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Severino-Freire M, Granier Tournier C, Chiaverini C, Audouze A, Morice-Picard F, Texier H, Dreyfus I, Bing-Lecointe AC, Mallet S, Bodemer C, Fischer J, Jonca N, Mazereeuw-Hautier J. French national protocol for the management of congenital ichthyosis. Ann Dermatol Venereol 2024; 151:103247. [PMID: 38513308 DOI: 10.1016/j.annder.2024.103247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 09/27/2023] [Indexed: 03/23/2024]
Abstract
Congenital ichthyoses (CI) comprise a heterogeneous group of monogenic genetic skin diseases characterized by diffuse scaling, often associated with skin inflammation. Diagnosis of the individual form of ichthyosis is complex and is guided by clinical expertise. CI usually has a major impact on quality of life (QOL) and thus requires lifelong treatment. To date, there are no curative therapies, although various symptomatic treatment options exist. The present protocol for the management of CI has been drawn up in accordance with the recommendations published in 2012 by the French National Authority for Health, based on a literature review, with the help and validation of members of the French network for rare skin diseases (FIMARAD). It provides a summary of evidence and expert-based recommendations and is intended to help clinicians with the management of these rare and often complex diseases.
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Affiliation(s)
- M Severino-Freire
- University Hospital Center of Toulouse, Reference Centre for Rare Skin Diseases, Department of Dermatology, Larrey Hospital, 24, Chemin de Pouvourville, TSA 30030 Toulouse Cedex 9, France
| | - C Granier Tournier
- University Hospital Center of Toulouse, Reference Centre for Rare Skin Diseases, Department of Dermatology, Larrey Hospital, 24, Chemin de Pouvourville, TSA 30030 Toulouse Cedex 9, France
| | - C Chiaverini
- University Hospital Center of Nice, Department of Dermatology, Archet 2 Hospital, CS 23079, 06202 Nice Cedex 3, France
| | - A Audouze
- Association Ichtyose France, 37 rue du Golf, 03700 Bellerive sur Allier, France
| | - F Morice-Picard
- Department of Dermatology, University Hospital Center of Bordeaux - Hôpital Saint André, 1 Rue Jean Burguet, 33075 Bordeaux Cedex, France
| | - H Texier
- University Hospital Center of Toulouse, Reference Centre for Rare Skin Diseases, Department of Dermatology, Larrey Hospital, 24, Chemin de Pouvourville, TSA 30030 Toulouse Cedex 9, France
| | - I Dreyfus
- University Hospital Center of Toulouse, Reference Centre for Rare Skin Diseases, Department of Dermatology, Larrey Hospital, 24, Chemin de Pouvourville, TSA 30030 Toulouse Cedex 9, France
| | - A-C Bing-Lecointe
- Hospital Annecy-Genevois site Annecy, 1 Avenue De L'hôpital, 74370 Annecy, France
| | - S Mallet
- Department of Dermatology, University Hospital Center of Marseille, 264 rue Saint-Pierre, 13005 Marseille, France
| | - C Bodemer
- Department of Dermatology, Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), Hôpital Necker-Enfants Malades, AP-HP, 149 Rue de Sèvres, 75743 Paris cedex 15, France
| | - J Fischer
- Institute of Human Genetics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 153, 79110 Freiburg, Germany
| | - N Jonca
- University Hospital Center of Toulouse, Hôpital Purpan, Cell Biology and Cytology Laboratory, Institut Fédératif de Biologie, Toulouse F-31300, France
| | - J Mazereeuw-Hautier
- University Hospital Center of Toulouse, Reference Centre for Rare Skin Diseases, Department of Dermatology, Larrey Hospital, 24, Chemin de Pouvourville, TSA 30030 Toulouse Cedex 9, France.
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2
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Dorf ILH, Lunen MS, Koppelhus U. Effect of topical treatment with 7.5% urea in Ichthyosis Vulgaris: A randomized, controlled, double blinded, split body study evaluating the effect of urea cream compared to the vehicle (moisturizing) cream. SKIN HEALTH AND DISEASE 2021; 1:e65. [PMID: 35663767 PMCID: PMC9060062 DOI: 10.1002/ski2.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/07/2021] [Accepted: 08/12/2021] [Indexed: 11/19/2022]
Abstract
Background Ichthyosis Vulgaris (IV) is a common genetic skin disease, characterized by dry, scaling skin and itch. Urea cream has been a central part of IV treatment for decades, but only few studies have evaluated the effect of urea compared to basic moisturizers. Objective To evaluate the treatment effect of 7.5% urea cream compared to a basic moisturizer in patients with IV. Methods Participants (n = 14) were randomized to apply the 7.5% urea cream on one body half and a basic moisturizer on the other during a study period of 4 weeks. Measuring points on participants arms and legs were evaluated at baseline and at endpoint with a patient questionnaire visual assessment scale (VAS), a clinical scoring, and electronic skin hydration analysis to assess the treatment effects. Results On the arms, no significant differences between the two treatments were found. On the legs, however, the urea treated areas had a significantly higher decrease in SRRC score (0.7 points [95% CI: 1.1–0.3, p < 0.005]) and increase in hydration (32.1 μS [95% CI: 10.9‐53.2, p < 0.006]). Conclusion Skin hydration improved significantly with both urea and moisturising treatment. On the legs, with most keratinization, urea was superior. Trial registry: https://clinicaltrials.gov/ct2/show/NCT02978209?cond=Ichthyosis+Vulgaris&draw=1&rank=2.
