Eczema and Transepidermal Moisture Loss: A Systematic Review and Meta-Analysis (Preprint)

BACKGROUND Eczema is a chronic, recurrent, inflammatory skin disease. Its main symptom is intermittent pruritus, as well as xerosis of the skin and eczematous lesions caused by the interaction of genetic and environmental factors. Risk factors for development are also associated with skin barrier defects that reduce skin hydration (capacity) and increase transepidermal water loss (TEWL). There are many studies and, in our analysis, we aimed to determine how TEWL scores differed significantly between patients with skin diseases, including eczema. OBJECTIVE The specific aims of our systematic review and meta-analysis were: • To determine, by analyzing studies, the change in the level of the epidermal barrier in skin diseases, namely eczema; • To study the effect of changes in transepidermal moisture loss in patients with eczema, taking into account gender characteristics. METHODS By conducting a systematic review and meta-analysis, we synthesized data from various studies that evaluated the association between TEWL scores and clinical severity of disease. Fifteen articles describing 1355 cases of eczema were included in our study. RESULTS About one third of patients with eczema had elevated TEWL levels. We found that the difference in TEWL levels between men and women was statistically significant. In the studies included in this meta-analysis, TEWL elevation in eczema patients ranged from 13.3% to 76.7%. Among the age group 19 to 44 years - 59.8% of eczema cases had TEWL elevation in contrast to other age groups. CONCLUSIONS Disruption of epidermal barrier permeability in eczematous conditions may also occur in other skin diseases. We have found that improvement in TEWL levels can prevent and alleviate the clinical severity of inflammatory dermatoses.