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Colloidal Oatmeal (Avena Sativa) Improves Skin Barrier Through Multi-Therapy Activity

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Oats (Avena sativa) are a centuries-old topical treatment for a variety of skin barrier conditions, including dry skin, skin rashes, and eczema; however, few studies have investigated the actual mechanism of action for the skin barrier strengthening activity of colloidal oatmeal. Four extracts of colloidal oatmeal were prepared with various solvents and tested in vitro for skin barrier related gene expression and activity. Extracts of colloidal oatmeal were found to induce the expression of genes related to epidermal differentiation, tight junctions and lipid regulation in skin, and provide pH-buffering capacity. Colloidal oatmeal boosted the expression of multiple target genes related to skin barrier, and resulted in recovery of barrier damage in an in vitro model of atopic dermatitis. In addition, an investigator-blinded study was performed with 50 healthy female subjects who exhibited bilateral moderate to severe dry skin on their lower legs. Subjects were treated with a colloidal oatmeal skin protectant lotion. Clinically, the colloidal oatmeal lotion showed significant clinical improvements in skin dryness, moisturization, and barrier. Taken together, these results demonstrate that colloidal oatmeal can provide clinically effective benefits for dry and compromised skin by strengthening skin barrier. J Drugs Dermatol . 2016;15(6):684-690.
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C ©  ORIGINAL ARTICLES J  D  D
SPECIAL TOPIC
Colloidal Oatmeal (Avena Sativa) Improves Skin Barrier
Through Multi-Therapy Activity
Olha Ilnytska PhD, Simarna Kaur PhD, Suhyoun Chon PhD, Kurt A. Reynertson PhD, Judith Nebus MBA,
Michelle Garay MS, Khalid Mahmood PhD, and Michael D. Southall PhD
Johnson & Johnson Skin Research Center, Johnson & Johnson Consumer Inc. Skillman, NJ
Oats (Avena sativa) are a centuries-old topical treatment for a variety of skin barrier conditions, including dry skin, skin rashes, and
eczema; however, few studies have investigated the actual mechanism of action for the skin barrier strengthening activity of colloidal
oatmeal. Four extracts of colloidal oatmeal were prepared with various solvents and tested in vitro for skin barrier related gene expres-
sion and activity. Extracts of colloidal oatmeal were found to induce the expression of genes related to epidermal differentiation, tight
junctions and lipid regulation in skin, and provide pH-buffering capacity. Colloidal oatmeal boosted the expression of multiple target
genes related to skin barrier, and resulted in recovery of barrier damage in an in vitro model of atopic dermatitis. In addition, an investi-
gator-blinded study was performed with 50 healthy female subjects who exhibited bilateral moderate to severe dry skin on their lower
legs. Subjects were treated with a colloidal oatmeal skin protectant lotion. Clinically, the colloidal oatmeal lotion showed signicant
clinical improvements in skin dryness, moisturization, and barrier. Taken together, these results demonstrate that colloidal oatmeal can
provide clinically effective benets for dry and compromised skin by strengthening skin barrier.
J Drugs Dermatol. 2016;15(6):684-690.
ABSTRACT
INTRODUCTION
Oats (Avena sativa) have been cultivated since the
Bronze Age, and the use of oats as a topical therapy
for variety of dermatological conditions dates to Ro-
man times. Initially, colloid baths were prepared by boiling oat-
meal to extract the gelatinous colloidal material.1 In the early to
mid twentieth century in the recorded scientic literature the
term of colloidal oatmeal was beginning to appear.2 In 1945,
a ready-to-use colloidal oatmeal became available, and soon
after several clinical studies demonstrated its benets as a rem-
edy for inamed, dry and itchy skin dermatoses.3-5 In 2003, the
FDA approved the use of colloidal oatmeal as a skin protec-
tant, and currently colloidal oatmeal is commonly used for skin
rashes, erythema, burns, itch, and eczema.5,6
Despite a rich history of traditional use, the exact mechanisms
of action that give colloidal oatmeal its clinical benets remain
unknown. A recent study has reported that colloidal oatmeal can
reduce the expression of pro-inammatory mediators in kera-
tinocytes and decrease activation of the NF-kB pathway, which
could contribute to the anti-inammatory activity of colloidal
oats on irritated skin.7 In addition, Chon and colleagues recently
reported that a lipophilic extract isolated from oats can induce
ceramide synthesis in keratinocytes through activation of the
PPAR pathway.8 We conducted a series of in vitro experiments
and a clinical study to help identify the mechanism of action for
the clinical benet of colloidal oatmeal on skin barrier. Extracts
of colloidal oatmeal were prepared using organic and aque-
ous solvents to concentrate constituents based on compound
polarity, and were subjected to molecular and functional assays
related to skin barrier. In addition, an investigator-blinded clini-
cal study was conducted to evaluate the efcacy of a colloidal
oatmeal skin protectant lotion in improving barrier function in
moderate to severely dry skin. Results of these studies dem-
onstrate that colloidal oats can increase skin’s expression of
epidermal differentiation targets and lipids involved in barrier
function, can provide pH-buffering capacity for skin and can
clinically improve skin barrier function. Thus, colloidal oatmeal
as an ingredient provides a multi-therapy approach for dry and
compromised skin by strengthening skin barrier.
MATERIALS AND METHODS
Preparation of Extracts of Colloidal Oatmeal
Four extracts of colloidal oatmeal were prepared using HPLC-
grade hexanes, 80% aqueous acetone, 80% aqueous methanol,
and water to generate extracts enriched in phytochemicals
based on polarity as previously described.7 For cell culture ex-
periments, stock solutions of each extract were dissolved in
DMSO (50 mg/mL) and diluted into media (DMSO < 0.01%).
