1. bookVolume 13 (2022): Edizione 1 (January 2022)
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1891-5469
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01 Jan 2010
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Open Access

Monitoring the skin biophysical parameters among coronavirus patients for three days in a row: a preliminary study

Pubblicato online: 20 May 2022
Volume & Edizione: Volume 13 (2022) - Edizione 1 (January 2022)
Pagine: 21 - 24
Ricevuto: 08 Apr 2022
Dettagli della rivista
License
Formato
Rivista
eISSN
1891-5469
Prima pubblicazione
01 Jan 2010
Frequenza di pubblicazione
1 volta all'anno
Lingue
Inglese
Introduction

The skin is the largest multifunctional organ of the human body with a total surface area of about 2 m2. The skin is composed of a set of complex organs, which provide protection and sense functions. As a physical barrier, the skin protects the body from environmental threats such as temperature, pathogens, and mechanical, and chemical impacts by acting as a selective barrier. From a sensory standpoint, the skin has several receptors, which provide afferent information related to pain, touch, and temperature [1]. The skin has three layers; epidermis, dermis, and the subcutaneous layer (hypodermis). The stratum corneum is the uppermost part of the epidermis and consists of dead, keratinized cells.

Healthy skin can be characterized by its biophysical characteristics, such as skin moisture, sebum (oil) content, and pH. The normal level of skin (stratum corneum) moisture is influenced by various factors such as the amount of supplied water from the viable epidermis, dermis, and sebaceous glands, and also the stratum corneum's ability to accumulate water, and the volume of water lost through evaporation [2]. Moreover, the value of skin moisture can also be influenced by the type of consumed foods [3]. The skin sebum level is linked to individual characteristics and environmental conditions. Sebum production is dependent on the location, density, and activity of sebaceous glands [4]. Normal levels of sebum are associated with a high level of moisture [5]. Healthy skin has a pH value between 4.0 and 6.0. The normal pH value takes part in the maintenance of a normal level of skin moisture [2]. An increase in the skin pH leads to activation of cathepsins, breaking down of filaggrin, which decreases the natural moisturizing factor [6]. Also, an increase in transepidermal water loss is related to increased pH values [5].

Biophysical characteristics of the skin could also be a significant indicator of skin diseases. For instance, atopic dermatitis is associated with higher skin pH [7], and lower skin moisture and sebum [8]. In addition, a positive correlation between atopic dermatitis severity and pH values is observed in various studies [9]. Moreover, acne is related to increased skin pH [10], and sebum [11]. Therefore, understanding the biophysical properties characteristics of the skin might be useful in dealing with skin diseases with a proper approach.

To the best of our knowledge, no data are available on the skin biophysical parameters of patients with coronavirus. Therefore, in the present study, skin moisture, sebum and pH were measured to investigate the association between skin biophysical properties and coronavirus patients for three days in a row. Without any doubt, the body temperature, the primary test that is performed, of patients who had confirmed coronavirus symptoms was significantly higher than that of the unaffected controls. Therefore, this study hypothesized that an increase in skin temperature in coronavirus patients leads to altering its biophysical parameters such as skin moisture, sebum, and pH for three consecutive days of hospital stay.

Materials and methods
Study protocol and patients

A total of 30 coronavirus patients (14 males and 16 females), age range 27–90 years (mean 64 years) were enrolled in the study. All the recordings were performed at the coronavirus hospital in Duhok city under standard working conditions (T= 20-23 °C and relative humidity 40-60%).

Skin moisture, sebum content, pH, and temperature data were recorded from patients for three days in a row. It is worth noting that severe cases were not included in this study. All precautionary measures related to coronavirus were considered during the data collection.

Instrumentation

Skin moisture, oil (sebum), pH, and temperature were recorded by using three different portable instruments. An SK-IV digital moisture monitor (Riuty, China) was employed to measure skin moisture and oil. It is based on bioimpedance technology and could measure the skin moisture within the range of 0-99.9%. Skin pH was measured by employing a pH meter with an accuracy of ±0.1 pH, using a high precision, corrosion resistant probe. Lastly, skin temperature was monitored by utilizing an infrared thermometer device (EFT-162-China).

