Experimental induction of rough dermatitic skin in humans

The response after application of various concentrations of sodium lauryl sulfate (SLS) on human skin is reported. The induced changes associated variable degrees of roughness and erythema characterizing rough dermatitic skin (RDS). These clinical changes were almost invariably (less than 5% experimental error) associated with increased values of transepidermal water loss (TEWL) and increased cutaneous blood flow values (CBFV). A significant positive correlation was found between TEWL and CBFV at all concentrations of SLS. However, values of TEWL higher than those found in 84% of the controls (mean + SD: 8.127 + 2.89 gr/m2/h) were usually significantly correlated with clearcut clinical changes (total clinical score greater than 2 or erythema greater than 1) at all concentrations of SLS, while CBFV (mean + SD of controls: 2.717 + 2.165) which had a wider dispersion, were significantly associated only with erythema after 10% and 1% SLS. This reflects the distinction that is being made between a primary chemical insult, which we identify clinically as roughness and functionally as increased TEWL associated with alterations of barrier function of the skin, and a secondary, delayed inflammatory response, which is clinically recognized as erythema and functionally objectivated by increased CBFV. These results provide a rational basis supporting the use of this experimental model of RDS for testing of preventive and therapeutic efficacy as well as refining the evaluation of tolerance of cosmetics especially designed for use on sensitive skin.     

Differences of skin irritation between Japanese and European women

BACKGROUND: After using cosmetics, Japanese women frequently complain about sensitive, stinging skin. We wondered whether Japanese women's skin is more sensitive than that of Caucasians. OBJECTIVES: To examine possible racial differences of skin irritation and subjective sensations. METHODS: We performed patch testing on the forearm with sodium lauryl sulphate (SLS) at different concentrations (0.25%, 0.5%) and 24-h exposure time. Skin reaction was evaluated by measurement of transepidermal water loss (TEWL), stratum corneum hydration, sebum secretion, laser Doppler flowmetry (LD), content of melanin and erythema. During a stinging test with 10% lactic acid (applied to one side of the cheeks) the subjects were asked to describe the present intensity of any sensation. We used a Chromameter to measure skin colour before and after application of lactic acid. This study was performed in Marburg, Germany, with healthy Japanese and German women living in Marburg. RESULTS: After SLS testing, we found no significant differences of the barrier function in the stratum corneum, but we found significant subjective sensory differences between Japanese and German women. CONCLUSIONS: Japanese women may complain about stronger sensations reflecting a different cultural behaviour rather than measurable differences in skin physiology; however, a faster penetration of SLS in Japanese cannot be excluded.     

Susceptibility to cumulative and acute irritant dermatitis An experimental approach in human volunteers

Reactivity to repeated daily sodium lauryl sulfate (SLS) applications and patch test reactivity to SLS was studied in 23 females. Skin changes were quantified by transepidermal water loss (TEWL), dielectric water content (DEWC), laser Doppler velocimetry (LDV) and visual scoring (VS). Dermatologic histories (HS) and susceptibility to sunburn (ST) were obtained and clinical skin dryness evaluated (DS). Great interindividual variation occurred in the degrees of changes in the biophysical parameters measured: the variation was most apparent in TEWL. The subjects with HS 1 or more developed greatest TEWL increase after open SLS applications (p less than 0.05). DS showed poor correlation with SLS reactivity and only minor DEWC alterations were seen. ST showed some non-significant correlation with erythema reactivity in the patch test.     

On the course of the irritant reaction after irritation with sodium lauryl sulphate

Background: The sodium lauryl sulphate (SLS) irritation test is a well-established model for irritant contact dermatitis after the effects of surfactants.
Aim of the study: The course of changes in corneometric measurements (stratum corneum hydration), in transepidermal water loss (TEWL), in laser Doppler measurements (epidermal perfusion) and in colorimetric measurements (skin redness), after a single SLS irritation, should be studied over time.
Methods: Twenty healthy volunteers were studied. Irritation with 1% SLS solution was applied to the side of one forearm for 24 h under occlusive conditions, while the symmetrical experimental site remained untreated. Measurements were made for 9 days after completion of SLS irritation.
Results: Stratum corneum hydration was reduced immediately after irritation, and subsequently a hyper-hydration was observed. The increase in TEWL, laser Doppler measurements and skin redness persisted for 7–9 days. With regard to skin redness, a mild blanching effect was noticeable after 9 days.
Discussion: The evidence of very short-term exsiccation of the stratum corneum with persistent barrier damage, as well as reactive hyper-hydration and blanching of the skin, is remarkable. These first findings suggest that exsiccation of the stratum corneum is not caused by a damage to barrier lipids.     

