Superiority of a vitamin B12-barrier cream compared with standard glycerol-petrolatum-based emollient cream in the treatment of atopic dermatitis: A randomized, left-to-right comparative trial

Improvements in Gut Microbiome Composition Predict the Clinical Efficacy of a Novel Synbiotics Formula in Children with Mild to Moderate Atopic Dermatitis

Atopic dermatitis (AD) is a common chronic inflammatory skin disease with a significant association with various type-2 inflammation-related comorbidities. Ongoing research suggests the crucial involvement of gut microbiome, especially in childhood onset AD, and hence, probiotics have emerged as a potential non-steroid-based therapeutics option to complement existing AD management plans. In order to delineate the impact of probiotics in the gut microbiome of pediatric AD patients from southern China, targeted 16S rRNA sequencing and thorough bioinformatic analysis were performed to analyze the gut microbiome profiles of 24 AD children after taking an orally administered novel synbiotics formula with triple prebiotics for 8 weeks. A notable improvement in Eczema Area and Severity Index (EASI) (p = 0.008) was observed after taking an 8-week course of probiotics, with no adverse effects observed. The relative abundances of key microbial drivers including Bacteroides fragilis and Lactobacillus acidophilus were significantly increased at week 8. We also found that the positive responsiveness towards an 8-week course of probiotics was associated with improvements in the gut microbiome profile with a higher relative abundance of probiotic species. Over-represented functional abundance pathways related to vitamin B synthesis and peptidoglycan recycling may imply the underlying mechanism. In summary, our study suggests how the gut microbial landscape shifts upon probiotic supplementation in AD children, and provides preliminary evidence to support targeted probiotic supplementation for the management of childhood AD.

How and what adverse events are reported and captured in randomized control trials of emollients in the treatment of eczema?

BACKGROUND

Emollients are universally recommended for atopic dermatitis/eczema ('eczema'), to improve the skin barrier and reduce symptoms. However, our knowledge of the frequency and nature of adverse effects associated with their use is limited.

OBJECTIVES

We sought to determine how well adverse events are reported in randomized controlled trials (RCTs) of emollients for eczema.

METHODS

MEDLINE was searched from inception (1946) to May 2022. Inclusion criteria were RCTs of moisturizers or emollients used as a leave-on treatment (as the intervention or control) in adults or children with eczema. Exclusion criteria were non-RCTs; patients with other diagnoses included; use of emollient as bath additives, soap substitutes or as preventative; and not published in English. References of eligible papers were reviewed for any additional, relevant research. Data were extracted into an Excel spreadsheet and analysed descriptively. An assessment of study quality was carried out using the Joanna Briggs Institute tool for RCTs.

RESULTS

From 369 potential papers, 35 papers (reporting on 34 studies) were included. Most research was conducted in research centres or hospitals (unclear in 34%). In total, 89% reported collecting data on adverse events related to emollient treatment use but the methods used were poorly reported (40% unclear). Four papers used patient questionnaires/diaries. However, it was unclear how and what was collected as only two studies showed the questionnaires used.

CONCLUSIONS

Reporting of adverse events related to emollient use in trials of patients with eczema is poor and inconsistent. Agreement should be reached on how and what adverse events should be collected, to standardize reporting across studies.

A Review of Moisturizing Additives for Atopic Dermatitis

Atopic dermatitis, the most common form of eczema, is a chronic, relapsing inflammatory skin condition that occurs with dry skin, persistent itching, and scaly lesions. This debilitating condition significantly compromises the patient’s quality of life due to the intractable itching and other associated factors such as disfigurement, sleeping disturbances, and social stigmatization from the visible lesions. The treatment mainstay of atopic dermatitis involves applying topical glucocorticosteroids and calcineurin inhibitors, combined with regular use of moisturizers. However, conventional treatments possess a certain degree of adverse effects, which raised concerns among the patients resulting in non-adherence to treatment. Hence, the modern use of moisturizers to improve barrier repair and function is of great value. One of the approaches includes incorporating bioactive ingredients with clinically proven therapeutic benefits into dermocosmetics emollient. The current evidence suggests that these dermocosmetics emollients aid in the improvement of the skin barrier and alleviate inflammation, pruritus and xerosis. We carried out a critical and comprehensive narrative review of the literature. Studies and trials focusing on moisturizers that include phytochemicals, natural moisturizing factors, essential fatty acids, endocannabinoids, and antioxidants were identified by searching electronic databases (PubMed and MEDLINE). We introduce the current knowledge on the roles of moisturizers in alleviating symptoms of atopic dermatitis. We then further summarize the science and rationale of the active ingredients in dermocosmetics and medical device emollients for treating atopic dermatitis. Finally, we highlight the limitations of the current evidence and future perspectives of cosmeceutical research on atopic dermatitis.