Statistical analysis

Differences among skin moisture, oil and pH recordings were statistically analyzed by using the one-way repeated analysis of variation (ANOVA) followed by post hoc multiple pairwise comparisons using Sidak correction. The statistical analyses were done by employing IBM SPSS Statistics and the 0.05 level of confidence was used to define statistical significance.

Informed consent

Informed consent has been obtained from all individuals included in this study.

Ethical approval

The protocol has been complied with all the relevant national regulations, institutional policies and in accordance with the Helsinki Declaration, and the study protocol was approved by the director of the coronavirus hospital in Duhok city.

Results
Skin moisture

Skin moisture data recorded during three days for all patients are presented in Figure 1. It can be seen that there are variations in the skin moisture of patients. In addition, on average, skin moisture was increased by comparing the second (44.03%) and third days (44.82%) to the first one (42.43%). Moreover, statistical analysis with ANOVA tests showed significant (p<0.05) differences between data of the three days, and also the data of the third day were significantly (p<0.05) different from the first and second days as indicated by post hoc multiple pairwise comparison using Sidak correction.

Fig.1

Skin moisture recorded from 30 patients during the three days.

Skin sebum content

Shown in Figure 2 is the skin sebum content computed for each patient during the three days.

Fig.2

Skin sebum content recorded from 30 patients during the three days.

According to the data seen in the figure, skin sebum content values for the patients are slightly changed with respect to days. In addition, on average per 30 patients, skin sebum content is increased from 9.12 (on the first day) to 9.19 (on the second day), and 9.66 (on the third day). However, when the obtained data from over 30 patients were analyzed with ANOVA tests, non-significant (p>0.05) differences were observed over the three days.

Skin pH

The results for skin pH with respect to the three days are presented in Figure 3. Variations in values of skin pH are also observed. Moreover, fluctuations are seen in average values of skin pH, but comparing the third day (4.68) to the first day (4.62), it is slightly increased. However, when the statistical analysis with post hoc pairwise multiple comparison tests was employed, non-significant (p>0.05) differences among the data for three days were obtained.

Fig.3

Skin pH recorded from 30 patients during the three days.

Skin temperature

Fluctuations are also seen (Figure 4) in the skin temperature of patients during the three days. In addition, highly significant (p<0.001) differences were found between skin temperature results recorded during the three days. Moreover, skin temperature levels monitored during the second day were significantly (p<0.001) different from those measured throughout the other days as indicated by post hoc pairwise multiple comparison tests.

Fig.4

Skin temperature (oC) recorded from 30 patients during the three days.

Discussion

This study aimed at recording biophysical parameters of the skin of coronavirus patients for three days in a row. According to the initial results, the biophysical characteristics of the coronavirus patients changed during the period of the study recordings.

Skin moisture, or the retention of water in the outermost layer of the skin known as the stratum corneum, which regulates skin inflammation, proliferation, and differentiation [12, 13], was significantly increased. This might be due to an increase in skin temperature and sweating, which consequently leads to increases in skin hydration. Jung et al. [14], reported that there is a positive correlation between skin temperature and skin moisture. Also, an increase in skin moisture could be related to elevated breathing rate or increased respiratory effort of the patients, as on average, the respiratory rate is elevated during diseases [15].

Small variations are obtained in the skin sebum content. According to the observed findings, skin sebum on average was slightly increased compared to the first day, but these results were statistically non-significant (p>0.05). One of the reasons is probably that increased body temperature led to an increase in sebum excretion rate. Cunliffe et al. [16], reported a significant correlation between skin temperature and the skin sebum excretion rate and showed that the skin sebum rate increased by 10% for each temperature rise of 1 °C. Also, Park et al. [17], linked the increased sebum secretion with the increase in body temperature. Jung et al. [14], also noted a positive relationship between skin temperature and sebum secretion. Also, there are other factors such as gender, ethnicity, hormones, and age [12] that are not considered in this study and could affect sebum secretion.

There were fluctuations in the skin pH of patients over the three days of monitoring. On the second and third days, it increased. The skin acidic milieu is necessary for epidermal permeability barrier homeostasis, restoration of the disrupted barrier, and the skin nonspecific antimicrobial defense [18, 19]. The reduction in skin pH on the third compared to the second day, may be due to increased body temperature and sweating. Jung et al. [14] showed that there is a negative correlation between skin temperature and skin pH. In addition, they reported that as the skin moisture increases, skin pH decreases [14].

