Article

Apple cider vinegar soaks [0.5%] as a treatment for atopic dermatitis do not improve skin barrier integrity

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Abstract

Background/objectives: Atopic dermatitis (AD) is a common chronic inflammatory skin condition associated with high transepidermal water loss, high skin pH, and Staphylococcus aureus skin colonization. The treatment of AD with bath additives remains highly debated. Recent evidence suggests that dilute apple cider vinegar (ACV) may improve skin barrier integrity in AD, but its safety and efficacy are not well studied. This pilot split-arm study analyzed the effect of dilute apple cider vinegar soaks on skin barrier integrity in patients with atopic dermatitis as measured by skin transepidermal water loss and skin pH. Methods: A total of 22 subjects (11 AD and 11 healthy controls) were enrolled. Subjects soaked both of their forearms for 14 days, with one arm in dilute ACV (0.5% acetic acid) and the other in water 10 minutes daily. Transepidermal water loss and pH were measured pre- and post-treatment. Results: In both groups, transepidermal water loss increased and pH decreased at 0 minutes post-ACV treatment, but these effects were not sustained at 60 minutes. In total, 72.7% (16/22) of subjects reported mild side effects from ACV with improvement after discontinuing the soaks. Conclusions: Dilute ACV soaks have no significant effect on skin barrier integrity but caused skin irritation in a majority of subjects. Study limitations include analysis of a single brand, dilution, and application of ACV. Future studies are needed to explore whether lower concentrations of ACV soaks or other applications such as a leave-on acidic ointment could improve skin barrier integrity in a safe, nonirritating way.

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... In contrast, a recent small study found that dilute ACV compresses did not reduce eczematous skin S. aureus burden [35]. Similarly, in our pilot study of 11 AD patients and 11 healthy controls, we showed that dilute ACV soaks did not improve skin barrier integrity as measured by transepidermal water loss and skin pH, and caused skin irritation in a majority of subjects [36]. In spite of theoretical and ex-vivo benefits, the effect of dilute ACV baths on S. aureus colonization and the skin microbiome are currently unknown [36]. ...
... Similarly, in our pilot study of 11 AD patients and 11 healthy controls, we showed that dilute ACV soaks did not improve skin barrier integrity as measured by transepidermal water loss and skin pH, and caused skin irritation in a majority of subjects [36]. In spite of theoretical and ex-vivo benefits, the effect of dilute ACV baths on S. aureus colonization and the skin microbiome are currently unknown [36]. ...
... Participants with AD and healthy controls, age � 12 years, were recruited through advertisement and from University of Virginia dermatology clinics [36]. Subjects were enrolled between June 2017 and October 2017 (Fig 1A). ...
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Introduction Atopic dermatitis is a common skin disease characterized by altered cutaneous immunity in which patients often exhibit lower skin microbiota diversity compared to healthy skin and are prone to colonization by Staphylococcus aureus . Apple cider vinegar has been shown to have antibacterial effects; however, its effects on the skin microbiome have not previously been well-described. Objectives We aimed to examine the effects of topical dilute apple cider vinegar soaks on Staphylococcus aureus abundance, skin bacterial microbiome composition, and skin bacterial microbiome diversity in atopic dermatitis participants compared to healthy skin. Methods Eleven subjects with atopic dermatitis and 11 healthy controls were enrolled in this randomized, non-blinded, single-institution, split-arm pilot study. Subjects soaked one forearm in dilute apple cider vinegar (0.5% acetic acid) and the other forearm in tap water for 10 minutes daily. Skin bacteria samples were collected from subjects’ volar forearms before and after 14 days of treatment. 16S sequencing was used to analyze Staphylococcus aureus abundance and skin bacterial microbiome composition, and alpha diversity of microbiota were determined using Shannon diversity index. Results There was no difference in skin bacterial microbiome in atopic dermatitis subjects after 2 weeks of daily water or apple cider vinegar treatments (p = 0.056 and p = 0.22, respectively), or in mean abundance of S . aureus on apple cider vinegar-treated forearms (p = 0.60). At 2 weeks, the skin bacterial microbiomes of healthy control subjects were not significantly different from the skin bacterial microbiome of atopic dermatitis subjects (p = 0.14, 0.21, 0.12, and 0.05). Conclusions Our results suggest that daily soaks in 0.5% apple cider vinegar are not an effective method of altering the skin bacterial microbiome in atopic dermatitis. Further studies are needed to explore the effects of different concentrations of apple cider vinegar on skin microflora and disease severity. Trial number UVA IRB-HSR #19906.