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Affiliation(s)
- I. L. H. Dorf
- Department of Dermatology Aarhus University Hospital Aarhus Denmark
| | - M. S. Lunen
- Department of Intern medicin Regionshospitalet Silkeborg Silkeborg Denmark
| | - U. Koppelhus
- Department of Dermatology Aarhus Universitetshospital Skejby Aarhus Denmark
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3
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Baldo F, Brena M, Carbogno S, Minoia F, Lanni S, Guez S, Petaccia A, Agostoni C, Cimaz R, Filocamo G. Juvenile idiopathic arthritis in Harlequin ichthyosis, a rare combination or the clinical spectrum of the disease? Report of a child treated with etanercept and review of the literature. Pediatr Rheumatol Online J 2021; 19:80. [PMID: 34082764 PMCID: PMC8173856 DOI: 10.1186/s12969-021-00571-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 05/20/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Harlequin ichthyosis (HI) is the most severe phenotype of autosomal recessive congenital ichthyosis. Juvenile Idiopathic Arthritis (JIA) represents a heterogenous group of disorders all sharing the clinical manifestation of chronic arthritis. Association of HI and chronic arthritis has been reported in few cases. CASE PRESENTATION We report the case of a child with HI who developed a severe form of chronic polyarthritis during the first years of life, treated with repeated multiple joint injections, methotrexate and etanercept with good response and without any adverse events. CONCLUSION The reported case and the literature review highlighted the presence of a peculiar severe seronegative polyarthritis with early onset in a series of patients with HI, suggesting that polyarthritis may be a specific manifestation of HI, rather than a rare combination of two separate conditions.
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Affiliation(s)
- Francesco Baldo
- grid.414818.00000 0004 1757 8749Pediatric Rheumatology, Pediatric Medium Intensity Care Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Via della Commenda, 9, 20122 Milan, Italy ,grid.4708.b0000 0004 1757 2822University of Milan, Milan, Italy
| | - Michela Brena
- grid.414818.00000 0004 1757 8749Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Simone Carbogno
- grid.414818.00000 0004 1757 8749Pediatric Rheumatology, Pediatric Medium Intensity Care Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Via della Commenda, 9, 20122 Milan, Italy ,grid.4708.b0000 0004 1757 2822University of Milan, Milan, Italy
| | - Francesca Minoia
- grid.414818.00000 0004 1757 8749Pediatric Rheumatology, Pediatric Medium Intensity Care Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Via della Commenda, 9, 20122 Milan, Italy
| | - Stefani Lanni
- grid.414818.00000 0004 1757 8749Pediatric Rheumatology, Pediatric Medium Intensity Care Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Via della Commenda, 9, 20122 Milan, Italy
| | - Sophie Guez
- grid.414818.00000 0004 1757 8749Pediatric Rheumatology, Pediatric Medium Intensity Care Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Via della Commenda, 9, 20122 Milan, Italy
| | - Antonella Petaccia
- grid.414818.00000 0004 1757 8749Pediatric Rheumatology, Pediatric Medium Intensity Care Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Via della Commenda, 9, 20122 Milan, Italy
| | - Carlo Agostoni
- grid.414818.00000 0004 1757 8749Pediatric Rheumatology, Pediatric Medium Intensity Care Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Via della Commenda, 9, 20122 Milan, Italy ,grid.4708.b0000 0004 1757 2822University of Milan, Milan, Italy
| | - Rolando Cimaz
- ASST G.Pini-CTO, Milan, Italy ,grid.4708.b0000 0004 1757 2822Department of Clinical Sciences and Community Health, and RECAP-RD, University of Milan, Milan, Italy
| | - Giovanni Filocamo
- Pediatric Rheumatology, Pediatric Medium Intensity Care Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Via della Commenda, 9, 20122, Milan, Italy.
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4
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Annunziata MC, Cacciapuoti S, Cosentino C, Fabbrocini G. Urea-containing topical formulations. Int J Clin Pract 2020; 74 Suppl 187:e13660. [PMID: 33249709 DOI: 10.1111/ijcp.13660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 08/06/2020] [Indexed: 12/01/2022] Open
Abstract
Urea is a well-known moisturiser and keratolytic topical agent. As it is widely used in dermatology, several formulations at different concentrations have been marketed: lotions, creams, foams, ointments, gels and lacquers. Availability of different vehicles and concentration may vary in different countries, but in general products at low, medium and high urea concentration are accessible worldwide. The proper formulation should be chosen according to the disorder to treat, its severity, body areas involved and patients' preference.
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Affiliation(s)
- Maria Carmela Annunziata
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Sara Cacciapuoti
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | | | - Gabriella Fabbrocini
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
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5
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Lacarrubba F, Nasca MR, Puglisi DF, Micali G. Clinical evidences of urea at low concentration. Int J Clin Pract 2020; 74 Suppl 187:e13626. [PMID: 33249706 DOI: 10.1111/ijcp.13626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 07/15/2020] [Indexed: 11/28/2022] Open
Abstract
Urea is a hygroscopic molecule that, because of its moisturising properties, is topically used for the treatment of skin dryness at concentrations ranging from 2% to 12% in different formulations. Based on existing literature, low-concentration urea-containing products are effective in the treatment and/or prevention of xerosis in some skin disorders such as ichthyosis, atopic dermatitis and psoriasis, or unrelated to specific skin diseases. Generally, urea formulations at low concentration are well-tolerated and suited for the treatment of large skin areas, once or twice daily, even for a long period of time. At low concentrations stinging and burning sensation is rare and transient, whit no reported sensitisation despite its widespread use.
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6
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Non-invasive methods for evaluation of skin manifestations in patients with ichthyosis. Arch Dermatol Res 2019; 312:231-236. [DOI: 10.1007/s00403-019-01987-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 07/24/2019] [Accepted: 09/25/2019] [Indexed: 12/15/2022]
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Cortés H, Del Prado-Audelo ML, Urbán-Morlán Z, Alcalá-Alcalá S, González-Torres M, Reyes-Hernández OD, González-Del Carmen M, Leyva-Gómez G. Pharmacological treatments for cutaneous manifestations of inherited ichthyoses. Arch Dermatol Res 2019; 312:237-248. [DOI: 10.1007/s00403-019-01994-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/26/2019] [Accepted: 10/03/2019] [Indexed: 12/11/2022]
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8
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Mazereeuw-Hautier J, Vahlquist A, Traupe H, Bygum A, Amaro C, Aldwin M, Audouze A, Bodemer C, Bourrat E, Diociaiuti A, Dolenc-Voljc M, Dreyfus I, El Hachem M, Fischer J, Gånemo A, Gouveia C, Gruber R, Hadj-Rabia S, Hohl D, Jonca N, Ezzedine K, Maier D, Malhotra R, Rodriguez M, Ott H, Paige DG, Pietrzak A, Poot F, Schmuth M, Sitek JC, Steijlen P, Wehr G, Moreen M, O'Toole EA, Oji V, Hernandez-Martin A. Management of congenital ichthyoses: European guidelines of care, part one. Br J Dermatol 2018; 180:272-281. [PMID: 30216406 DOI: 10.1111/bjd.17203] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2018] [Indexed: 12/21/2022]
Abstract
These guidelines for the management of congenital ichthyoses have been developed by a multidisciplinary group of European experts following a systematic review of the current literature, an expert conference held in Toulouse in 2016 and a consensus on the discussions. They summarize evidence and expert-based recommendations and are intended to help clinicians with the management of these rare and often complex diseases. These guidelines comprise two sections. This is part one, covering topical therapies, systemic therapies, psychosocial management, communicating the diagnosis and genetic counselling.
