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P. Gomes PW, Mannochio-Russo H, Mao J, Zhao HN, Ancira J, Tipton CD, Dorrestein PC, Li M. Co-occurrence network analysis reveals the alterations of the skin microbiome and metabolome in adults with mild to moderate atopic dermatitis. mSystems 2024; 9:e0111923. [PMID: 38319107 PMCID: PMC10949451 DOI: 10.1128/msystems.01119-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/04/2024] [Indexed: 02/07/2024] Open
Abstract
Skin microbiome can be altered in patients with atopic dermatitis (AD). An understanding of the changes from healthy to atopic skin can help develop new targets for treatment by identifying microbial and molecular biomarkers. This study investigates the skin microbiome and metabolome of healthy adult subjects and lesion (ADL) and non-lesion (ADNL) of AD patients by 16S rRNA gene sequencing and mass spectrometry, respectively. Samples from AD patients showed alterations in the diversity and composition of the skin microbiome, with ADL skin having the greatest divergence. Staphylococcus species, especially S. aureus, were significantly increased in AD patients. Metabolomic profiles were also different between the groups. Dipeptide derivatives are more abundant in ADL, which may be related to skin inflammation. Co-occurrence network analysis of the microbiome and metabolomics data revealed higher co-occurrence of metabolites and bacteria in healthy ADNL compared to ADL. S. aureus co-occurred with dipeptide derivatives in ADL, while phytosphingosine-derived compounds showed co-occurrences with commensal bacteria, for example, Paracoccus sp., Pseudomonas sp., Prevotella bivia, Lactobacillus iners, Anaerococcus sp., Micrococcus sp., Corynebacterium ureicelerivorans, Corynebacterium massiliense, Streptococcus thermophilus, and Roseomonas mucosa, in healthy and ADNL groups. Therefore, these findings provide valuable insights into how AD affects the human skin metabolome and microbiome.IMPORTANCEThis study provides valuable insight into changes in the skin microbiome and associated metabolomic profiles in an adult population with mild to moderate atopic dermatitis. It also identifies new therapeutic targets that may be useful for developing personalized treatments for individuals with atopic dermatitis based on their unique skin microbiome and metabolic profiles.
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Affiliation(s)
- Paulo Wender P. Gomes
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California, USA
| | - Helena Mannochio-Russo
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California, USA
| | - Junhong Mao
- Colgate−Palmolive Company, Piscataway, New Jersey, USA
| | - Haoqi Nina Zhao
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California, USA
| | | | | | - Pieter C. Dorrestein
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California, USA
- Department of Pediatrics, University of California, San Diego, California, USA
| | - Min Li
- Colgate−Palmolive Company, Piscataway, New Jersey, USA
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Dähnhardt D, Dähnhardt-Pfeiffer S, Schulte-Walter J, Hanisch E, Neubourg T, Fölster-Holst R. Comparison of lipid foam cream and basic cream on epidermal reconstruction in mild atopic eczema. Skin Pharmacol Physiol 2022; 35:282-290. [PMID: 35705066 DOI: 10.1159/000525283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/11/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Basic therapy is of central importance in the treatment of atopic eczema. Using electron microscopic images, the morphology of epidermal skin barrier and its lipids was investigated after application of a lipid foam cream and basic cream. METHODS Patients with two contralateral comparable atopic eczema (local SCORAD 1-10) on the forearms were tested. Eczema was treated with a lipid foam cream or basic cream twice daily for 28 days. At the beginning, after 14 days and at the end of application, the local SCORAD, transepidermal water loss (TEWL), skin hydration, intercellular lipid length (ICLL) in the intercellular space (ICS) of the stratum corneum (SC) and skin lipids were determined. RESULTS After application of the foam cream, the epidermal skin barrier could be completely restored and corresponded to skin-healthy skin, while the epiderrmal skin barrier could not reach this state after care with the basic cream. The content of lipids in the SC increases significantly by 31% after basic cream treatment, whereas they are significantly increased by 85% after application of the lipid foam cream. The local SCORAD improved for both treatments to about the same extent, no significant results could be shown for TEWL and skin hydration. CONCLUSION In subjects with mild atopic eczema, the lipid foam cream leads to a measurable recovery of the skin barrier which is much more pronounced in comparison to the basic cream.