... As acidic and alkaline pH seems to limit the growth of S. aureus in vitro and in vivo, acidification of the skin could be one strategy. However, sustained acidification of the skin was not yet successful [64,123]. Therefore, more acidic products, well-buffered products or a more continuous application of the emollient could be beneficial. ...
... Therefore, more acidic products, well-buffered products or a more continuous application of the emollient could be beneficial. Dilute bleach baths also do not reduce S. aureus load and AE severity in vivo or in vitro [64,95,123,124]. Contrastingly, removal of S. aureus by UVB is known to be quite successful [125]. ...
Preprint
Atopic eczema (AE) is an inflammatory skin disease with involvement of genetic, immunological, and environmental factors. One hallmark of AE is a skin barrier disruption on multiple, highly interconnected levels: filaggrin mutations, increased skin pH, and a microbiome dysbiosis towards Staphylococcus aureus overgrowth are observed in addition to an abnormal type 2 immune response. Extrinsic factors seem to play a major role in the development of AE. As AE is a first step in the atopic march, its prevention and appropriate treatment is essential. Although standard therapy remains topical treatment, powerful systemic treatment options emerged in the last years. However, thorough endotyping of the individual patients is still required for ideal precision medicine approaches in the future. Therefore, novel microbial and immunological biomarkers were described recently for the prediction of disease development and treatment response. This review summarizes the current state of the art in AE research.
... As acidic and alkaline pH seems to limit the growth of S. aureus in vitro and in vivo, acidification of the skin could be one strategy. However, sustained acidification of the skin was not yet successful 67,130 . ...
... Therefore, more acidic products, well-buffered products or a more continuous application of the emollient could be beneficial. Dilute bleach baths also do not reduce S. aureus load and AE severity in vivo or in vitro 67,101,130,131 . Contrastingly, removal of S. aureus by UVB is known to be quite successful 132 . ...
Article
Full-text available
Atopic eczema (AE) is an inflammatory skin disease with involvement of genetic, immunological, and environmental factors. One hallmark of AE is a skin barrier disruption on multiple, highly interconnected levels: filaggrin mutations, increased skin pH, and a microbiome dysbiosis towards Staphylococcus aureus overgrowth are observed in addition to an abnormal type 2 immune response. Extrinsic factors seem to play a major role in the development of AE. As AE is a first step in the atopic march, its prevention and appropriate treatment is essential. Although standard therapy remains topical treatment, powerful systemic treatment options emerged in the last years. However, thorough endotyping of the individual patients is still required for ideal precision medicine approaches in the future. Therefore, novel microbial and immunological biomarkers were described recently for the prediction of disease development and treatment response. This review summarizes the current state of the art in AE research.
... 43 Patients with atopic dermatitis showed a significantly lessened skin tolerance for acetic acid and higher incidence of irritant reactions. 28,43 Chemical burns: partial or complete thickness burns have been reported on application of glacial acetic acid or undiluted acetic acid. 5 Vaginal burns, bleeding and blistering if accidently high concentration is applied. ...
Article
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p class="keywords">Vinegar is widely available as a food ingredient for flavouring and as a preservative. It is one of the oldest skin remedy known to mankind. However, its status in treatment regimens has declined over the decades. This article is an attempt to highlight its therapeutic armamentarium in dermatology, venereology and leprosy. Acetic acid in vinegar has antibacterial, antifungal and antiviral properties. This review talks about various studies of acetic acid for various indications, such as screening for cervical cancer, healing of chronic wounds, atopic dermatitis, onychomycosis, marine dermatoses, acne vulgaris, warts, in sclerotherapy and many others dermatoses. Combination therapies and newer indications are also described in this article. Recently, its antiviral action in vitro has been demonstrated against the ongoing coronavirus disease of 2019 (COVID-19) pandemic.</p
... aeruginosa, but persistence of low pH after topical exposure to vinegar is unlikely to be sufficient to restore barrier (17). ...
