1
|
Allen OGE, MacNeill S, Ridd MJ. Parent satisfaction with lotion, cream, gel and ointment emollient types: secondary analysis of the Best Emollients for Eczema study. Clin Exp Dermatol 2024; 49:573-577. [PMID: 38113393 DOI: 10.1093/ced/llad452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/14/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND The main determinant of emollient effectiveness is whether it is used, which in turn is linked with user satisfaction. OBJECTIVES To compare parental satisfaction with emollient type for the treatment of childhood eczema. METHODS Secondary analysis of data from the Best Emollients for Eczema (BEE) trial was undertaken. In total, 550 children aged between 6 months and 12 years were recruited from primary care in England and randomized to use a lotion, cream, gel or ointment as their main emollient for 16 weeks. At week, 16 parents were asked to complete an Emollient Satisfaction Questionnaire (ESQ). Completion rates and scores were compared, using χ2 test, t-test calculations and one-way Anova as appropriate. RESULTS Data on 378 participants (68.7% of those randomized) were analysed. Mean ESQ scores were gel 20.9 (SD 5.3), lotion 20.4 (SD 5.6), cream 18.8 (SD 6.3) and ointment 15.2 (SD 6.8) (P < 0.001). In pairwise comparisons, there was a statistically significant difference in mean ESQ scores between ointment and lotion (P < 0.001), ointment and cream (P < 0.001) and ointment and gel (P < 0.001) but not between lotion, cream and gel. Participants using lotions had highest overall satisfaction and were most likely to continue using their emollient. ESQ scores were correlated with reported emollient use and improvements in parent-reported eczema severity. CONCLUSIONS Overall, lotions and gels were favoured over creams and ointments. Although satisfaction is determined by personal preference, these results will aid parents, clinicians and children to find the right emollient(s) for them.
Collapse
|
2
|
Chu DK, Schneider L, Asiniwasis RN, Boguniewicz M, De Benedetto A, Ellison K, Frazier WT, Greenhawt M, Huynh J, Kim E, LeBovidge J, Lind ML, Lio P, Martin SA, O'Brien M, Ong PY, Silverberg JI, Spergel JM, Wang J, Wheeler KE, Guyatt GH, Capozza K, Begolka WS, Chu AWL, Zhao IX, Chen L, Oykhman P, Bakaa L, Golden D, Shaker M, Bernstein JA, Greenhawt M, Horner CC, Lieberman J, Stukus D, Rank MA, Wang J, Ellis A, Abrams E, Ledford D, Chu DK. Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE- and Institute of Medicine-based recommendations. Ann Allergy Asthma Immunol 2024; 132:274-312. [PMID: 38108679 DOI: 10.1016/j.anai.2023.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Guidance addressing atopic dermatitis (AD) management, last issued in 2012 by the American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force, requires updating as a result of new treatments and improved guideline and evidence synthesis methodology. OBJECTIVE To produce evidence-based guidelines that support patients, clinicians, and other decision-makers in the optimal treatment of AD. METHODS A multidisciplinary guideline panel consisting of patients and caregivers, AD experts (dermatology and allergy/immunology), primary care practitioners (family medicine, pediatrics, internal medicine), and allied health professionals (psychology, pharmacy, nursing) convened, prioritized equity, diversity, and inclusiveness, and implemented management strategies to minimize influence of conflicts of interest. The Evidence in Allergy Group supported guideline development by performing systematic evidence reviews, facilitating guideline processes, and holding focus groups with patient and family partners. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach informed rating the certainty of evidence and strength of recommendations. Evidence-to-decision frameworks, subjected to public comment, translated evidence to recommendations using trustworthy guideline principles. RESULTS The panel agreed on 25 recommendations to gain and maintain control of AD for patients with mild, moderate, and severe AD. The eAppendix provides practical information and implementation considerations in 1-2 page patient-friendly handouts. CONCLUSION These evidence-based recommendations address optimal use of (1) topical treatments (barrier moisturization devices, corticosteroids, calcineurin inhibitors, PDE4 inhibitors [crisaborole], topical JAK inhibitors, occlusive [wet wrap] therapy, adjunctive antimicrobials, application frequency, maintenance therapy), (2) dilute bleach baths, (3) dietary avoidance/elimination, (4) allergen immunotherapy, and (5) systemic treatments (biologics/monoclonal antibodies, small molecule immunosuppressants [cyclosporine, methotrexate, azathioprine, mycophenolate, JAK inhibitors], and systemic corticosteroids) and UV phototherapy (light therapy).
