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Journal of Dermatological Treatment
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Topical use of dexpanthenol: a 70th anniversary
article
Ehrhardt Proksch, Raymond de Bony, Sonja Trapp & Stéphanie Boudon
To cite this article: Ehrhardt Proksch, Raymond de Bony, Sonja Trapp & Stéphanie Boudon
(2017) Topical use of dexpanthenol: a 70th anniversary article, Journal of Dermatological
Treatment, 28:8, 766-773, DOI: 10.1080/09546634.2017.1325310
To link to this article: https://doi.org/10.1080/09546634.2017.1325310
© 2017 The Author(s). Published by Informa
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REVIEW ARTICLE
Topical use of dexpanthenol: a 70th anniversary article
Ehrhardt Proksch
a
, Raymond de Bony
b
, Sonja Trapp
b
and St
ephanie Boudon
b
a
Department of Dermatology, University of Kiel, Kiel, Germany;
b
Bayer Consumer Care AG, Basel, Switzerland
ABSTRACT
Approximately 70 years ago, the first topical dexpanthenol-containing formulation (Bepanthen
TM
Ointment) has been developed. Nowadays, various topical dexpanthenol preparations exist, tailored
according to individual requirements. Topical dexpanthenol has emerged as frequently used formulation
in the field of dermatology and skin care. Various studies confirmed dexpanthenol’s moisturizing and skin
barrier enhancing potential. It prevents skin irritation, stimulates skin regeneration and promotes wound
healing. Two main directions in the use of topical dexpanthenol-containing formulations have therefore
been pursued: as skin moisturizer/skin barrier restorer and as facilitator of wound healing. This 70th anni-
versary paper reviews studies with topical dexpanthenol in skin conditions where it is most frequently
used. Although discovered decades ago, the exact mechanisms of action of dexpanthenol have not been
fully elucidated yet. With the adoption of new technologies, new light has been shed on dexpanthenol’s
mode of action at the molecular level. It appears that dexpanthenol increases the mobility of stratum cor-
neum molecular components which are important for barrier function and modulates the expression of
genes important for wound healing. This review will update readers on recent advances in this field.
ARTICLE HISTORY
Received 7 April 2017
Revised 21 April 2017
Accepted 27 April 2017
KEYWORDS
Bepanthen; dexpanthenol;
skin; topical; anniversary
Introduction
Pantothenic acid, a member of the B complex vitamins (vitamin B5),
was discovered in 1931 by Roger J. Williams (1893–1988) during his
studies on microbial growth factors. The name pantothenic acid,
given to this substance by Williams and Saunders in 1933, should
indicate its wide spread occurrence in nature (1,2). In 1934, it was
shown that pantothenic acid has a profound stimulating effect on
cell proliferation in yeast (3) which eventually led to the develop-
ment of the first topical dexpanthenol preparation (Bepanthen
TM
).
Dexpanthenol is a stable alcoholic analog of pantothenic acid.
Contrary to pantothenic acid, it is well absorbed through the skin
(4,5). Bepanthen
TM
was first introduced as an ointment approxi-
mately 70 years ago (in 1944). When applied topically, dexpanthenol
is readily absorbed and rapidly converted enzymatically to panto-
thenic acid, a constituent of coenzyme A (6). Nowadays, different
topical dexpanthenol preparations exist (cream, emollient, drops,
gel, lotion, oil, ointment, solution and spray), tailored according to
individual needs, ranging from pediatric to adult use. Dexpanthenol
is also used as dissolving lozenge/pastille for mouth and throat irri-
tations (7). Coenzyme A catalyzes the synthesis of fatty acids and
sphingolipids which are important for stratum corneum lipid layers
(7–10). Hence, pantothenic acid is essential for epithelia to maintain
their physiological function (11).
It has been shown that topical dexpanthenol acts like a mois-
turizer with barrier-improving properties; in addition, it exerts
wound healing effects (e.g. 10,12–17). Two main directions of its
use have therefore been pursued: as skin moisturizer/skin barrier
restorer and as facilitator of wound healing. It may be inferred
that this molecule provides a dual action benefit for subjects in
need for skin care and/or wound healing.
