BARRIERE EPIDERMIQUE ET IMPLICATIONS CLINIQUES ALFRED BALBUL. MD,CM. 9 JUIN, 2018

STRUCTURE NORMAL DE L'EPIDERME PROCESSUS DE CORNIFICATION. BUT : SURFACE NORMAL DE LAPEAU COMPARER AU MEMBRANE DE CELLULES REGULIERES MUCOSES INTESTINS ETC.

BIOCHIMIE MIRACULEUSE TRANSFORMATION BIOCHIMIQUE A UNE SURFACE HYDROPHOBE, PLASTIQUE, RESISTANTE.

Saturee ( pas de bonds double) Structure organisee COMPOSITION SIMPLE. 3 PHASES CHOLESTEROL GLOBULE HYDROFUGE BARRIERE MOBILE FATTY ACIDS # de C pair Saturee ( pas de bonds double) Structure organisee Partie ionisee vers l'externe ( hydrophilique) Queue hydrophobique vers le centre.

Ceramides What's the big deal ? Leur rôle unique dans la barrière cutanée. Double couche de lipide

The components of NMF

Ma modele de la barriere de base

Facteurs supplementaires

In the stratum corneum, the corneocytes are embedded in epidermal lipids. The corneocytes can be imagined as bricks and the lipids as the mortar or cement in between.

In the uppermost layers of the skin, filaggrin decomposes into NMF In the uppermost layers of the skin, filaggrin decomposes into NMFThe generation of NMF from filaggrin—key points   Profilaggrin in the living epidermis is broken down to filaggrin Filaggrin increases the mechanical stability in the upper layers of the epidermis Filaggrin is decomposed (with the help of enzymes) to NMF components These NMF components are essential for the regulation of skin moisture content and skin barrier function

Filaggrin deficiency can cause dry skin conditions When healthy skin encounters dry conditions, proteolytic enzymes are activated, triggering the breakdown of filaggrin into amino acids and other components of NMF Xerotic skin suffers from an inadequate transformation of filaggrin to NMF Some atopic eczema patients do not produce filaggrin, lack NMF, and become more susceptible to allergens Optimized moisturizing therapies provide NMF components to improve water-binding capacity of the stratum corneum, and create an environment that promotes self-repair of the barrier

Skin Barrier Dysfunction in Dry Skin/Atopic Dermatitis TEWL TEWL = transepidermal water loss Adapted from Cork J Allergy Clin Immunol. 2006; 118; 3-21 and Dahnhardt-Pfeiffer. JDDG. 2013; 11(5); 437-443

Guenther L, et al. J Cutan Med Surg. 2012 Jan-Feb; 16(1);23-31

Skin Care for Dry and Inflammatory Skin Conditions Products Functio n Ingredient s Cleansers Removing pollutants and bacteria Synthetically produced detergent cleansers Emollients: mineral oils, waxes, long-chain esters, fatty acids, etc.   Emollients close fissures by filling spaces and seal moisture into the skin Mineral oils (eg. liquid paraffin, petrolatum), waxes (eg. lanolin, beeswax, carnauba), long-chain esters, fatty acids, and mono-, di-, and triglycerides Humectants: alpha-hydroxy acids, propylene glycol, ceramides, and hyaluronic acid Moisturizers act as humectants, hydrate the stratum corneum through a hygroscopic effect, increasing its elasticity Combine a humectant with an emollient, eg, alpha-hydroxy acids, such as LA, GA, TA, urea, glycerine, ceramides and propylene glycol Topical steroids and moisturizers Antiinflammatory and effects of the moisturizer Combine a moisturizer, such as urea cream or ceramide containing cream with TCS Topical calcineurin inhibitors Anti-inflammatory for chronic cases Combine a moisturizer such as ceramide containing cream with CI LA = lactic acid, GA = glycolic acid, TA = tartaric acid, TCS = Topical corticosteroids = TCS, TCI = topical calcineurin inhibitors Adapted from: Guenther L, Lynde CW, Andriessen A, Barankin B et al. J Cutan Med Surg. 2012 Jan-Feb; 16(1);23-31

XéROSIS – Sécheresse Cutanée: Un problème commun La combinaison de multiples carences de la couche cornée et de la couche épidermique profonde sont les causes de la peau très sèche et la peau squameuse. Les patients qui souffrent de xérosis ont besoin d’une recommendation de produits de soin de la peau qui ne vise qu'un soulagement immédiat et qui procure une longue durée des symptômes typiques de la peau sèche tel que les démangeaisons, la peau squameuse, rude et rugueuse. Peau sèche 07/04/201907/04/201907/04/2019

XéROSIS – Sécheresse Cutanée: Un problème commun Urée et les facteurs d’hydratation naturels unique retientent l’eau sur les couches superficielles de l'épiderme. Les céramides forme une enveloppe protectrice des lipides cutanés et ameliore la fonction barrière cutanée de la corneum Gluco Glycérol renforce la distribution de l’eau dans couches profondes de l’épiderme 07/04/201907/04/201907/04/2019

Moisturizers & Cleansers www.eczemahelp.ca The Eczema Society of Canada Seal of Acceptance A-Derma Exomega Emollient Balm Aveeno Eczema Care line (creams, washes) Avene Xeracalm Balm CeraVe Moisturizing Cream Cetaphil Restoraderm wash and moisturizer Eucerin Eczema Relief Cream Glaxal Base .Spectro E-Care cream, wash Gold Bond Ultimate Eczema Relief Skin Protectant Cream Lipikar Baume AP+, Lipikar Syndet Polysporin Eczema Essentials cream, wash Skinfix Eczema Balm