Collapse
Affiliation(s)
- Derek K Chu
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada.
| | - Lynda Schneider
- Division of Immunology, Boston Children's Hospital, Boston, Massachusetts.
| | | | - Mark Boguniewicz
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Division of Pediatric Allergy and Clinical Immunology, National Jewish Health, Denver, Colorado
| | - Anna De Benedetto
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York
| | | | - Winfred T Frazier
- Department of Family Medicine, UPMC St. Margaret, Pittsburgh, Pennsylvania
| | - Matthew Greenhawt
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Section of Allergy and Immunology, Children's Hospital Colorado, Aurora, Colorado
| | - Joey Huynh
- Sepulveda VA Medical Center, North Hills, California
| | | | - Jennifer LeBovidge
- Division of Immunology, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Mary Laura Lind
- School for Engineering of Matter, Transport and Energy, Arizona State University, Tempe, Arizona
| | - Peter Lio
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stephen A Martin
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Monica O'Brien
- Tufts University School of Medicine, Boston, Massachusetts
| | - Peck Y Ong
- Division of Clinical Immunology and Allergy, Children's Hospital Los Angeles, Los Angeles, California; Department of Pediatrics, USC Keck School of Medicine, Los Angeles, California
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Jonathan M Spergel
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Julie Wang
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Kathryn E Wheeler
- Department of Pediatrics, University of Florida, Gainesville, Florida
| | - Gordon H Guyatt
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Korey Capozza
- Global Parents for Eczema Research, Santa Barbara, California
| | | | - Alexandro W L Chu
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Irene X Zhao
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Lina Chen
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Paul Oykhman
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Layla Bakaa
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - David Golden
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marcus Shaker
- Dartmouth Geisel School of Medicine and Dartmouth Hitchcock Medical Center, Section of Allergy, Lebanon, New Hampshire
| | | | - Matthew Greenhawt
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Section of Allergy and Immunology, Children's Hospital Colorado, Aurora, Colorado
| | - Caroline C Horner
- Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Jay Lieberman
- University of Tennessee Health Science Center and LeBonheur Children's Hospital, Memphis, Tennessee
| | - David Stukus
- Nationwide Children's Hospital and Ohio State University College of Medicine, Columbus, Ohio
| | - Matthew A Rank
- Mayo Clinic in Arizona and Phoenix Children's Hospital, Scottsdale and Phoenix, Arizona
| | - Julie Wang
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Anne Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Elissa Abrams
- Section of Allergy and Clinical Immunology, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dennis Ledford
- Morsani College of Medicine, University of South Florida and James A. Haley Veterans' Affairs Hospital, Tampa, Florida
| | - Derek K Chu
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| |
Collapse
|
3
|
Sitepu EK, Hudiyono S, Sinaga ZAP, Pramudhita R, Desmita D, Ginting YF, Sebayang F, Tarigan JB. Microwave-Assisted Enzymatic Esterification Production of Emollient Esters. ACS OMEGA 2023; 8:39168-39173. [PMID: 37901503 PMCID: PMC10601427 DOI: 10.1021/acsomega.3c04336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 09/27/2023] [Indexed: 10/31/2023]
Abstract
Currently, esterification production of isopropyl myristate (IPM) or isopropyl palmitate (IPP) uses a homogeneous or heterogeneous acid substance as a catalyst and is conducted at high temperatures and pressures. Utilization of this type of catalyst requires an additional postproduction process (neutralization and purification), which burdens the production cost. Microwave enzymatic esterification is a simple and fast method. The results showed that reaction time, ratio molar of fatty acids to isopropyl alcohol, catalyst weight, and microwave power have a significant effect on the IPM or IPP conversion. Further, the energy consumption of this process is less than other enzymatic esterification and is certainly more energy efficient, which could save 99 and 29% of processing time.