Based on a systematic literature search in the PubMed and
Embase databases, this 70th anniversary paper reviews studies
with topical dexpanthenol, with particular emphasis on its useful-
ness in different skin conditions. In addition, it will update readers
on recent advances of dexpanthenol’s mechanism of action when
used as a component of skin care products (Part I) and when
used therapeutically (Part II). Double-blind controlled studies
on topical dexpanthenol cited in Part I and Part II have been
summarized in Table 1 and Table 2, respectively.
Part I –dexpanthenol as moisturizer with
barrier-improving properties
Impaired skin barrier plays a major role in various skin conditions
like dry skin (as a condition itself), sensitive skin, seborrheic
dermatitis, atopic dermatitis (AD) or contact dermatitis (18,19).
Moisturization and restoration of the stratum corneum skin barrier
are therefore important properties of any skin care product (20).
Dexpanthenol improves skin hydration when applied topically;
this activity may be related to dexpanthenol’s hygroscopic proper-
ties and its capability to promote retention of moisture (11,20).
The hydrating effect seems to be interrelated with its capacity to
regenerate the epidermal barrier (5). A recent experimental study
with excised porcine skin showed that dexpanthenol increases the
molecular mobility of several lipid and protein segments of the
stratum corneum thereby generating properties of a hydrated skin
also in dehydrated conditions. Specifically, it has been demon-
strated that dexpanthenol interacts with lipid segments of the
extracellular lamellae and protein residues in the corneocytes in
stratum corneum and thus compensates for reduced hydration by
retaining/increasing molecular fluidity (21).
The mechanisms by which dexpanthenol restores and protects
skin barrier function have not been fully elucidated. As the differ-
ent layers of the skin undergo continual renewal, moisturizers pro-
vide an environment which promotes physiological processes
CONTACT St
ephanie Boudon stephanie.boudon@bayer.com Bayer Consumer Care AG, Peter Merian-Strasse 84, CH-4002 Basel, Switzerland
ß2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/),
which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.
JOURNAL OF DERMATOLOGICAL TREATMENT, 2017
VOL. 28, NO. 8, 766–773
https://doi.org/10.1080/09546634.2017.1325310
(e.g. enzyme functioning) necessary for maintaining or restoring
skin barrier function. In addition, topically applied substances may
also penetrate deeper into the epidermis and interfere with the
production of barrier lipids and the maturation of corneocytes
(20). In fact, it has been suggested that dexpanthenol promotes
epidermal regeneration by enhancing epidermal differentiation
and lipid synthesis (19).
Role of topical dexpanthenol in atopic dermatitis and
nappy rash
Atopic dermatitis
Deficient skin barrier function leading to increased transepidermal
water loss (TEWL) and decreased stratum corneum hydration (dry
skin) is a characteristic feature of AD (22,23). Clinical studies
showed that the daily use of skin care products may prevent AD
or can prolong the time between flare-ups (24–26). Therefore, top-
ical dexpanthenol has a clear role as skin care product during
post-inflammatory AD maintenance stages due to its proven skin
moisturization and skin barrier restoration potential.
In a double-blind, randomized controlled trial (RCT) in a total
of 60 healthy subjects, topical dexpanthenol formulated in two
different lipophilic vehicles at a concentration of 2.5% was
administered to the skin. Twice-daily application over 7 d statis-
tically significantly improved stratum corneum hydration and
reduced TEWL compared with controls (27). In the context of a
randomized study in 20 healthy subjects, the same group eval-
uated a hydrophilic emulsion containing 2.5 or 5% dexpanthenol
with respect to its effect on hydration and skin barrier repair
using the repetitive washing test with sodium lauryl sulfate (SLS)
(28). Topical application of both dexpanthenol-containing emul-
sions statistically significantly improved stratum corneum hydra-
tion and skin barrier function compared with control. The effects
were numerically more pronounced with the 5% dexpanthenol-
containing emulsion. The results were in accordance with a
similarly designed study which tested a 2.5% dexpanthenol-
containing lotion in 20 healthy volunteers as to its effect on
hydration and skin barrier repair using the repetitive washing
test with SLS (29).
