Pediatric Patients with Atopic Dermatitis Have Lower SCH and Higher TEWL, Compared to Those Without

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A new study assessed levels of stratum corneum hydration (SCH) and transepidermal water loss (TEWL) across multiple areas of the skin in pediatric patients with atopic dermatitis (AD).¹ It was found that areas with atopic lesions had lower SCH and higher TEWL compared to non-lesional areas.

The cross-sectional, observational study took place from September 2021 to March 2022 at the Samsung Kids Pediatric Adolescent Clinic in Hwaseong, Gyeonggi Province, South Korea. Investigators enrolled 98 patients under the age of 10. This included 15 children in the control group and 83 in the AD patient group. The average age of the patient group was 50 months while the control was slightly higher at 59 months.

Participants had Objective SCORAD Index (OSI) scores within the mild to moderate ranges, with an average score of 15.4 ± 8. More specifically, 53% of patients were classified as mild and 47% were considered to have a moderate disease state. Levels were measured using the AF200 AquaFlux and the Corneometer on 15 areas on the body, which included the forehead, cheeks (left/right), neck (front/back), inner elbow (left/right), wrists (left/right), abdomen, back, back of the knee (left/right), and ankles (left/right).

The head and neck regions had the highest SCH among all body sites. Overall, SCH was slightly higher in the control group than the patient group, but this was not statistically significant. The ankle showed the lowest SCH, and notable differences were observed in the face, inner elbows, and forearms.

TEWL was highest on the wrist in both groups. Additionally, there were statistically significant differences in TEWL between atopic patients with lesions and those without lesions in the forehead, cheek, and ankle. As atopic lesions increased, TEWL decreased notably. Still, patients with AD lesions on the face and ankle had higher TEWL.

More than half of patients with AD had frequent lesions on the arms and legs, especially on the inner elbow and back of the knee. Although the percentage of patients with lesions on the forehead was relatively low, the mean OSI was highest on those with forehead lesions, at a value of 29.7.

“When analyzing the OSI values based on the presence or absence of lesions at each body site, it was found that atopic patients with lesions consistently demonstrated higher OSI scores than those without lesions across all body sites,” the authors concluded.

Patients with AD lesions had lower SCH and higher TEWL. More specifically, there was a significant difference between these levels in the head and neck region. Overall moisture levels were highest in the face, neck, wrist, and trunk, with the forehead demonstrating the highest moisture content.

The study did not analyze based on age and severity and did not apply continuous site-specific monitoring. However, the overall large sample size, use of the SCORAD scale, and utilization of 15 distinct areas of the body have made this research valuable. Expanding the control group and incorporating more external factors could enrich any future studies.

Due to the negative effects on SCH and TEWL, replenishing and moisturizing the skin and its barrier is vital in AD management.² These findings confirm that considering the unique characteristics of each body area in conjunction with the SCORAD system can tailor pediatric treatment approaches.

“The results strongly support the clinical benefit of incorporating body area-specific evaluations of moisture level into routine practice,” the authors wrote. “Clinicians could implement this by systematically monitoring and recording symptom severity and moisture loss across different body areas, allowing for more precise, site-targeted interventions.”

References

1. Kwon BY, Kim D, Shim K, et al. Area‐specific assessment of stratum corneum hydration and transepidermal water loss in pediatric patients with atopic dermatitis. Dermatology Research and Practice. 2025;2025(1). doi:10.1155/drp/2376970

2. Czarnowicki T, Krueger JG, Guttman-Yassky E. Novel concepts of prevention and treatment of atopic dermatitis through barrier and immune manipulations with implications for the atopic march. J Allergy Clin Immunol. 2017;139(6):1723-1734. doi:10.1016/j.jaci.2017.04.004