The Efficacy of an Emollient/Moisturiser (Topicrem®) in restoring Transepidermal Water Loss (TEWL), skin pH, hydration, and in African patients with Atopic Dermatitis – the EMTePHADerm double blind trial

Efficacy of emollients in restoring skin biophysical properties of atopic dermatitis in Nigeria

Abstract

Introduction: The skin biophysical parameters of atopic dermatitis (AD) patients show decreased hydration,
elevated skin pH, and increased trans-epidermal water loss (TEWL). Emollients that improve these are not
commonly tested in African climes. We aimed to compare the effects of two emollients used in moisturizing on
AD clinical severity, skin hydration, pH, and TEWL in Nigeria.

Methods: Prospective cohort review of AD patients in two tertiary hospitals in Lagos, Nigeria, from June to
December 2022, in a randomised double-blind trial of two emollients following ethical approval. The EASI
scores, hydration, skin pH, and TEWL were measured before the intervention and re-evaluated after six
weeks and three months of daily use of either the intervention or control emollient. Skin measurements were
done on the chin and forearm using the Courage + Khazaka Electronic GmbH® system.

Results: Of 140 participants, 62.9% were females; the mean age was 24.5±19.8 years. Baseline
measurements were higher on the chin compared with the forearm, with mean hydration values of 56.7±18.5:
40.0± 20.7, pH 6.5±2.1: 5.5 ±0.4, and TEWL 32.4 [CI: 24.5 – 52.2]: 18.8 [ CI: 13.7 – 34.8]. Skin hydration
increased, and TEWL and pH levels (p < 0.042) were reduced with the intervention emollient compared to the
control (Vaseline Advanced Repair Intensive Lotion) at both six weeks and three months. The daily use of both
emollients significantly reduced skin pH (p < 0.001). EASI scores significantly improved (p < 0.001) in patients
from baseline, regardless of the emollient used; however, there was no significant difference in EASI scores
between the emollients.

Conclusion: Daily moisturizing improves skin pH and hydration in AD patients residing in the southwestern
part of Nigeria, resulting in a reduction in disease severity. TEWL is reduced with daily moisturization.
Individuals with AD are encouraged to moisturize at least daily, regardless of the weather conditions.

Keywords: Atopic Dermatitis; Emollient; pH, TEWL, Nigeria