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Affiliation(s)
| | | | | | | | | | - Regina Fölster-Holst
- Klinik für Dermatologie, Allergologie und Venerologie, UKSH, Campus Kiel, Universitäts-Hautklinik Kiel, Kiel, Germany
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3
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Fölster-Holst R, Naß C, Dähnhardt-Pfeiffer S, Freitag-Wolf S. Analysis of the structure and function of the epidermal barrier in patients with ichthyoses - clinical and electron microscopical investigations. J Eur Acad Dermatol Venereol 2022; 36:726-738. [PMID: 35015925 DOI: 10.1111/jdv.17914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ichthyoses are pathogenetically characterised by a pronounced disorder of the epidermal barrier. Clinically, hyperkeratosis, severe scaling and erythroderma are present on the entire integument. The time-consuming therapy includes daily baths and the application of skin care products to restore the epidermal barrier. OBJECTIVES AND METHODS To enhance the knowledge about the structure and function of the epidermal barrier in ichthyoses, we conducted clinical, biophysical and electron microscopical measurements on 46 patients with ichthyoses, including autosomal recessive ichthyoses, keratinopathic ichthyoses, X-chromosomal recessive ichthyosis and Netherton syndrome. RESULTS The patients displayed a significantly decreased skin hydration along with unexpectedly low transepidermal waterloss values. Electron microscopical examinations demonstrated a severe occlusion of the epidermis by lipid remnants of skin care products in the stratum corneum. We found decreased intercellular lipid lamellae and an increased undulation of the corneocyte membrane of all ichthyoses, mostly pronounced in Netherton syndrome. The lipid profiles of ichthyoses showed decreased esterified Ω-hydroxy-sphingosine (EOS) ceramide levels. CONCLUSIONS The results demonstrate the extent of the epidermal barrier disruption in ichthyoses. In combination with the knowledge about pathogenetic causes, individually improved therapeutic options can be derived from our results. In the future, the analyses of the organisation of intercellular lipid lamellae and corneocyte membrane undulation will enable improved investigations of the epidermal barrier in ichthyoses and may be used to study and evaluate possible effects of topical skin preparations.
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Affiliation(s)
- R Fölster-Holst
- Department of Dermatology, Venereology and Allergology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - C Naß
- Department of Dermatology, Venereology and Allergology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | | | - S Freitag-Wolf
- Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Germany
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4
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Blaak J, Staib P. An updated review on efficacy and benefits of sweet almond, evening primrose and jojoba oils in skin care applications. Int J Cosmet Sci 2021; 44:1-9. [PMID: 34957578 DOI: 10.1111/ics.12758] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/16/2021] [Accepted: 12/16/2021] [Indexed: 11/28/2022]
Abstract
Renewed consumer and industry interest in natural ingredients has led to a large growth of natural cosmetics. This has put pressure on formulation skills and product claims when it comes to using natural compounds. Taking a strategic and comprehensive approach in viewing natural ingredients, including natural oils, as 'active' ingredients rather than just providing for so-called 'natural' claims, aids both innovation and development. Given the ever-increasing consumer demand for natural ingredients, and more importantly the demand for effective natural ingredients including plant oils, it is important for the cosmetic industry to re-evaluate them in this context. The objectives of this review are to provide an update of three popular cosmetic plant oils - Sweet Almond, Evening Primrose, and Jojoba - in terms of their cosmetic applications as 'active' ingredients. This review highlights the activity of these oils, in the management of dry skin, ageing skin, juvenile skin, atopic dermatitis, scalp conditions, and their wider potential. Attention is given to formulation considerations where the content of these oils impacts product oxidation, skin penetration and stratum corneum homeostasis. Benefits of these oils have been well documented both pre-clinically and clinically. Historically, they have been used for hundreds if not thousands of years for their management and treatment of various skin and other ailments. Given the discrepancies in some clinical data presented for a variety of dermatoses, the importance of the choice of oil and how to formulate with them within the context of the epidermal barrier function, skin penetration, and toxicity, cannot be underestimated. Care should be taken in terms of the quality and stability of theses oils, as well as ensuring best formulation type, if the reported activities of these oils are to be achieved with consistency. Despite discrepancies in the literature and questionable study designs, it is clear, that Sweet Almond, Evening Primrose and Jojoba oils, do have skin care benefits for both adult and juvenile applications. They are effective ingredients for skin care preparations to strengthen stratum corneum integrity, recovery, and lipid ratio. Nevertheless, further experimental data are required concerning the impact on stratum corneum physiology and structure.
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Affiliation(s)
- J Blaak
- Research & Development and Regulatory Affairs, Kneipp GmbH, Würzburg, Germany
| | - P Staib
- Research & Development and Regulatory Affairs, Kneipp GmbH, Würzburg, Germany
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Hüppop F, Dähnhardt-Pfeiffer S, Fölster-Holst R. Characterization of Classical Flexural and Nummular Forms of Atopic Dermatitis in Childhood with Regard to Anamnestic, Clinical and Epidermal Barrier Aspects. Acta Derm Venereol 2021; 102:adv00664. [PMID: 34935994 DOI: 10.2340/actadv.v101.979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Nummular (coin-shaped) and classical (flexural) atopic dermatitis differ morphologically, but no other distinguishing features are known. The aim of this study was to determine differences and similarities of both variants in children. Detailed interviews, clinical examinations, biophysical measurements and electron microscopic analyses were performed on 10 children with nummular atopic dermatitis, 14 with classical atopic dermatitis and 10 healthy controls. Nummular atopic dermatitis affected more boys than girls and manifested less frequently within the first year of life than classical atopic dermatitis. Localization, distribution and morphology of the eczema varied more over time, and expression of keratosis pilaris was more severe in children with nummular atopic dermatitis. Both disease groups showed reduced hydration, increased transepidermal water loss and reduced intercellular lipid lamellae in lesional skin areas compared with non-lesional areas. These findings underline the separate classification of both variants. Further research is necessary to investigate the potential of diverging therapeutic approaches.