The Role of Methyl Donors of the Methionine Cycle in Gastrointestinal Infection and Inflammation

Vitamin deficiency is well known to contribute to disease development in both humans and other animals. Nonetheless, truly understanding the role of vitamins in human biology requires more than identifying their deficiencies. Discerning the mechanisms by which vitamins participate in health is necessary to assess risk factors, diagnostics, and treatment options for deficiency in a clinical setting. For researchers, the absence of a vitamin may be used as a tool to understand the importance of the metabolic pathways in which it participates. This review aims to explore the current understanding of the complex relationship between the methyl donating vitamins folate and cobalamin (B12), the universal methyl donor S-adenosyl-L-methionine (SAM), and inflammatory processes in human disease. First, it outlines the process of single-carbon metabolism in the generation of first methionine and subsequently SAM. Following this, established relationships between folate, B12, and SAM in varying bodily tissues are discussed, with special attention given to their effects on gut inflammation.

Histological Skin Changes After Treatment with 675 nm Laser

Objective: To evaluate the histological effects of a new 675-nm laser device on the skin. Background: Innovative technologies based on physical principles have been proposed in recent years to improve the treatment of aging skin. Laser technology is currently being studied for its potential in skin care treatments. A new 675-nm laser device is being used for the treatment of hyperpigmentation, scars, and various types of wrinkles. Methods: A 42-year-old man underwent a 675-nm RedTouch^® laser session for the treatment of aging signs on the neck. Two 2.5-mm biopsies were taken from the treated area and the adjacent area untreated with the laser, 45 days after the procedure. Comparison of the immunohistochemistry findings and assessment of the collagen and elastin fibers were performed by a board-certified dermatopathologist. Results: Skin biopsies revealed histological changes that comprised proliferation of new collagen fibers in the treated area, when compared to that in the untreated areas. Conclusions: Histological analysis suggests that the 675-nm laser has a potential role in stimulating collagen remodeling, with a significant increase in thin and new collagen fibers.

Combination of Fractional CO2 Laser and Rhodamine-Intense Pulsed Light in Facial Rejuvenation: A Randomized Controlled Trial

Objective: This randomized controlled trial aims to verify the efficacy of a combined fractional CO₂ laser and rhodamine-intense pulsed-light (r-IPL) protocol in the photoaging therapy. Background: Skin aging is related to multiple environmental and genetic factors that give rise to different manifestations. In recent years many techniques have been proposed for the rejuvenation of the skin of the face such as ablative and nonablative procedures. Combination of laser or light sources with different wavelengths represents a safe and effective treatment method. r-IPL is a new pulsed-light technique capable to generate wavelengths varying from 550 to 650 nm proposed in nonablative photorejuvenation with a good efficacy and safety profile. Methods: Twenty-two patients (skin phototypes II-III, aged 46-67 years) were randomly allocated into two groups: group A was treated only with a therapeutic standard dose of the fractional CO₂ laser, whereas group B was treated with a combined therapy of r-IPL and fractional CO₂ laser. All patients were treated up to three times at a 2-month interval. Efficacy of the procedures was assessed thanks to the Fitzpatrick Wrinkle Severity Scale (scores 1-9) before treatment and at a 4-month follow-up from the last treatment. Results: Patients treated with the combination of r-IPL and fractional CO₂ laser showed better results in terms of wrinkle reduction according to the Fitzpatrick Wrinkle Severity score (2.82 ± 0.87 vs. 3.09 ± 1.14), with a statistically significant reduction in healing times (7.82 ± 0.75 vs. 13.82 ± 1.94 days, p ≤ 0.001) and duration of post-treatment erythema (3.55 ± 0.93 vs. 8.18 ± 1.47 days, p ≤ 0.001). Patient satisfaction was higher after combined fractional CO₂ laser and r-IPL treatment. Conclusions: Our data suggest that combined use of fractional CO₂ laser and r-IPL may lead to excellent results in terms of skin rejuvenation with a simple post-treatment management and an optimal tolerability.