In Vitro Skin Models and Treatment
Epidermal equivalents (EPI 200 HCF) were purchased from
MatTek (Ashland, MA). Equivalents were topically treated
(2mg/cm2) with colloidal oatmeal skin protectant lotion twice
every 24 hours. Equivalents were incubated for 48 hours at
37°C with maintenance medium then tissues were harvested
for the protein or mRNA expression analysis. Primary human
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Measurement of Transepithelial Electrical
Resistance (TEER)
For TEER immature epidermal skin equivalents (EPI-20, Mat-
Tek Corporation, Ashland, MA) were transferred to medium
containing 100ng/ml IL-4, 100 ng/ml IL-13, 50ng/ml IL-31 and
30ng/ml TNFα (R&D Systems, Minneapolis, MN). Colloidal oat-
meal skin protectant lotion was applied topically twice every
24 hours after 4 hours of pretreatment with cytokines. TEER
was measured at 0, 24, and 48 hours by using Millicell ERS-2
Epithelial Volt-Ohm Meter (Milipore). Tissues were placed in six-
well tissue culture plates containing 5ml of culture medium and
overlaid with 400 ml of PBS for the time required to measure
electrical resistance The percentage change in TEER between
time 0 (100%) and time 24 hours was expressed as follows:
(TEER24hours/TEER0hours)X100.
Clinical Study Design
A ve-week investigator-blinded randomized clinical study
was conducted to demonstrate the effectiveness of an oatmeal
skin protectant lotion in improving the moisture and barrier
function of moderate to severe dry skin and to measure the
residual skin effects after treatment is stopped. A standard
Kligman Regression model was utilized. The protocol was ap-
proved by an IRB and informed consent was obtained from
all subjects. Following a conditioning period, subjects used
the oatmeal skin protectant lotion on their lower leg twice a
day for a period of three weeks (Days 1-21). For the following
2 weeks (Days 22-34), subjects did not use the test product
or any other lotions on their legs. Dry skin was evaluated by
an expert graded and instrumental analysis (trans-epider-
mal water loss and Skicon) measured barrier function and
skin moisture. Statistical analysis of data was performed to
determine efcacy.
Population
50 subjects completed the study. Subjects were healthy fe-
males, between the ages of 18-65 years old, with moderate to
severe dry skin on both lower legs at the time of enrollment.
Subjects washed with a standardized soap for ve days prior to
the baseline visit.
keratinocytes (PromoCell GmbH, Heidelberg, Germany) were
maintained in Keratinocyte Growth Medium-2 in the presence
of supplements and 0.06mM CaCl2 (PromoCell). Addition-
al CaCl2 was added to induce differentiation at the point of
treatment. Keratinocytes were treated for 48 hours in the pres-
ence of 1.2 mM CaCl2 with colloidal oatmeal extract or vehicle
(DMSO).
Gene Expression
RNA was extracted from primary human keratinocytes or epi-
dermal human skin equivalents using Qiagen RNeasy Plus
Mini kit with DNase I digestion (Qiagen, Valencia, CA). Reverse
transcription was performed using High Capacity cDNA kit (Life
Technologies, Grand Island, NY). 40 to 60ng of cDNA samples
were used in a qPCR reaction to measure CLDN4, CLDN7,
TGM1, ELOVL4, UGCG, HMGCR, and PPARβ/δ using ABI 7500
fast amplier. All gene expression data were normalized by
reference gene, polymerase (RNA) II polypeptide A (POLR2A),
and veried using GAPDH. Statistical signicance (P< 0.05) was
determined by one-way ANOVA. Gene expression is reported
relative to untreated samples or vehicle control.
Protein ELISAs
Epidermal skin equivalents were homogenized on ice in RIPA
buffer (Alfa Aesar, Ward Hill, MA) in the presence of protease in-
hibitors (Sigma, St Louis, MO). Homogenates were centrifuged
at 14,000 × g at 4°C for 15 min. Total protein in was measured in
supernatants by bicinchoninic acid protein assay (BCA) (Pierce
Biotechnology, Rockford, IL) and ANGPTL4 immunoassay was
carried out using Milliplex Map Human Liver Protein Magnetic
Bead Panel hANGPTL4-MAG (EMD Millipore, Billerica, MA)
according to manufacturer’s instructions on a Luminex xMAP
platform (Luminex Corporation, Austin, TX). ANGPTL4 concen-
trations were normalized per mg protein. Involucrin protein
level was assessed in keratinocytes whole cell extracts using
Milliplex Map Human Skin Magnetic Bead INVOL-MAG (EMD
Millipore, Billerica, MA).
PH Buffering
Extracts prepared for buffering capacity determination were in
the form of water insoluble solids. The solids were dispersed
in water to enable pH measurements and titration with hy-
drochloric acid (HCl). The pH of the dispersed samples was
measured before and after the titration. Hydrochloric acid solu-
tions (0.001 to 0.01N) were used to drop the pH by one unit. The
initial pH of the samples ranged between pH 5 to 9. Buffering
capacity was determined and expressed as the micro equiva-
lent of hydrogen ions required to change the pH of the sample
equivalent by one pH unit using previously published proce-
dures (28). The given formula was used for calculation of the
buffering capacity (BC) value: BC (µeq H+ ions) = (Na*Va)/W,
wherein: Na = Normality of acid (mol/L); Va = Volume of acid
used (L); W = weight of material used (g).
TABLE 1.
Summary of Colloidal Oat Extracts
Extraction solvent Abbreviation Expected Phytochemistry
Hexanes HCO Oils and lipophilic
compounds
80% Acetone ACO Mid-polar compounds
80% MeOH MCO Mid-polar to polar
compounds
Water WCO
Polar compounds
such as proteins and
carbohydrates
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O. Ilnytska, S. Kaur, S. Chon, et al
point. A Student’s t-test was used at each post treatment time
point for the analysis of moisturization and transepidermal wa-
ter loss data, with signicance set at P<0.05.
