Treatment with a barrier-strengthening moisturizing cream delays relapse of atopic dermatitis: a prospective and randomized controlled clinical trial.

BACKGROUND: Standard treatment of atopic dermatitis (AD) is based on topical glucocorticosteroids or calcineurin inhibitors to treat flares combined with moisturizer treatment to alleviate dry skin symptoms. Patients with AD have an abnormal skin barrier function, and strategies for reducing the risks for eczema would be to repair the barrier or prevent barrier dysfunction. OBJECTIVES: The objective of this study was to explore the time to relapse of eczema during a 26-week maintenance treatment with a urea containing moisturizer compared to no treatment (neither medical nor non-medicated preparations) after successful clearing of atopic lesions. The moisturizer has previously been shown to improve skin barrier function. METHODS: Patients applied betamethasone valerate (0.1%) on eczematous lesions during a 3-week period. Those with cleared eczema entered a 26-week maintenance phase, applying the moisturizer or left the previously affected area untreated. Upon eczema relapse, patients were instructed to contact the clinic and to have the relapse confirmed by the investigator. RESULTS: Fifty-five patients entered the study and 44 patients were included in the maintenance phase (22 using moisturizer twice daily and 22 using no treatment). Median time to relapse for patients treated with moisturizer was > 180 days (duration of the study) compared with 30 days for the no-treatment group. Sixty-eight per cent of the patients treated with the moisturizer and 32% of the untreated patients remained free from eczema during the observation period. CONCLUSIONS: Maintenance treatment with a barrier-improving urea moisturizer on previous eczematous areas reduced the risk of relapse to approximately one third of that of no treatment.

A double-blind and controlled study on the influence of the vehicle on the skin susceptibility to stinging from lactic acid.

Synopsis For patients with skin diseases, the process of treating the skin with topical medications adds to the burden of having the disease. Inconvenient skin reactions can make the treatment troublesome and lower the compliance. Moreover, epidemiological surveys indicate that 50% or more of female consumers believe they have sensitive skin. In the present study, the influence of the vehicle on the adverse skin reaction to lactic acid was judged by the test subjects after application of the test formulations to the facial skin. The results showed a water-in-oil (w/o) emulsion to induce less stinging than an ordinary oil-in-water (o/w) emulsion. Increasing the mineral oil content in the o/w emulsion from 10% to 50% tended (P = 0.077) to decrease the stinging potential of the formulation. An o/w emulsion free from lactic acid but with pH adjusted to 3 using hydrochloric acid induced significantly less stinging than the corresponding lactic acid formulation at pH 3. In conclusion, the present study gives new insights into the influence of vehicle on the stinging capacity of lactic acid, which may be related to its possible penetration via appendages. Hence, encapsulation of the stinging substances in the inner water phase of an emulsion may be a possible option to reduce adverse skin reactions and to increase compliance to water-soluble substances.

Irritation potential of bath and shower oils before and after use: a double-blind randomized study.

BACKGROUND: Difficulties in avoiding weak irritants may contribute to chronic contact dermatitis. A large variety of shower and bath oils are claimed to be suitable for use on dry skin because of their mildness and because they deposit a protective oil film on the skin. OBJECTIVES: The aim of the present study was to investigate possible differences in the irritation potential of eight shower or bath oils and to investigate whether surfactant residues may form a reservoir of irritant substance on the skin. PATIENTS AND METHODS: The study was double-blind and randomized using healthy human volunteers. The inherent capacity of the products to induce irritation was determined using conventional patch test techniques. Detection of potentially irritant residues was done by occlusion of the treated and rinsed skin area, followed by evaluation of the biological response. Instrumental measurements of transepidermal water loss and superficial skin blood flow served as indicators of the injurious effects of the products. RESULTS AND CONCLUSIONS: The results showed large differences between the products in irritant potential. Some did not irritate skin more than water, whereas others demonstrated considerably damaging effects. Moreover, the study proved the presence of barrier-impairing residues on the skin after rinsing with water. Thus, instead of protecting the skin, some formulations may induce subclinical injuries and delay skin barrier function recovery with prolonged risk for patients with eczema.