Vitamin B12 and Atopic Dermatitis: Any Therapeutic Relevance For Oral Supplementation?

In vitro experimental studies have demonstrated the anti-inflammatory and immune-regulatory potential of vitamin B 12. Nevertheless, few studies have explored so far the relevance of topical products containing vitamin B12 as a treatment option for atopic dermatitis, and the association between blood levels of Vitamin B12 and the severity of atopic dermatitis has never been investigated. Thus the effect of Vitamin B12 oral supplementation in atopic dermatitis is unknown. We describe the case of a 18 years old boy affected by severe refractory atopic dermatitis requiring continuous topical steroid therapy and 5-6 oral steroid trials per year to achieve satisfactory control. During a three years follow-up, an association between Vitamin B12 blood levels and atopic dermatitis severity was detected, as well as a clinically significant SCORAD improvement following Vitamin B12 oral supplementation. Although the cause-effect relationship between Vitamin B12 deficiency and AD severity or relapse needs to be confirmed in larger studies, our case report suggests that Vitamin B12 levels deserve to be assessed in patients with difficult to control atopic dermatitis and points out the potential therapeutic relevance of Vitamin B12 oral supplementation.

A comparison of Myribase and Doublebase gel: Does qualitative similarity of emollient products imply their direct interchangeability in everyday practice?

Emollients are acknowledged as a part of standard care in therapeutic and prevention protocols as well as a part of everyday skin care routine. When it comes to making a final decision between two emollient products, the ingredient list, that is, the formulation composition could be the determining factor. In such cases the consumer, and some healthcare providers, believe that products with the same qualitative composition (ingredient list) must have the same efficacy. In this study, we have investigated the skin hydration performance of two emollient preparations (DBG and MBG), which appear to contain the same ingredients, and hence, could be considered interchangeable in everyday practice. Our studies showed that the effects of DBG were overall superior to the ones attributed to MBG at each investigated time point (1, 2, 4, and 24 h post application) when tested on normal and dry skin. Consequently, it is shown that two apparently qualitatively identical products do not necessarily provide matching efficacy.

A New 675 nm Laser Device in the Treatment of Melasma: Results of a Prospective Observational Study

Objective: This study evaluates the efficacy and safety of a new 675 nm laser source system on melasma. Background: Melasma is an acquired circumscribed hyperpigmented disorder that has a negative impact on patients' life quality. Different treatments are currently available. This study evaluates this new 675 nm laser source system, on melasma with the use of established parameters that guarantee minimum pain, the absence of side effects, and simplifying posttreatment management. Materials and methods: A total of 25 subjects (all women, 21-50 years old), with facial melasma and Fitzpatrick skin types I-III, were treated with three sessions of a new 675 nm laser system. Efficacy of treatment was evaluated using Melasma Severity Index (MSI) score before and 3 months after the last session. The appearance of side effects has also been monitored to evaluate safety. A preclinical study was executed to evaluate laser effectiveness on sheep skin. Results: All 25 subjects treated with the 675 nm laser had significant improvement in melasma according to MSI score (mean baseline MSI 26.4 ± 19.2; mean 3-month follow-up MSI 17.3 ± 15, p: 0.003). Histology in preclinical study showed selective damage of melanin-rich areas. No side effects have been observed except some minor erythematous reactions in two patients. Conclusions: Due to its high affinity with melanin, and its minimal interaction with the vascular component, novel 675 nm laser may be considered promising when treating benign pigmented lesions with a low risk of side effects and simple posttreatment management.