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Affiliation(s)
| | | | - Regina Fölster-Holst
- Department of Dermatology, Venereology and Allergology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller Str. 3, DE-24105 Kiel, Germany.
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6
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Fölster-Holst R, Reimer R, Neumann C, Proksch E, Rodriguez E, Weidinger S, Goldust M, Hanisch E, Dähnhardt-Pfeiffer S, Freitag-Wolf S. Comparison of Epidermal Barrier Integrity in Adults with Classic Atopic Dermatitis, Atopic Prurigo and Non-Atopic Prurigo Nodularis. Biology (Basel) 2021; 10:1008. [PMID: 34681107 PMCID: PMC8533604 DOI: 10.3390/biology10101008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/26/2021] [Accepted: 10/02/2021] [Indexed: 12/20/2022]
Abstract
A deficient epidermal barrier is a key feature of atopic dermatitis (AD) and comprises altered lipid and protein content and composition of the stratum corneum resulting in disturbed water balance. Clinically, eczematous lesions on dry skin and pruritus develop. Pruritic nodules occur in prurigo nodularis (PN), another chronic skin disease, which can be associated with atopy. We aimed at comparing the three clinical pictures, classic AD, atopic prurigo (AP), and non-atopic PN, to healthy controls regarding the epidermal barrier. We determined clinical parameters and performed biophysical measurements, histology/immunohistochemistry, electron microscopy, and molecular biological analysis. We found distinctively elevated clinical scores, reduced hydration and increased transepidermal water loss, epidermal hyperplasia and inflammation reduced filaggrin and increased loricrin and involucrin expression, as well as reduced intercellular lipid lamellae in all three disease groups. These findings show a severe disruption in epidermal barrier structure and function in all three disorders so that epidermal barrier impairment is now proven not only for AD but also for PN.
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Affiliation(s)
- Regina Fölster-Holst
- Department of Dermatology, Venereology and Allergology, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (C.N.); (E.P.); (E.R.); (S.W.)
| | - Rahel Reimer
- Department of Dermatology, Venereology and Allergology, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (C.N.); (E.P.); (E.R.); (S.W.)
| | - Claudia Neumann
- Department of Dermatology, Venereology and Allergology, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (C.N.); (E.P.); (E.R.); (S.W.)
| | - Erhardt Proksch
- Department of Dermatology, Venereology and Allergology, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (C.N.); (E.P.); (E.R.); (S.W.)
| | - Elke Rodriguez
- Department of Dermatology, Venereology and Allergology, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (C.N.); (E.P.); (E.R.); (S.W.)
| | - Stephan Weidinger
- Department of Dermatology, Venereology and Allergology, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (C.N.); (E.P.); (E.R.); (S.W.)
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center Mainz, 55101 Mainz, Germany;
| | | | | | - Sandra Freitag-Wolf
- Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
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7
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Affiliation(s)
- H Stettler
- Bayer Consumer Care AG, Peter Merian-Strasse 84, Basel, CH-4052, Switzerland
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8
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Rawlings AV. 'Targeted dry skin treatment using a multifunctional moisturizer'. Int J Cosmet Sci 2021; 43:269-271. [PMID: 33598921 DOI: 10.1111/ics.12690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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9
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Cointereau‐Chardon S, Caberlotto E, Vicic M, Flament F. Self‐recording the skin hydration and Trans‐Epidermal Water Loss parameters: A pilot study. Skin Res Technol 2020; 26:713-717. [DOI: 10.1111/srt.12862] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/29/2020] [Indexed: 12/24/2022]
Affiliation(s)
| | | | - Marco Vicic
- L’Oréal Research and Innovation Chevilly‐Larue France
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10
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Bergmann S, von Buenau B, Vidal-Y-Sy S, Haftek M, Wladykowski E, Houdek P, Lezius S, Duplan H, Bäsler K, Dähnhardt-Pfeiffer S, Gorzelanny C, Schneider SW, Rodriguez E, Stölzl D, Weidinger S, Brandner JM. Claudin-1 decrease impacts epidermal barrier function in atopic dermatitis lesions dose-dependently. Sci Rep 2020; 10:2024. [PMID: 32029783 DOI: 10.1038/s41598-020-58718-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 01/17/2020] [Indexed: 12/15/2022] Open
Abstract
The transmembrane protein claudin-1 is a major component of epidermal tight junctions (TJs), which create a dynamic paracellular barrier in the epidermis. Claudin-1 downregulation has been linked to atopic dermatitis (AD) pathogenesis but variable levels of claudin-1 have also been observed in healthy skin. To elucidate the impact of different levels of claudin-1 in healthy and diseased skin we determined claudin-1 levels in AD patients and controls and correlated them to TJ and skin barrier function. We observed a strikingly broad range of claudin-1 levels with stable TJ and overall skin barrier function in healthy and non-lesional skin. However, a significant decrease in TJ barrier function was detected in lesional AD skin where claudin-1 levels were further reduced. Investigations on reconstructed human epidermis expressing different levels of claudin-1 revealed that claudin-1 levels correlated with inside-out and outside-in barrier function, with a higher coherence for smaller molecular tracers. Claudin-1 decrease induced keratinocyte-autonomous IL-1β expression and fostered inflammatory epidermal responses to non-pathogenic Staphylococci. In conclusion, claudin-1 decrease beyond a threshold level results in TJ and epidermal barrier function impairment and induces inflammation in human epidermis. Increasing claudin-1 levels might improve barrier function and decrease inflammation and therefore be a target for AD treatment.