Long-term repetitive sodium lauryl sulfate-induced irritation of the skin: an in vivo study

Skin may adapt to topical irritants through accommodation. This study focuses on long-term exposure to irritants and attempts to demonstrate accommodation. Sodium lauryl sulfate (SLS) induced irritant contact dermatitis at 3 concentrations (0.025% to 0.075%). Distilled water, acetone and an empty chamber served as controls. Experimental compounds were applied to forearms of 7 healthy volunteers for 24 hr before replacing by a fresh chamber for 6 non-consecutive weeks over 103 days. Possible accommodation was quantified by visual scoring (erythema and dryness) and by bioengineering parameters: transepidermal water loss (TEWL), capacitance, chromametry and laser Doppler flowmetry (LDF). Significant erythema, dryness, elevated TEWL, skin colour reflectance and LDF values occurred during the exposure periods. Upon repeat exposure, an immediate and augmented response in erythema, TEWL, skin colour reflectance and LDF developed. However, irritant skin changes were not sustained. Irritation parameters return to baseline after cessation of exposure. There was no evidence of sustained irritation or accommodation after the last exposure. Study findings do not document sustained accommodation or adaptive hyposensitivity after long-term repetitive irritant exposure under these test conditions. Alternative models should be developed to prove or disprove the accommodation hypothesis.     

Basal transepidermal water loss, skin thickness, skin blood flow and skin colour in relation to sodium-lauryl-sulphate- induced irritation in normal skin

The influence of basal transepidermal water loss (TEWL), skin thickness, blood flow and skin colour on susceptibility to sodium-lauryl-sulphate(SLS)-induced irritant contact dermatitis was studied in 70 healthy volunteers. SLS 0.5% was applied as a patch test. For assessment of basal values and skin response to SLS, bioengineering methods were used: TEWL was measured by an evaporimeter, skin thickness by ultrasound A-scan, blood flow by laser Doppler flowmetry, and skin colour by a colorimeter, using the L*a*b* system of the Commission Internationale de l'Eclairage (CIE). By use of multiple regression analysis, it was demonstrated that basal TEWL was substantially related to skin susceptibility to SLS, high basal TEWL predicting an increased susceptibility to SLS. Also increased light reflection from the skin, indicating a 'fair' skin, was found to be associated with increased susceptibility to SLS.     

Evaluation of skin susceptibility to irritancy by routine patch testing with sodium lauryl sulfate

Irritant patch testing with sodium lauryl sulfate (SLS) will become more and more a routine test determining skin susceptibility in men. Recently, it has been shown that for practical reasons, irritant SLS patch testing can take place on the back simultaneously with a routine allergic patch test to other contact allergens. However, SLS patch testing has mostly been performed on the forearm in studying experimental skin irritation so far. The aim of this study was to determine whether there is a relationship in skin response to aqueous SLS (0.125%; 0.25%; 0.5% and 1.0%) between the forearm and the back assessed by visual scoring and measurement of transepidermal water loss (TEWL). We found a pronounced reaction of the forearm compared to the back. TEWL values as well as visual scores correlated well with SLS concentration. There was also a high correlation in visual scoring between the forearm and the back. Based on test sensitivity and specificity we suggest a 48 hrs patch test for routine screening with 0.5% SLS on the forearm evaluated by TEWL measurement or visual scoring 24 hrs after patch removal. A mild erythema (scored as < or =1) is considered to be normal. If for practical reasons, the SLS patch is placed on the back simultaneously with the allergic patch test, 0.5% SLS may be sufficient, too. TEWL measurement so far provides a reliable method and will certainly be necessary for experimental studies on irritant skin reactions, particularly when different SLS concentrations are used. After a 48 hrs patch test with SLS 0.5% TEWL measurement should be performed at 72 hrs. A value of < or =31.6 g/m(2)hr seems to follow the normal distribution.     