Long-Term Follow-Up for Q-Switched Nd:YAG Treatment of Nevus of Ota: Are High Number of Treatments Really Required? A Case Report

Objective: Q-switched laser is considered a gold standard treatment for Nevus of Ota (NO). We report how few laser sessions in long intervals of time may achieve satisfying outcomes reducing the rate of possible procedure-linked side effects such as burning, cornea injuries, or hyperpigmentation. Background: NO represents a congenital dermal melanocytosis in the trigeminal distribution majorly occurring in Asian individuals. Multiple reports have shown efficacy and safety of Q-switched laser for the treatment of this condition, but they were based on an empiric regimen, often leading to unnecessary overtreatments. At the best of our knowledge, no long-term follow-up observations of single laser sessions have been conducted to assess the proper intervals and number of treatments. Materials and methods: A 36-year-old Asian woman, Fitzpatrick skin type IV with clinical diagnosis of NO, was treated with 1064 nm 6 ns Q-switched laser one session per year for a total of two sessions. Clinical result was valued by two physicians independently using standardized and polarized light. No use of general anesthesia or sedation was needed in our experience. Corneal shields have been used. Results: After only two sessions of the Q-switched laser performed 1 year apart, the result was excellent with a 95% of clinical response. No side effect was observed. Conclusions: In our experience, Q-switched Nd:YAG laser is an effective treatment for NO with no necessity of high number of treatments. A larger population is needed to confirm this preliminary result.

Effects of Formulation Excipients on Skin Barrier Function in Creams Used in Pediatric Care

Semisolid dosage forms are recommended for the dermal care of babies and children. If we look at the ingredients of these preparations, there are still many cases in which there are substances (occlusive agents, preservatives) that no longer meet certain requirements of the modern age, so it is timely to replace them with other substances. The aim of this work was to formulate a science-based formulation with new components that keep or improve its moisturizing properties, rheological parameters, and microbiological stability. Occlusive oils, like white petrolatum and liquid paraffin and the preservative parabens are traditional ingredients in oil in water creams, were replaced with white beeswax, sunflower oil, and phenoxyethanol, respectively. Cocoa butter, urea, and glycerol were added to improve long-lasting hydration and support the barrier function of the reformulated creams. The rheological properties of the formulations were determined. The effects of the preparations on skin hydration and on the barrier function of the skin were tested. Furthermore, microbiological stability was investigated. The result of the reformulation was an o/w cream that provided a good longer-lasting hydration effect; supported the barrier function of the baby skin without occlusion; and had adequate consistency, easy spreading, a pleasant skin feeling, proper pH, and good microbiological stability.

Assessment of the Effectiveness of Vitamin Supplement in Treating Eczema: A Systematic Review and Meta-Analysis

Background

The morbidity of eczema has increased in the recent years, and the methods to prevent or ameliorate its effects are becoming more important. To this end, this research was conducted to determine the effectiveness of vitamin supplements in eczema therapy.

Method

Embase, PubMed, and Cochrane Central Register of Clinical Trials were searched. Only randomized controlled trials were included, and we included all quantified eligible data where the SCORing Atopic Dermatitis (SCORAD) Index or Eczema Area and Severity Index (EASI) scores were applied to assess the severity of eczema.

Results

Ten studies fulfilled the inclusion criteria, and eight of them were included for quantitative analysis (total: 456 patients). Compared to the controls, the SCORAD index or EASI decreased in the vitamin supplement group (mean difference -5.96, 95% CI: -7.69 to -4.23 for vitamin D3; mean difference -5.72, 95% CI: -11.41 to -0.03 for vitamin E; and mean difference -3.19, 95% CI: -4.27 to -2.10 for vitamin B12).

Conclusion

This study suggests that vitamin supplements could be important therapeutics to help manage eczema patients.

What's new in the treatment of atopic dermatitis?

Atopic dermatitis (AD) is a pruritic, chronic and inflammatory skin disease, with an usual onset in the pediatric age. Several drugs are used in the treatment of this skin disease. Drugs as steroid, calcineurin inhibitors, and moisturizing creams are widely used in the treatment of this disease but often patients are not satisfied with the obtained results. New drugs like dupilumab or crisaborole seem to be a promising option for moderate and severe forms of AD. This article analyzes the newest therapy available today for the treatment of AD.