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Routine skin care as prophylaxis and treatment.

Beginning in the mid-1960s, researchers in dermatology began publishing the results of studies on transepidermal water loss (TEWL). Subsequent research gradually revealed the dynamic relationship between the healthy function of skin, proper skin hydration, and TEWL. Over the subsequent decades, the role of the stratum corneum in maintaining optimal skin hydration and preventing excess TEWL has been further studied, understood, and appreciated. The most recent research has revealed the wide range of physiologic functions of the stratum corneum beyond TEWL, and the term "stratum corneum barrier" is becoming increasingly familiar to clinicians outside of the specialty of dermatology.

Both in vitro and in vivo studies also have demonstrated much about the medical and environmental factors that perturb the stratum corneum, disrupting the many and interdependent functions of the skin barrier, including permeability and defense functions.

Dermatologists and other clinicians have made enormous strides in parent and patient education when it comes to routine cleansing and other skin care measures that help the skin heal and, therefore, restore the barrier function to normal (or as normal as possible in the case of chronic conditions). This is seen particularly in the specific and detailed instructions given to parents of children with atopic dermatitis (AD).

However, in the absence of skin pathology, we have considerable work left to do when it comes to educating ourselves and our patients (or their caregivers). Because of its ordinariness, the routine activities involved in well skin care--cleansing, moisturizing, and sun protection--are almost always underappreciated by both clinicians and patients, unless and until a dermatologic condition emerges. For example, in the care of normal skin, "use mild cleansers" is advice used often and broadly by clinicians, and without advice regarding a specific mild cleanser that is appropriate in a particular patient.

In this supplement, the authors review the physiology of the stratum corneum across the age spectrum and a range of demographic and other variables, consider AD as an exemplar of stratum corneum barrier perturbation, provide an overview of the chemistry of skin cleansers, and offer recommendations for incorporating well skin care into every clinical encounter. Included is an educational handout for parents that may be freely copied and distributed by clinicians; this is designed to allow clinicians to write in their own recommendations for specific products that are appropriate for each patient.

The authors, who are guest editors of this supplement, provide further insight and discussion on these topics in a companion educational webcast titled, "An Evidence-Based Approach to Skin Cleansing: Restoring and Maintaining the Skin Barrier in Diverse Patient Populations." The webcast is available to healthcare professionals and may be found at

Joseph F. Fowler, Jr, MD, Chair

Clinical Professor of Dermatology

Contact and Occupational Dermatology

University of Louisville

Louisville, Kentucky

Publication of this CME article was jointly sponsored by the University of Louisville School of Medicine Continuing Medical Education and Global Academy for Medical Education, LLC, and is supported by an educational grant from Johnson & Johnson Consumer and Personal Products Worldwide, Division of Johnson & Johnson Consumer Companies, Inc.

Joseph F. Fowler, Jr, MD, has been a consultant and/or speaker and/or investigator for 3M, Abbott Laboratories, Allerderm, Allergan, Amgen Astellas Pharma US, Inc, Centocor, Dermik, Dow Pharmaceutical Sciences, Inc., Eli Lilly and Company, Galderma Laboratories, L.P., GlaxoSmithKline, Johnson & Johnson Consumer Products Company, Medicis Pharmaceutical Corporation, Merck Pharmaceuticals, Merz Aesthetics, Novartis Pharmaceutical Corporation, OnSet, Promius, Pfizer, Quinnova, Ranbaxy, SmartPractice, Taisho, Taro, and Valeant Pharmaceuticals International.

Joseph F. Fowler, Jr, MD, has received an honorarium from Global Academy for Medical Education for his participation in this activity. He acknowledges the editorial assistance of Joanne Still, medical writer, and Global Academy for Medical Education in the development of this continuing medical education journal article. Joanne Still has no relevant financial relationships with any commercial interests.
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Author:Fowler, Joseph F., Jr.
Publication:Family Practice News
Date:Aug 1, 2013
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