Proksch and Nissen (10) showed that a 5% dexpanthenol-
containing cream enhanced skin barrier repair and stratum cor-
neum hydration in experimentally damaged human skin when
applied twice-daily for 7 d as assessed by TEWL and corneometry,
respectively (Figures 1 and 2).
Table 1. Double-blind controlled studies related to dexpanthenol’s use as skin care product.
Author Objective Treatment duration NKey results
Gehring and Gloor (27) Effect of DEX 2.5% on SC hydration
and TEWL (control: vehicle)
Twice-daily application for 7 d 60 HS DEX 2.5% increased SC hydra-
tion and reduced TEWL (for
both: p<.05 vs. vehicle)
Biro et al. (30) Efficacy of DEX 5% in skin
protection against irritation
(control: PL)
Twice-daily application for 26 d;
from days 15–22, SLS 2% was
applied twice-daily
25 HS SC hydration remained stable at
DEX 5%-treated sites, at PL-
treated sites SC hydration
decreased (p<.05); DEX 5%
showed better protection
against irritation than PL
Sznurkowska et al. (44) Efficacy of DEX in protecting infants
from diaper rash (control: zinc
oxide paste)
28 d, at each diaper change 109 children predisposed to
nappy rash
Almost all subjects (about 96%
for both DEX and zinc oxide)
remained free of clinically
relevant diaper rash during
the study
DEX: topical dexpanthenol; HS: healthy subjects; N: total number of subjects; PL: placebo; SC: stratum corneum; SLS: sodium lauryl sulfate; TEWL: transepidermal
water loss.
Table 2. Double-blind controlled studies related to dexpanthenol’s topical use as facilitator of wound healing.
Author Objective Treatment duration NKey results
Pugliese et al. (59) Efficacy of DEX 5% on healing
process of epidermal shave
biopsy wounds (controls:
vehicle, first aid cream)
Daily application for 5 d 15 HS Histologically, in 10 of 15 sub-
jects, DEX 5% was most
effective in improving the
wound healing process and it
received higher healing rat-
ings than vehicle treatment
(p¼.013)
Dubecq and Detchart (64) Efficacy of DEX 5% in treatment
of nipple fissures (control:
vehicle)
1 week (not further specified) 60 nursing mothers with nipple
fissures
With DEX 5%, the proportion of
subjects who experienced
healing of their nipple fis-
sures was higher compared
with vehicle treatment (68 vs.
34%, p<.05)
Girard et al. (68) Efficacy of DEX 5% in the graft
donor site wound healing
model (control: vehicle)
Mesh graft donor sites were
treated twice-daily for 14 d
35 patients undergoing skin
grafting due to burns
Skin area treated with DEX 5%
showed earlier normalization
tendencies than with vehicle;
from 7th day onwards, skin
was more hydrated than
vehicle-treated area (p¼.05)
and the healing-associated
pruritus ceased earlier
(p¼.06)
DEX: topical dexpanthenol; HS: healthy subjects; N: total number of subjects.
JOURNAL OF DERMATOLOGICAL TREATMENT 767
Biro et al. (30) conducted a double-blind RCT in 25 healthy
subjects to investigate the efficacy of dexpanthenol in skin protec-
tion against irritation. The forearms of the subjects were treated
with either an ointment containing 5% dexpanthenol or placebo
twice-daily for 26 d. From days 15–22, SLS 2% was applied to
these skin areas. Hydration of the stratum corneum remained
essentially stable at the dexpanthenol-treated sites throughout
the study, whereas corneometry results showed a decrease at the
placebo-treated sites at the end of the SLS challenge period
(p<.05). Moreover, topical dexpanthenol exhibited better protect-
ive effects against skin irritation than placebo. This observation
was explained by dexpanthenol’s ability to preserve good hydra-
tion of the stratum corneum under the influence of an irritant
agent, whereas placebo treatment failed to do so. The results
were in agreement with an earlier single-blind study using an
ointment in 35 female volunteers to investigate dexpanthenol’s
protective effect against irritation induced by SLS (31).