RESULTS
Preparations of Extracts
The hexane extract of colloidal oatmeal (HCO) generated an
oily residue (3.8% yield); the aqueous acetone extract of col-
loidal oatmeal (ACO) generated a sticky amorphous powder
(2.6% yield); the aqueous methanol extract of colloidal oatmeal
(MCO) generated a dry amorphous powder (2.5% yield); the
water extract of colloidal oatmeal (WCO) generated a white
powder (0.7% yield). An approximate qualitative composition
of each extract based on the nature of extraction processes is
presented in Table 1 along with a summary of bioactivities.
Colloidal Oatmeal Extracts Upregulated Barrier
Genes
We rst analyzed whether colloidal oatmeal extracts can
modulate expression of key target genes associated with skin
barrier in human primary keratinocytes (KCs). MCO, ACO, and
HCO extracts dose-dependently induced mRNA expression
In Vivo Treatment
Subjects applied the colloidal oatmeal skin protectant lotion
twice a day for three weeks to the lower leg area. Subjects were
instructed to apply an approximate amount of the lotion from
the knee to the ankle. Product applications were made at a min-
imum of 8 hours apart. For the following 2 weeks, no treatment
or any moisturizing products were applied to the lower leg
area. A mild cleanser was provided for use during all showering
or bathing. No product related adverse events were observed
during the study.
Measurements
Dry skin was evaluated by an expert grader and instrumental
analysis (trans-epidermal water loss (TEWL): Dermalab (Cortex
Technology, Denmark) and Moisture measurements: Skicon
200 EX (IBS Co, Japan)) at baseline and various time points
over the 5-week study.
Statistical Analysis
The data used in the statistical analysis were the changes from
baseline. For the analysis of visual dryness scores, a Wilcoxon’s
Signed Rank Test was conducted at each post treatment time
FIGURE 1. Colloidal oatmeal extracts upregulated skin barrier biomarkers in primary human keratinocytes.
(A) Effect of colloidal oatmeal extracts on mRNA level of key regulators of skin barrier. Primary human keratinocytes were cultured in 1.2 mM
of CaCl2 in the presence or absence of colloidal oatmeal extracts for 48 hours. RNA was extracted from the cells and the levels of ELOVL4,
TGM1, IVL and CLDN7 were evaluated by real time quantitative PCR. Data were presented as fold activation over vehicle (mean ± SEM from
triplicates). (B) Involucrin protein expression level was evaluated by ELISA in whole cell KC extracts at 48 hours after treatment with 50 PPM
MCO. VEH-vehicle control (DMSO). HCO, MCO, WCO and ACO – hexane, methanol, water and acetone oatmeal extracts, respectively.
* P<0.05, **P<0.01, ***P<0.001 compared with VEH.
(A) (B)
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O. Ilnytska, S. Kaur, S. Chon, et al
of epidermal differentiation markers involved in cornied en-
velope formation, transglutaminase-1 (TGM1), and involucrin
(IVL) compared with vehicle control (Figure 1A). We also ob-
served an enhancement of mRNA level of claudin-family tight
junction (TJ) protein claudin-7 (CLDN7) induced by MCO and
ACO. Additionally, mRNA expression of enzyme involved in
the synthesis of long chain FFAs, and acyl-ceramide synthesis,
elongase of very long chain fatty acids-4 (ELOVL4), was upregu-
lated following treatment with MCO, ACO, and HCO. MCO also
resulted in a 3-fold upregulation of involucrin protein levels in
primary keratinocytes (Figure 1B).
Colloidal Oat Enhanced Expression of Barrier Genes
The pH buffering capacity (BC) of whole colloidal oatmeal wa-
ter extract and its fractions were investigated (Table 2). The BC
of the water extract of colloidal oat was signicantly higher
(BC=142) than the BC of the native colloidal oat (BC=40.8). The
extract is enriched in globulin proteins (20-35 kDa and 50-60
kDa), assessed by protein gel electrophoresis analysis (data not
shown) and consistent with previously published data,9 and
carbohydrates. The >20 kDa fraction, which contains primarily
globulins, had a slightly lower BC=114 than the crude water ex-
tract. The fraction isolated in the 3-20 kDa range presumably
contains the gluteins, as well as some prolamins,9 did not sig-
nicantly contribute to the overall BC of colloidal oat (Table 2).
Collectively, the buffering capacity demonstrated that the water
extract of colloidal oatmeal possessed effective pH buffering
activity, suggesting that colloidal oats can be benecial for skin
by helping to provide a skin barrier with enhanced pH buffer-
ing capacity and therefore potentially aid in protection against
irritants.
We next analyzed expression of barrier regulatory genes in hu-
man skin equivalents after topical application of colloidal oatmeal
protectant lotion. The colloidal oatmeal containing lotion signi-
cantly induced the expression of TJ genes CLDN7 and CLDN4,
and other target genes including TGM1, HMG-CoA reductase
(HMGCR - the key enzyme of cholesterol synthesis), and ceramide
glucosyltransferase UGCG (which is involved in the initial step of
glycosphingolipid synthesis; Figure 2A). Furthermore, an increase
in the expression of PPARβ/δ (transcription factor with critical
roles in regulating lipid homeostasis) and its direct target protein
ANGPLT4-encoding adipocytokine was also observed (Figure 2B).
Taken together, these results demonstrate that the colloidal oat-
meal up-regulated genes of key biological targets responsible for
the functionality of the cellular and lipid skin barrier and therefore
can provide overall skin barrier related benets.
FIGURE 2. Colloidal oatmeal lotion upregulated skin barrier markers
in human epidermal skin equivalents. Human epidermal skin equiva-
lents were treated with topical application of colloidal oatmeal
lotion for 48 hours. (A) mRNA was isolated and changes in mRNA
level for CLDN4, CLDN7, TGM1, UGCG, HMGCR, and PPARβ/δ were
assessed by real time quantitative PCR. Data were presented as
fold activation over untreated. (B) Total protein was extracted from
tissues and ANGPLT4 level was assessed by ELISA, as described in
Materials and Methods. COPL-colloidal oatmeal protectant lotion.
**P<0.01 compared with untreated
(A)
(B)
TABLE 2.