Collapse
Affiliation(s)
- Eko K. Sitepu
- Department
of Chemistry, Universitas Sumatera Utara, Medan 20155, Indonesia
| | - Sumi Hudiyono
- Department
of Chemistry, Universitas Indonesia, Depok 16424, Indonesia
| | | | - Rara Pramudhita
- Department
of Chemistry, Universitas Sumatera Utara, Medan 20155, Indonesia
| | - Desmita Desmita
- Department
of Chemistry, Universitas Sumatera Utara, Medan 20155, Indonesia
| | - Yose F. Ginting
- Department
of Chemistry, Universitas Sumatera Utara, Medan 20155, Indonesia
| | - Firman Sebayang
- Department
of Chemistry, Universitas Sumatera Utara, Medan 20155, Indonesia
| | | |
Collapse
|
4
|
Ridd MJ, Wells S, MacNeill SJ, Sanderson E, Webb D, Banks J, Sutton E, Shaw AR, Wilkins Z, Clayton J, Roberts A, Garfield K, Liddiard L, Barrett TJ, Lane JA, Baxter H, Howells L, Taylor J, Hay AD, Williams HC, Thomas KS, Santer M. Comparison of lotions, creams, gels and ointments for the treatment of childhood eczema: the BEE RCT. Health Technol Assess 2023; 27:1-120. [PMID: 37924282 PMCID: PMC10679965 DOI: 10.3310/gzqw6681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023] Open
Abstract
Background Emollients are recommended for children with eczema (atopic eczema/dermatitis). A lack of head-to-head comparisons of the effectiveness and acceptability of the different types of emollients has resulted in a 'trial and error' approach to prescribing. Objective To compare the effectiveness and acceptability of four commonly used types of emollients for the treatment of childhood eczema. Design Four group, parallel, individually randomised, superiority randomised clinical trials with a nested qualitative study, completed in 2021. A purposeful sample of parents/children was interviewed at ≈ 4 and ≈ 16 weeks. Setting Primary care (78 general practitioner surgeries) in England. Participants Children aged between 6 months and 12 years with eczema, of at least mild severity, and with no known sensitivity to the study emollients or their constituents. Interventions Study emollients sharing the same characteristics in the four types of lotion, cream, gel or ointment, alongside usual care, and allocated using a web-based randomisation system. Participants were unmasked and the researcher assessing the Eczema Area Severity Index scores was masked. Main outcome measures The primary outcome was Patient-Oriented Eczema Measure scores over 16 weeks. The secondary outcomes were Patient-Oriented Eczema Measure scores over 52 weeks, Eczema Area Severity Index score at 16 weeks, quality of life (Atopic Dermatitis Quality of Life, Child Health Utility-9 Dimensions and EuroQol-5 Dimensions, five-level version, scores), Dermatitis Family Impact and satisfaction levels at 16 weeks. Results A total of 550 children were randomised to receive lotion (analysed for primary outcome 131/allocated 137), cream (137/140), gel (130/135) or ointment (126/138). At baseline, 86.0% of participants were white and 46.4% were female. The median (interquartile range) age was 4 (2-8) years and the median Patient-Oriented Eczema Measure score was 9.3 (SD 5.5). There was no evidence of a difference in mean Patient-Oriented Eczema Measure scores over the first 16 weeks between emollient types (global p = 0.765): adjusted Patient-Oriented Eczema Measure pairwise differences - cream-lotion 0.42 (95% confidence interval -0.48 to 1.32), gel-lotion 0.17 (95% confidence interval -0.75 to 1.09), ointment-lotion -0.01 (95% confidence interval -0.93 to 0.91), gel-cream -0.25 (95% confidence interval -1.15 to 0.65), ointment-cream -0.43 (95% confidence interval -1.34 to 0.48) and ointment-gel -0.18 (95% confidence interval -1.11 to 0.75). There was no effect modification by parent expectation, age, disease severity or the application of UK diagnostic criteria, and no differences between groups in any of the secondary outcomes. Median weekly use of allocated emollient, non-allocated emollient and topical corticosteroids was similar across groups. Overall satisfaction was highest for lotions and gels. There was no difference in the number of adverse reactions and there were no significant adverse events. In the nested qualitative study (n = 44 parents, n = 25 children), opinions about the acceptability of creams and ointments varied most, yet problems with all types were reported. Effectiveness may be favoured over acceptability. Parents preferred pumps and bottles over tubs and reported improved knowledge about, and use of, emollients as a result of taking part in the trial. Limitations Parents and clinicians were unmasked to allocation. The findings may not apply to non-study emollients of the same type or to children from more ethnically diverse backgrounds. Conclusions The four emollient types were equally effective. Satisfaction with the same emollient types varies, with different parents/children favouring different ones. Users need to be able to choose from a range of emollient types to find one that suits them. Future work Future work could focus on how best to support shared decision-making of different emollient types and evaluations of other paraffin-based, non-paraffin and 'novel' emollients. Trial registration This trial is registered as ISRCTN84540529 and EudraCT 2017-000688-34. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (HTA 15/130/07) and will be published in full in Health Technology Assessment; Vol. 27, No. 19. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Matthew J Ridd