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Affiliation(s)
- J Mazereeuw-Hautier
- Reference Centre for Rare Skin Diseases, Dermatology Department, Larrey Hospital, Toulouse, France
| | - A Vahlquist
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - H Traupe
- Department of Dermatology, University Hospital of Münster, Von-Esmarch-Straße 58,, D-48149, Münster, Germany
| | - A Bygum
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - C Amaro
- Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - M Aldwin
- Ichthyosis Support Group, PO Box 1242, Yateley, GU47 7FL, U.K
| | - A Audouze
- Association Ichtyose France, Bellerive sur Allier, France
| | - C Bodemer
- Department of Dermatology, Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), Paris, France.,Institut Imagine, Université Descartes, Sorbonne Paris Cité, Hôpital Necker-Enfants Malades, Paris
| | - E Bourrat
- Department of Dermatology, Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), Paris, France
| | - A Diociaiuti
- Dermatology Division, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
| | - M Dolenc-Voljc
- Department of Dermatovenereology, University Medical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - I Dreyfus
- Reference Centre for Rare Skin Diseases, Dermatology Department, Larrey Hospital, Toulouse, France
| | - M El Hachem
- Dermatology Division, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
| | - J Fischer
- Institute of Human Genetics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - A Gånemo
- Department of Dermatology, Institute of Clinical Research in Malmö, Skåne University Hospital, Lund University, Malmö, Sweden
| | - C Gouveia
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - R Gruber
- Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - S Hadj-Rabia
- Department of Dermatology, Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), Paris, France.,Institut Imagine, Université Descartes, Sorbonne Paris Cité, Hôpital Necker-Enfants Malades, Paris
| | - D Hohl
- Department of Dermatology, Hôpital de Beaumont, Lausanne, Switzerland
| | - N Jonca
- Epithelial Differentiation and Rheumatoid Autoimmunity Unit (UDEAR), UMR 1056 Inserm - Toulouse 3 University, Purpan Hospital, Toulouse, France
| | - K Ezzedine
- Department of Dermatology, Hôpital Henri Mondor, EA EpiDerm, UPEC-Université Paris-Est Créteil, 94010, Créteil, France
| | - D Maier
- Dermatology Department, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - R Malhotra
- Corneoplastic Unit, Queen Victoria Hospital NHS Trust, East Grinstead, U.K
| | - M Rodriguez
- Department of Ear, Nose and Throat, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - H Ott
- Division of Pediatric Dermatology and Allergology, Auf Der Bult Children's Hospital, Hanover, Germany
| | - D G Paige
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, E1 1BB, U.K
| | - A Pietrzak
- Department of Dermatology, Venereology and Paediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | - F Poot
- ULB-Erasme Hospital, Department of Dermatology, Brussels, Belgium
| | - M Schmuth
- Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - J C Sitek
- Department of Dermatology and Centre for Rare Disorders, Oslo University Hospital, Oslo, Norway
| | - P Steijlen
- Department of Dermatology, Maastricht University Medical Centre, GROW Research School for Oncology and Developmental Biology, Maastricht, the Netherlands
| | - G Wehr
- Selbsthilfe Ichthyose, Kürten, Germany
| | - M Moreen
- Department of Dermatology, University Hospitals Leuven, Leuven, Belgium.,Department of Microbiology and Immunology, KU Leuven, Belgium
| | - E A O'Toole
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, U.K
| | - V Oji
- Department of Dermatology, University Hospital of Münster, Von-Esmarch-Straße 58,, D-48149, Münster, Germany.,Hautarztpraxis am Buddenturm, Rudolf-von-Langen-Straße 55, D-48147, Münster, Germany
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9
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Oji V, Preil ML, Kleinow B, Wehr G, Fischer J, Hennies HC, Hausser I, Breitkreutz D, Aufenvenne K, Stieler K, Tantcheva-Poór I, Weidinger S, Emmert S, Hamm H, Perusquia-Ortiz AM, Zaraeva I, Diem A, Giehl K, Fölster-Holst R, Kiekbusch K, Höger P, Ott H, Traupe H. S1-Leitlinie zur Diagnostik und Therapie der Ichthyosen - Aktualisierung. J Dtsch Dermatol Ges 2017; 15:1053-1065. [DOI: 10.1111/ddg.13340_g] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Vinzenz Oji
- Klinik für Hautkrankheiten - Allgemeine Dermatologie und Venerologie; Universitätsklinikum Münster; Von-Esmarch-Str. 58 D-48149 Münster
| | | | | | | | - Judith Fischer
- Institut für Humangenetik; Universitätsklinikum Freiburg; Breisacher Str. 33 D-79106 Freiburg i. Br
| | | | - Ingrid Hausser
- Pathologie IPH; EM-Labor; Universitätsklinikum Heidelberg; INF 224 D-69120 Heidelberg
| | - Dirk Breitkreutz
- DGZ/DKFZ Heidelberg & HS-Mannheim; Im Fuchsloch 18 D-69221 Dossenheim/bei Heidelberg
| | - Karin Aufenvenne
- IUF - Leibniz-Institut für umweltmedizinische Forschung gGmbH; Auf'm Hennekamp 50 D-40225 Düsseldorf
| | - Karola Stieler
- Charité Universitätsmedizin Berlin; Campus Mitte; Kinderdermatologische Ambulanz am Campus Mitte; Klinik für Dermatologie; Venerologie und Allergologie; Schumannstr. 20-21 D-10117 Berlin
| | | | - Stefan Weidinger
- Universitätsklinikum Schleswig-Holstein, Campus Kiel Dermatologie, Venerologie und Allergologie; Schittenhelmstr. 7 D-24105 Kiel
| | - Steffen Emmert
- Universitätsmedizin Rostock; Klinik und Poliklinik für Dermatologie und Venerologie; Strempelstr. 13 D-18057 Rostock
| | - Henning Hamm
- Klinik und Poliklinik für Dermatologie; Venerologie und Allergologie; Universitätsklinikum Würzburg; Josef-Schneider-Str. 2 D-97080 Würzburg
| | | | - Irina Zaraeva