Article
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Preventing allergic contact dermatitis hinges on maintaining the integrity of the skin barrier and responding appropriately when it is disturbed. While intact skin is subject to sensitization via highly irritating allergens such as poison ivy, acutely inflamed and chronically inflamed skin are subject to sensitization to allergens without inherent irritant potential. In the chronically inflamed state of atopic dermatitis, sensitization to proteins such as food also carries a risk for systemic contact dermatitis via ingestion of the allergen. Minimizing the development of irritant dermatitis is key to preventing sensitization. However, in those with already chronically inflamed skin, reducing the use of products to the involved areas, recommending hypo-allergenic products with caution, and taking measures to prevent biofilm formation are also integral to preventing sensitization to chemicals and to proteins such as food and commensal organisms.
... As previously described, skin pH cannot be easily altered sustainably by the study emollients although a short term change was observed (Supplement Fig. S5) 9,45 . However, especially in AD, a temporary difference in skin pH was observed, hinting towards a reduced buffer capacity in AD. ...
Article
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Background Atopic eczema (atopic dermatitis, AD) is characterized by disrupted skin barrier associated with elevated skin pH and skin microbiome dysbiosis, due to high Staphylococcus aureus loads, especially during flares. Since S. aureus shows optimal growth at neutral pH, we investigated the longitudinal interplay between these factors and AD severity in a pilot study. Method Emollient (with either basic pH 8.5 or pH 5.5) was applied double blinded twice daily to 6 AD patients and 6 healthy (HE) controls for 8 weeks. Weekly, skin swabs for microbiome analysis (deep sequencing) were taken, AD severity assessed and skin physiology (pH, hydration, transepidermal water loss) measured. Results Physiological, microbiome and clinical results were not robustly related to the pH of applied emollient. In contrast to longitudinally stable microbiome in HE, S. aureus frequency significantly increased in AD over 8 weeks. High S. aureus abundance was associated with skin pH 5.7‐6.2. High baseline S. aureus frequency predicted both increase in S. aureus and in AD severity (EASI and local SCORAD) after 8 weeks. Conclusion Skin pH is tightly regulated by intrinsic factors and limits the abundance of S. aureus . High baseline S. aureus abundance in turn predicts an increase in AD severity over the study period. This underlines the importance and potential of sustained intervention regarding the skin pH and urges for larger studies linking skin pH and skin S. aureus abundance to understand driving factors of disease progression.
Chapter
Atopic dermatitis (AD) is a prevalent chronic condition that significantly contributes to childhood and adult morbidity. Sequalae of AD include infectious complications as well as decreased quality of life and negative psychosocial impacts. The treatment options of AD depend on the severity of AD; therefore accurate assessment of AD severity is important. Patient-Oriented Eczema Measures, Patient-Oriented SCOring AD, and validated Investigator Global Assessment are practical tools for clinicians in the assessment of AD severity. In addition to disease severity, it is important to document the impact of itch and sleep based on patient’s/parent’s rating scales. The primary treatment of AD mainly involves routine skincare and the use of topical antiinflammatory medications (corticosteroids, calcineurin inhibitors, and crisaborole). A shared-decision and multipronged approach in addressing patients’ or parents’ treatment preferences and concerns of side effects and triggers is important in ensuring treatment adherence. A written treatment plan or a simple, practical tool, such as the fingertip unit guide for topical medication use, can further increase patients’/parents’ confidence and adherence. Relatively safe and effective systemic treatment using dupilumab is now available for more severe AD presentations and is approved in patients as young as 6 years. Alternative treatments including other biologics and Janus kinase inhibitors are on the horizon. While more treatment options are being developed, further research into the pathophysiology and mechanisms of AD is necessary for improved safety and treatment success.
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Vinegar is commonly used as a home remedy for many skin problems. It is important for dermatologists to understand the evidence supporting its use in skin disease, as well as potential adverse effects, so they can properly counsel patients on the safe use of this widely available treatment. Vinegar possesses antimicrobial and antioxidant properties that provide utility in wound care as well as bacterial and fungal infections. There is also evidence to support its use in pruritus, head lice removal, and treatment of striae gravidarum. While generally safe, inappropriate use can result in damage to the skin. In this review, we discuss the evidence supporting vinegar as a treatment for skin disease, as well as adverse events reported from misuse, to provide dermatologists the knowledge to counsel patients on the safe and appropriate use of vinegar.