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sian Wells
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | - Douglas Webb
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jonathan Banks
- National Institute for Health and Care Research Collaborations for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Eileen Sutton
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alison Rg Shaw
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Zoe Wilkins
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Julie Clayton
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Amanda Roberts
- Nottingham Support Group for Carers of Children with Eczema, Nottingham, UK
| | | | - Lyn Liddiard
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tiffany J Barrett
- South West Medicines Information and Training, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - J Athene Lane
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Helen Baxter
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Laura Howells
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Jodi Taylor
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hywel C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Miriam Santer
- Primary Care Research Centre, University of Southampton, Southampton, UK
| |
Collapse
|
5
|
Burlando M, Castelli R, Salvi I, Cozzani E, Parodi A. A novel moisture for xerosis in psoriatic patients: a single center study. Ital J Dermatol Venerol 2023; 158:39-41. [PMID: 36800804 DOI: 10.23736/s2784-8671.23.07364-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND Xerosis is an extremely common condition, especially in the elderly population. It is the most common cause of pruritus in the older adult. Since xerosis is generally caused by a lack of epidermal lipids, the use of leave-on skin care products is the mainstay treatment. The aim of this open prospective analytical observational study was to investigate the clinical and self-reported hydrating efficacy of a moisturizer formulation containing a synergy between amino-inositol and urea (INOSIT-U 20) in patients with psoriasis and xerosis. METHODS Twenty-two patients with psoriasis successfully treated with biologic therapy, and who presented xerosis, were recruited. Each patient was instructed to apply the topical with a frequency of two applications per die on the identified skin area. Corneometry values and a VAS itch questionnaire were measured at baseline (T0) and after 28 days (T4). To evaluate the cosmetic efficacy, the volunteers also completed a self-assessment questionnaire. RESULTS Comparing Corneometry values at T0 and T4, a statistically significant increase value was observed in the area subjected to topical treatment (P<0.0001). A significant decrease in itch (P=0.001) was also observed. Moreover, the patients' ratings of the cosmetic properties of the moisturizer showed significant confirmation rates. CONCLUSIONS This study provides preliminary evidence that INOSIT-U20 provides a good hydrating effect on xerosis, further reducing self-reported itch.
Collapse
Affiliation(s)
- Martina Burlando
- Section of Dermatology, Department of Health Sciences (DISSAL), IRCCS San Martino University Hospital, University of Genoa, Genoa, Italy -
| | - Riccardo Castelli
- Section of Dermatology, Department of Health Sciences (DISSAL), IRCCS San Martino University Hospital, University of Genoa, Genoa, Italy
| | - Ilaria Salvi
- Section of Dermatology, Department of Health Sciences (DISSAL), IRCCS San Martino University Hospital, University of Genoa, Genoa, Italy
| | - Emanuele Cozzani
- Section of Dermatology, Department of Health Sciences (DISSAL), IRCCS San Martino University Hospital, University of Genoa, Genoa, Italy
| | - Aurora Parodi
- Section of Dermatology, Department of Health Sciences (DISSAL), IRCCS San Martino University Hospital, University of Genoa, Genoa, Italy
| |
Collapse
|
6
|
Constantinou S, Evans J, Goodwin RG. Fifteen-minute consultation: How to manage eczema in children. Arch Dis Child Educ Pract Ed 2022; 107:162-168. [PMID: 33658292 DOI: 10.1136/archdischild-2020-320560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 11/03/2022]
Abstract
Atopic eczema is common and has a major impact on quality of life. Paediatricians and general practitioners play a key role in the non-specialist treatment of atopic eczema. However, the clinical nature of the diagnosis, multitude of topical therapies and sometimes complicated treatment strategies can leave both clinicians and families feeling bewildered. This article aims to provide a concise, patient-focused summary of the assessment and management of childhood atopic eczema.