- Klinik für Hautkrankheiten - Allgemeine Dermatologie und Venerologie; Universitätsklinikum Münster; Von-Esmarch-Str. 58 D-48149 Münster
| | - Anja Diem
- EB-Haus Austria; Universitätsklinik für Dermatologie; Salzburger Landeskliniken; Paracelsus Medizinische Privatuniversität Salzburg; Müllner Hauptstr. 48 A-5020 Salzburg
| | - Kathrin Giehl
- Zentrum für seltene und genetische Hautkrankheiten; Klinik und Poliklinik für Dermatologie und Allergologie Ludwig-Maximilians-Universität München; Frauenlobstr. 9-11 D-80337 München
| | - Regina Fölster-Holst
- Universitätsklinikum Schleswig-Holstein, Campus Kiel Dermatologie, Venerologie und Allergologie; Schittenhelmstr. 7 D-24105 Kiel
| | - Kirstin Kiekbusch
- Kirstin Kiekbusch; Straße der Einheit 5d D-15749 Mittenwalde/Brusendorf
| | - Peter Höger
- Zentrum für Kinder- und Jugendmedizin; Liliencronstr. 130 D-22149 Hamburg
| | - Hagen Ott
- Pädiatrische Dermatologie und Allergologie; Auf der Bult; Zentrum für Kinder und Jugendliche; Kinder- und Jugendkrankenhaus; Janusz-Korczak-Allee 12 D-30173 Hannover
| | - Heiko Traupe
- Klinik für Hautkrankheiten - Allgemeine Dermatologie und Venerologie; Universitätsklinikum Münster; Von-Esmarch-Str. 58 D-48149 Münster
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10
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Oji V, Preil ML, Kleinow B, Wehr G, Fischer J, Hennies HC, Hausser I, Breitkreutz D, Aufenvenne K, Stieler K, Tantcheva-Poór I, Weidinger S, Emmert S, Hamm H, Perusquia-Ortiz AM, Zaraeva I, Diem A, Giehl K, Fölster-Holst R, Kiekbusch K, Höger P, Ott H, Traupe H. S1 guidelines for the diagnosis and treatment of ichthyoses - update. J Dtsch Dermatol Ges 2017; 15:1053-1065. [DOI: 10.1111/ddg.13340] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Vinzenz Oji
- Department of Dermatology - General Dermatology and Venereology; Münster University Medical Center; Von-Esmarch-Str. 58 48149 Münster Germany
| | - Marie-Luise Preil
- Dermatology Practice am Färberturm; Weißenburger Str. 19 91710 Gunzenhausen Germany
| | | | - Geske Wehr
- In den Dellen 21; 51515 Kürten-Hufe Germany
| | - Judith Fischer
- Institute for Human Genetics; Freiburg University Hospital; Breisacher Str. 33 D-79106 Freiburg i. Br. Germany
| | - Hans Christian Hennies
- Department of Dermatogenetics; University of Cologne; Weyertal 115b 50931 Cologne Germany
| | - Ingrid Hausser
- Pathology IPH; EM Laboratory; Heidelberg University Hospital; INF 224 , 69120 Heidelberg Germany
| | - Dirk Breitkreutz
- German Society for Cell Biology/German Cancer Research Center Heidelberg & Mannheim University of Applied Sciences; Im Fuchsloch 18 , 69221 Dossenheim/bei Heidelberg Germany
| | - Karin Aufenvenne
- IUF - Leibniz Research Institute for Environmental Medicine; Auf'm Hennekamp 50 40225 Düsseldorf Germany
| | - Karola Stieler
- Charité Berlin - University Medicine; Mitte Campus; Outpatient Clinic for Pediatric Dermatology at Mitte Campus; Department of Dermatology; Venereology, and Allergology; Schumannstr. 20-21 10117 Berlin Germany
| | - Illiana Tantcheva-Poór
- Department of Dermatology; Cologne University Hospital; Kerpener Str. 62 50937 Cologne Germany
| | - Stefan Weidinger
- Department of Dermatology; Venereology and Allergology; University Hospital Schleswig-Holstein; Kiel Campus, Schittenhelmstr. 7 24105 Kiel Germany
| | - Steffen Emmert
- Department of Dermatology and Venereology; University Medicine Rostock; Strempelstr. 13 18057 Rostock Germany
| | - Henning Hamm
- Department of Dermatology; Venereology, and Allergology; Würzburg University Hospital; Josef-Schneider-Str. 2 97080 Würzburg Germany
| | | | - Irina Zaraeva
- Department of Dermatology - General Dermatology and Venereology; Münster University Medical Center; Von-Esmarch-Str. 58 48149 Münster Germany
| | - Anja Diem
- EB House Austria; Department of Dermatology; Salzburg Medical Center; Paracelsus Private Medical University; Müllner Hauptstr. 48 A-5020 Salzburg Austria
| | - Kathrin Giehl
- Center for Rare and Genetic Skin Diseases; Department of Dermatology and Allergology; LMU Munich; Frauenlobstr. 9-11 80337 Munich Germany
| | - Regina Fölster-Holst
- Department of Dermatology; Venereology and Allergology; University Hospital Schleswig-Holstein; Kiel Campus, Schittenhelmstr. 7 24105 Kiel Germany
| | - Kirstin Kiekbusch
- Kirstin Kiekbusch; Straße der Einheit 5d 15749 Mittenwalde/Brusendorf Germany
| | - Peter Höger
- Center for Pediatric and Adolescent Medicine; Liliencronstr. 130 22149 Hamburg Germany
| | - Hagen Ott
- Department of Pediatric Dermatology and Allergology; Center for Pediatric and Adolescent Medicine; Children's Hospital Auf der Bult; Janusz-Korczak-Allee 12 30173 Hanover Germany
| | - Heiko Traupe
- Department of Dermatology - General Dermatology and Venereology; Münster University Medical Center; Von-Esmarch-Str. 58 48149 Münster Germany
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Marukian NV, Deng Y, Gan G, Ren I, Thermidor W, Craiglow BG, Milstone LM, Choate KA. Establishing and Validating an Ichthyosis Severity Index. J Invest Dermatol 2017; 137:1834-1841. [DOI: 10.1016/j.jid.2017.04.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/04/2017] [Accepted: 04/19/2017] [Indexed: 10/19/2022]
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Toledo PRAB, Toci AT, Pezza HR, Pezza L. Green Determination of Urea in Moisturizers by Diffuse Reflectance Spectroscopy. ANAL LETT 2017. [DOI: 10.1080/00032719.2016.1255223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Aline Theodoro Toci
- Latin American Institute of Science of Life and Nature, Federal University of Latin American Integration – UNILA, Paraná, Brazil
| | | | - Leonardo Pezza
- Institute of Chemistry, São Paulo State University – UNESP, São Paulo, Brazil