In a single-blind, placebo-controlled study, Camargo et al. (32)
evaluated the skin moisturizing efficacy of formulations containing
0.5, 1 or 5% dexpanthenol in a total of 40 healthy female subjects.
Dexpanthenol-containing formulations (1.0 and 5.0%) produced
significant decreases (p<.001) in TEWL after 15 and 30 d periods
of daily application when compared with baseline and control site
(vehicle only) values. Moreover, in skin washed with SLS, a
significant reduction of TEWL was evident 2 h after application of
formulations loaded with dexpanthenol.
Stettler et al. (33) conducted two randomized, intra-individual
comparison studies in a total of 43 healthy subjects to evaluate
the skin moisturization and barrier restoration potential of a new
topical dexpanthenol-containing emollient, and its effect on skin
microflora. This skin care preparation has been developed for sub-
jects with non-inflammatory dry and sensitive skin conditions,
such as AD while in remission phase between flares. Study 1
showed that barrier restoration was more pronounced with the
emollient as reflected by mean AUC for TEWL reduction from
baseline (168.36 vs. 123.38 g/m
2
/h, p¼.023). Emollient use was
also associated with statistically significant improvements in stra-
tum corneum hydration and an increase in intercellular lipid
lamellae length in the stratum corneum (increase from baseline
on day 22: 120.61 vs. 35.85 nm/1000 nm
2
,p<.001). In study 2, the
dexpanthenol emollient use had no negative impact on bacterial
viability; a numerically higher proportion of subjects showed com-
mensal bacteria.
In another set of two studies, Stettler et al. (34) investigated
the skin moisturizing effect of the dexpanthenol-containing emol-
lient in healthy adults with dry skin and in healthy infants. Study
1(N¼44) was a randomized, intra-individual comparison
study while study 2 was a non-comparative trial (N¼65, age:
3–25 months). In study 1, application of emollient produced an
increase in stratum corneum hydration as reflected by an
enhanced electrical capacitance of the skin surface. In study 2, the
dexpanthenol emollient was well tolerated by the infants and skin
hydration significantly increased over the study course.
In studies with AD patients, the moisturizing and barrier-
improving properties of topical dexpanthenol were well perceived
by affected subjects (35,36).
Nappy rash
Nappy rash (irritant diaper dermatitis and napkin dermatitis) is a
form of irritant contact dermatitis occurring in the diaper area, it
is a common skin condition among infants (37). The most crucial
factor for developing nappy rash is prolonged skin contact with
urine and feces which causes disruption of the skin barrier by
maceration (softening and weakening of the stratum corneum
with extraction of natural moisturizing factors), locally increased
alkalinity leading to activation of fecal proteases and lipases, and
friction (38,39). The key to successful nappy rash management is
the implementation of preventive measures. It comprises gentle
cleansing, immediate changing of diapers containing urine and
feces, and regular application of a protective barrier preparation
(39–41). The application of barrier creams or ointments at each
diaper change has been recommended as protective or preventive
measure; they form a lipid film on the skin surface and protect it
from contact with moisture and irritants (39,41). In fact, the use of
barrier emollients at nappy changes is now standard practice (42).
In recognition of the increasing importance of the use of barrier
skin care preparations as a measure in the prevention of nappy
rash, an international expert panel of dermatologists and pediatri-
cians agreed in 2012 on nine standards for the ideal nappy care
preparation that is suitable for repeated application on the vulner-
able skin of infants (Table 3)(39). The panel revised an earlier con-
sensus published in 2004 (43), increasing the previous seven
standards to nine by adding the items “enhances natural protec-
tion of the skin”and “is pleasant to use”.