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11
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Youssef R, Hafez V, Elkholy Y, Mourad A. Glycerol 85% efficacy on atopic skin and its microbiome: a randomized controlled trial with clinical and bacteriological evaluation. J DERMATOL TREAT 2020; 32:730-736. [PMID: 31869257 DOI: 10.1080/09546634.2019.1708246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Treating atopic dermatitis (AD) is still a challenge. The staphylococcal skin load is known to aggravate AD. Narrow band ultraviolet B (NB-UVB) and glycerol in low concentration (20-40%) are established therapies for AD. NB-UVB has proven antimicrobial actions, while high concentration glycerol (85-100%) showed similar effects in vitro but has not been clinically tested.Objective: To evaluate the efficacy and tolerability of concentrated glycerol 85% compared to NB-UVB in patients with AD, as assessed by clinical improvement and reduction of staphylococcal colonization of the skin.Methods: 30 patients with mild to moderate AD were randomized into either NB-UVB or glycerol 85% group. Patients were treated for one month and followed for an additional month. Swabs were taken from the skin and nose to be cultured on mannitol-salt agar for Staphylococci and quantified to determine Colony Forming Units.Results: Both groups showed statistically insignificant microbial changes and statistically significant clinical improvement after treatment. The results were comparable between both groups.Conclusions: Concentrated glycerol 85% is a cheap effective readily accessible alternative for phototherapy in patients with mild-moderate AD who cannot access the facility. Reduction of staphylococcal skin load seems to be involved, but its role is minimal.
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Affiliation(s)
- Randa Youssef
- Dermatology Department, Cairo University, Cairo, Egypt
| | - Vanessa Hafez
- Dermatology Department, Cairo University, Cairo, Egypt
| | - Yasmine Elkholy
- Medical Microbiology and Immunology Department, Cairo University, Cairo, Egypt
| | - Ahmed Mourad
- Dermatology Department, Cairo University, Cairo, Egypt
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12
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Dähnhardt D, Bastian M, Dähnhardt-Pfeiffer S, Buchner M, Fölster-Holst R. Comparing the effects of proactive treatment with tacrolimus ointment and mometasone furoate on the epidermal barrier structure and ceramide levels of patients with atopic dermatitis. J DERMATOL TREAT 2020; 32:721-729. [DOI: 10.1080/09546634.2019.1708240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
| | | | | | - Matthias Buchner
- Department of Dermatology, Allergology and Venereology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Regina Fölster-Holst
- Department of Dermatology, Allergology and Venereology, University Hospital of Schleswig-Holstein, Kiel, Germany
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Caberlotto E, Cornillon C, Njikeu S, Monot M, Vicic M, Flament F. Synchronized
in vivo
measurements of skin hydration and trans‐epidermal water loss. Exploring their mutual influences. Int J Cosmet Sci 2019; 41:437-442. [DOI: 10.1111/ics.12556] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 05/22/2019] [Indexed: 12/23/2022]
Affiliation(s)
- E. Caberlotto
- L’Oréal Research and Innovation 9 Rue Pierre Dreyfus 92110 Clichy France
| | - C. Cornillon
- L’Oréal Research and Innovation 9 Rue Pierre Dreyfus 92110 Clichy France
| | - S. Njikeu
- L’Oréal Research and Innovation 9 Rue Pierre Dreyfus 92110 Clichy France
| | - M. Monot
- L’Oréal Research and Innovation 9 Rue Pierre Dreyfus 92110 Clichy France
| | - M. Vicic
- L’Oréal Research and Innovation 9 Rue Pierre Dreyfus 92110 Clichy France
| | - F. Flament
- L’Oréal Research and Innovation 9 Rue Pierre Dreyfus 92110 Clichy France
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14
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Kilic A, Masur C, Reich H, Knie U, Dähnhardt D, Dähnhardt-Pfeiffer S, Abels C. Skin acidification with a water-in-oil emulsion (pH 4) restores disrupted epidermal barrier and improves structure of lipid lamellae in the elderly. J Dermatol 2019; 46:457-465. [PMID: 31106905 PMCID: PMC6593431 DOI: 10.1111/1346-8138.14891] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 03/19/2019] [Indexed: 11/29/2022]
Abstract
The pH of the skin surface increases with age and thus reduces epidermal barrier function. Aged skin needs appropriate skin care to counterbalance age‐related pH increase and improve barrier function. This confirmatory randomized study investigated the efficacy of water‐in‐oil (w/o) emulsions with either pH 4 or pH 5.8 in 20 elderly subjects after 4 weeks of treatment. After the treatment, the skin was challenged with a sodium dodecyl sulphate (SDS) solution in order to analyze barrier protection properties of both formulations. The pH 4 w/o emulsion resulted in a significantly lower skin pH compared with the pH 5.8 w/o emulsion and an improved skin hydration after 4‐week treatment. Further, the pH 4 emulsion led to more pronounced improvements in length of intercellular lipid lamellae, lamellar organization as well as lipid levels than the pH 5.8 emulsion. Following SDS‐induced barrier damage to the skin, the pH of all test areas increased, but the area treated with the pH 4 emulsion showed the lowest increase compared with baseline. In addition, even after the SDS challenge the skin area treated with the pH 4 emulsion still maintained a significantly increased length of intercellular lipid lamellae compared with the beginning of the study. This study provides evidence that topical application of a w/o emulsion with pH 4 reacidifies the skin in elderly and has beneficial effects on skin moisturization, regeneration of lipid lamellae and lipid content. Application of a pH 4 emulsion can improve the epidermal barrier as well as the stratum corneum organization in aged skin.