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Lindh JD, Bradley M. Clinical Effectiveness of Moisturizers in Atopic Dermatitis and Related Disorders: A Systematic Review. Am J Clin Dermatol 2015; 16:341-59. [PMID: 26267423 DOI: 10.1007/s40257-015-0146-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Moisturizers are widely used for atopic dermatitis (AD) and related conditions, but available evidence of their effectiveness has not been reviewed in a systematic fashion. OBJECTIVES Our objective was to investigate the effectiveness of emollients, as a group and individually, in the treatment of AD and related conditions, by means of a systematic review. DATA SOURCES Studies indexed in MEDLINE and/or Embase before 16 January 2015. STUDY ELIGIBILITY CRITERIA Controlled clinical studies comparing the clinical effect of a moisturizer against its vehicle, another moisturizer, or no treatment were eligible. For the outcomes transepidermal water loss (TEWL) and stratum corneum hydration, uncontrolled before-after designs were also eligible. PARTICIPANTS Participants were patients with AD, irritant hand dermatitis, and/or ichthyosis vulgaris. RESULTS Out of the 595 publications initially identified, 45 (48 studies, 3262 patients) were eligible for inclusion. A vast majority of studies indicate that moisturizers have beneficial effects on clinical symptoms [SCORAD (SCORing Atopic Dermatitis) reductions ranging from 0 to 2.7 points], TEWL (range 0 to -12.2 g/m(2)h) and stratum corneum hydration (range +8 to +100%). Direct comparisons between individual moisturizers are still scarce, but the clinical effect appears to be much more well-documented for urea and glycerin than, for example, propylene glycol, lactate, ceramide, and aluminum chlorohydrate. Compared with urea studies, glycerin studies were more often associated with a high risk of bias. LIMITATIONS Due to differences in study designs and outcome measures, a quantitative meta-analytic approach was not deemed feasible, and formal indicators of publication bias such as funnel plots could not be used. However, a large number of moderately sized studies with positive outcomes could be compatible with selective publishing of favourable results. CONCLUSIONS The clinical effect of moisturizers is well-documented. Urea-based preparations may be preferable as a first-line treatment, but there is an unmet need for well-powered comparisons between individual moisturizers.
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Affiliation(s)
- Jonatan D Lindh
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Maria Bradley
- Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Hernández-Martin A, Aranegui B, Martin-Santiago A, Garcia-Doval I. A systematic review of clinical trials of treatments for the congenital ichthyoses, excluding ichthyosis vulgaris. J Am Acad Dermatol 2013; 69:544-549.e8. [PMID: 23870202 DOI: 10.1016/j.jaad.2013.05.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 05/13/2013] [Accepted: 05/17/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND The ichthyoses comprise a group of inherited disorders of keratinization. Because of the need for lifelong treatment, it is important that therapies are beneficial, safe, and well tolerated. OBJECTIVES We sought to review the evidence on existing treatments for the congenital ichthyoses, excluding ichthyosis vulgaris. METHOD We undertook a systematic review using the methodology of the Cochrane Collaboration. Articles published in MEDLINE, EMBASE, and CENTRAL and registered clinical trials were screened. Randomized controlled trials involving patients with the inherited ichthyoses, either syndromic or nonsyndromic but excluding ichthyosis vulgaris, were considered. RESULTS Six trials met the inclusion criteria. Topical treatments including 5% urea, 20% propylene glycol alone or in combination with 5% lactic acid, calcipotriol ointment, and liarozole 5% cream showed therapeutic benefit. Oral liarozole, a retinoic acid metabolism blocking agent, showed no advantage over oral acitretin. LIMITATIONS Most studies were performed on a small sample of patients and lacked methodological and reporting quality. The small number of trials and the nearly constant positive results make publication bias likely. The absence of standardization of outcome measures precluded the comparison of studies. CONCLUSIONS Topical treatments including emollients, calcipotriol ointment, and liarozole cream seem to have therapeutic benefit and a good safety profile, although the use of topical calcipotriol is limited by a maximum weekly dose of 100 g. The advantage of oral liarozole over acitretin is uncertain. Multicenter trials comparing oral and topical interventions and evaluation of long-term outcomes are needed.
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Autosomal recessive congenital ichthyosis. ACTAS DERMO-SIFILIOGRAFICAS 2013; 104:270-84. [PMID: 23562412 DOI: 10.1016/j.adengl.2011.11.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 11/13/2011] [Indexed: 12/15/2022] Open
Abstract
The term autosomal recessive congenital ichthyosis (ARCI) refers to a group of rare disorders of keratinization classified as nonsyndromic forms of ichthyosis. This group was traditionally divided into lamellar ichthyosis (LI) and congenital ichthyosiform erythroderma (CIE) but today it also includes harlequin ichthyosis, self-healing collodion baby, acral self-healing collodion baby, and bathing suit ichthyosis. The combined prevalence of LI and CIE has been estimated at 1 case per 138 000 to 300 000 population. In some countries or regions, such as Norway and the coast of Galicia, the prevalence may be higher due to founder effects. ARCI is genetically highly heterogeneous and has been associated with 6 genes to date: TGM1, ALOXE3, ALOX12B, NIPAL4, CYP4F22, and ABCA12. In this article, we review the current knowledge on ARCI, with a focus on clinical, histological, ultrastructural, genetic, molecular, and treatment-related aspects.