Recently, a new dexpanthenol-containing water-in-oil ointment
has been developed to be used topically in the diaper area of
infants. Data from various in vitro and in vivo studies showed that
after SLS
Hydration (a.u.)
20
30
40
50
60
70
0246
**
25
35
45
55
65
**
Days
Verum
Untreated
Placebo
Figure 2. Stratum corneum hydration after SLS pretreatment and twice-daily
application for 7 d of a dexpanthenol-containing preparation (cream), vehicle or
being left untreated. Stratum corneum hydration was measured by Corneometer.
N¼20, p<.05 (verum vs. vehicle). a.u.¼arbitrary units. From Ref. (10) with kind
permission from Taylor & Francis Ltd. (http://www.tandfonline.com).
TEWL (g/hm2)
Days
0
5
10
15
20
25
0246
*
*
after SLS
Verum
Untreated
Placebo
Figure 1. Transepidermal water loss (TEWL) after SLS pretreatment and twice-
daily application for 7 d of a dexpanthenol-containing preparation (cream),
vehicle, or being left untreated. Permeability barrier disruption was induced by
5% SLS under occlusion by plastic chambers for 24h. TEWL was measured by
Tewameter. N¼20, p<.05 (verum vs. vehicle). From Ref. (10) with kind permis-
sion from Taylor & Francis Ltd. (http://www.tandfonline.com).
768 E. PROKSCH ET AL.
this formulation meets the suggested standards for an ideal nappy
care preparation (44). In a double-blind RCT in 109 children pre-
disposed to nappy rash (3–24 months), this formulation was
equivalent to zinc oxide lipophilic paste in protecting infants form
clinically relevant diaper rash when used for 28 d. According to
pediatricians’assessment, the overwhelming majority of subjects
(about 96% for both dexpanthenol ointment and zinc oxide) were
free of clinically relevant diaper rash during the study course (44).
The usefulness of dexpanthenol-containing ointments in the
management of nappy rash has also been shown by others
(45–48).
Putet et al. (46) reported results from two clinical trials (on pre-
vention and treatment) which showed that an ointment contain-
ing 5% dexpanthenol can help to manage nappy rash. The
prevention study was an open, randomized trial in hospitalized
newborns free from nappy rash at study inclusion with a double-
blind evaluation of standardized photographs taken from treated
skin areas at baseline and at study end (45,46). Subjects were
randomized to receive either an ointment containing 5% dexpan-
thenol on the buttocks at each of the four diaper changes per
day (N¼26) or no treatment (N¼28). The study population
included 15 twins out of which 12 twins were allocated to differ-
ent treatment groups. For both groups, the average study length
was approximately 2 weeks. In the group treated with the oint-
ment, 31% of subjects developed nappy rash over the study
course compared with 57% of subjects in the untreated group.
In the subpopulation of twins, the difference was even more
pronounced (Figure 3).
Role of topical dexpanthenol in dermatologic
conditions associated with diabetes
Proksch (49) showed that two dexpanthenol-containing lotions
suitable for skin care of diabetic feet and legs significantly
improved skin hydration (as assessed by corneometry) when
administered twice daily to diabetics with dry skin for 4 weeks.
Both preparations were well accepted by study participants and
improved subjective findings (tension, itching and dryness) in the
treated areas. It was inferred that the tested preparations can help
preventing foot infections in patients with diabetes mellitus.
Part II –dexpanthenol as facilitator of wound healing
The process of wound healing is often divided in three phases:
inflammation, cell proliferation and matrix deposition. Tissue
remodeling has an increased need for pantothenic acid because
of the increased turnover of cells for wound repair (14,50,51). It
has been suggested that the reported beneficial effect of dexpan-
thenol on wound healing is the result of increased fibroblast pro-
liferation and accelerated epithelialization (17); both processes are
important for the cure of both deep and superficial wounds (7).
This complies with in vitro findings gathered with dexpanthenol.
