A pilot trial of skin barrier restoration to reduce systemic inflammation

PROJECT SUMMARY A chronic inflammatory state, termed inflammageing, is a major driver of morbidity and premature death among older adults. Although the identification of inflammatory triggers has been identified as a critical area for aging research, little attention has focused on the skin, despite its role as a primary immunoregulatory organ. Normal aging is associated with increased skin barrier permeability, which leads to subclinical inflammatory cascades in the skin and serum. We hypothesize that age-associated decline of skin barrier function contributes to inflammageing and that restoring the skin barrier with moisturizers will reduce systemic inflammation. We propose a pilot trial designed to determine the best measures of skin barrier function in older adults, the most sensitive measures of systemic inflammation, the role of the cutaneous microbiome, and the feasibility and acceptability of moisturizer use. In a parallel, 8-week, self-controlled design, 32 subjects ≥70 years of age will be randomized to treatment with a ceramide moisturizing cream or petrolatum ointment. Changes in inflammatory markers, skin barrier function, and microbial diversity will be compared between a 4-week treatment period of moisturizer application and a 4-week placebo period. We will also examine recruitment efficacy, retention rates, fidelity to the treatment, data integrity, and the acceptability of the intervention and protocol. The results will be used to design a future randomized efficacy trial of moisturizers to reduce systemic inflammation. While many other pharmacologic strategies for reducing inflammation in older adults are considered too risky or expensive for widespread use, moisturizers are a promising intervention that is safe and accessible in diverse community settings.