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Abstract
A daily moisturizing routine is a vital part of the management of patients with atopic dermatitis and other dry skin conditions. The composition of the moisturizer determines whether the treatment strengthens or deteriorates the skin barrier function, which may have consequences for the outcome of the dermatitis. One might expect that a patient's impaired skin barrier function should improve in association with a reduction in the clinical signs of dryness. Despite visible relief of the dryness symptoms, however, the abnormal transepidermal water loss has been reported to remain high, or even to increase under certain regimens, whereas other moisturizers improve skin barrier function. Differing outcomes have also been reported in healthy skin: some moisturizers produce deterioration in skin barrier function and others improve the skin. Possible targets for barrier-influencing moisturizing creams include the intercellular lipid bilayers, where the fraction of lipids forming a fluid phase might be changed due to compositional or organizational changes. Other targets are the projected size of the corneocytes or the thickness of the stratum corneum. Moisturizers with barrier-improving properties may delay relapse of dermatitis in patients with atopic dermatitis. In a worst-case scenario, treatment with moisturizing creams could increase the risks of dermatitis and asthma.
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Affiliation(s)
- Marie Lodén
- Eviderm Institute AB, Bergshamra Allé 9, SE-170 77 Solna, Sweden.
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Tadini G, Giustini S, Milani M. Efficacy of topical 10% urea-based lotion in patients with ichthyosis vulgaris: a two-center, randomized, controlled, single-blind, right-vs.-left study in comparison with standard glycerol-based emollient cream. Curr Med Res Opin 2011; 27:2279-84. [PMID: 22007909 DOI: 10.1185/03007995.2011.628381] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Ichthyoses are genetic disorders of keratinization which are uncomfortable due to their conspicuous scaling, itching and cosmetic problems. Ichthyoses can lead to social discrimination and psychological problems. Ichthyosis vulgaris (IV) is the most common form of these geno-dermatoses. IV is a chronic disorder that often requires continuous therapy. Emollient and keratolytic products are the mainstay treatments of IV. It is important that efficient, safe and well tolerated therapies should be available. Direct comparative data regarding efficacy of different emollient products in IV patients are very few. OBJECTIVE The aim of the study was to investigate the keratolytic and moisturizing properties as well as the tolerance of a new urea topical formulation (Ureadin Rx10) when applied to hyperkeratotic and dry skin in patients with (IV) in comparison with a standard emollient cream. METHODS The study was conducted as a two-center, randomized, controlled, single-blind, intra-patient (right-vs.-left) trial design. A total of 30 patients with IV between 8 and 65 (mean age: 25 years) treated with a 10% urea-based lotion, Ureadin Rx 10 * *Ureadin RX 10 is a registered trade name of ISDIN, Spain. (URx), for 4 weeks or a glycerol-based emollient cream, Dexeryl † †Dexeryl is a registered trade name of Pierre Fabre Dermatologie. (DC), in a right-vs.-left study design. Primary outcome was a 5-point SRRC Index score (evaluating scaling roughness, redness and cracks) evaluated at baseline and after 2 and 4 weeks of treatment. As secondary endpoints patients evaluated also the global efficacy (GE) and global tolerability (GT) scores with the help of a 10 cm visual analogue scale (0 = no efficacy at all/very bad tolerability; 10: excellent efficacy/excellent tolerability). RESULTS At baseline the mean (SD) SRRC score was 9.5 (1.9) in the URx treated sites and 9.5 (1.9) in the DC treated sites. A total of 27 patients (90%) concluded the study period. Three patients were withdrawn prematurely because of itching and burning sensation after DC application (1 patient) or URx application (2 patients). At week 4, in comparison with baseline values, both treatments were shown to be clinically effective: SRRC significantly (p = 0.0001) decreased to 3.3 (1.8) after URx (a 65% relative reduction) and to 5.7 (2.5) after DC (a 40% relative reduction). SRRC was significantly lower in URx treated regions in comparison with DC both after 2 and 4 weeks of treatment (p = 0.0005). Mean GE score in areas treated with URx was significantly (p = 0.0001) higher than in the areas treated with the DC (8.9 vs.7.3). Both treatments were in general well tolerated. GT score was 8.1 (range 10 to 3) with URx and 8.4 (range 10 to 3) with DC application (p = ns). The two main limitations of this trial are the study design (single blind), and the small sample size which is not adequate for an evaluation of safety. CONCLUSION Ureadin Rx 10 lotion has shown a greater efficacy on ichthyosis vulgaris in term of reduction of scaling, roughness, redness and cracking in comparison with a glycerol-based emollient cream. Tolerability of the two topical treatments was comparable. Further studies with larger sample sizes are needed for the evaluation of safety and tolerability of urea 10% lotion in this clinical setting.
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Affiliation(s)
- Gianluca Tadini
- Dermatologic Clinic, Centre for hereditary dermatoses, Maggiore Hospital, University of Milan, Italy
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Borelli C, Bielfeldt S, Borelli S, Schaller M, Korting HC. Cream or foam in pedal skin care: towards the ideal vehicle for urea used against dry skin. Int J Cosmet Sci 2011; 33:37-43. [DOI: 10.1111/j.1468-2494.2010.00576.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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O'Shaughnessy RF, Choudhary I, Harper JI. Interleukin-1 alpha blockade prevents hyperkeratosis in an in vitro model of lamellar ichthyosis. Hum Mol Genet 2010; 19:2594-605. [DOI: 10.1093/hmg/ddq145] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kamalpour L, Rice ZP, Pavlis M, Veledar E, Chen SC. Reliable methods to evaluate the clinical severity of ichthyosis. Pediatr Dermatol 2010; 27:148-53. [PMID: 20537064 DOI: 10.1111/j.1525-1470.2010.01114.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A reliable method for assessing ichthyosis severity has not been uniformly agreed upon. The objective of our study was to develop and validate a tool to measure the clinical severity of the congenital ichthyoses, the Congenital Ichthyoses Severity Index. A prospective study was performed to determine reliability of three Likert scales to evaluate clinical severity of ichthyosis. Thirty-eight subjects recruited from the Foundation for Ichthyosis and Related Skin Types National Conference were evaluated separately by two blinded investigators using the Likert scales. Subjects were then asked to evaluate themselves using these scales. Inter-rater reliability was determined between ratings provided by all three raters. Test-retest validation was conducted with 21 subjects who completed follow-up surveys 4 weeks later. Our severity scales had excellent inter-rater and test-retest reliability as determined by intraclass correlation coefficients (ICC >0.7), with the exception of our hyperkeratosis scale, which demonstrated moderate test-retest reliability (ICC = 0.4). This pilot study provides a promising method for evaluating clinical severity of the congenital ichthyoses, one easily employed by both physicians and patients. Future epidemiologic studies may benefit from use of this instrument, as well as studies evaluating emerging therapies for ichthyosis.