Skin temperature monitoring plays an important role in the preliminary screening of coronavirus patients. Although on average skin temperature did not exceed the normal range, the temperature of patients on average rose significantly (p< 0.001) on the second day, then lowered in the third day. However, this does not mean that no patient had a high temperature, since several of the patients had an elevated skin temperature on the second day, which might be due to inflammation. In addition, it is reported that fever is one of the prominent clinical symptoms of novel coronavirus patients [20]. Moreover, the decrease in temperature (3rd day) may be due to the patients being given antipyretic drugs as a part of the hospital treatment protocol. Generally speaking, when the skin temperature of a patient exceeds 37.3 °C, such as in this study it means that they have reached the fever standard.

The current study is the first that monitored the variations in biophysical properties of the skin for hospitalized coronavirus patients. Yet, two limitations must be considered. First, we tried to measure the variables for the first three days of symptoms appearing in patients infected with the coronavirus; however, controlling the admission of patients to the hospital as soon as symptoms appear is very difficult. Independent replication over longer periods with larger samples is needed to assess the strength of the directionality of the effects identified here. Second, we analyzed the data based on the provided treatment protocol at the hospital, and no information on the treatment provided to patients was obtained.

Conclusions

Overall, we observed that skin moisture, sebum content, pH, and skin temperature increased over three days in a row of recordings. Changes in both skin moisture and temperature were significant, but changes in skin sebum and pH were non-significant. Skin biophysical parameters could be further investigated to be used as a useful indicator for the health conditions of coronavirus patients in clinical settings.

Fig.1

Skin moisture recorded from 30 patients during the three days.
Skin moisture recorded from 30 patients during the three days.

Fig.2

Skin sebum content recorded from 30 patients during the three days.
Skin sebum content recorded from 30 patients during the three days.

Fig.3

Skin pH recorded from 30 patients during the three days.
Skin pH recorded from 30 patients during the three days.

Fig.4

Skin temperature (oC) recorded from 30 patients during the three days.
Skin temperature (oC) recorded from 30 patients during the three days.

Boucsein W. Electrodermal activity. Berlin:Plenum Press; 2012. https://doi.org/10.1007/978-1-4614-1126-0Boucsein W Electrodermal activity BerlinPlenum Press; 2012 10.1007/978-1-4614-1126-0Apri DOISearch in Google Scholar

Boer M, Duchnik E, Maleszka R, Marchlewicz M. Structural and biophysical characteristics of human skin in maintaining proper epidermal barrier function. Postepy Dermatol Alergol. 2016;33:1-5. https://doi.org/10.5114/pdia.2015.48037Boer M Duchnik E Maleszka R Marchlewicz M Structural and biophysical characteristics of human skin in maintaining proper epidermal barrier function Postepy Dermatol Alergol 2016331 5 10.5114/pdia.2015.48037479305226985171Apri DOISearch in Google Scholar

Boelsma E, Van de Vijver LP, Goldbohm RA, Klöpping-Ketelaars IA, Hendriks HF, Roza L. Human skin condition and its associations with nutrient concentrations in serum and diet. Am J Clin Nutr. 2003;77:348-55. https://doi.org/10.1093/ajcn/77.2.348Boelsma E Van de Vijver LP Goldbohm RA Klöpping-Ketelaars IA Hendriks HF Roza L Human skin condition and its associations with nutrient concentrations in serum and diet Am J Clin Nutr 200377348 55 10.1093/ajcn/77.2.34812540393Apri DOISearch in Google Scholar

Rode B, Ivens U, Serup J. Degreasing method for the seborrheic areas with respect to regaining sebum excretion rate to casual level. Skin Res Technol. 2000;6:92-7. https://doi.org/10.1034/j.1600-0846.2000.006002092.xRode B Ivens U Serup J Degreasing method for the seborrheic areas with respect to regaining sebum excretion rate to casual level Skin Res Technol 2000692 7 10.1034/j.1600-0846.2000.006002092.x11428949Apri DOISearch in Google Scholar

Darlenski R, Sassning S, Tsankov N, Fluhr J. Non-invasive in vivo methods for investigation of the skin barrier physical properties. Eur J Pharm Biopharm. 2009;72:295-303. https://doi.org/10.1016/j.ejpb.2008.11.013Darlenski R Sassning S Tsankov N Fluhr J Non-invasive in vivo methods for investigation of the skin barrier physical properties Eur J Pharm Biopharm 200972295 303 10.1016/j.ejpb.2008.11.01319118626Apri DOISearch in Google Scholar