The dermal fibroblast possesses multilineage differentiation
potential and plays a key role in tissue repair and thus cutaneous
wound healing (52,53). The effects of dexpanthenol on human
fibroblasts (e.g. enhanced proliferation, cellular migration, attach-
ment of fibroblasts and collagen synthesis) have been shown in
several in vitro studies (14,53–56). Although the beneficial influ-
ence of dexpanthenol on cell proliferation and wound healing has
been well documented, its properties at the molecular level
remained unclear for a long time. With the availability of novel
molecular tools the situation changed.
Wiederholt et al. (53) investigated the molecular mechanisms
linked to the stimulatory effect of pantothenate on the prolifer-
ation of dermal fibroblasts in vitro. Gene expression was analyzed
in human dermal fibroblasts cultivated with 20 lg/ml of panto-
thenate compared with untreated cells. Microarray analysis
detected a significant upregulation of IL-6, IL-8, Id1, HMOX-1,
HspB7 and CYP1B1 expression by pantothenate. As IL-6 and IL-8
are among the cytokines most strongly expressed during wound
healing (57), the upregulation of IL-6 and IL-8 expression in der-
mal fibroblasts may therefore contribute to the wound healing
features of dexpanthenol-containing topicals (53). To correlate
these in vitro findings with the in vivo situation of wound healing,
Heise et al. (58) conducted a randomized, double-blind study in
which the dexpanthenol-induced gene expression profile in punch
biopsies of previously injured and dexpanthenol-treated skin in
comparison to placebo-treated skin was analyzed at the molecular
level. In samples treated topically with dexpanthenol, upregulation
of IL-6, IL-1b, CYP1B1, CXCL1, CCL18 and KAP 4–2 gene expression
was detected thereby suggesting a strong correlation between
in vitro data assessed in cultured dermal fibroblasts and the in
vivo situation. The favorable wound healing characteristics of dex-
panthenol may therefore be mediated –at least in part –by a
dexpanthenol-induced upregulation of the expression of genes
(with enhanced mRNA levels) important for wound healing (58). In
a recent study, a novel human three-dimensional skin wound
healing model was applied to investigate the dexpanthenol-medi-
ated stimulatory effects on wound closure. Topical treatment of
skin wounds with different dexpanthenol containing preparations
clearly enhanced wound closure compared to untreated or vasel-
ine-treated controls. Gene expression analysis showed increased
mRNA expression of genes involved in wound healing (16).
Role of topical dexpanthenol in the treatment of minor
wounds
Models of superficial injury
Pugliese et al. (59) conducted a double-blind RCT with a water-in-oil-
emulsion containing 5% dexpanthenol in healthy adult volunteers.
Frequency of diaper rash appearance (%)
Entire population
0
10
Sub-population of twins
p = 0.025
Wilcoxon test
p = 0.06
X2 test
57
31
58
17
TreatedNon treated
20
30
40
50
60
70
Figure 3. Frequency of nappy rash occurrence in newborns preventively treated
with a dexpanthenol-containing ointment (5%) compared with untreated sub-
jects. From Ref. (46) with kind permission from Realitespediatriques.
Table 3. The nine standards of an ideal topical nappy care preparation
a
.
1. Has proven clinical efficacy and safety in babies
2. Enhances natural protection of the skin
3. Maintains optimum moisture levels
4. Contains ingredients with documented safety and benefit
5. Contains no unnecessary ingredients
6. Contains no potentially toxic ingredients
7. Contains no potential sensitizers such as fragrances
8. Contains no antiseptics or preservatives
9. Is pleasant to use
a
From Ref. (39).
JOURNAL OF DERMATOLOGICAL TREATMENT 769
In all subjects, four standardized epidermal shave biopsy wounds
were produced; three wounds were each treated daily for 5 d with
either the dexpanthenol water-in-oil emulsion, a corresponding
water-in-oil emulsion without dexpanthenol, or a first aid cream.
The fourth wound remained untreated and served as additional
control. Erythema, wound closure, wound volume and viscoelasti-
city were assessed using ultrasound and histological techniques.
