THE EFFECTIVITY OF PH 4 EMULSION ON SKIN BARRIER FUNCTION IN THE ELDERLY: A SYSTEMATIC REVIEW AND META-ANALYSIS


The Effectivity of pH 4 Emulsion on Skin Barrier Function in The Elderly: A Systematic review and meta-analysis


Milka Wulansari Hartono*, Diah Adriani Malik, Retno Indar Widayati, Asih Budiastuti, Puguh Riyanto, Muslimin

Department of Dermatovenereology, Faculty of Medicine, Diponegoro University / Dr. Kariadi Hospital, Jalan Dr. Sutomo No. 16 Semarang, Indonesia.


Background: The pH of the skin surface is elevated in the elderly therefore it may cause impaired barrier function manifest as various cutaneous abnormalities, including xerosis, pruritus, dermatitis, and skin infections. Consequently, skin care products for the elderly should contain moisturizing ingredients which are formulated to normalize the skin surface pH. Application of pH 4 emulsion is potentially beneficial to improve barrier function in the elderly and promoting skin health. We aimed to determine the difference of effectiveness of pH 4 emulsion compared to identical non pH 4 emulsion on decreasing TEWL in the elderly. A systematic review and meta-analysis was performed of randomized clinical trials assessing the effects of pH 4 emulsion on skin barrier function in the elderly.

Methods: Medline Pubmed, Scopus, ProQuest, Cochrane library, ClinicalTrials.gov, the reference list, conference proceedings, researchers in the field of eligible studies were searched. Four studies (n=98 subjects) were included in qualitative analysis of which two studies (n=45 subjects) were included in the meta-analysis. The mean age of the participants was 71.1 years old.

Interventions use the application of pH 4 water in oil emulsion (n=2) and pH 4 oil in water emulsion (n=2). Duration of intervention (24 hours-7 weeks) and outcomes of interest varied among included studies.

Results: Pooling of data using random-effects model found lower TEWL score in the pH 4 emulsion than in non pH 4 emulsion, with no significant difference (overall effect mean difference -0.068, 95% confidence interval -0.485 – 0.348, p = 0.11, I2=60.1, two RCTs). In addition to that, the qualitative analysis found that the application of pH 4 emulsion increased stratum corneum hydration, decreased skin surface roughness and scaliness, decreased DASI, and improved ICLL length and lamellar organization.

Conclusion: The meta-analysis result of the mean differences of TEWL scores lowering effect between pH 4 emulsion and non pH 4 emulsion is statistically inconclusive. This is despite the observation that the pH 4 emulsion appears to be more effective comparatively. The qualitative analysis found that the application of pH 4 emulsion had improved skin barrier function in the elderly. Larger scale, well-designed RCTs assessing the effects of pH 4 emulsion on skin barrier function in the elderly, are still needed.


Keywords: pH 4 emulsion; Skin barrier elderly

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How to cite this article:
Milka Wulansari Hartono, Diah Adriani Malik, Retno Indar Widayati, Asih Budiastuti, Puguh Riyanto, Muslimin. The Effectivity of pH 4 Emulsion on Skin Barrier Function in The Elderly: A Systematic review and meta-analysis. American Journal of Dermatological Research and Reviews, 2021; 4:40. DOI: 10.28933/ajodrr-2021-03-1705


References:

1. UN DESA’s Population Division. World Population Ageing 2019 [Internet]. United Nations. 2019. Available from: https://www.un.org/development/desa/en/news/population/our-world-isgrowing-older.htmL
2. Kubo A, Amagai M. Skin Barrier. In: Kang S, Amagai M, Bruckner AL, ENK AH, Margolis DJ, McMichael AJ, et al., editors. Fitzpatrick’s Dermatology. 9th edition. New York: McGraw-Hill Education; 2019. p. 206–31.
3. Choi EH. Aging of the skin barrier. Clin Dermatol [Internet]. 2019;37(4):336–45. Available from: https://doi.org/10.1016/j.clindermatol.2019.04.009
4. Fluhr JW, Elias PM. Stratum corneum pH: Formation and function of the “acid mantle.” Exog Dermatology. 2002;1(4):163–75.
5. Man MQ, Xin SJ, Song SP, Cho SY, Zhang XJ, Tu CX, et al. Variation of skin surface pH, sebum content and stratum corneum hydration with age and gender in a large chinese population. Skin Pharmacol Physiol. 2009;22(4):190–9.
6. Surber C, Brandt S, Cozzio A, Kottner J. Principles of skin care in the elderly. G Ital di Dermatologia e Venereol. 2015;150(6):699–716.
7. Kilic A, Masur C, Reich H, Knie U, Dähnhardt D, Dähnhardt-Pfeiffer S, et al. Skin acidification with a water-in-oil emulsion (pH 4) restores disrupted epidermal barrier and improves structure of lipid lamellae in the elderly. J Dermatol. 2019;46(6): 457–65.
8. Moher D, Liberati A, Tetzlaff J, Altman DG, Altman D, Antes G, et al. Preferred reporting items for systematic reviews and metaanalyses: The PRISMA statement. PLoS Med. 2009;6(7).
9. Higgins J, Thomas J. Collecting data – form for RCTs only. In: Higgins J, Thomas J, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 510 [Internet]. The Co- chrane Collaboration; 2011. Available from: https://training.cochrane.org/datacollection-form-rcts
10. Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343(7829):1–9.
11. Angelova-Fischer I, Fischer TW, Abels C, Zillikens D. Accelerated barrier recovery and enhancement of the barrier integrity and properties by topical application of a pH 4 vs. a pH 5·8 water-in-oil emulsion in aged skin. Br J Dermatol. 2018;179(2):471–7.
12. Blaak J, Kaup O, Hoppe W, BaronRuppert G, Langheim H, Staib P, et al. A Long-Term Study to Evaluate Acidic Skin Care Treatment in Nursing Home Residents: Impact on Epidermal Barrier Function and Microflora in Aged Skin. Skin Pharmacol Physiol. 2015;28(5):269–79.
13. Blaak J, Dähnhardt D, DähnhardtPfeiffer S, Bielfeldt S, Wilhelm KP, Wohlfart R, et al. A plant oilcontaining pH 4 emulsion improves epidermal barrier structure and enhances ceramide levels in aged skin. Int J Cosmet Sci. 2017;39(3):284–91.
14. Moncrieff G, Van Onselen J, Young T. The role of emollients in maintaining skin integrity. Wounds UK. 2015;11(1):68–74.
15. Korting MSHC. The pH of the Skin Surface and Its Impact on the Barrier Function. 2006;296–302.
16. Redoules D, Tarroux R. Epidermal Enzymes: Their Role in Homeostasis and Their Relationships with Dermatoses. 1999;183–92.