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Affiliation(s)
- Ana Kilic
- Dr August Wolff GmbH & Co. KG Arzneimittel, Bielefeld, Germany
| | - Clarissa Masur
- Dr August Wolff GmbH & Co. KG Arzneimittel, Bielefeld, Germany
| | - Hubert Reich
- Dr August Wolff GmbH & Co. KG Arzneimittel, Bielefeld, Germany
| | - Ulrich Knie
- Dr August Wolff GmbH & Co. KG Arzneimittel, Bielefeld, Germany
| | | | | | - Christoph Abels
- Dr August Wolff GmbH & Co. KG Arzneimittel, Bielefeld, Germany
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15
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Siegfried EC, Jaworski JC, Mina-Osorio P. A Systematic Scoping Literature Review of Publications Supporting Treatment Guidelines for Pediatric Atopic Dermatitis in Contrast to Clinical Practice Patterns. Dermatol Ther (Heidelb) 2018; 8:349-377. [PMID: 29858763 PMCID: PMC6109028 DOI: 10.1007/s13555-018-0243-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Treatment guidelines endorse a variety of strategies for atopic dermatitis (AD) which may vary from published data and clinical practice patterns. The objective of this review was to quantify the volume of available medical literature supporting pediatric AD treatments and compare these patterns to those recommended by published guidelines and/or clinical practice patterns. METHODS Searches of Embase (2005-2016) and abstracts from selected meetings (2014-2016) related to AD treatment in patients younger than 17 years of age yielded references that were assessed by study design, primary treatment, age groups, and AD severity. RESULTS Published literature partially supports clinical guidelines, with emollients and topical medications being the most investigated. There were disproportionately more publications for topical calcineurin inhibitors (TCI) compared with topical corticosteroids (TCS); however, the search interval may have biased the results toward treatments approved near the beginning of the time frame. In contrast, publications documenting clinical practice patterns reflect greater use of emollients and TCS (over TCI), as well as systemic corticosteroids. Data is relatively limited for long-term and combination treatment, treatment of severe AD, and patients younger than 2 years of age, and completely lacking for systemic corticosteroids. CONCLUSION This scoping review demonstrates that available medical literature largely supports published guidelines for topical therapy; however, clinical practice patterns are less aligned. There is a lack of data for older, more frequently used generic treatments, including oral antihistamines, oral antibiotics, and systemic corticosteroids. Overall, literature is lacking for long-term treatment, treatment for patients younger than 2 years of age, and for systemic treatment for severe disease. FUNDING Regeneron Pharmaceuticals Inc.
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Affiliation(s)
- Elaine C Siegfried
- Saint Louis University and Cardinal Glennon Children's Hospital, St. Louis, MO, USA
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16
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Fölster-Holst R, Sperl A, Albrecht T, Klimek L. [Basis for the treatment of eczematous diseases in otorhinolaryngology]. HNO 2017; 65:826-33. [PMID: 28695412 DOI: 10.1007/s00106-017-0383-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
According to Coombs and Gell, cell-mediated immune responses belong to type IV reactions and are borne mainly by T lymphocytes. The eliciting allergens are usually so-called haptens. Haptens are substances which develop to whole antigens only by binding to protein carriers. In otorhinolaryngology, delayed allergic hypersensitivities are apparent mainly as contact eczemata. Facial dermatitis, auricle and ear canal eczema as well as perioral eczema belong to the most common forms of contact dermatitis in ENT patients. The patient's medical history and morphology of the eczema give a strong indication for a proper diagnosis. Verification is carried out by patch test according to the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF, The Association of the Scientific Medical Societies in Germany) guidelines. Hereby the most widespread contact allergens are tested in a so-called "standard block", which can be reduced to an individualized allergen spectrum, based on medical history. For therapy, allergen avoidance is the most important measure which should also be applied prophylactically. Moreover, antiinflammatory treatment of the contact eczema is carried out with tapering topical corticosteroids. Depending on the patient's age, location and severity of the contact eczema, newer class II or III preparations should be chosen. Skin care preparations are helpful to reduce corticosteroid consumption and are indicated additionally after the acute phase treatment. An important differential diagnosis of contact eczema is atopic dermatitis. Whilst contact dermatitis experiences healing by avoiding the triggering noxious agent, genetically determined atopic dermatitis shows a chronic, recurrent course. In addition to topical corticosteroids, calcineurin inhibitors have been approved for treatment of atopic eczema. In all eczema diseases, regular skin care is a necessary measure which contributes mainly to barrier repair.