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Background Our skin is a very important and complex organ of the body. The microorganisms of the skin, the so-called microbiome, represent an important part of the healthy skin barrier and are influenced by various external and internal factors.AimThe question to what extent the skin microbiome represents a diagnostic or even therapeutic target in the context of skin diseases is discussed.Materials and methodsA literature search was performed.ResultsSeveral diseases are associated with negative alterations of the skin microbiome. In atopic dermatitis, a correlation between severity and increased availability of Staphylococcus aureus is known, with a loss of bacterial diversity on the skin. In the future, S. aureus will not only be used as a diagnostic marker in atopic dermatitis, but also represents a promising target as a predictive marker for therapeutic success. The role of the skin microbiome in psoriasis has not yet been researched in depth. However, there is evidence that dysbiosis of the skin microbiome contributes to the course of psoriasis and that there is a disturbance in immune tolerance in patients. In the case of acne, the involvement of Cutibacterium acnes in the clinical picture is well known; however, recent findings show that it is not sufficient to identify the species, but certain characteristics of C. acnes strains are associated.Conclusion Microbial biomarkers are currently only established in atopic dermatitis. For other diseases, this might be the case in the future; however combinations of microorganisms, single species and also strains with specific characteristics must be considered.
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Objective Atopic dermatitis (AD) is a chronic inflammatory skin disease that is complicated by an increased risk for skin and systemic infections. Preventive therapy for AD is based on skin barrier improvement and anti-inflammatory treatments, whereas overt skin and systemic infections require antibiotics or anti-viral treatments. This review updates the pathophysiology, diagnosis, management, controversy of antibiotic use, and potential treatments of AD infectious complications. Data Sources Published literature obtained through PubMed searches and clinical pictures. Study Selections Studies relevant to the mechanisms, diagnosis, management and potential therapy of AD infectious complications. Results Skin barrier defects, type 2 inflammation, S. aureus colonization and cutaneous dysbiosis are the major predisposing factors for the increased infections in AD. While overt infections require antibiotics, the use of antibiotics in AD exacerbation remains controversial. Conclusion Infectious complications are a co-morbidity of AD. Although not common, systemic bacterial infections and eczema herpeticum can be life-threatening. Preventive therapy of infections in AD emphasizes skin barrier improvement and anti- inflammatory therapy. The use of antibiotics in AD exacerbation requires further studies.
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Background The acidic pH of the stratum corneum (SC) is important for epidermal permeability barrier homeostasis. Acidification of the skin surface has been suggested as a therapeutic strategy for skin disorders such as atopic dermatitis (AD). Objective We performed an animal study to evaluate the usefulness of acidification of SC for inhibition of AD lesions and to find out if the therapeutic effect of vinegar is attributable to its herbal contents, rather than its acidity. Methods Five groups of six oxazolone-treated (Ox)-AD mice were treated for three weeks with creams of different acidity: vehicle cream alone (pH 5.5), neutralized vinegar cream (pH 7.4), pH 5.0 vinegar cream, pH 3.5 vinegar cream, and pH 3.5 hydrogen chloride (HCl) cream. Also, we have compared two groups of Ox-AD mice treated with pH 5.5 vehicle cream or pH 5.5 vinegar cream. Results Ox-AD mice treated with acidic creams exhibited fewer AD-like lesions, had significantly lower eczema scores, decreased basal by transepidermal water loss (TEWL), and increased SC hydration compared to the groups given only vehicle and neutral cream. There was no significant difference between the acidic vinegar and HCl groups. Between the groups treated with vehicle and pH 5.5 vinegar cream, there was no difference in eczema score, basal TEWL and SC hydration. Conclusion Application of topical acids, regardless of their source materials, inhibits the development of AD lesions by maintenance of skin surface pH and skin barrier function in murine model.