Collapse
Affiliation(s)
| | - Jordan Evans
- Paediatric Emergency Department, University Hospital of Wales, Cardiff, UK.,Emergency Department, The Children's Hospital at Westmead, The Sydney Children's Hospitals Network, Westmead, New South Wales, Australia
| | | |
Collapse
|
7
|
Rowley GG, MacNeill SJ, Ridd MJ. Emollient satisfaction questionnaire: validation study in children with eczema. Clin Exp Dermatol 2022; 47:1337-1345. [PMID: 35315540 PMCID: PMC9321994 DOI: 10.1111/ced.15189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/27/2022] [Accepted: 03/18/2022] [Indexed: 11/30/2022]
Abstract
Background Emollients are used as maintenance therapy for all severities of eczema but there is a lack of head‐to‐head comparisons of effectiveness and acceptability. Aim To determine the validity of a self‐report questionnaire designed to assess user satisfaction with a given emollient and to report the findings. Methods Data were analysed from the Choice of Moisturiser for Eczema Treatment trial, which compared four emollient types (Aveeno® lotion, Diprobase® cream, Doublebase® gel and Hydromol® ointment) in children aged < 5 years with clinically diagnosed eczema. An emollient satisfaction questionnaire was completed after 12 weeks. Responses for individual items were scored from 0 to 4. Total scores ranged from 0 to 28 (low to high satisfaction). Completion rates and distributions of responses for individual items and total scores, categorized by emollient type, were assessed, and two hypotheses were tested to determine the questionnaire's construct validity. Results Data from 77.2% (152 of 197) of participants were analysed. One item was rejected because of a high rate (44.7%) of ‘don't know’ responses, leaving seven items with high completion rates (98.7%) and weak evidence of floor or ceiling effects. A positive association was observed between total score and overall emollient satisfaction (Spearman correlation 0.78; P < 0.001). Total scores were highest (mean ± SD 23.5 ± 3.9) in the lotion group and lowest (18.4 ± 4.6) in the ointment group. Conclusion The emollient satisfaction questionnaire appears to have good validity. Further work is required to validate the questionnaire in other settings and to assess its reliability.
Collapse
Affiliation(s)
| | | | - Matthew J Ridd
- Population Health Sciences, Bristol Medical School, Bristol, UK
| |
Collapse
|
8
|
Gallinger J, Kuhn A, Wessel S, Behm P, Heinecke S, Filbry A, Hillemann L, Rippke F. Depth-dependent hydration dynamics in human skin: Vehicle-controlled efficacy assessment of a functional 10% urea plus NMF moisturizer by near-infrared confocal spectroscopic imaging (KOSIM IR) and capacitance method complemented by volunteer perception. Skin Res Technol 2022; 28:342-349. [PMID: 35034387 PMCID: PMC9907705 DOI: 10.1111/srt.13137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 12/18/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Stratum corneum (SC) hydration is vital for the optimal maintenance and appearance of healthy skin. In this context, we evaluated the efficacy of an NMF-enriched moisturizer containing 10% urea on different aspects of SC hydration of dry skin. MATERIAL AND METHODS In two clinical studies, the hydration efficacy of the moisturizer in comparison to its vehicle was investigated. In the first study, 42 subjects applied the moisturizer and the vehicle to one lower leg each. Thirty minutes and 24 h after this single treatment, SC hydration was measured by corneometry. Volunteers also rated skin moisturization and evaluated product properties. In the second study, 27 subjects each treated one forearm twice daily for 2 weeks with the moisturizer and the vehicle. Then, depth-resolved water-absorption spectra were measured by near-infrared confocal spectroscopic imaging (KOSIM IR). RESULTS The moisturizer exerted a superior hydrating effect compared to the vehicle. KOSIM IR measurements show that, compared to the vehicle, the moisturizer significantly improved the water gradient in the SC from the surface to a depth of 15 μm. Moreover, the moisturizer received high acceptance ratings from the volunteers and was preferred to the vehicle. CONCLUSION The humectants applied in the investigated moisturizer improved SC water content in total and as a function of depth. The combination of depth-resolved data (KOSIM IR) with classical corneometry provides an integrated concept in the measurement of skin hydration, rendering both methods complementary. These findings were in line with the volunteers` self-assessments of the moisturizer properties that are relevant to treatment adherence.