Epidermal wounds treated with the dexpanthenol emulsion showed
a reduction in erythema and a more elastic and solid tissue regen-
eration. Histologically, in 10 of 15 subjects, the dexpanthenol prep-
aration was most effective in improving the wound healing
process.
Wollina and Kubicki (15) investigated the potential of topical
dexpanthenol to improve epidermal regeneration and wound
healing by employing different in vivo models of minor skin
trauma, including cryosurgery and suction blistering to induce
superficial subepidermal wounds. The reduction of wound area
was measured by TEWL. A faster healing was observed upon treat-
ment with dexpanthenol compared with vehicle control.
Hartel et al. (60) performed a RCT in 12 healthy subjects to
explore the wound healing effect of water-filtered infrared-A using
an acute wound model (superficial wounds generated by suction
cup technique). The formation of the stratum corneum was meas-
ured by laser scanning microscopy. Four different treatments were
administered over 10 d, including no therapy. The fastest stratum
corneum formation was observed when water-filtered infrared-A
irradiation was combined with the daily use of a dexpanthenol
cream.
Cracked nipples
Cracked nipples may occur during the breastfeeding period. It is a
painful condition and can lead to early cessation of breastfeeding
despite the mothers wish to continue breastfeeding (61).
Dexpanthenol-containing ointments have a long history in nipple
care during breastfeeding, particularly in the treatment of nipple
cracks and fissures (62,63).
Dubecq and Detchart (64) conducted a double-blind RCT in 60
nursing mothers with nipple fissures. Study participants were
treated with an ointment containing 5% dexpanthenol or with
placebo (vehicle only) for 1 week under hospitalized conditions. In
three additional groups, the prophylactic effect of the dexpanthe-
nol ointment was studied when administered for 1 week. These
breastfeeding women received either the ointment (N¼25),
vehicle only (N¼28), or were left untreated (N¼80). The propor-
tion of subjects who experienced healing of their nipple fissures
was significantly higher in the active group compared with pla-
cebo (68 vs. 34%, p<.05). In the prophylaxis study, 92% of sub-
jects in the active group remained free from nipple fissures
compared with 82% in the vehicle group, and 77.5% in the
untreated group.
In the context of a single-blind RCT in 66 primiparous mothers
with sore nipples, it was shown that a dexpanthenol-containing
ointment had favorable effects on nipple pain when administered
four times daily for 2 weeks. Over the entire study period, mean
pain scores were lower with the ointment compared with control
(only warm water and soap). On day 3, the difference in
mean ± SEM pain scores reached statistical significance (1.27 ± 0.12
vs. 3.50 ± 0.14, p<.05) (65). Similarly, Shanazi et al. demonstrated
that topical dexpanthenol (5%) significantly reduced nipple pain
compared with baseline in breastfeeding mothers suffering from
traumatic nipples. In the group treated with dexpanthenol cream
for 2 weeks (N¼42), the mean ± SD pain score on day 3 was
1.33 ± 0.65 compared with 3.07 ± 1.02 at baseline (p<.001).
The improvement in nipple pain was associated with significantly
reduced nipple trauma scores (66).
Based on the results from a small observational study,
Staubach et al. suggested that daily application of an ointment
containing 5% dexpanthenol has the potential to alleviate symp-
toms associated with mammillary eczema (67).
Postoperative use
A double-blind intra-individual comparative study investigated the
wound healing properties of a 5% dexpanthenol-containing oint-
ment in 35 patients undergoing skin grafting due to burns (68).
Mesh graft donor sites were treated with either the dexpanthenol
ointment or vehicle for 14 d. An untreated area of healthy skin
served as additional control. The skin area treated with the dex-
panthenol ointment tended to return to a normal status sooner
than with vehicle alone. From the 7th day onwards, the skin was
more hydrated than the vehicle-treated area (p¼.05) as assessed
by clinical scores. In addition, the healing-associated pruritus
ceased earlier (p¼.06).