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Oláh A, Szabó-Papp J, Soeberdt M, Knie U, Dähnhardt-Pfeiffer S, Abels C, Bíró T. Echinacea purpurea-derived alkylamides exhibit potent anti-inflammatory effects and alleviate clinical symptoms of atopic eczema. J Dermatol Sci 2017; 88:67-77. [PMID: 28610718 DOI: 10.1016/j.jdermsci.2017.05.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 05/12/2017] [Accepted: 05/18/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Atopic eczema (AE) is a chronic inflammatory and pruritic skin disease. There is still an unmet need for topical anti-inflammatory and anti-pruritic substances exhibiting an excellent safety profile. The endocannabinoid system is known to regulate various aspects of cutaneous barrier and immune functions, thus targeting it may be a valid approach for alleviating the symptoms of AE. OBJECTIVE To assess the putative efficacy of Echinacea purpurea-derived alkylamides (Ec. extract) activating cannabinoid (CB)-2 receptors in exerting anti-inflammatory effects and alleviating symptoms of AE. METHODS In vitro anti-inflammatory efficiency was investigated by monitoring the effects of Ec. extract on poly-(I:C)-induced pro-inflammatory cytokine expression (Q-PCR) and release (ELISA) of HaCaT keratinocytes. Irritancy and sensitization potential (assessed by Human Repeat Insult Patch Test; Clinical trial 1); clinical efficiency in alleviating symptoms of AE (Clinical trial 2) as well as effects on human skin structure and lipid content (Clinical trial 3 followed by transmission electron microscopy and HPTLC) were investigated in randomized double blind clinical trials. RESULTS Ec. extract significantly reduced mRNA expression as well as release of poly-(I:C)-induced pro-inflammatory cytokines (IL-6 and IL-8) in keratinocytes. Thus, not surprisingly, the well-tolerated (Clinical trial 1) Ec. extract-based cream reduced local SCORAD statistically significantly, not only compared to baseline, but also compared to the comparator (Clinical trial 2). Of great importance, besides the in vitro anti-inflammatory effects, administration of the Ec. extract-based cream also resulted in significantly higher levels of overall epidermal lipids, ceramide EOS (ω-esterified fatty acid+sphingosine sphingoid base), and cholesterol at Day 15 compared to baseline as well as significantly greater numbers of intercellular lipid lamellae in the intercellular space (Clinical trial 3). CONCLUSION The investigated Ec. extract shows great potential in alleviating cutaneous symptoms of AE, and by exerting remarkable anti-inflammatory actions and restoring the epidermal lipid barrier, it will be very likely a well-tolerated, powerful novel ingredient for the adjuvant therapy of AE.
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Affiliation(s)
- Attila Oláh
- Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Judit Szabó-Papp
- Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Michael Soeberdt
- Dr. August Wolff GmbH & Co. KG Arzneimittel, Sudbrackstrasse 56, 33611 Bielefeld, Germany
| | - Ulrich Knie
- Dr. August Wolff GmbH & Co. KG Arzneimittel, Sudbrackstrasse 56, 33611 Bielefeld, Germany
| | | | - Christoph Abels
- Dr. August Wolff GmbH & Co. KG Arzneimittel, Sudbrackstrasse 56, 33611 Bielefeld, Germany
| | - Tamás Bíró
- Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary; Department of Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
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Abstract
Atopic dermatitis is one of the most common skin diseases and is associated with an impaired quality of life due to tormenting itching and stigmatization. The disease almost always manifests in early childhood and exhibits specific features in this phase, with involvement of the extensor sides of the extremities. During the further course of disease, the typical flexor involvement becomes quite clear and a considerable proportion of patients develop the associated atopic respiratory diseases. Therapeutic and prophylactic measures focus on the prevention of trigger factors, basic skin care, and application of lipid-replenishing creams, as well as patient and parent education. In the case of exacerbation, anti-inflammatory drugs are treatment of choice.
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Affiliation(s)
- R Fölster-Holst
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Rosalind-Franklin-Str. 7, 24105, Kiel, Deutschland.
