Novel and Rapid Method for Quantification of Stratum Corneum Disruption by Adhesive Wound Dressings

1
Novel and Rapid Method for Quantification of
Stratum Corneum Disruption by Adhesive Wound
Dressings Magnus S. Ågren¹, Åsa Rosqvist² and
Maria Werthén² ¹Department of Surgery K,
Bispebjerg Hospital, Copenhagen University
Hospital, Copenhagen, Denmark, and ²Mölnlycke
Health Care AB, Gothenburg, Sweden

• Background
• Stratum corneum is the outermost layer of the
  skin
• Stratum corneum maintains the water and
  electrolyte homeostasis, and protects from
  entrance of micro-organisms and toxic agents
• Stratum corneum comprises layers of keratinized
  corneocytes

• Keratin proteins account for at least 80 of the
  corneocyte mass
• Frequent changes of adhesive dressings can
  damage the skin barrier due to removal of
  corneocytes 1
• Transepidermal water loss (TEWL) is the gold
  standard for the indirect non-invasive
  measurement of disruptions of the skin barrier
  function but is cumbersome and show high
  variability.

• Aim
• To evaluate the potential of estimating the
  amount of stratum corneum removed by the
  different types of adhesives of dressings by
  protein analysis.

Materials and methods

• Results
• Corneocyte removal, measured indirectly as
  protein, varied among the different dressing
  adhesives over time (Fig. 3). The constant rate
  in the Mepilex Border group most likely reflects
  the basal steady-state desquamation.

• Patients
• 10 (7 females) healthy volunteers
• Aged 20-61 years (41 4 years, mean SEM)
• Dressing adhesives tested
• Allevyn Adhesive (Smith Nephew)
• Biatain Adhesive (Coloplast)
• Cellosorb Adhesive (Urgo)
• DuoDERM Extra Thin (ConvaTec)
• Mepilex Border (Mölnlycke Health Care)
• Tielle (Johnson Johnson)

Fig. 3. Corneocyte removal measured as protein
content of used dressing adhesive (mean SEM).

• Treatment
• Dressing adhesives randomized to 6 positions on
  posterior lower leg
• (Fig. 1)
• Dressings applied and removed every second to
  third day for 11 days

• Cumulative corneocyte removal was lowest with
  Mepilex Border and highest with DuoDERM (Table
  I).

Fig. 1. Test adhesive patches applied to the
lower leg. Dressings were covered with Tubifast.
Table I. Total stratum corneum removal, measured
as cumulative protein, by dressing adhesives over
the 11-day experimental period arranged in
ascending order (mean SEM).

• Protocol for protein extraction and determination
  2
• Extraction and analyses were carried out in
  96-well plates (Fig. 2)

• Conclusions
• The method presented here was simple, fast and
  precise in quantification of adherent corneocytes
  to the adhesives of wound dressings.
• The six examined dressing adhesives can be ranked
  according to their ability to remove corneocytes
  from skin as follows
• Mepilex Border lt Allevyn lt Tielle Biatain lt
  Cellosorb lt DuoDERM
• These data support earlier studies measuring
  stratum corneum damage by the TEWL technique 1.

Fig. 2. 96-well plate for protein measurement of
extracts.

• References
• Zillmer R, Ågren MS, Gottrup F, Karlsmark T.
  Biophysical effects of repetitive removal of
  adhesive dressings on peri-ulcer skin. J Wound
  Care 2006 15 187-191.
• Dreher F, Modjtahedi BS, Modjtahedi SP, Maibach
  HI. Quantification of stratum corneum removal by
  adhesive tape stripping by total protein assay in
  96-well microplates. Skin Res Technol 2005 11
  97-101.

Acknowledgment This work was made possible by a
research grant from Mölnlycke Health Care AB.