Instrumental Evaluation of the Protective Effects of a Barrier Film on Surrounding Skin in Chronic Wounds

Valentina Dini, MD; Francesca Salibra, MD; Cinzia Brilli, RN; Marco Romanelli, MD, PhD

Variability in the water permeability values for periulcer tissue, together with histological images, confirmed that the presence of an impaired skin barrier in such tissue is likely the result of the effects of wound exudate on the tissue. When the skin barrier is damaged, the passive diffusion of water from the deeper skin layers to outside TEWL increases; even subtle changes in barrier integrity can be detected by measuring TEWL. This noninvasive technique is applicable in vivo and offers the possibility to quantify periulcer skin responses after the application of protective products.7 It should therefore be possible to administer agents to the wound periphery, which would permit a more efficient water delivery through the skin.

     It is particularly important to protect the surrounding skin from maceration caused by exudate, because this reddens the wound edges and makes it difficult to attach the dressing material. Progress in the management of wound edges has generally been unsatisfactory and in many cases the products used have not been developed with the aim of skin protection. The lack of supporting clinical evidence creates difficulties for caregivers in prescribing the most effective treatment.

     Shuren et al8 published a review, which demonstrated that there is no statistically significant difference between the protective properties of different periwound skin barriers. Coutts et al9 observed that zinc oxide and petrolatum are effective, but can interfere with the dressing’s absorption and adhesion. Several reports have confirmed that zinc oxide and petrolatum are difficult to remove.10 Most studies conclude that more research is needed to determine the objective efficacy of the products used to protect surrounding skin. In the literature, only 1 intra-individual, double-blind, randomized trial objectively demonstrated the efficacy of a film barrier on perilesional skin using a chromometer to measure erythema, which could detect color changes not visible to the naked eye.11 The erythema completely disappeared after 3 days in 88.1% of the patients and after 4 days in all patients when treated with NSBF.

     In the present study, the skin barrier was monitored by measuring TEWL during treatment with 2 types of skin protective agents in order to achieve an objective efficacy evaluation of the skin barrier product.


     The results of this study showed that TEWL measurements are the most important biophysical parameters for evaluating the efficiency of the human skin water barrier and that the NSBF and zinc oxide ointment helped improve the surrounding skin barrier. As an additional benefit, the NSBF was easy to apply—therefore reducing patient discomfort and suffering.


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