Variation in barrier impairment and inflammation of human skin as determined by sodium lauryl sulphate penetration rate

BACKGROUND: Skin irritability after a brief exposure to the model skin irritant, sodium lauryl sulphate (SLS), is known to vary considerably between individuals. A difference in the skin barrier to SLS may contribute to this variation. To date, no human in vivo data have been available on SLS penetration into the skin. OBJECTIVES: We studied whether the SLS penetration rate into the stratum corneum (SC) is related to impairment of the water barrier function and inflammation of the skin. METHODS: The penetration of SLS into the SC was assessed using a noninvasive tape-stripping procedure in 20 volunteers after a 4-h exposure to 1% SLS. Additionally, the effect of a 24-h exposure to 1% SLS on the skin water barrier function was assessed by measuring the transepidermal water loss (TEWL). The accompanying inflammation was quantified by measuring erythema. RESULTS: The mean +/- SD diffusivity of SLS (D) and the SLS permeability coefficient (Kp) were 1.4 +/- 0.6 x 10(-8) cm2 h(-1) and 1.5 +/- 0.7 x 10(-3) cm h(-1), respectively. A multiple regression analysis showed that the baseline TEWL, SC thickness and SLS penetration parameters K (SC/water partition coefficient) and D clearly influenced the increase in TEWL after the 24-h irritation test (explained variance: r2 = 0.80). Change in erythema was mainly influenced by SC thickness. CONCLUSIONS: We found that variation in the barrier impairment and inflammation of human skin depends on the SLS penetration rate, which was mainly determined by SC thickness.     

Potential for irritation increases from the wrist to the cubital fossa

The effect of site on the irritant dermatitis potential was studied in 10 subjects using the volar surface of the forearm. Erythema scoring and transepidermal water loss (TEWL) measurements were used to assess irritation at different levels on the forearm. A sodium lauryl sulphate (SLS 2 g/v%) solution was used as a standard irritant in a patch test procedure and on open tests. Both the erythema scores and measurements of the TEWL of exposed skin showed significant localization differences, and demonstrated that the same sites on the forearm should be used for irritancy tests and possibly physiological studies.     

Anti-inflammatory effect of pimecrolimus in the sodium lauryl sulphate test

Background Pimecrolimus is a calcineurin inhibitor used for the topical treatment of inflammatory skin diseases. We have shown previously that pimecrolimus cream is not effective on intact skin in the ultraviolet erythema test. Objective To test the anti‐inflammatory effect of pimecrolimus cream after damage of the skin barrier by sodium lauryl sulphate (SLS) in a randomised, placebo‐controlled, observer‐blinded study. Methods SLS (3% v/v) was applied under occlusion on the back of 36 healthy volunteers for 24 h. Subsequently, the test areas were treated for 24 h with pimecrolimus cream, 1% hydrocortisone in a hydrophilic ointment, and the vehicle alone over three consecutive days. One control area remained untreated. The erythema index and the transepidermal water loss (TEWL) served as readout parameters to assess the SLS‐induced skin irritation. Results Pimecrolimus cream and 1% hydrocortisone cream significantly reduced the SLS‐induced erythema. The two test preparations did not have a significant effect on the TEWL. Conclusion After damage to the skin barrier by SLS, pimecrolimus seems to penetrate into the skin as shown by a reduction of the irritation‐induced erythma. These data further support the notion that pimecrolimus is selectively effective in the treatment of skin disorders with an impaired function of the epidermal barrier.     

Biophysical measurements of human forearm skin in vivo: effects of site, gender, chirality and time

Background/aims: Measurements of transepidermal water loss (TEWL) and skin colour are biophysical techniques commonly used to measure the in vivo skin effects of cosmetics, topical medicaments and chemical irritants. The purpose of this study was to investigate the variability of TEWL and skin colour on human forearm skin as a function of regional variation, gender and preferred chirality over an 8 h period.
Methods: Biophysical measurements of TEWL and skin colour were made at five sites on both forearms of male ( n =8) and female ( n =9) human volunteers in vivo (38% relative humidity, 21°C).
Results: Rates of TEWL at the forearm midpoint were 10% lower than at the forearm extremities ( P <0.01). Skin redness ( a *) near the wrist was 5–10% higher than at other sites ( P <0.05). Rates of TEWL were 5% higher in male volunteers ( P <0.05). Red and blue ( b *) colour measurements of male forearm skin differed by 18% and 20% in comparison with female, respectively. Rates of TEWL, skin brightness ( L *) and b * decreased by 9% ( P <0.05), 1.8% ( P <0.05) and 4% ( P <0.05), respectively, with time whereas a * and skin temperature increased by 4.5% ( P <0.01) and 7.2% ( P <0.01), respectively. There was a significant correlation between the change in all measured parameters with time.
Conclusions: Significant differences in TEWL and skin colour were identified that may have relevance in the design and interpretation of multivariate analyses of human forearm skin. Diurnal variation of TEWL, skin colour and temperature may have a single underlying mechanism.     