Buffering Capacity of Colloidal Oatmeal, Water Extract of
Colloidal Oatmeal, and Its Fractions
Sample Buffer capacity
colloidal oat 40.8
water extract of colloidal oatmeal 142.0
>20kDa fraction 114.0
<20kDa fraction 52.6
<3kDa fraction 89.5
3-20kDa fraction 1 7. 1
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period. After 3 weeks of treatment, there was highly signicant
(P<0.05) increase in skin moisture when compared to the base-
line mean score. At the end of the regression phase (2 weeks no
treatment) mean moisturization values were still signicantly
higher than baseline suggesting the maintenance of barrier
homeostasis. Skin barrier integrity and hydration was also as-
sessed by transepidermal water loss (TEWL) measurements.13
Reduced TEWL values indicated a signicant improvement in
skin barrier (P<0.05) at all time points during the treatment pe-
riod and up to day 9 of the regression (no treatment) phase of
the study.
DISCUSSION
The aim of this study was to investigate the mechanism of action
of colloidal oatmeal on skin barrier in vitro and in vivo. Treatment
of primary human keratinocytes with colloidal oatmeal extracts
signicantly induced the gene expression of key skin barrier bio-
markers that was accompanied by production of involucrin, a
protein required for the formation of the cornied envelope (Fig-
ure 1). Our study further demonstrates that the topical application
of the colloidal oatmeal lotion was able to enhance expression of
genes involved in keratinocyte differentiation (TGM1), lipid produc-
tion (PPARβ/δ, HMGCR and UGCG) and TJ formation (CLDN4 and
CLDN7) in the human skin equivalent model (Figure 2) suggesting
an enhancement in cornied cell envelope maturation, permeabil-
ity barrier structure and TJ integrity, respectively, in normal skin.14
The fractions of colloidal oat that resulted in the greatest induction
of skin barrier gene expression were the methanol and acetone
extracts, which contain phenolic compounds such as avonoids
and avenanthramides, and alcohol-soluble albumin proteins.
The current study determined that colloidal oatmeal protected the
epidermal skin barrier from the damage caused by exogenous
treatment with cytokines in epidermal skin model of atopic der-
matitis. Th2 cytokine treatment in combination with TNF-α perturbs
skin barrier by inhibiting differentiation of keratinocytes, inducing
cytoskeletal rearrangement and disturbing TJ integrity, and mim-
ics atopic dermatitis skin.10,11,15 Using a skin barrier integrity test
we observed a remarkable reduction of TEER following treatment
with Th2 cytokines and TNF-α, and the colloidal oatmeal protectant
lotion treatment signicantly alleviated the damaging effect of
cytokines on skin barrier (Figure 3). The inammation reduction
and barrier improvement by colloidal oatmeal can be also poten-
tially triggered by up-regulation of the nuclear hormone receptor
PPARβ/δ and its target gene, ANGPTL4. Indeed, PPARα and PPAR
β/δ activators signicantly inhibited Th2-mediated inammation
and decreased generation of Il1-α and TNF-α in murine model of
dermatitis.16 Evidence for the important role of PPARα, PPARβ/δ
and LXR activators in regulation of normal and compromised bar-
rier function is emerging.8,16-19 Collectively these in vitro results
suggest that the colloidal oatmeal protectant lotion could be ben-
ecial for dry or compromised skin conditions such as xerosis or
atopic dermatitis.
Colloidal Oatmeal Helped in the Recovery of Cyto-
kine-induced Barrier Disruption
T-helper cell 2 (Th2)-derived cytokines Il-4, Il-13, IL-31 and
pro-inammatory TNF-α have previously been reported to
down-regulate expression of key barrier genes such as llag-
grin (FLG), loricrin (LOR) and involucrin (IVL)10,11 that leads to
differentiation defects and reduced lipid envelope reminiscent
of atopic dermatitis. To generate inammatory skin phenotype
and therefore weaken skin barrier we exposed developing
human epidermis to a cocktail of four above mentioned cyto-
kines. We employed a transepithelial electrical resistance TEER
method to quantify the barrier integrity and evaluate TJ bar-
rier function.12 We found remarkable (52%) decrease in TEER
at 48 hours after treatment with cytokines compared with the
untreated tissues (Figure 3). This condition was signicantly
alleviated by topical colloidal oatmeal skin protectant lotion
treatment (32% of protection compared with cytokines alone).
Colloidal Oatmeal Lotion Significantly Improved Skin
Dryness, Hydration and Skin Barrier Integrity In Vivo
Clinical evaluations of skin dryness of individuals with moderate
to severe dry skin showed signicant improvements (P<0.05) at
all time-points during the treatment and regression period with
the colloidal oatmeal protectant lotion, including 13 days after
the last application when compared to baseline values (Figure
4). Skin was signicantly (P<0.05) more hydrated at all time
periods measured during both the treatment and regression
FIGURE 3. Colloidal oatmeal lotion protected skin barrier from disrup-
tion caused by cytokines. Untreated or colloidal oatmeal protectant
lotion-treated (COPL) epidermal skin equivalents were incubated in
the presence or absence of cytokine cocktail (CC) containing TNF-α
(30ng/mL), IL-4 (100ng/mL), IL-13 (100ng/mL) and IL-31 (50ng/mL) and
TEER was measured at 48 hours.
**P<0.01 compared with untreared, ##P<0.01 compared with CC
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J  D  D
J 2016 • V 15 • I 6
O. Ilnytska, S. Kaur, S. Chon, et al
Dry skin is a common condition on the legs, particularly devel-
oped during winter and is often correlated with impaired barrier,
decreased stratum corneum hydration and increased TEWL.20
Our clinical study demonstrated that treatment of individuals
with moderate to severely dry skin with the colloidal oatmeal
protectant lotion was effective in signicantly restoring the skin
barrier, improving visual dryness and moisturization of dry
skin. In addition, skin benet continued for up to 13 days after
the last application in the regression phase of the study. Clinical
evaluations of skin dryness showed signicant improvements
(P<0.05) at all time points during the treatment and regression
period, including 13 days after the last application. Skin was
signicantly more hydrated (P<0.05) at all time periods mea-
sured during both the treatment and regression period. At the
end of the regression phase (2 weeks no treatment) mean mois-
turization values were still signicantly higher than baseline.