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Yamamoto K, Klossek A, Flesch R, Rancan F, Weigand M, Bykova I, Bechtel M, Ahlberg S, Vogt A, Blume-Peytavi U, Schrade P, Bachmann S, Hedtrich S, Schäfer-Korting M, Rühl E. Influence of the skin barrier on the penetration of topically-applied dexamethasone probed by soft X-ray spectromicroscopy. Eur J Pharm Biopharm 2016; 118:30-37. [PMID: 27998691 DOI: 10.1016/j.ejpb.2016.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 10/06/2016] [Accepted: 12/14/2016] [Indexed: 12/27/2022]
Abstract
The penetration of dexamethasone into human skin ex vivo is reported. X-ray microscopy is used for label-free probing of the drug and quantification of the local drug concentration with a spatial resolution reaching 70±5nm. This is accomplished by selective probing the dexamethasone by X-ray absorption. Varying the penetration time between 10min and 1000min provides detailed information on the penetration process. In addition, the stratum corneum has been damaged by tape-stripping in order to determine the importance of this barrier regarding temporally resolved drug penetration profiles. Dexamethasone concentrations distinctly vary, especially close to the border of the stratum corneum and the viable epidermis, where a local minimum in drug concentration is observed. Furthermore, near the basal membrane the drug concentration strongly drops. High spatial resolution studies along with a de-convolution procedure reveal the spatial distribution of dexamethasone in the interspaces between the corneocytes consisting of stratum corneum lipids. These results on local drug concentrations are interpreted in terms of barriers affecting the drug penetration in human skin.
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Affiliation(s)
- K Yamamoto
- Physikalische Chemie, Freie Universität Berlin, Takustr. 3, 14195 Berlin, Germany
| | - A Klossek
- Physikalische Chemie, Freie Universität Berlin, Takustr. 3, 14195 Berlin, Germany
| | - R Flesch
- Physikalische Chemie, Freie Universität Berlin, Takustr. 3, 14195 Berlin, Germany
| | - F Rancan
- Klinisches Forschungszentrum für Haut- und Haarforschung, Charité Universitätsmedizin, Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - M Weigand
- Max-Planck-Institut für Metallforschung, Heisenbergstraβe 3, 70569 Stuttgart, Germany
| | - I Bykova
- Max-Planck-Institut für Metallforschung, Heisenbergstraβe 3, 70569 Stuttgart, Germany
| | - M Bechtel
- Max-Planck-Institut für Metallforschung, Heisenbergstraβe 3, 70569 Stuttgart, Germany
| | - S Ahlberg
- Klinisches Forschungszentrum für Haut- und Haarforschung, Charité Universitätsmedizin, Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - A Vogt
- Klinisches Forschungszentrum für Haut- und Haarforschung, Charité Universitätsmedizin, Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - U Blume-Peytavi
- Klinisches Forschungszentrum für Haut- und Haarforschung, Charité Universitätsmedizin, Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - P Schrade
- Abteilung für Elektronenmikroskopie at Campus Virchow Klinikum (CVK), Charité Universitätsmedizin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - S Bachmann
- Abteilung für Elektronenmikroskopie at Campus Virchow Klinikum (CVK), Charité Universitätsmedizin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - S Hedtrich
- Institut für Pharmazie, Freie Universität Berlin, Königin-Luise-Str. 2+4, 14195 Berlin, Germany
| | - M Schäfer-Korting
- Institut für Pharmazie, Freie Universität Berlin, Königin-Luise-Str. 2+4, 14195 Berlin, Germany
| | - E Rühl
- Physikalische Chemie, Freie Universität Berlin, Takustr. 3, 14195 Berlin, Germany.