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Atopic dermatitis (AD) is the most common allergic skin disease in the general population. It is a chronic inflammatory skin disease complicated by recurrent bacterial and viral infections that, when left untreated, can lead to significant complications. The current article will review immunologic and molecular mechanisms underlying the propensity of AD patients to microbial infections. These infections include Staphylococcus aureus (S. aureus) skin infections, eczema herpeticum, eczema vaccinatum, and eczema coxsackium. Previous studies have shown that skin barrier defects, a decrease in antimicrobial peptides, increased skin pH, or Th2 cytokines such as IL-4 and IL-13 are potential contributing factors for the increased risk of skin infections in AD. In addition, bacterial virulence such as methicillin-resistant S. aureus (MRSA) produces significantly higher number of superantigens that increase their potential in causing infection and more severe cutaneous inflammation in AD patients. More recent studies suggest that skin microbiome including Staphylococcus epidermidis or other coagulase-negative staphylococci may play an important role in controlling S. aureus skin infections in AD. Other studies also suggest that genetic variants in the innate immune response may predispose AD patients to increased risk of viral skin infections. These genetic variants include thymic stromal lymphopoietin (TSLP), type I interferon (α, ß, ω), type II interferon (γ), and molecular pathways that lead to the production of interferons (interferon regulatory factor 2). A common staphylococcal toxin, α-toxin, may also play a role in enhancing herpes simplex virus skin infections in AD. Further understanding of these disease processes may have important clinical implications for the prevention and treatment of skin infections in this common skin disease.
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Atopic dermatitis is a form of dermatitis commonly seen in children and adults. Its pathophysiology is complex and is centered on the barrier function of the epidermis. An important aspect of the skin's barrier is pH, which in turn affects a number of parameters such as the skin flora, protease function, and mediators of inflammation and pruritus. Normal pH for non-neonatal skin is acidic and ranges from 4 to 6. Skin pH in atopic dermatitis patients is often increased into the neutral to basic range, and the resulting cascade of changes contributes to the phenotype of atopic dermatitis. Therefore, the maintenance of normal skin pH remains an important topic in understanding and treating atopic dermatitis. This article will review skin pH and its impact on normal barrier function, pathological pH changes in atopic dermatitis, and the therapeutic considerations related to restoring and maintaining pH balance.
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Loss-of-function mutations in the skin barrier protein filaggrin (FLG) are a major risk for atopic dermatitis (AD). The pathogenic sequence of disturbances in skin barrier function before or during the early development of AD is not fully understood. A more detailed understanding of these events is needed to develop a clearer picture of disease pathogenesis. A robust, noninvasive test to identify babies at high risk of AD would be important in planning early intervention and/or prevention studies. To ascertain whether a noninvasive measurement of skin barrier function at day 2 after birth and at 2 months predicts the development of AD at 1 year. Furthermore, to determine whether increases in transepidermal water loss (TEWL) predate the development of clinical AD. A total of 1903 infants were enrolled in the Cork Babies After Scope: Evaluating the Longitudinal Impact Using Neurological and Nutritional Endpoints Birth Cohort study from July 2009 to October 2011. Measurements of TEWL were made at birth (day 2) and at 2 and 6 months. The presence of AD was ascertained at 6 and 12 months, and disease severity was assessed by using the SCORing Atopic Dermatitis clinical tool at 6 months and by using both the SCORing Atopic Dermatitis clinical tool and Nottingham Severity Score at 12 months. A total of 1300 infants were genotyped for FLG mutations. At 6 months, 18.7% of the children had AD, and at 12 months, 15.53%. In a logistic regression model, day 2 upper quartile TEWL measurement was significantly predictive of AD at 12 months (area under the receiver operating characteristic curve, 0.81; P < .05). Lowest quartile day 2 TEWL was protective against AD at 12 months. An upper quartile 2 month TEWL was also strongly predictive of AD at 12 months (area under the receiver operating characteristic curve, 0.84; P < .05). At both ages, this effect was independent of parental atopy, FLG status, or report of an itchy flexural rash at 2 months. Associations were increased when parental atopy status or child FLG mutation status was added into the linear regression model. Impairment of skin barrier function at birth and at 2 months precedes clinical AD. In addition to providing important mechanistic insights into disease pathogenesis, these findings have implications for the optimal timing of interventions for the prevention of AD. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.
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Non-invasive investigations of skin morphology and function are standard tools to study the pathophysiology of several cutaneous disorders, yet they have not been used in population-based epidemiological studies. Here we examined skin surface pH, stratum corneum hydration, trans-epidermal water loss (TEWL) and skin roughness by profilometry in a study population comprising 377 primary school children (8-9 years old) as part of a multicentre survey on risk factors for allergic diseases in school children. Skin surface pH showed significant higher values (p=0.029) in the group with atopic eczema (n=45) compared with the group without atopic eczema; all other parameters did not differ significantly between children with and without atopic eczema. With increasing skin dryness there was a significant increase in pH values (p=0.004). Stratum corneum hydration showed a significant decrease with increasing dryness (p<0.001). Measurement of skin roughness also revealed a significant linear relationship with skin dryness (p=0.02). It is concluded that measurement of skin surface pH, corneometry and profilometry are useful non-invasive techniques to objectively assess skin dryness in epidemiological studies regarding atopic skin disease.