Collapse
Affiliation(s)
| | - Andreas Kuhn
- Research and Development, Beiersdorf AG, Hamburg, Germany
| | - Sonja Wessel
- Research and Development, Beiersdorf AG, Hamburg, Germany
| | - Peter Behm
- Research and Development, Beiersdorf AG, Hamburg, Germany
| | - Silke Heinecke
- Research and Development, Beiersdorf AG, Hamburg, Germany
| | | | | | - Frank Rippke
- Research and Development, Beiersdorf AG, Hamburg, Germany
| |
Collapse
|
9
|
Marrouche N, Lancaster N, Grindlay DJC, Rogers NK, Olabi B. What's new in atopic eczema? An analysis of systematic reviews published in 2019. Part 2: treatment. Clin Exp Dermatol 2021; 46:1211-1215. [PMID: 34080205 DOI: 10.1111/ced.14775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 05/31/2021] [Indexed: 11/29/2022]
Abstract
This review forms part of a series of annual evidence updates on atopic eczema (AE), and provides a summary of key findings from systematic reviews (SRs) published or indexed in 2019 related to AE treatment. Several SRs assessed the efficacy of topical corticosteroids (TCS), topical calcineurin inhibitors, topical phosphodiesterase-4 inhibitors and topical Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathway inhibitors. However, there is a lack of good-quality trials comparing topical treatment agents with TCS, which remain the standard of care for patients with AE. Most of the included trials lack meaningful comparisons as they used vehicle as a comparator. There is also lack of harmonization of outcome measures for AE across studies. Large, well-designed RCTs are needed to further determine whether any specific emollients offer superior benefit. There is evidence highlighting limited benefit of oral H1 antihistamines as 'add-on' therapy to topical treatment of eczema. Mycophenolate mofetil may have a role in patients with refractory AE. Among biologic therapies, most of the efficacy data relate to dupilumab. Furthermore, there is growing evidence for the efficacy and safety of systemic JAK/STAT pathway inhibitors, but the existing data are of low quality.
Collapse
Affiliation(s)
- N Marrouche
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK
| | - N Lancaster
- Research and Development, Barnsley Hospital NHS Foundation Trust, Barnsley, UK
| | - D J C Grindlay
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - N K Rogers
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - B Olabi
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
10
|
Chong JH. Atopic dermatitis in children: when topical steroid treatment "does not work". BMJ 2021; 372:n297. [PMID: 33602868 DOI: 10.1136/bmj.n297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Jin Ho Chong
- Raffles Children's Centre, Raffles Hospital, Singapore
| |
Collapse
|
11
|
Hebert AA, Rippke F, Weber TM, Nicol NH. Efficacy of Nonprescription Moisturizers for Atopic Dermatitis: An Updated Review of Clinical Evidence. Am J Clin Dermatol 2020; 21:641-655. [PMID: 32524381 PMCID: PMC7473959 DOI: 10.1007/s40257-020-00529-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Twice-daily moisturization is recommended by international guidelines as the bedrock of the management of atopic dermatitis (AD). Moisturizers should be selected based on proven clinical effectiveness in improving the skin barrier and improving the symptoms of AD. We searched the PubMed database for clinical trials assessing daily moisturization for the treatment of AD published between 2006 and 2019. Studies had to assess the efficacy of commercially available moisturizers using objective measures of corneometry, transepidermal water loss, or incidence of flare as endpoints, and treatments had to be currently available to patients. Clinical studies showed that moisturization (typically twice daily) significantly improved the skin barrier in adults and children with AD. Longer-term flare studies showed that daily moisturization reduced the incidence of flares and extended the time between flares. Proactive moisturization of infants at high risk of developing AD may reduce its manifestation. Therapeutic moisturizers for AD are specifically formulated with ingredients that target symptoms of AD, such as itch, inflammation, or compromised skin barrier. The US FDA requires that any moisturizer available in the USA and claiming to treat AD must contain colloidal oatmeal. Healthcare providers can maximize compliance and outcomes by educating patients on the benefits of liberally applying a therapeutic moisturizer twice daily to support the skin barrier and help reduce the incidence of flares. Specific recommendations should be for clinically tested moisturizers evaluated using objective, validated skin assessments.