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Affiliation(s)
- Loebat Kamalpour
- Department of Dermatology, Emory University, Atlanta, Georgia 30322, USA
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22
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Chiavérini C. Ichtyoses génétiques. Ann Dermatol Venereol 2009; 136:923-34. [DOI: 10.1016/j.annder.2009.01.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Accepted: 01/23/2009] [Indexed: 01/07/2023]
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Abstract
Ichthyoses constitute a large group of cornification disorders that affect the entire integument. The skin is characterized by visible scaling and in many cases by inflammation, for example, in bullous/keratinopathic ichthyosis or Netherton syndrome. From the viewpoint of classification it is useful to distinguish non-syndromic from syndromic types of ichthyosis. Ichthyosis vulgaris and recessive X-linked ichthyosis are common disorders - often of delayed onset, in contrast to congenital ichthyoses, which belong to the group of rare diseases and present at birth with either the features of collodion membrane or congenital ichthyosiform erythroderma. The diagnostic steps are based on clinical data, analyses such as the steroid sulfatase activity test, skin biopsies, and genetic results. However, the dramatic increase in knowledge about the pathophysiology of these conditions has not led to a curative therapy so far. The therapeutic management is multidisciplinary and involves ichthyosis patient organizations in many countries. The mainstay of treatment remains with moisturizing creams containing, for example, urea, lactic acid and other humectants and keratolytics, regular bathing, and mechanical scale removal. Patients with lamellar ichthyosis or ichthyosiform erythroderma in particular profit from oral therapy with retinoids or retinoic acid metabolism-blocking agents.
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Affiliation(s)
- Vinzenz Oji
- Department of Dermatology, University of Münster, Münster, Germany.
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Couteau C, Coiffard LJM, Sébille-Rivain V. Influence of Excipients on Moisturizing Effect of Urea. Drug Dev Ind Pharm 2008; 32:239-42. [PMID: 16537204 DOI: 10.1080/03639040500466361] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Water is the most important molecule contained in the skin and is bound to the intracellular hygroscopic substances called natural moisturizing factors (NMF). The clinical characteristic of xerosis is rough and/or coarse skin. This anaesthetic alteration necessitates cosmetic products application. In this study, we tested the efficiency of urea incorporated into six different emulsions (O/W) and 10 different gels. Skin of 10 healthy women (20 to 45 years) was treated using 50 mg of emulsion or gel containing 5% of urea. A skin surface of 16 cm(2) was chosen in the area of the forearm. The gain in moisturizing was performed measuring the skin electrical capacity using a corneometer (Courage & Khazaka, model CM 825), one hour after treatment. Sodium carboxymethyl cellulose gel has the least moisturizing effect. On the other hand, the mixture of polyacrylamide and C13-14 isoparaffin polysorbate 85 can be a good vehicle in the treatment of skin dehydration. Adding various oils (6%) or collagen in aqueous solution does not improve the efficiency of the tested products. Moisturizing effect of gels (polyacrylamine with C13-14 isoparaffin polysorbate 85) is higher than the one of emulsions (L/H).
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Affiliation(s)
- C Couteau
- L.P.I.C., Faculty of Pharmacy, SMAB (EA 2160), University of Nantes, 1 rue Gaston Veil, 44035, Nantes Cedex, France.
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Abstract
Moisturizers are used on large body surfaces to maintain the smoothness of the skin and to break the dry-skin cycle. Many healthcare professionals and patients overlook the importance of moisturizers and do not consider them to be 'active' treatments. However, evidence from clinical and experimental studies shows that moisturizers enhance both the smoothness and hydration of skin. Different moisturizers have different ingredients, and each may have a different mode of action. Some smooth the skin, others affect barrier function. Some enhance barrier function in both diseased and normal skin. Others impair barrier function in both diseased and normal skin. Defective barrier function may trigger the development of eczema. The composition of a particular moisturizer should reflect its desired therapeutic effect, i.e. a moisturizer to diminish dryness may need different ingredients from those required to improve barrier function. The content of excipients, such as emulsifiers, chelating agents and antioxidants, may have greater impact than is commonly believed. Greater tailoring of moisturizers will improve their efficacy. Confidence in the therapeutic effects of moisturizers will be enhanced by well-designed randomized controlled trials.
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Affiliation(s)
- M Lodén
- ACO HUD AB, Box 622, SE-194 26 Upplands Väsby, Sweden.
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Abstract
UNLABELLED Moisturizing creams marketed to consumers often contain trendy ingredients and are accompanied by exciting names and attractive claims. Moisturizers are also an important part of the dermatologist's armamentarium to treat dry skin conditions and maintain healthy skin. The products can be regarded as cosmetics, but may also be regulated as medicinal products if they are marketed against dry skin diseases, such as atopic dermatitis and ichthyosis. When moisturizers are used on the so-called dry skin, many distinct disorders that manifest themselves with the generally recognized symptoms of dryness are treated. Dryness is not a single entity, but is characterized by differences in chemistry and morphology in the epidermis depending on the internal and external stressors of the skin. Patients and the society expect dermatologists and pharmacists to be able to recommend treatment for various dry skin conditions upon evidence-based medicine. LEARNING OBJECTIVE Upon completing this paper, the reader should be aware of different types of moisturizers and their major constituents. Furthermore, s/he will know more about the relief of dryness symptoms and the functional changes of the skin induced by moisturizers.
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Affiliation(s)
- M Lodén
- ACO HUD AB, Stockholm, Sweden.