All these changes were accompanied by signicantly improved
TEWL values at all time points during the treatment period and
up to day 9 of the regression (no treatment) phase of the study
indicating that the colloidal oat treatment was effective in re-
storing the skin barrier.
The acid-mantle in skin of individuals with atopic dermatitis
or compromised skin has been found to be disrupted, result-
ing in an elevated skin pH in those individuals.21-23 Previous
studies have demonstrated that colloidal oats can buffer
skin pH in subjects with either dry skin dermatitis or indi-
viduals with atopic dermatitiss.4 The pH-buffering capacity of
colloidal oat fractions demonstrated that the water fraction
(WCO) which is rich in water-soluble oat proteins (globulins
and prolamines) and carbohydrates, demonstrated very ef-
fective pH buffering activity (Table 2). These ndings support
the notion that oat proteins may directly contribute to the
skin barrier benets of colloidal oatmeal. The use of colloi-
dal oats for skin irritation and compromised skin barrier has
been well documented. Only recently studies have deter-
mined the mechanisms of action of how colloidal oatmeal
can reduce inammation and restore skin barrier.7 The cur-
rent study demonstrates in vitro that the colloidal oatmeal
increased expression of genes for skin barrier protein and
skin lipid, which could contribute to improved skin barrier.
And nally a colloidal oatmeal skin protectant lotion yielded
signicant clinical improvements in visual skin dryness, skin
moisture, decreased TEWL and therefore improved the skin
barrier, suggesting that colloidal oatmeal can exert benecial
effects on skin barrier through the enhancement of barrier
homeostasis. Taken together, these results demonstrate that
oatmeal-containing lotions can restore skin barrier thereby
providing benets for dry and compromised skin.
DISCLOSURES
Funding sources: Studies were supported by Johnson & Johnson
Consumer Companies, Inc. Skillman, New Jersey, USA.
FIGURE 4. The effectiveness of the oatmeal lotion in improving and main-
taining barrier function and moisture levels of moderate to severe dry skin.
(A) Visual dryness. Expert grader evaluations showed significant improve-
ment (P<0.05) in visual dryness at all time points when compared to base-
line values. (B) Conductance measurements show significant increase
in skin moisturization (P<0.05) were observed at all time points compared
to baseline, including up to 13 days after last application. (C) Significant
reduction (P<0.05) in the TEWL were observed during all time periods of
the treatment phase of the study (Days 3,7,14,21) and during days 22, 24,
30, and 32 of the regression phase when compared to the baseline mean
score. There were no significant improvements on days 28 and 34 of the
regression phase of the study when compared to baseline. A decrease in
TEWL values is indicative of an improvement of barrier function.
(A)
(B)
(C)
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J  D  D
J 2016 • V 15 • I 6
O. Ilnytska, S. Kaur, S. Chon, et al
AUTHOR CORRESPONDENCE
Michael D. Southall PhD
E-mail:................……....................................... msoutha@its.jnj.com
Drs. Olha Ilnytska, Simarna Kaur, Suhyoun Chon, Kurt A. Rey-
nertson, Khalid Mahmood, and Michael D. Southall and Judith
Nebus and Michelle Garay are employees of Johnson & Johnson
Consumer Companies, Inc. Skillman, New Jersey, USA.
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... According to Vie et al., Avena sativa extracts are able to modulate SLS-induced skin irritation, confirming their preventive effects on alteration of the cutaneous barrier function and microvasculature [21]. These data correspond with other studies, which have determined that the topical three-week application of oat extract containing β-glucans significantly increased moisture content and improved skin barrier function [22]. Criquet et al. have determined that hydration of the forearm skin increased significantly (5.6-22.2%) ...
... A negative (−1.28%) skin moisture change was determined after 4 h (p < 0.01 vs. 180 min). Although other studies indicate that oat extract significantly affects skin moisture and improves barrier function (after 21 days of daily use skin moisture increased three times), the tested W/O/W type emulsion containing herbal extracts showed a significantly lower skin-moisturizing effect after 15-240 min compared to O/W type control emulsion [22]. Also there is a chance that such effect occurred due to the presence of ethanol in the system. ...
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The increased interest in natural cosmetics has resulted in a higher market demand for preservative-free products based on herbal ingredients. An innovative W/O/W type emulsions containing herbal extracts were prepared directly; its cation form was induced by an ethanolic rosemary extract and stabilized using weak herbal gels. Due to the wide phytochemical composition of herbal extracts and the presence of alcohol in the emulsion system, which can cause skin irritation, sensitization or dryness when applied topically, the safety of the investigated drug delivery system is necessary. The aim of our study was to estimate the potential of W/O/W emulsions based on natural ingredients for skin irritation and phototoxicity using reconstructed 3D epidermis models in vitro and to evaluate in vivo its effect on human skin moisture, sebum content and pigmentation by biomedical examination using a dermatoscopic camera and corneometer. According to the results obtained after in vitro cell viability test the investigated emulsion was neither irritant nor phototoxic to human skin keratinocytes. W/O/W emulsion did not cause skin dryness in vivo, despite the fact that it contained ethanol. We can conclude that the emulsion is safe for use as a leave-on product due to the positive effect on human skin characteristics or as a semisolid pharmaceutical base where active compounds could be encapsulated.
... 27 In vitro model of dermatitis showed colloidal oatmeal through inducing the expression of genes related to epidermal differentiation and tight junctions, and lipid regulation can enhance recovery of skin barrier damage. 28 Ceramides, cholesterol, and fatty acids are the major lipid species of the stratum corneum that act as a barrier to irritants, allergens, and microbes and limits skin water loss and regulates temperature. 29 Common skin irritants such as Sodium Lauryl Sulfate (SLS) and sodium dodecyl sulfate (SDS) can reduce the content of ceramides in the stratum corneum. ...