Collapse
Affiliation(s)
- Adelaide A Hebert
- Department of Dermatology, University of Texas McGovern Medical School, 6655 Travis, Suite 980, Houston, TX, 77030, USA.
| | - Frank Rippke
- Research and Development, Beiersdorf, Hamburg, Germany
| | - Teresa M Weber
- Research and Development, Beiersdorf Inc., Wilton, CT, USA
| | - Noreen Heer Nicol
- College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
12
|
Chalmers JR, Haines RH, Bradshaw LE, Montgomery AA, Thomas KS, Brown SJ, Ridd MJ, Lawton S, Simpson EL, Cork MJ, Sach TH, Flohr C, Mitchell EJ, Swinden R, Tarr S, Davies-Jones S, Jay N, Kelleher MM, Perkin MR, Boyle RJ, Williams HC. Daily emollient during infancy for prevention of eczema: the BEEP randomised controlled trial. Lancet 2020; 395:962-972. [PMID: 32087126 PMCID: PMC7086156 DOI: 10.1016/s0140-6736(19)32984-8] [Citation(s) in RCA: 157] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/14/2019] [Accepted: 11/21/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Skin barrier dysfunction precedes eczema development. We tested whether daily use of emollient in the first year could prevent eczema in high-risk children. METHODS We did a multicentre, pragmatic, parallel-group, randomised controlled trial in 12 hospitals and four primary care sites across the UK. Families were approached via antenatal or postnatal services for recruitment of term infants (at least 37 weeks' gestation) at high risk of developing eczema (ie, at least one first-degree relative with parent-reported eczema, allergic rhinitis, or asthma, diagnosed by a doctor). Term newborns with a family history of atopic disease were randomly assigned (1:1) to application of emollient daily (either Diprobase cream or DoubleBase gel) for the first year plus standard skin-care advice (emollient group) or standard skin-care advice only (control group). The randomisation schedule was created using computer-generated code (stratified by recruiting centre and number of first-degree relatives with atopic disease) and participants were assigned to groups using an internet-based randomisation system. The primary outcome was eczema at age 2 years (defined by UK working party criteria) with analysis as randomised regardless of adherence to allocation for participants with outcome data collected, and adjusting for stratification variables. This trial is registered with ISRCTN, ISRCTN21528841. Data collection for long-term follow-up is ongoing, but the trial is closed to recruitment. FINDINGS 1394 newborns were randomly assigned to study groups between Nov 19, 2014, and Nov 18, 2016; 693 were assigned to the emollient group and 701 to the control group. Adherence in the emollient group was 88% (466 of 532) at 3 months, 82% (427 of 519) at 6 months, and 74% (375 of 506) at 12 months in those with complete questionnaire data. At age 2 years, eczema was present in 139 (23%) of 598 infants with outcome data collected in the emollient group and 150 (25%) of 612 infants in the control group (adjusted relative risk 0·95 [95% CI 0·78 to 1·16], p=0·61; adjusted risk difference -1·2% [-5·9 to 3·6]). Other eczema definitions supported the results of the primary analysis. Mean number of skin infections per child in year 1 was 0·23 (SD 0·68) in the emollient group versus 0·15 (0·46) in the control group; adjusted incidence rate ratio 1·55 (95% CI 1·15 to 2·09). INTERPRETATION We found no evidence that daily emollient during the first year of life prevents eczema in high-risk children and some evidence to suggest an increased risk of skin infections. Our study shows that families with eczema, asthma, or allergic rhinitis should not use daily emollients to try and prevent eczema in their newborn. FUNDING National Institute for Health Research Health Technology Assessment.
Collapse
Affiliation(s)
- Joanne R Chalmers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Rachel H Haines
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Lucy E Bradshaw
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Alan A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Sara J Brown
- Skin Research Group, School of Medicine, University of Dundee, Dundee, UK; Department of Dermatology, Ninewells Hospital and Medical School, Dundee, UK
| | - Matthew J Ridd
- Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Eric L Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | - Michael J Cork
- Sheffield Dermatology Research, Department of Infection and Immunity, University of Sheffield, Sheffield, UK
| | - Tracey H Sach
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Carsten Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Eleanor J Mitchell
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Richard Swinden
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Stella Tarr
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Susan Davies-Jones
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Nicola Jay
- Sheffield Children's Hospital, Sheffield, UK
| | - Maeve M Kelleher
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Robert J Boyle
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Hywel C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK.
| |
Collapse
|