Efficacy of skin barrier creams

2 barrier creams (BC) were evaluated against the anionic detergent sodium lauryl sulphate (SLS) using a new human test model. In the repetitive irritation test (RIT) on human skin, the irritant SLS is applied to the ventral forearm of Healthy volunteers daily for 2 weeks. 1%, 5%, and 10% SLS is exposed to the skin for 30 min. using a glass cup 2.5 cm in diameter. The BC is applied 30 min before the irritant. Cutaneous irritation is assessed on a score for erythema (0 to 5+), and quantified by various biophysical techniques: transepidermal water loss (TEWL) by evaporimetry, skin blood flow volume (BFV) by laser-Doppler velocimetry, and -skill colour bi colorimetry (La^* value). 10 subjects were tested with SLS on one forearm without pretreatment (control) and with Taktosan Salbe as BC on the other forearm. A 2nd panel of 10 subjects was tested in the same way with SLS and Marly skin as BC. Taktosan Salbe was extremely effective in reducing the irritation by SLS: there were significant differences regarding all lest parameters for 10% SLS in the 2nd week. The most differentiating parameter was TEWL, revealing statistical differences as early as the 1st week for 10%. SLS and Taktosan Salbe, while the least differentiating sensitivity was found for La^*. In contrast, there was no significant suppression of irritancy in any parameter with Marly skin, either in the 1st week or in the 2nd week with any concentration of SLS. The results show the differentiating potential of the model developed. Results obtained with the previously described animal model are confirmed- Noninvasive biophysical techniques, particularly TEWL measurements, might be extremely valuable in identifying new active ingredients of BC.     

Skin irritation in man: a comparative bioengineering study using improved reflectance spectroscopy

Variable types of skin irritation were induced in 8 human female volunteers, ranging from subclinical to visible erythema with slight oedema. Skin reactions were graded clinically and objectively using transepidermal water loss (TEWL), laser Doppler flowmetry (LDF) and improved reflectance spectroscopy. This last technique enables separation of in vivo erythemas into relatively deoxygenated (venous-deoxy hem) and oxygenated (arterial oxy hem) haemoglobin components. Compared to uninvolved skin, an empty patch increased oxy hem by 197%± 121%( p < 0.05). Exposure to vehicles also changed skin biophysics. At sodium lauryl sulfate (SLS) and hydrochloric acid (HCL) exposed sites, a linear correlation between concentration and oxy hem. LDF and TEWL was found. These chemicals predominantly increased TEWL values. Nonanoic acid (NON) and imipramine (IMI) also raised oxs hem, LDI and TEWL values linear at increasing concentrations. Although IMI 2.5% clinically was graded as a type ++ response, no significant increase in TEWL was found. The improved reflectance spectroscopic technique proved valid in skin irritation studies, with a higher sensitivity than laser Doppler flowmetry, and allowed irritant vascular reactions to be discriminated into arterial and venous components. Furthermore, our observations clearly demonstrate that clinical indistinguishable skin irritation reactions induce significantly different changes in barrier function (disruption) and vascular status.     

Sodium lauryl sulfate (SLS) induced irritant contact dermatitis: a correlation study between ceramides and in vivo parameters of irritation

Sodium lauryl sulfate (SLS), a surfactant frequently used in the induction of experimental irritant contact dermatitis in animals and in humans, characterstically induces a dose-related increase in TEWL (transepidermal water loss). Ceramides are considered to be important in the regulation of the skin barrier. We therefore examined the relationship between initial ceramide content of stratum corneum and induced changes in skin color (erythema) and barrier function, after SLS application under occlusion (1% and 3% in water) to the forearm of 14 volunteers. Stratum corneum sheets were removed, stratum corneum lipids extracted, and ceramide composition determined from chromatograms (TLC) using densitometry. After determining baseline skin color and TEWL at each area. 2 samples of stratum corneum were obtained from each volunteer. Clinical and instrumental controls of the SLS-induced irritation were performed at 24, 48, 72 and 96 h. Erythema was evaluated by colorimetry; barrier impairment by changes in TEWL. We found inverse correlations between baseline ceramide 61 (weight) and the 24 h erythema score for SLS: between ceramide I and 24 h TEWL, and between ceramide 611 and 72 h TEWL for SLS 3%. Our findings suggest that low levels of these ceramides may determine a proclivity to SLS-induced irritant contact dermatitis.     