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Daehnhardt D, Daehnhardt-Pfeiffer S, Schulte-Walter J, Neubourg T, Hanisch E, Schmetz C, Breuer M, Fölster-Holst R. The Influence of Two Different Foam Creams on Skin Barrier Repair of Foot Xerosis: A Prospective, Double-Blind, Randomised, Placebo-Controlled Intra-Individual Study. Skin Pharmacol Physiol 2016; 29:266-272. [DOI: 10.1159/000448690] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 07/24/2016] [Indexed: 11/19/2022]
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Blaak J, Dähnhardt D, Dähnhardt-Pfeiffer S, Bielfeldt S, Wilhelm KP, Wohlfart R, Staib P. A plant oil-containing pH 4 emulsion improves epidermal barrier structure and enhances ceramide levels in aged skin. Int J Cosmet Sci 2016; 39:284-291. [DOI: 10.1111/ics.12374] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/10/2016] [Indexed: 01/15/2023]
Affiliation(s)
- J. Blaak
- Research and Development; Kneipp GmbH; D-97084 Würzburg Germany
| | - D. Dähnhardt
- Microscopy Services Dähnhardt GmbH; D-24220 Flintbek Germany
| | | | - S. Bielfeldt
- proDERM Institut für Angewandte Dermatologische Forschung GmbH; D-22869 Schenefeld Germany
| | - K.-P. Wilhelm
- proDERM Institut für Angewandte Dermatologische Forschung GmbH; D-22869 Schenefeld Germany
| | - R. Wohlfart
- Research and Development; Kneipp GmbH; D-97084 Würzburg Germany
| | - P. Staib
- Research and Development; Kneipp GmbH; D-97084 Würzburg Germany
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Stettler H, Kurka P, Lunau N, Manger C, Böhling A, Bielfeldt S, Wilhelm KP, Dähnhardt-Pfeiffer S, Dähnhardt D, Brill FHH, Lenz H. A new topical panthenol-containing emollient: Results from two randomized controlled studies assessing its skin moisturization and barrier restoration potential, and the effect on skin microflora. J DERMATOL TREAT 2016; 28:173-180. [PMID: 27425824 DOI: 10.1080/09546634.2016.1214235] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Two randomized, intra-individual comparison studies were performed in healthy subjects to evaluate the skin moisturization and barrier restoration potential of a new topical panthenol-containing emollient (NTP-CE) (Study 1), and its effect on skin microflora (Study 2). METHODS In Study 1 (N = 23), two skin areas, one challenged with 0.5% sodium dodecyl sulfate (SDS) solution and one unchallenged, were treated with NTP-CE for 3 weeks. Transepidermal water loss (TEWL), skin hydration, and intercellular lipid lamellae (ICLL) organization were measured at regular intervals during the study. In Study 2 (N = 20), quantitative bacterial cultures were obtained over 6 h from a skin area undergoing wash stress with 10% SDS with subsequent single application of NTP-CE. RESULTS In Study 1, mean AUC for TEWL reduction from baseline was more pronounced with NTP-CE compared with control (-168.36 vs. -123.38 g/m2/h, p = 0.023). NTP-CE use was also associated with statistically significant improvements in stratum corneum hydration and an increase in mean ICLL length from baseline (day 22: 120.61 vs. 35.85 nm/1000 nm2, p < 0.001). In Study 2, NTP-CE use had no negative impact on bacterial viability. CONCLUSIONS NTP-CE use has favorable and lasting effects on barrier function and repair as well as skin hydration without negatively influencing bacterial viability.
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Affiliation(s)
| | - Peter Kurka
- a Bayer Consumer Care AG , Basel , Switzerland
| | - Nathalie Lunau
- b proDERM Institute for Applied Dermatological Research , Schenefeld/Hamburg , Germany
| | - Caroline Manger
- b proDERM Institute for Applied Dermatological Research , Schenefeld/Hamburg , Germany
| | - Arne Böhling
- b proDERM Institute for Applied Dermatological Research , Schenefeld/Hamburg , Germany
| | - Stephan Bielfeldt
- b proDERM Institute for Applied Dermatological Research , Schenefeld/Hamburg , Germany
| | - Klaus-Peter Wilhelm
- b proDERM Institute for Applied Dermatological Research , Schenefeld/Hamburg , Germany
| | | | | | - Florian H H Brill
- d Dr. Brill + Partner GmbH Institute for Hygiene Und Microbiology , Hamburg , Germany
| | - Holger Lenz
- a Bayer Consumer Care AG , Basel , Switzerland
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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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Fölster-Holst R, Dähnhardt-Pfeiffer S, Dähnhardt D, Proksch E. The role of skin barrier function in atopic dermatitis: an update. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.12.17] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Dähnhardt-Pfeiffer S, Dähnhardt D, Buchner M, Walter K, Proksch E, Fölster-Holst R. Comparison of effects of tacrolimus ointment and mometasone furoate cream on the epidermal barrier of patients with atopic dermatitis. J Dtsch Dermatol Ges 2013; 11:437-43. [PMID: 23551950 DOI: 10.1111/ddg.12074] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 02/05/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND The skin barrier plays a crucial role in the pathophysiology of atopic dermatitis. The quality of the skin barrier can be assessed using a new semi-quantitative method to measure intercellular lipid lamellae. This procedure was used to evaluate the influence of the topical application of the calcineurin inhibitor tacrolimus 0.1% ointment (Protopic®) versus mometasone furoate cream (Ecural®) on the quality of the skin barrier. PATIENTS AND METHODS 20 adult patients with active atopic dermatitis (SCORAD 10-63) were included in an open, non-interventional study. Lesions on their forearms were treated twice daily over 10 days with either tacrolimus 0.1% ointment or mometasone furoate cream. At the beginning and the end of the treatment period, SCORAD, TEWL and skin hydration were determined and the intercellular lipids were measured using transmission electron microscopy. RESULTS The SCORAD improved in both groups nearly to the same extent, whereas TEWL and skin hydration improved significantly only in the tacrolimus group. Using the semi-quantitative analysis of intercellular lipid length per 1,000 nm(2) intercellular space, a twofold increase for mometasone furoate cream and a fourfold increase for tacrolimus 0.1% ointment were determined. CONCLUSIONS In addition to its known antiinflammatory effect, tacrolimus 0.1% ointment leads also to a measurable increase of the lipids of the skin barrier in patients with atopic dermatitis, exceeding the effect of mometasone furoate cream.
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