skin barrier function testing in the Management of plaque psoriasis among adult dermatology patients

Abstract

Background: Plaque psoriasis is usually described as keratinocyte hyperproliferation driven by interleukin-17/23-axis inflammation, but the disease also produces a well-documented breakdown of epidermal permeability barrier function, with altered ceramide composition, disrupted tight junctions, and elevated surface pH in lesional and non-lesional skin.

Objective: This review examines instrumented methods for assessing barrier function in adult psoriasis patients, evidence linking barrier parameters to disease severity and treatment response, and obstacles limiting routine barrier testing in practice.

Methods: We synthesized mechanistic studies of psoriatic stratum corneum lipid and structural biology, methodological consensus documents for TEWL, corneometry, and pH measurement, and clinical studies correlating barrier parameters with disease extent and therapeutic response.

Findings: Lesional plaques show markedly elevated transepidermal water loss and reduced hydration relative to healthy skin, with a measurable field effect in clinically non-lesional psoriatic skin; ceramide deficits and tight junction alterations underlie this impairment, and barrier parameters improve with topical and systemic therapy, though measurement standardization remains inconsistent.

Conclusions: Instrumented skin barrier testing provides objective, continuous endpoints that complement clinical severity scoring in plaque psoriasis, and wider adoption depends chiefly on measurement standardization and psoriasis-specific normative ranges rather than on uncertainty about the underlying barrier pathophysiology.