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Background Increased skin surface pH is an important host‐related factor for deteriorated barrier function in the aged. Objectives We investigated whether restoration of the skin pH through topical application of a water‐in‐oil (w/o) emulsion with pH 4 improved the barrier homeostasis in aged skin and compared the effects to an identical galenic formulation with pH 5.8. Methods The effects of the test formulations on the barrier recovery were investigated by repeated measurements of transepidermal water loss (TEWL) and skin pH 3 h, 6 h and 24 h after acetone‐induced impairment of the barrier function in aged skin. The long‐term effects of the pH 4 and pH 5.8 emulsions were analyzed by investigation of the barrier integrity/cohesion, the skin surface pH and the skin roughness and scaliness before and after a 4‐week, controlled application of the formulations. Results The application of the pH 4 emulsion accelerated the barrier recovery in aged skin: 3 h and 6 h after acetone‐induced barrier disruption the differences in the TEWL recovery between the pH4‐treated and acetone control field were significant. Furthermore, the long‐term application of the pH 4 formulation resulted in significantly decreased skin pH, enhanced barrier integrity and reduced skin surface roughness and scaliness. At the same time points, the pH 5.8 formulation exerted only minor effects on the barrier function parameters. Conclusions Exogenous acidification through topical application of a w/o emulsion with pH 4 leads to improvement of the barrier function and maintenance of the barrier homeostasis in aged skin. This article is protected by copyright. All rights reserved.
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Nursing care and patient education are integral to compliance with dermatologic medical treatments. This column has been developed in partnership with caring nurses dedicated to optimizing patient care through practicum-based education and treatment. This article focuses on apple cider vinegar baths for atopic dermatitis.
Chapter
The pathophysiology of atopic dermatitis is complex and multifactorial, involving elements of barrier dysfunction, alterations in cell mediated immune responses, IgE mediated hypersensitivity, and environmental factors. Loss of function mutations in filaggrin have been implicated in severe atopic dermatitis due to a potential increase in trans-epidermal water loss, pH alterations, and dehydration. Other genetic changes have also been identified which may alter the skin’s barrier function, resulting in an atopic dermatitis phenotype. The imbalance of Th2 to Th1 cytokines observed in atopic dermatitis can create alterations in the cell mediated immune responses and can promote IgE mediated hypersensitivity, both of which appear to play a role in the development of atopic dermatitis. One must additionally take into consideration the role of the environment on the causation of atopic dermatitis and the impact of chemicals such as airborne formaldehyde, harsh detergents, fragrances, and preservatives. Use of harsh alkaline detergents in skin care products may also unfavorably alter the skin’s pH causing downstream changes in enzyme activity and triggering inflammation. Environmental pollutants can trigger responses from both the innate and adaptive immune pathways. This chapter will discuss the multifaceted etiology of atopic dermatitis which will help us to elucidate potential therapeutic targets. We will also review existing treatment options and their interaction with the complex inflammatory and molecular triggers of atopic dermatitis.
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The importance of the epidermal acid mantle in maintaining the natural flora of the skin and its role in skin barrier homeostasis has been known for decades. Despite well-established evidence that the skin barrier pH is elevated in patients with inflammatory dermatoses such as atopic dermatitis, epidermal pH modification has been an underexplored therapeutic option that could potentially prevent overuse of antibiotics, topical glucocorticoids, and immune modulators. By optimizing the skin using a novel therapeutic regimen, we report three cases of recalcitrant atopic dermatitis that were successfully treated based on the concept of epidermal acidification combined with optimization of the skin barrier.
