Advances in Management of Atopic Dermatitis: New Therapies and Novel Uses of Existing Treatments

Dual intervention on the gut and skin microbiota attenuates facial cutaneous aging

The gut and skin microbiota are microbial barriers, resisting harmful foreign microorganisms and maintaining internal homeostasis. Dysbiosis of the gut and skin microbiota is involved in aging progression. However, interventions targeting facial skin wellness taking into account the gut-skin axis are scarce. In this study, the impact of an eight-week intervention with oral (O), topical (T), and both oral and topical (OT) xylo-oligosaccharides (XOS) by regulating gut and skin microbiota on facial cutaneous aging was investigated in a double-blind placebo-controlled trial in females. An increase in the proportion of participants with skin rejuvenation was observed, along with a significant reduction in facial pores after OT intervention. The reduction of cutaneous Cutibacterium by OT intervention was greater than that in the O and T groups. These interventions can change the skin microbial structure. Intestinal Bifidobacterium was enriched only by dual treatment with oral and topical XOS. Function prediction analysis revealed a decrease in K02770 encoding fructose-1-phosphate kinase involved in de novo lipid synthesis from fructose with dual intervention, suggesting that inhibition of lipophilic Cutibacterium may contribute to reducing facial pores. Overall, the dual XOS intervention approach is most effective for improving both gut and skin microbiota, as well as facial skin aging.

Steroid-sparing effects and acceptability of a new skin gel containing the anti-inflammatory medicinal substance-nicotinamide

Background/aim: Adex gel (DENI) is a leave-on emollient, containing an ancillary anti-inflammatory medicinal substance, nicotinamide, for use in the treatment and management of dry skin conditions prone to inflammation. The aim of the study was to obtain patients’ and a Medical Investigator’s feedback on the clinical performance and acceptability of the product, and to assess the product’s potential for reducing patients’ reliance on topical corticosteroids and immunomodulators.

Methods: Forty-eight patients were enrolled with 43 patients completing the study. These patients used the product on its own, or as adjunctive therapy, for two weeks instead of their usual emollient, applying it three times daily or more often if necessary. Using a questionnaire, subjects then indicated whether they were in agreement or not with various statements about the clinical performance and acceptability of the product. In the second part of the study, twenty patients used the product for four weeks, this time using it as often as they liked. The Medical Investigator looked at both the performance and the acceptability of the treatment. Patients completed a questionnaire again to indicate how they used it and whether their use of topical corticosteroids and/or immunomodulator treatments had changed.

Results: Patient’s responses were very positive, ranging from 81% to 100% agreement with each performance statement in relation to beneficial effects on the skin. The Medical Investigator considered that for nearly all patients, DENI gel was a helpful and convenient addition to their treatment regime. When questioned on steroid-sparing effects, more than half reported that they needed to use less of their other anti-inflammatory treatments, and nearly 95% reported that they felt their skin condition had benefited from using DENI gel.

Conclusion: This new anti-inflammatory emollient appears to be a helpful addition to the treatment armamentarium for eczema and psoriasis that may reduce reliance on topical corticosteroids and immunomodulators.

An open-label forearm-controlled pilot study to assess the effect of a proprietary emollient formulation on objective parameters of skin function of eczema-prone individuals over 14 days

Background

This study examines the efficacy of a new plant-based emollient and assesses product acceptability.

Methods

Primary efficacy endpoints were improvement in transepidermal water loss, hydration, skin elasticity and firmness, erythema, and skin roughness and smoothness as measured using the versions of Tewameter, Corneometer, Cutometer, Mexameter, and Visioscan VC98, respectively. The cream was applied twice daily by 32 participants to an area of one forearm unaffected by eczema, while the same area of the other forearm was used as a control. Measurements were taken at day 0 and day 14. Secondary endpoints assessed the acceptability of the product.

Results

At the end of 2 weeks, transepidermal water loss, hydration, skin elasticity and firmness, erythema, and skin roughness and smoothness improved. All changes were statistically significant (p<0.01). The rate of satisfaction with the emollient properties was 82%, and the rate of absorption into the skin was 88%. Results show that the emollient hydrates and repairs eczema-prone skin with high levels of acceptability.