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Abstract
Emollients and moisturizing creams are used to break the dry skin cycle and to maintain the smoothness of the skin. The term 'moisturizer' is often used synonymously with emollient, but moisturizers often contain humectants in order to hydrate the stratum corneum. Dryness is frequently linked to an impaired barrier function observed, for example, in atopic skin, psoriasis, ichthyosis, and contact dermatitis. Dryness and skin barrier disorders are not a single entity, but are characterized by differences in chemistry and morphology in the epidermis. Large differences also exist between moisturizing creams. Moisturizers have multiple functions apart from moistening the skin. Similar to other actives, the efficacy is likely to depend on the dosage, where compliance is a great challenge faced in the management of skin diseases. Strong odor from ingredients and greasy compositions may be disagreeable to the patients. Furthermore, low pH and sensory reactions, from lactic acid and urea for example, may reduce patient acceptance. Once applied to the skin, the ingredients can stay on the surface, be absorbed into the skin, be metabolized, or disappear from the surface by evaporation, sloughing off, or by contact with other materials. In addition to substances considered as actives, e.g. fats and humectants, moisturizers contain substances conventionally considered as excipients (e.g. emulsifiers, antioxidants, preservatives). Recent findings indicate that actives and excipients may have more pronounced effects in the skin than previously considered. Some formulations may deteriorate the skin condition, whereas others improve the clinical appearance and skin barrier function. For example, emulsifiers may weaken the barrier. On the other hand, petrolatum has an immediate barrier-repairing effect in delipidized stratum corneum. Moreover, one ceramide-dominant lipid mixture improved atopic dermatitis and decreased transepidermal water loss (TEWL) in an open-label study in children. In double-blind studies moisturizers with urea have been shown to reduce TEWL in atopic and ichthyotic patients. Urea also makes normal and atopic skin less susceptible against irritation to sodium laurilsulfate. Treatments improving the barrier function may reduce the likelihood of further aggravation of the disease. In order to have optimum effect it is conceivable that moisturizers should be tailored with respect to the epidermal abnormality. New biochemical approaches and non-invasive instruments will increase our understanding of skin barrier disorders and facilitate optimum treatments. The chemistry and function of dry skin and moisturizers is a challenging subject for the practicing dermatologist, as well as for the chemist developing these agents in the pharmaceutical/cosmetic industry.
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Affiliation(s)
- Nelly Rubeiz
- Department of Dermatology, American University of Beirut Medical Center, Riad El Solh, Beirut, Lebanon.
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Rippke F, Schreiner V, Schwanitz HJ. The acidic milieu of the horny layer: new findings on the physiology and pathophysiology of skin pH. Am J Clin Dermatol 2002; 3:261-72. [PMID: 12010071 DOI: 10.2165/00128071-200203040-00004] [Citation(s) in RCA: 147] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The acidic pH of the horny layer, measurable on the skin surface, has long been regarded as a result of exocrine secretion of the skin glands. The 'acid mantle' was thought to regulate the bacterial skin flora and to be sensitive primarily to skin cleansing procedures. In recent years, an increasing number of investigations have been published on the changes in, and constituents and functions of, the pH of the deeper layers of the stratum corneum, as well as on the influence of physiological and pathological factors. A central role for the acidic milieu as a regulating factor in stratum corneum homeostasis is now emerging. This has relevance to the integrity of the barrier function, from normal maturation of the stratum corneum lipids through to desquamation. Changes in the pH and the organic factors influencing it appear to play a role, not only in the pathogenesis, prevention and treatment of irritant contact dermatitis, but also of atopic dermatitis and ichthyosis and in wound healing. On the basis of these findings, a broader concept, exceeding the superficial 'acid mantle' theory, has been formulated.
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Shemer A, Nathansohn N, Kaplan B, Weiss G, Newman N, Trau H. Treatment of scalp seborrheic dermatitis and psoriasis with an ointment of 40% urea and 1% bifonazole. Int J Dermatol 2000; 39:532-4. [PMID: 10940120 DOI: 10.1046/j.1365-4362.2000.00986-3.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- A Shemer
- Department of Dermatology,; Chaim Sheba Medical Center, Tel Hashomer, Israel
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Gånemo A, Virtanen M, Vahlquist A. Improved topical treatment of lamellar ichthyosis: a double-blind study of four different cream formulations. Br J Dermatol 1999; 141:1027-32. [PMID: 10606847 DOI: 10.1046/j.1365-2133.1999.03200.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Lamellar ichthyosis (LI) is characterized by generalized scaling of the skin and is often resistant to ordinary emollients. Recently, Locobase(R) fatty cream containing a mixture of 5% lactic acid and 20% propylene glycol (LPL) was found to be markedly effective in a pilot study. To consolidate this finding, a double-blind study comparing LPL with the corresponding mixture in Essex(R) (Diprobase(R)) cream (LPE) and Locobase(R) fatty cream containing either 5% urea or 20% propylene glycol was conducted in 20 patients with LI. Before and after applying the creams twice daily on each of the four extremities for 4 weeks, the following investigations were performed: scoring of xerosis, scaling and erythema, measurements of skin hydration (capacitance) and transepidermal water loss (TEWL), and moulding of the skin surface (replicas). Xerosis was reduced by all four creams, but significantly more so by LPL (P < 0.001) and LPE (P < 0.01). Scaling was only reduced by LPL (P < 0.001) and LPE (P < 0.01), which also caused a slight increase in the erythema score (P < 0.05 for both). The patients' weekly evaluation of symptoms showed that LPL produced the most rapid effect: the response rate after 4 weeks was 63%. Skin hydration and TEWL were both significantly increased by LPL and LPE, whereas skin roughness was reduced most by LPL. Fourteen patients preferred LPL over the other cream formulations. Ten patients continued using LPL for up to 8 weeks with good results and no side-effects other than occasional irritation in the skin folds. LPL is a major advance in the topical treatment of LI that suits most patients. Some patients, however, seem to prefer the more hydrophilic LPE formulation. Both formulations effectively reduce hyperkeratosis and xerosis, but may cause slight irritation and adversely affect the epidermal barrier function.
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Affiliation(s)
- A Gånemo
- Section of Dermatology, Department of Medical Sciences, University of Uppsala, Sweden
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