Changes in skin barrier function following long-term treatment with moisturizers, a randomized controlled trial

BACKGROUND: Moisturizers are commonly used by patients with dry skin conditions as well as people with healthy skin. Previous studies on short-term treatment have shown that moisturizers can weaken or strengthen skin barrier function and also influence skin barrier recovery. However, knowledge of the effects on skin barrier function of long-term treatment with moisturizers is still scarce. OBJECTIVES: To investigate the impact of long-term treatment with moisturizers on the barrier function of normal skin, as measured by transepidermal water loss (TEWL) and susceptibility to an irritant, and to relate those effects to the composition of the designed experimental moisturizers. METHODS: Volunteers (n = 78) were randomized into five groups. Each group treated one volar forearm for 7 weeks with one of the following preparations: (i) one of three simplified creams, containing only a few ingredients in order to minimize the complexity of the system; (ii) a lipid-free gel; (iii) one ordinary cream, containing 5% urea, which has previously been shown to decrease TEWL. The lipids in the simplified creams were either hydrocarbons or vegetable triglyceride oil, and one of them also contained 5% urea. After 7 weeks, treated and control forearms were exposed for 24 h to sodium lauryl sulfate (SLS) using a patch test. TEWL, blood flow and skin capacitance of both SLS-exposed and undamaged skin were evaluated 24 h after removal of patches. Additionally, a 24-h irritancy patch test of all test preparations was performed on 11 volunteers in order to check their possible acute irritancy potential. RESULTS: Changes were found in the barrier function of normal skin after 7 weeks of treatment with the test preparations. The simplified creams and the lipid-free gel increased TEWL and skin response to SLS, while the ordinary cream had the opposite effect. One of the simplified creams also decreased skin capacitance. All test preparations were shown to be nonirritant, both by short-term irritancy patch test and by measurement of blood flow after long-term treatment. CONCLUSIONS: Moisturizers influence the skin barrier function of normal skin, as measured by TEWL and susceptibility to SLS. Moreover, the effect on skin barrier function is determined by the composition of the moisturizer. The ingredients which influence the skin barrier function need to be identified, and the mechanism clarified at the molecular level.     

Profile of irritant patch testing with detergents: sodium lauryl sulfate,sodium laureth sulfate and alkyl polyglucoside

The cutaneous reaction to detergents follows distinct kinetic rules: the duration of application and the irritant concentration are of major importance. The aim of this study was to evaluate the differences in kinetics of skin reaction between the standard irritant sodium lauryl sulfate (SLS), and 2 modern detergents: sodium laureth sulfate (SLES) and alkyl polyglucoside (APG). We performed patch testing with SLS and SLES (or APG) at different concentrations (0.125, 0.25, 0.5, 1.0 and 2.0%) and with different exposure times (6, 12 and 24 h). Evaluation was conducted by measurement of transepidermal water loss (TEWL) and laser Doppler flowmetry (LD) 24 h, 7 and 10 days after patch removal. We found a pronounced reaction to SLS, and a far milder one to SLES. Even at the highest concentration the skin reaction to APG was hard to detect. During the regeneration period (day 3-10) SLS showed even at day 10 an increased TEWL at all concentrations tested. The irritation due to SLES was convincingly detectable only up to day 7, whereas the APG-tested skin areas showed no significant reaction even at day 3. These results demonstrate the improvement in reduction of skin irritation achieved by development of novel detergents.     

