality attributable to 24 skin disease categories in the US population. In this first of 3 articles, the presented data demonstrate that nearly 85 million Americans were seen by a physician for at least 1 skin disease in 2013. This led to an estimated direct health care cost of $75 billion and an indirect lost opportunity cost of $11 billion. Further, mortality was noted in half of the 24 skin disease categories.

We counted the number of cell layers in the stratum corneum (SC) of normal skin taken from different anatomical locations of the body of 301 individuals of various ages. Frozen 6 microm thick sections were stained with a 1% aqueous solution of safranin and observed under a microscope after application of 2% KOH solution. There were great variations in the number of SC cell layers (mean +/- SD) according to location and among different individuals. The smallest number was found in genital skin (6 +/- 2), followed in order by skin of the face (9 +/- 2), neck (10 +/- 2), scalp (12 +/- 2), trunk (13 +/- 4), extremities (15 +/- 4) and the palms and soles (47 +/- 24). The heel showed the largest number (86 +/- 36). No definite correlation was found between the number of corneocyte layers and sex of the individual, whereas there was a slight increase in the number of SC layers with age in the skin of the cheek and back, particularly in male individuals. Comparison of these data with those from functional assessments of the SC of the skin from various locations of healthy adults showed that transepidermal water loss, an indicator of SC barrier function, reflected the number of corneocyte cell layers. In contrast, high-frequency conductance, an indicator of the hydration state of the outer SC, did not seem to be under the influence simply of the number of SC cell layers.