... Preliminary in vitro evidence has shown that the ingredients in oatmeal, such as saponins can act as a buffer system, restoring the normal PH of the skin and through it can enhance recovery of barrier damage in skin dermatitis. 28 Activation of the epidermal keratinocytes and subsequent release of pro-inflammatory cytokines, such as interleukin (IL)-1α, IL-1β, IL-6, and tumor necrosis factor (TNF)-α is another key pathogenic factor in acute-phase reactions of ICD. Releasing these cytokines can stimulate further production of other proinflammatory biomarkers that enhance the delivery of immune cells into the irritant injury site and exacerbate skin inflammation. ...
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Background: Irritant contact dermatitis (ICD) is the most frequent cause of hand eczema (HE). There is promising evidence with the use of topical oatmeal compounds in the management of inflammation- and itch-responses associated with diverse dermatologic conditions. This study aimed to evaluate the clinical benefit of colloidal oatmeal cream in the management of chronic irritant HE. Methods: From October 2018 to November 2019, 79 patients with diagnosis of chronic irritant HE were allocated into either intervention or control groups by block randomization method. Besides fluocinolone 0.025% ointment for the first 2 weeks of treatment period, patients in the intervention and control groups were asked to use colloidal oatmeal 1% cream or base cream for additional 4 weeks as monotherapy. Changes in the HE severity based on the hand eczema severity index (HESCI) score, pruritus severity based on the visual analogue scale (VAS), and impact of skin disorder on patients quality of life based on the Dermatology Life Quality Index (DLQI) from baseline to weeks 2, 4, and 6 were assessed in the study groups. Results: Fifty subjects, 26 in intervention and 24 in control, completed the course of the study. The results indicated, though relatively comparable decrease in mean HESI and VAS scores was observed in both groups by the end of week 2, thereafter until end of the study a non-return of symptoms to baseline conditions was observed in the intervention group, while there was a significant return of symptoms to baseline conditions in the control group (p value<0.001 in both conditions). Further, a noticeable improvement in the DLQI score was seen in the intervention group compared with the control group (p value<0.001). Conclusion: Findings demonstrate that colloidal oatmeal, a natural product with proven barrier protection, moisturization, anti-inflammatory, and soothing properties, can have ameliorative effects on eczema severity symptoms in patients with chronic irritant HE.
... The highest number of RCTs concerning selected skin conditions tested natural products for their skin protection properties (n = 12) and was published between 1997 and 2018. The investigated plants/products included Polypodium leucotomos (Gonzalez et al., 1997), Camellia sinensis (Camouse et al., 2009), Hibiscus abelmoschus (Rival et al., 2009), Calendula officinalis (Akhtar et al., 2011), Avena sativa (Michelle, 2016), Ribes nigrum (Ray et al., 2016), phenolic veratric acid , and Cucumis melo (Egoumenides et al., 2018), as a single ingredient within the formulation. Four other RCTs investigated the combination of extracts, including soy and jasmine (Bazin et al., 2010), dead sea water and Himalayan extracts (Wineman et al., 2012), Olea europaea and Helianthus annuus (Danby et al., 2013), and Portulaca oleracea and Prinsepia utilis (Wang et al., 2018). ...
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Cosmetics are marketed and used worldwide for various purposes. Several natural products are used for the development of cosmetic preparations. This paper systematically reviews randomized controlled trials (RCTs) investigating plant extracts, herbal preparations, and isolated plant-derived compounds used particularly for skin and hair care. Two independent electronic searches were conducted through PubMed and EMBASE to identify eligible RCTs. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was followed. Data extraction was performed independently by four authors based on standardized extraction forms. The risk of bias was assessed using the Cochrane Collaboration’s tool for assessing the risk of bias in randomized trials. Sixty-three RCTs were identified; 53 were using natural products for skin care and 10 for hair care. The results were summarized in tables including the population, type of intervention, comparisons with placebo or other natural products, outcomes reported, follow-up period (P: Patient, Population; I: Intervention; C: Comparison (or Control); O: Outcome; T: Time), and country in which the study was conducted. Ten plants were identified to be present in different locations in Jordan by referring to the Royal Botanic Gardens’ publication, titled “The Plants of Jordan: An Annotated Checklist.” Some plants were found to have promising findings requiring further investigations in bigger RCTs with robust design and adequate reporting.
... The topical use of natural products may produce health benefits for some individuals. [48][49][50] Nevertheless, natural skincare products containing food ingredients cannot be considered safe for all consumers. The natural origins of a product and safety under customary use are not equivalent to safety when the food ingredients are used in altered conditions. ...
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Background The application of preparations containing food allergens can cause percutaneous sensitisation and provocation. The prevalence of food allergens in children's cosmetics is unknown. Objectives To analyse the prevalence of food allergens in skincare products marketed for children and its association with marketing claims and product price. Methods We reviewed 276 skincare product ingredient labels for the presence of milk, eggs, wheat, soy, oats, tree nuts, peanuts and sesame. Results More than one third (108; 39.1%) of the products listed at least one allergen. A total of 156 allergens were recorded, of which 65 (41.7%) were almonds, 35 (22.4%) wheat, 24 (15.4%) soy, 16 (10.3%) oats, 13 (8.3%) sesame, 2 (1.3%) milk and 1 (0.6%) peanuts. Products that claimed to be natural or ecological were more likely to contain food allergens than those not labelled so (P < .001). The prices were higher for products containing food allergens compared to allergen‐free products (P = .028). Conclusions Food allergens are prevalent in children's cosmetics, especially those that claim to be natural or ecological. The most incorporated food allergens are almonds, wheat and soy. Products containing food allergens cost more than allergen‐free ones. This article is protected by copyright. All rights reserved.