Lambers H, Piessens S, Bloem A, Pronk H, Finkel P. Natural skin surface pH is on average below 5, which is beneficial for its resident flora. Int J Cosmet Sci. 2006;28:359-70. https://doi.org/10.1111/j.1467-2494.2006.00344.xLambers H Piessens S Bloem A Pronk H Finkel P Natural skin surface pH is on average below 5, which is beneficial for its resident flora Int J Cosmet Sci 200628359 70 10.1111/j.1467-2494.2006.00344.x18489300Apri DOISearch in Google Scholar

Rippke F, Schreiner V, Doering T, Maibach HI. Stratum corneum pH in atopic dermatitis. Am J Clin Dermatol. 2004;5:217-23. https://doi.org/10.2165/00128071-200405040-00002Rippke F Schreiner V Doering T Maibach HI Stratum corneum pH in atopic dermatitis Am J Clin Dermatol 20045217 23 10.2165/00128071-200405040-0000215301569Apri DOISearch in Google Scholar

Firooz A, Gorouhi F, Davari P, Atarod M, Hekmat S, Rashighi‐ Firoozabadi M, et al. Comparison of hydration, sebum and pH values in clinically normal skin of patients with atopic dermatitis and healthy controls. Clin Exp Dermatol. 2007;32:321-2. https://doi.org/10.1111/j.1365-2230.2007.02364.xFirooz A Gorouhi F Davari P Atarod M Hekmat S Rashighi‐ Firoozabadi M et al Comparison of hydration, sebum and pH values in clinically normal skin of patients with atopic dermatitis and healthy controls Clin Exp Dermatol 200732321 2 10.1111/j.1365-2230.2007.02364.x17335552Apri DOISearch in Google Scholar

Stalder J, Taieb A, Atherton D, Bieber P, Bonifazi E, Broberg A, et al. Severity scoring of atopic dermatitis: the SCORAD index: consensus report of the european task force on atopic dermatitis. Dermatology. 1993;186:23-31. https://doi.org/10.1159/000247298Stalder J Taieb A Atherton D Bieber P Bonifazi E Broberg A et al Severity scoring of atopic dermatitis: the SCORAD index: consensus report of the european task force on atopic dermatitis Dermatology 199318623 31 10.1159/0002472988435513Apri DOISearch in Google Scholar

Prakash C, Bhargava P, Tiwari S, Majumdar B, Bhargava RK. Skin surface pH in acne vulgaris: insights from an observational study and review of the literature. J Clin Aesthet Dermatol. 2017;10:33.Prakash C Bhargava P Tiwari S Majumdar B Bhargava RK Skin surface pH in acne vulgaris: insights from an observational study and review of the literature J Clin Aesthet Dermatol 20171033Search in Google Scholar

Choi C, Choi J, Park K, Youn S. Facial sebum affects the development of acne, especially the distribution of inflammatory acne. J Eur Acad Dermatol Venereol. 2013;27:301-6. https://doi.org/10.1111/j.1468-3083.2011.04384.xChoi C Choi J Park K Youn S Facial sebum affects the development of acne, especially the distribution of inflammatory acne J Eur Acad Dermatol Venereol 201327301 6 10.1111/j.1468-3083.2011.04384.x22176122Apri DOISearch in Google Scholar

Firooz A, Sadr B, Babakoohi S, Sarraf-Yazdy M, Fanian F, Kazerouni-Timsar A, et al. Variation of biophysical parameters of the skin with age, gender, and body region. Sci World J. 2012; 2012:386936. https://doi.org/10.1100/2012/386936Firooz A Sadr B Babakoohi S Sarraf-Yazdy M Fanian F Kazerouni-Timsar A et al Variation of biophysical parameters of the skin with age, gender, and body region Sci World J 2012 2012386936 10.1100/2012/386936331761222536139Apri DOISearch in Google Scholar

Turner G, Hoptroff M, Harding C. Stratum corneum dysfunction in dandruff. Int J Cosmet Sci. 2012;34:298-306. https://doi.org/10.1111/j.1468-2494.2012.00723.xTurner G Hoptroff M Harding C Stratum corneum dysfunction in dandruff Int J Cosmet Sci 201234298 306 10.1111/j.1468-2494.2012.00723.x349438122515370Apri DOISearch in Google Scholar