Topical application of probiotics in skin: adhesion, antimicrobial and antibiofilm in vitro assays

AIMS

When skin dysbiosis occurs as a result of skin disorders, probiotics can act as modulators, restoring microbial balance. Several properties of selected probiotics were evaluated so that their topical application could be considered.

METHODS AND RESULTS

Adhesion, antimicrobial, quorum sensing and antibiofilm assays were carried out with several probiotic strains and tested against selected skin pathogens. All tested strains displayed significant adhesion to keratin. All lactobacilli with the exception of Lactobacillus delbrueckii, showed antimicrobial activity against skin pathogens, mainly due to organic acid production. Most of them also prevented biofilm formation, but only Propioniferax innocua was able to break down mature biofilms.

CONCLUSIONS

This study demonstrates that although all tested probiotics adhered to human keratin, they showed limited ability to prevent adhesion of some potential skin pathogens. Most of the tested probiotics successfully prevented biofilm formation, suggesting that they may be successfully used in the future as a complement to conventional therapies in the treatment of a range of skin disorders.

SIGNIFICANCE AND IMPACT OF STUDY

The topically used probiotics may be a natural, targeted treatment approach to several skin disorders and a complement to conventional therapies which present many undesirable side effects.

Beneficial health characteristics of native and hydrolysed konjac (Amorphophallus konjac) glucomannan

The impact of ingesting glucomannans on health is not limited to colonic-focused fermentation into short-chain fatty acids (SCFAs), which might have some local health benefits; it also helps in treating disease states and enhancing the body's immune system, both within the gut and in/on other parts of the body. The local and systemic roles of hydrolysed glucomannans, especially konjac glucomannans, in the mouth, oesophagus, stomach, small intestine, large intestine, gut-associated lymphoid tissue (GALT), skin and vagina, are highlighted. Therapeutic applications are discussed. © 2015 Society of Chemical Industry.

Targeting key proximal drivers of type 2 inflammation in disease

Systemic type 2 inflammation encompassing T helper 2 (TH2)-type responses is emerging as a unifying feature of both classically defined allergic diseases, such as asthma, and a range of other inflammatory diseases. Rather than reducing inflammation with broad-acting immunosuppressants or narrowly targeting downstream products of the TH2 pathway, such as immunoglobulin E (IgE), efforts to target the key proximal type 2 cytokines - interleukin-4 (IL-4), IL-5 and IL-13 - represent a promising strategy to achieve therapeutic benefit across multiple diseases. After several initial disappointing clinical results with therapies targeting IL-4, IL-5 or IL-13 in asthma, applying a personalized approach achieved therapeutic benefit in an asthma subtype exhibiting an 'allergic' phenotype. More recently, efficacy was extended into a broad population of people with asthma. This argues that the Type 2 inflammation is broadly relevant across the severe asthma population if the key upstream drivers are properly blocked. Moreover, the simultaneous inhibition of IL-4 and IL-13 has shown significant clinical activity in diseases that are often co-morbid with asthma - atopic dermatitis and chronic sinusitis with nasal polyps - supporting the hypothesis that targeting a central 'driver pathway' could benefit multiple allergic diseases.

Impact of prebiotics and probiotics on skin health

This review discusses the role of pre- and probiotics with respect to improving skin health by modulating the cutaneous microbiota. The skin ecosystem is a complex environment covered with a diverse microbiota community. These are classified as either transient or resident, where some are considered as beneficial, some essentially neutral and others pathogenic or at least have the capacity to be pathogenic. Colonisation varies between different parts of the body due to different environmental factors. Pre- and probiotic beneficial effects can be delivered topically or systemically (by ingestion). The pre- and probiotics have the capacity to optimise, maintain and restore the microbiota of the skin in different ways. Topical applications of probiotic bacteria have a direct effect at the site of application by enhancing the skin natural defence barriers. Probiotics as well as resident bacteria can produce antimicrobial peptides that benefit cutaneous immune responses and eliminate pathogens. In cosmetic formulations, prebiotics can be applied to the skin microbiota directly and increase selectively the activity and growth of beneficial 'normal' skin microbiota. Little is known about the efficacy of topically applied prebiotics. Nutritional products containing prebiotics and/or probiotics have a positive effect on skin by modulating the immune system and by providing therapeutic benefits for atopic diseases. This review underlines the potential use of pre- and probiotics for skin health.