... 9 There is a paucity of controlled studies evaluating the purported active ingredients in emollients (eg, plant extracts, colloidal oatmeal), with several studies relying on biochemical markers rather than clinical outcomes to demonstrate efficacy. [10][11][12]13 Hydrophilic ointments and creams without added fragrances or preservatives are recommended over lipophilic emollients, as lipophilic products may cause irritation and should be applied to wet skin after bathing. 14 At least 130 g/m 2 /wk of emollient should be recommended, which is approximately 250 g weekly for adults. ...
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The objectives of therapy for atopic dermatitis (AD) are to reduce skin inflammation and pruritus, restore skin barrier function, and improve quality of life (QoL). Treatments can be classified as moisturizing and basic care, topical therapy, phototherapy, and systemic therapy. In this review, we summarize the treatments for AD and recommendations for their use.
... Furthermore, prescribing emollients was associated with a potential for fewer antibiotic or potent/very potent TCS prescriptions. Timely prescribing of Aveeno to improve the integrity of the skin barrier [47,48] can result in fewer flares and would probably result in decreased antimicrobial prescribing in UK primary care. Prescribing Aveeno was also associated with overall lower costs compared with prescribing other emollients, and overall costs were lowered most when Aveeno was prescribed first, rather than when prescribed as a second or subsequent choice for patients who may have found other products unsuitable. ...
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Background The Clinical Practice Research Datalink (CPRD) was used to evaluate the overall costs to the National Health Service, including healthcare utilisation, of prescribing emollients in UK primary care for dry skin and atopic eczema (DS&E). Methods Primary care patients in the UK were identified using the CPRD and their records were interrogated for the 2 years following first diagnosis of DS&E. Data from patients with (n = 45,218) and without emollient prescriptions (n = 9780) were evaluated. Multivariate regression models were used to compare healthcare utilisation and cost in the two matched groups (age, sex, diagnosis). Two sub-analyses of the Emollient group were performed between matched groups receiving (1) a colloidal oatmeal emollient (Aveeno-First) versus non-colloidal oatmeal emollients (Aveeno-Never) and (2) Aveeno prescribed first-line (Aveeno-First) versus prescribed Aveeno later (Aveeno-Subsequently). Logistic regression models calculated the odds of prescription with either potent / very potent topical corticosteroids (TCS) or skin-related antimicrobials. Results Costs per patient were £125.80 in Emollient (n = 7846) versus £128.13 in Non-Emollient (n = 7846) matched groups (p = 0.08). The Emollient group had fewer visits/patient (2.44 vs. 2.66; p < 0.0001) and lower mean per-visit costs (£104.15 vs. £113.25; p < 0.0001), compared with the Non-Emollient group. Non-Emollient patients had 18% greater odds of being prescribed TCS and 13% greater odds of being prescribed an antimicrobial than Emollient patients. In the Aveeno-First (n = 1943) versus Aveeno-Never (n = 1943) sub-analysis, costs per patient were lower in the Aveeno-First compared with the Aveeno-Never groups (£133.46 vs. £141.11; p = 0.0069). The Aveeno-Never group had ≥21% greater odds of being prescribed TCS or antimicrobial than the Aveeno-First group. In the Aveeno-First (n = 1357) versus Aveeno-Subsequently (n = 1357) sub-analysis, total costs were lower in the Aveeno-First group (£140.35 vs. £206.43; p < 0.001). Patients in the Aveeno-Subsequently group had 91% greater odds of being prescribed TCS and 75% greater odds of being prescribed an antimicrobial than the Aveeno-First group. Conclusions Acknowledging limitations from unknown disease severity in the CRPD, the prescription of emollients to treat DS&E was associated with fewer primary care visits, reduced healthcare utilisation and reduced cost. Prescribing emollients, especially those containing colloidal oatmeal, was associated with fewer TCS and antimicrobial prescriptions. Trial registration The study is registered at http://isrctn.com/ISRCTN91126037.
... The use and efficacy of colloidal oatmeal for skin irritation reduction and moisturizing are well documented. [14] Scientific reports indicate beta-glucan is a film-forming moisturizer, a biological response modifier, and a promoter of wound healing. Skincare actions of oat beta-glucan such as anti-radiation, anti-wrinkle, and anti-aging were most likely attributed to its long-lasting and film-forming property. ...
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Background: Dry skin or xeroderma is a very frequent condition which occurs at any age. Moisturizers including conventional oatmeal have been widely used to improve dry skin conditions. Oat-based moisturizer can protect, hydrate, and promote the endogenous barrier repair. Aim: This study aims to evaluate the efficacy and safety of oat extract-based moisturizer in adult individuals with dry skin. Materials and Methods: This study was a treatment-randomized, assessor-blinded, no treatment controlled, comparative study. A total of 36 individuals were included in the study. Oat extract-based moisturizer (test product) and control treatment (no product application) were randomized, as per randomization plan and applied to all individuals on the surface of volar forearm 2 cm (1 cm radius) in diameter. In addition, right cheek as control site and left cheek as test site (oat extract-based moisturizer lotion) were considered for sebum level and facial skin pH analysis. Results: Oat extract-based moisturizer possessed excellent skin moisturizing properties. Both the Corneometer® and modified Kligman score, respectively, showed significant improvement (P < 0.0001) in skin hydration and decrease in skin dryness with respect to baseline till 24 h postapplication. Furthermore, Cutometer® reading had statistically significant increase in skin elasticity as compared to baseline till 6 h postapplication. There was no statistically significant effect on skin pH and sebum level as compared to control treatment. This concludes that oat extract-based moisturizer is effective in improving skin hydration and elasticity without any change in skin pH and sebum levels. Conclusion: Test product (oat extract-based moisturizer lotion) was safe and well tolerated. Efficacy analysis showed that the effect of oat extract-based moisturizer was significant in terms of skin hydration and skin elasticity.