Jung Y, Kim E, Cho J, Suh K, Nam G. Effect of skin pH for wrinkle formation on Asian: Korean, Vietnamese and Singaporean. J Eur Acad Dermatol Venereol. 2013;27:e328-e32. https://doi.org/10.1111/j.1468-3083.2012.04660.xJung Y Kim E Cho J Suh K Nam G Effect of skin pH for wrinkle formation on Asian: Korean, Vietnamese and Singaporean J Eur Acad Dermatol Venereol 201327e328 e32 10.1111/j.1468-3083.2012.04660.x22830637Apri DOISearch in Google Scholar

Jensen MM, Brabrand M, editors. The relationship between body temperature, heart rate and respiratory rate in acute patients at admission to a medical care unit. Scand J Trauma Resusc Emerg Med. 2015;23:A12. https://doi.org/10.1186/1757-7241-23-S1-A12Jensen MM Brabrand M editors The relationship between body temperature, heart rate and respiratory rate in acute patients at admission to a medical care unit Scand J Trauma Resusc Emerg Med 201523A12 10.1186/1757-7241-23-S1-A12Apri DOISearch in Google Scholar

Cunliffe W, Burton J, SHUSTER S. The effect of local temperature variations on the sebum excretion rate. Br J Dermatol Suppl. 1970;83:650-4. https://doi.org/10.1111/j.1365-2133.1970.tb15759.xCunliffe W Burton J SHUSTER S The effect of local temperature variations on the sebum excretion rate Br J Dermatol Suppl 197083650 4 10.1111/j.1365-2133.1970.tb15759.x4250118Apri DOISearch in Google Scholar

Park Sr, Han J, Yeon YM, Kang NY, Kim E. Effect of face mask on skin characteristics changes during the COVID‐19 pandemic. Skin Res Technol. 2021;27:554-9. https://doi.org/10.1111/srt.12983Park Sr Han J Yeon YM Kang NY Kim E Effect of face mask on skin characteristics changes during the COVID‐19 pandemic Skin Res Technol 202127554 9 10.1111/srt.12983775363033217053Apri DOISearch in Google Scholar

Hachem J-P, Crumrine D, Fluhr J, Brown BE, Feingold KR, Elias PM. pH directly regulates epidermal permeability barrier homeostasis, and stratum corneum integrity/cohesion. J Invest Dermatol. 2003;121:345-53. https://doi.org/10.1046/j.1523-1747.2003.12365.xHachem J-P Crumrine D Fluhr J Brown BE Feingold KR Elias PM pH directly regulates epidermal permeability barrier homeostasis, and stratum corneum integrity/cohesion J Invest Dermatol 2003121345 53 10.1046/j.1523-1747.2003.12365.x12880427Apri DOISearch in Google Scholar

Fluhr JW, Behne MJ, Brown BE, Moskowitz DG, Selden C, Mao-Qiang M, et al. Stratum corneum acidification in neonatal skin: secretory phospholipase A2 and the sodium/hydrogen antiporter-1 acidify neonatal rat stratum corneum. J Invest Dermatol. 2004;122:320-9. https://doi.org/10.1046/j.0022-202X.2003.00204.xFluhr JW Behne MJ Brown BE Moskowitz DG Selden C Mao-Qiang M et al Stratum corneum acidification in neonatal skin: secretory phospholipase A2 and the sodium/hydrogen antiporter-1 acidify neonatal rat stratum corneum J Invest Dermatol 2004122320 9 10.1046/j.0022-202X.2003.00204.x15009712Apri DOISearch in Google Scholar

Zhang L, Zhu Y, Jiang M, Wu Y, Deng K, Ni Q. Body Temperature Monitoring for Regular COVID-19 Prevention Based on Human Daily Activity Recognition. Sensors. 2021;21:7540. https://doi.org/10.3390/s21227540Zhang L Zhu Y Jiang M Wu Y Deng K Ni Q Body Temperature Monitoring for Regular COVID-19 Prevention Based on Human Daily Activity Recognition Sensors 2021217540 10.3390/s21227540862219434833616Apri DOISearch in Google Scholar

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