Effects of Immunomodulatory Therapy on the Skin Barrier Function in Patients with Psoriasis Vulgaris.

Background and

Objectives

Psoriasis vulgaris features epidermal barrier dysfunction. Materials and

Methods

Barrier function changes were prospectively evaluated over 12 weeks during TNF-α inhibition with adalimumab, along with concurrent changes in disease severity and quality of life. Adults with moderate-to-severe plaque psoriasis initiating adalimumab (80 mg loading on day 1; 40 mg every other week thereafter, starting day 8) underwent assessments at baseline and at week 12 (n = 9; mean age 44.1 ± 14.9 years, range 20-61). Transepidermal water loss (TEWL; g/m2/h) and skin pH were measured at the elbow, lower leg, abdomen, back, and scalp; PASI, BSA, and DLQI were recorded. The measurements were standardized, though room temperature/humidity were not identical between visits.

Results

The clinical indices improved markedly and TEWL also decreased at all sites-the elbow, lower leg, abdomen, back, and scalp-indicating barrier recovery; in contrast, the pH remained within a mildly acidic range at all sites. Lesion-to-non-lesion conversion occurred, and no site worsened.

Conclusions

In summary, 12 weeks of adalimumab were associated with a notable clinical improvement and consistent, site-spanning reductions in TEWL, whereas skin surface pH showed no material change. TEWL appears to be a sensitive objective adjunct to clinical indices for monitoring response.