Transepidermal water loss

Transepidermal water loss (TEWL or TWL) is the loss of water that passes from inside a body (animal or plant) through the epidermis (that is, either the epidermal layer of animal skin or the epidermal layer of plants) to the surrounding atmosphere via diffusion and evaporation processes. TEWL in mammals is also known as insensible water loss (IWL), as it is a process over which organisms have little physiologic control and of which they are usually mostly unaware. Insensible loss of body water can threaten fluid balance; in humans, substantial dehydration sometimes occurs before a person realizes what is happening. Measurements of TEWL may be useful for identifying skin damage caused by certain chemicals, physical insult (such as "tape stripping") or pathological conditions such as eczema, as rates of TEWL increase in proportion to the level of damage. However, TEWL is also affected by environmental factors such as humidity, temperature, the time of year (season variation) and the moisture content of the skin (hydration level). Therefore, care must be taken when interpreting the meaning of TEWL rates. From a clinical standpoint, TEWL measurements are of great importance in evaluating skin barrier functionality. Often normal rates of TEWL – from 2.3 g/(m2h) to 44 g/(m2h) – are compromised due to injury, infection and/or severe damage as in the case of burns causing rates over 50 or even over 100 g/m2/h. Damage to the stratum corneum and superficial skin layers not only results in physical vulnerability, but also results in an excess rate of water loss. Therefore, dehydration, metabolic acidosis, and conditions such as anhydremia or concentration of the blood are often critical issues for healthcare providers to consider in the treatment of burn patients. TEWL is of major concern in public health, considering the relatively high rate of burn incidence among communities in the developing world due to poor quality cooking stoves. Resources for burn care in local clinics are often scarce and depending on the affected surface area, TEWL is a major issue that can be overlooked.