In a double-blind RCT, the potential of a dexpanthenol pastille
containing 100 mg dexpanthenol was evaluated to alleviate pain
and to improve wound healing following tonsillectomy (69). In
total, 120 pediatric patients were randomized to one of four
groups (N¼30 each): surgical tonsillectomy technique 1 plus dex-
panthenol pastille or placebo, or surgical tonsillectomy technique
2 plus dexpanthenol pastille or placebo. Study medication was
administered three times a day. Postoperative throat pain and
mucosal healing patterns were assessed at regular intervals over
2 weeks. Pain was assessed by visual analog scale and mucosal
healing by the size of the post-tonsillectomy slough. Regardless of
surgical technique, post-tonsillectomy throat pain was significantly
less in the dexpanthenol groups than in the placebo groups
(p<.05), and tonsillar wound healing was significantly better in
the dexpanthenol groups than in the placebo groups (p<.05).
Role of topical dexpanthenol in scar management
Favorable effects of topical dexpanthenol preparations were also
published in the daily care of scars resulting from skin transplant-
ation and burns (70,71). This triggered the development of specific
topical dexpanthenol formulations which also contain silicone.
Topical silicone treatments have been recommended as first line
therapy for prevention and treatment of red and hypertrophic
scars (72,73). Recently, an international expert panel agreed that
four groups would particularly benefit from the use of topical for-
mulations containing silicone: burns patients, patients showing
personal risks for hypertrophic or keloid scars (e.g. familial predis-
position), patients with hypertrophic scars and small keloids, and
patients likely to develop psychological distress in case hyper-
trophic/keloid scars occur. The formulation should be applied as
early as possible after re-epithelialization to immature scars.
Application on mature scars is possible but the effect may be
smaller (51).
Stettler and colleagues (74) conducted an 8 week pilot study
with a new anti-scar gel containing dexpanthenol and silicone in
34 healthy subjects with hypertrophic scars formed between
1 month and 1 year before study start. The gel was applied twice-
daily, after having first massaged the scar with the integrated
massage ball. After 8 weeks of treatment, the scars were signifi-
cantly less vascularized, less pigmented, softer, thinner, flattened
and more elastic. Skin hydration measured by corneometry
increased while TEWL decreased over the study period (for both
p<.0001) indicating a strengthened skin barrier of the scars.
770 E. PROKSCH ET AL.
In addition, pain and itching scores decreased significantly from
baseline assessments.
Conclusions
Approximately 70 years ago, the first topical dexpanthenol-
containing formulation was commercialized as an ointment. Since
then, various galenical forms have been developed which are
widely used in the field of dermatology and skin care, and
are associated with a high consumer satisfaction (75,76).
Dexpanthenol, the stable alcoholic analog of pantothenic acid,
shows good skin penetration and has moisturizing as well as skin
barrier enhancing properties. It prevents skin irritation, stimulates
skin regeneration and promotes wound healing. Topical dexpan-
thenol is therefore recommended for the treatment of superficial
wounds and for skin care of different skin conditions. Although
discovered decades ago, the exact mechanisms of action of dex-
panthenol have not been fully elucidated yet. Recently, novel
techniques enabled shedding new light on dexpanthenol’s mode
of action. With these techniques, many favorable results from
older studies can now be explained at the molecular level. This
applies to dexpanthenol’s favorable effects on both barrier func-
tion as well as wound healing. It appears that dexpanthenol
increases the molecular mobility of several lipid and protein seg-
ments of the stratum corneum thereby generating properties of a
hydrated skin. For wound healing, dexpanthenol modulates the
expression of certain genes. Hence, with the adoption of new
technologies, the story of dexpanthenol continues, thereby pro-
viding further insight how this long-known molecule actually
works.
Disclosure statement
Ehrhardt Proksch has participated in expert panels organized by
Bayer Consumer Care AG. Raymond de Bony, Sonja Trapp and
St
ephanie Boudon are employees of Bayer Consumer Care AG,
Basel, Switzerland.
Funding
Writing assistance was provided by Edgar A. Mueller, 3 P
Consulting and has been funded by Bayer Consumer Care AG,
Basel, Switzerland.
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