Darlene McCord

Introduction and conclusion by Darlene McCord, Ph.D; Independent studies performed by Dow Corning.

Implications of Corneotherapy and Reduction of Excessive Transepidermal Water Loss Preventive corneotherapy, a term coined in the 1990s by Albert Kligman, M.D., Ph.D., is becoming one of the most important principles of treatment in advanced skin care.The object of corneotherapy, topical delivery of active concentrates through the skin, is skin barrier homeostasis.1 The ultimate development in the quest for understanding the stratum corneum is corneotherapy, focusing therapy toward correcting the defective horny layers.2 Dr. Kligman, a corneobiologist, explains, "Whenever you see inflamed skin, regardless of cause, the stratum corneum is leaky and permeable. But, if you repair the stratum corneum that tells the underlying tissues that they don't have to keep reacting like there's danger in the environment.” Peter Elias, M.D., the world's leading corneobiologist, has also endorsed this outside-in therapy, according to Kligman.

“Constant formation of the well-differentiated outermost layer of the epidermis and its orderly desquamation are necessary for correct barrier function as fulfilled by the stratum corneum,” according to Marek Haftek, M.D., Ph.D. The primary function of the epidermis is the production of stratum corneum. The epidermis and the dermis both have immune systems.3 The epidermis and its immune response to stratum corneum disruption are germane to barrier function and repair and the regulation of transepidermal water loss (TEWL).

TEWL is controlled by the stratum corneum and is a normal part of the cellular activity. The stratum corneum regulates TEWL and helps prevent dehydration, holding the average TEWL to 2 to 5g/hr/cm2.4 Excessive TEWL (e- TEWL) activates an inflammatory response in the epidermis and the dermis and initiates the repair process.5 Many factors contribute to e-TEWL including humidity below 40%, changes in skin pH, normal aging and disruption of the barrier. Correcting e-TEWL can be achieved by application of occlusive and semipermeable treatments. Occlusive products suppress barrier recovery and reduce the epidermal proliferative response to an abnormal stratum corneum barrier. Semipermeable or breathable barriers, like Nutrashield, do not slow barrier recovery and allow for normal cellular respiration.6

A fully occlusive therapy, like petrolatum or mineral oil, prevents TEWL. In doing so however, it slows epidermal maturation and reduces barrier repair. Further, occlusion of the skin increases the risk of infection and decreases the protection of the skin's normal pH mantle.6 Decreased TEWL may be achieved with occlusion however, the side effects of occlusion appear to outweigh its benefits.

Nutrashield is a semipermeable or breathable barrier which allows for normal epidermal proliferation and barrier repair. Nutrashield, when applied as part of a corneotherapy plan, reduces e-TEWL and allows for the normal repair process to take place. Olivamine™ and other specialty ingredients in Nutrashield, like lipids, vitamins and antioxidants, aid in the repair process.

The skin repair process is dependent upon proper skin hydration as accomplished with normal TEWL. Skin repair and reduced inflammation can be positively affected through the use of Nutrashield as a semipermeable barrier to e-TEWL.

Following is an in vivo study comparing wash-off resistance between Proshield Plus and Nutrashield. It is known that applying a semipermeable or breathable barrier do not slow barrier recovery and allow for normal cellular respiration. In order to provide this protection, it is also necessary that the product stays in place on the skin for a prolonged period of time, even after wash-offs (which could relate to incontinent episodes or contact with water and rubbing). Utilizing products that provides the proper protection against e-TEWL is critical to allow the proper repair process to take place.
Test methodology

• 1. Thoroughly cleanse the under side of each forearm with Ivory bar soap.
• 2. Draw two 1.5 x 4" rectangles, one on each forearm.
• 3. Collect a baseline spectrum of the neat skin.
• 4. Apply 0.1g of product to be tested in the test area.
• 5. Rub the material into the skin for 30 seconds.
• 6. Allow the test area to air dry for 5 minutes.
• 7. Collect a spectrum of the product after initial application.
• 8. Wait 30 minutes under normal conditions (go about normal business ensuring no exposure of the test site to additional silicone).
• 9. First wash cycle: rinse test area with luke warm water for 5 seconds, lather hand and rub test area lightly 15 times, rinse test area for 5 seconds, pat dry with paper towel.
• 10. Collect a spectrum
• 11. Wait 30 minutes under normal conditions (go about normal business ensuring no exposure of the test site to additional silicone).
• 12. Second wash cycle: same procedure as above.
• 13. Collect a spectrum.
• 14. Wait 30 minutes under normal conditions.
• 15. Third wash cycle: same procedure as above.
• 16. Collect last spectrum.

For Proshield Plus:

After initial IR reading the product was detectable on the skin however after 1 wash there was no product detected (silicone or organic).Water beaded on the surface of the test area after initial application but not after the 1st wash.

This material was very thick and easily spread upon the skin. A large portion was absorbed slowly but still some on the skin surface after initial application. Product was extremely durable through 3 washes and if peak intensity is qualitatively accessed, the material would probably last at least one additional wash cycle. Hydration level in the skin was completely masked after initial application (an assumed increase in mositurization, less moisture from the skin is escaping).

Water beaded on the surface of the test area up through the third wash.

The following is an in vitro study using collagen to examine the ability of Remedy Nutrashield and Skin repair Cream to prevent against excessive Transepidermal Water Loss and moisturize the skin. The collagen sheets represent a piece of human skin which stratum corneum has been removed. Test Methodology (please copy it form the Dow corning study)

When using Remedy products, more specifically Nutrashield, an artificial stratum corneum is laid down. This breathable barrier allows skin to start working on the repair process rather than concentrating time on fighting against inflammation and e-TEWL.

When applying Nutrashield on a collagen sheet, the moisture retention after 24 hours was over 90.1%, compared to just 23.6% retention of a sheet of collagen without protection.The sheet of collagen without protection lost 753% (or 7.53 times) more water than the one protected with Nutrashield.

It is critical to put in place something that stops TEWL in patients where there is any inflammation, or where they have any skin breakdown from moisture or from dryness (since both increase permeability). A patient cannot start healing until you fix the problem with stabilizing the stratum corneum.

With Nutrashield, or with Skin Repair Cream and Nutrashield on top, you will be laying down an artificial stratum corneum that is breathable, so skin can start healing rather than dedicating time to fight inflammation.