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The environment is being continuously deteriorated by air pollution and global warming, increased pressure of work or family on life, and changes in lifestyle; these factors have contributed to an increase in the proportion of both females and males with sensitive skin. To this end, the cosmetics market has focused on developing hypoallergenic or skin-soothing and make-up products. Here, we summarize the definition and causes of sensitive skin, list the mechanisms underlying the development of this condition, and review the natural plant products and purified active components that have potential for use in anti-allergic cosmetics. A review of studies that evaluated the anti-allergic properties of natural products was conducted. There has been a progressive increase in the number of natural products identified as potential anti-allergic raw materials in cosmetics. Finally, we suggest strategies for developing anti-allergic cosmetics in the future.
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Complementary and alternative medicine (CAM) treatments are growing in popularity as alternative treatments for common skin conditions. Objectives: To perform a systematic review and meta-analysis to determine the tolerability and treatment response to CAM treatments in acne, atopic dermatitis (AD), and psoriasis. Methods: PubMed/Medline and Embase databases were searched to identify eligible studies measuring the effects of CAM in acne, AD, and psoriasis. Effect size with 95% confidence interval (CI) was estimated using the random-effect model. Results: The search yielded 417 articles; 40 studies met the inclusion criteria. The quantitative results of CAM treatment showed a standard mean difference (SMD) of 3.78 (95% CI [-0.01, 7.57]) and 0.58 (95% CI [-6.99, 8.15]) in the acne total lesion count, a SMD of -0.70 (95% CI [-1.19, -0.21]) in the eczema area and severity index score and a SMD of 0.94 (95% CI [-0.83, 2.71]) in the scoring of atopic dermatitis score for AD, and a SMD of 3.04 (95% CI [-0.35, 6.43]) and 5.16 (95% CI [-0.52, 10.85]) in the Psoriasis Area Severity Index score for psoriasis. Limitations: Differences between the study designs, sample sizes, outcome measures, and treatment durations limit the generalizability of data. Conclusions: Based on our quantitative findings we conclude that there is insufficient evidence to support the efficacy and the recommendation of CAM for acne, AD, and psoriasis.
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The desire for naturally derived agents is a growing trend for patient, physicians, and pharmaceutical companies. Usage studies demonstrate that complementary and alternative medicine is often used by patients and parents of children with atopic dermatitis, not necessarily with beneficial results. A half -dozen natural agents (i.e. topical agents: coconut oil, colloidal oatmeal, sunflower oil, mustard oil, glycerin, and oral Chinese herbal therapy) are discussed as they have become popular for their expected activity in the therapy of atopic dermatitis. Acritical review of the published literature on these agents is presented with specific focus on potential such side effects as hepatotoxicity with Chinese herbals.
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Oat ( Avena sativa ) in colloidal form is a centuries-old topical treatment for a variety of skin conditions, including skin rashes, erythema, burns, itch, and eczema; however, few studies have investigated the exact mechanism of action for the anti-inflammatory activity of colloidal oatmeal. Four extracts of colloidal oatmeal were made with various solvents and tested in anti-inflammatory and antioxidant assays. In addition, an investigator blind study was performed with twenty-nine healthy female subjects who exhibited bilateral mild to moderate itch with moderate to severe dry skin on their lower legs. Subjects were treated with a colloidal oatmeal skin protectant lotion. Extracts of colloidal oatmeal diminished pro-inflammatory cytokines in vitro and the colloidal oat skin protectant lotion showed significant clinical improvements in skin dryness, scaling, roughness, and itch intensity. These results demonstrate that colloidal oat extracts exhibit direct anti-oxidant and anti-inflammatory activities, which may provide the mechanisms for observed dermatological benefits while using the colloidal oatmeal skin protectant lotion. J Drugs Dermatol. 2015;14(1):43-48.
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Channels are integral membrane proteins that form a pore, allowing the passive movement of ions or molecules across a membrane (along a gradient), either between compartments within a cell, between intracellular and extracellular environments or between adjacent cells. The ability of cells to communicate with one another and with their environment is a crucial part of the normal physiology of a tissue that allows it to carry out its function. Cell communication is particularly important during keratinocyte differentiation and formation of the skin barrier. Keratinocytes in the skin epidermis undergo a programme of apoptosis-driven terminal differentiation, whereby proliferating keratinocytes in the basal (deepest) layer of the epidermis stop proliferating, exit the basal layer and move up through the spinous and granular layers of the epidermis to form the stratum corneum, the external barrier. Genes encoding different families of channel proteins have been found to harbour mutations linked to a variety of rare inherited monogenic skin diseases. In this Commentary, we discuss how human genetic findings in aquaporin (AQP) and transient receptor potential (TRP) channels reveal different mechanisms by which these channel proteins function to ensure the proper formation and maintenance of the skin barrier.
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Atopic dermatitis (AD) is a chronic inflammatory skin disease in which the skin barrier function is disrupted. In this inflammatory AD environment, cytokines are up-regulated, but the cytokine effect on the AD skin barrier is not fully understood. We aimed to investigate the influence of Th2 (IL-4, IL-13, IL-31) and pro-inflammatory (TNF-α) cytokines on epidermal morphogenesis, proliferation, differentiation and stratum corneum lipid properties. For this purpose, we used the Leiden epidermal model (LEM) in which the medium was supplemented with these cytokines. Our results show that IL-4, IL-13, IL-31 and TNF-α induce spongiosis, augment TSLP secretion by keratinocytes and alter early and terminal differentiation-protein expression in LEMs. TNF-α alone or in combination with Th2 cytokines decreases the level of long chain free fatty acids (FFAs) and ester linked ω-hydroxy (EO) ceramides, consequently affecting the lipid organization. IL-31 increases long chain FFAs in LEMs but decreases relative abundance of EO ceramides. These findings clearly show that supplementation with TNF-α and Th2 cytokines influence epidermal morphogenesis and barrier function. As a result, these LEMs show similar characteristics as found in AD skin and can be used as an excellent tool for screening formulations and drugs for the treatment of AD.Journal of Investigative Dermatology accepted article preview online, 11 February 2014; doi:10.1038/jid.2014.83.
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