The face and neck: regional variation in skin barrier function and reactivity

Background/aims: Although there are many reports of regional variations in skin response to various stimuli, only a few studies have been performed on the face. The forearm is the most often used test site while the face is a frequent and specific target of many topical agents (drugs and cosmetics) and cosmetic procedures. The aim of this study was to compare regional variations of cutaneous sensation and skin barrier function in the cheek, neck and forearm before and after application of different stimuli (physical and/or chemical). Methods: Physiological changes of the skin were measured by non-invasive methods: TEWL (transepidermal water loss) and skin capacitance. Furthermore, clinical scoring and subjective sensations were reported. The anatomical sites evaluated were cheek, neck and volar forearm. Results: Great differences in clinical reactions, subjective sensations and skin barrier function in response to various stimuli have been observed between tested areas (cheek, neck and forearm). We observed a greater “sensitivity”, i.e., more severe clinical reactions and subjective sensations of the cheek and neck areas, in relation to chemical stimuli as compared to the forearm. After a mechanical stimulus, the forearm was the most sensitive site, but just for subjective sensations. Concerning skin barrier function, the cheeks exhibited the highest values of TEWL and the forearms the lowest. Conclusion: In view of the high “sensitivity” of the cheek as compared to the forearm, it will be more cautious to assess the safety of facial cosmetics on the sites of intended use.     

Irritant reactivity in males and females

Repeated, daily, open sodium lauryl sulfate (SLS) applications caused slight alterations in transepidermal water loss (TEWL) and dielectric water content (DEWC) in males and females. No erythema developed. Inter-individual variation in skin reactivity was demonstrated; sex-related patterns in reactivity to open cumulative irritant exposure did not exist. In patch testing with 0.5 and 1% SLS, reflecting acute irritation capacity, the reaction pattern, assessed by TEWL, DEWC, laser Doppler velocimetry (LDV) and visual scoring (VS), differed from that induced by open, cumulative SLS irritation. Again, inter-individual variation in the reactivity was demonstrated; significant sex-related differences did not develop. Individual reactivity showed considerable variation in acute and cumulative irritant response and was greater than the sex-related variation. We did not identify responses demonstrating that women have delicate (easily irritated) skin, nor that males have "tougher" skin than females.     

Biophysical parameters of skin: map of human face, regional, and age-related differences

The face showed anatomical variation on reaction to chemicals, which could be related to differences in biophysical specificities of the skin. The aim of this study was to establish a map of the face for 6 biophysical parameters.10 young human volunteers (24-34 years) and 10 old volunteers (66-83 years) were studied to prepare a map of the human face based on regional variations and age-related differences by measuring various biophysical parameters. 7 locations on the face, neck, and forearm were investigated. Skin blood flow, transepidermal water loss (TEWL), stratum corneum hydration (capacitance), temperature, pH, and sebum content of the skin surface were measured. In both groups, skin blood flow in the nose showed the highest value. Perioral and nasolabial areas showed the highest TEWL values. The neck showed the highest capacitance value. The highest skin temperature was detected in the neck in the young group and in the nasolabial area in the old group. The chin showed the most alkaline pH in both groups. Nasolabial area showed the highest sebum content in the young group, as did the chin in the old group. These baseline values provide a framework to build on for ascertaining disease and intervention-related effects.     

Noninvasive bioengineering assessment of the skin barrier function in patients with chronic venous insufficiency

Background  Chronic venous insufficiency (CVI) comprises all symptoms caused by permanent venous and capillary hypertension. While the clinical manifestations of the disease have been well characterized, there is little knowledge on the skin barrier function in the affected patients. Objectives  The aim of the study was to assess noninvasively the barrier function in patients with CVI stage C2 and stage C4 according to the CEAP classification in comparison with healthy controls (stage C0). Methods  Thirty patients with CVI without concomitant diseases and 15 healthy, aged‐matched controls were recruited for the study. The skin barrier function was assessed by measuring transepidermal water loss (TEWL), capacitance and skin colour symmetrically on the calf, medial and lateral malleolus, posterior arch (arcus venosus) and volar forearm. Results  Compared with the forearm, there was a tendency for increased TEWL and significant reduction of capacitance on all measurement sites on the lower limb. Compared with the control group, the patients with CVI had significantly higher TEWL values on all measurement sites on the lower extremities while no difference in capacitance between patients and controls was observed. Conclusions  Changes in the epidermal barrier function in patients with CVI are readily detectable by bioengineering methods as early as stage C2 and are manifested by significantly increased TEWL. Our results suggest that the reduced stratum corneum hydration in patients with CVI is due to anatomical differences rather than venous disease. These findings may help better understand the factors contributing to disease progression and its complications.