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Atopic dermatitis (AD) is a chronic inflammatory skin disease associated with defective epidermal barrier function, characterized by decreased stratum corneum (SC) hydration, and increased TEWL (transepidermal water loss) and pH. Staphylococcus aureus (SA) skin colonization is present in nearly all cases of AD exacerbation and correlates with disease severity, 1 suggesting an infection – inflammation cycle. The use of sodium hypochlorite (bleach) bath alone and as an adjunct to intranasal mupirocin ointment is associated with reduction in AD severity,2,3 and decreases annual skin infection cases by ten-fold.4 In a Cochrane review on various interventions to reduce SA colonization, including oral antibiotics, topical steroids and antibiotic ointments, only bleach bath showed a significant improvement in AD severity.5 This article is protected by copyright. All rights reserved.
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Non-invasive investigations of skin morphology and function are standard tools to study the pathophysiology of several cutaneous disorders, yet they have not been used in population-based epidemiological studies. Here we examined skin surface pH, stratum corneum hydration, trans-epidermal water loss (TEWL) and skin roughness by profilometry in a study population comprising 377 primary school children (8-9 years old) as part of a multicentre survey on risk factors for allergic diseases in school children. Skin surface pH showed significant higher values (p=0.029) in the group with atopic eczema (n=45) compared with the group without atopic eczema; all other parameters did not differ significantly between children with and without atopic eczema. With increasing skin dryness there was a significant increase in pH values (p=0.004). Stratum corneum hydration showed a significant decrease with increasing dryness (p<0.001). Measurement of skin roughness also revealed a significant linear relationship with skin dryness (p=0.02). It is concluded that measurement of skin surface pH, corneometry and profilometry are useful non-invasive techniques to objectively assess skin dryness in epidemiological studies regarding atopic skin disease.
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Recent studies have provided new insights into the occurrence, causes, and pathogenetic consequences of changes in the skin pH in atopic dermatitis, particularly with respect to skin barrier function and colonization with Staphylococcus aureus. Growing evidence suggests an impaired release of proton donors, such as amino acids, urocanic acid, and lactic acid, to the stratum corneum in atopic dermatitis, as a result of reductions in filaggrin proteolysis and sweat secretion. In addition, an impaired formation of free fatty acids from sebaceous lipids and epidermal phospholipids seems to be involved. Because both lipid organization and lipid metabolism in the stratum corneum requires an acidic pH, these alterations might contribute to the disturbance of skin barrier function observed in atopic dermatitis. Furthermore, bacterial growth and virulence of S. aureus, as well as defensive host mechanisms, have increasingly been delineated as pH dependent, giving rise to a new understanding of the pathophysiology underlying increased skin colonization seen in atopic dermatitis.
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The purpose is to investigate the demographics and course of common warts in children in an outpatient setting. A retrospective medical chart review and telephone survey study were completed on an outpatient cohort of children (0-17 yrs) with a clinical diagnosis of warts at a single-center, university-based pediatric dermatology practice. The main outcome measures included management, time to resolution, and associated factors of warts in children. Of the 254 patients we contacted, 214 agreed to participate in the survey. The most commonly involved sites were the hands and the head and neck area. Most children received some form of therapy, but it is unclear that any form of treatment altered the course. However, children with a medical history of childhood infections or more than one anatomic site had significantly greater risk of having a longer time to resolution. Warts resolved in 65% of children by 2 years and in 80% within 4 years, regardless of treatment. With the exception of a history of childhood infections and having more than one anatomic site, time to resolution was not altered by wart or patient characteristics. Thus counseling without aggressive destructive treatment is a reasonable approach to managing warts in most children. Our findings will provide guidance in the process of shared decision making with parents and children. © 2015 Wiley Periodicals, Inc.
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Atopic dermatitis is a common and chronic, pruritic inflammatory skin condition that can affect all age groups. This evidence-based guideline addresses important clinical questions that arise in its management. In this second of 4 sections, treatment of atopic dermatitis with nonpharmacologic interventions and pharmacologic topical therapies are reviewed. Where possible, suggestions on dosing and monitoring are given based on available evidence.
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Acetic acid has been shown to have good antibacterial activity against micro-organisms such as Pseudomonas aeruginosa. This study examined the activity against a range of bacterial pathogens and also assessed any reduction in antibacterial activity due to evaporation or inactivation by organic material in dressings. Acetic acid was active at dilutions as low as 0.166% and the activity was not reduced by evaporation nor by inactivation by cotton swabs. Burn injuries are a major problem in countries with limited resources. Acetic acid is an ideal candidate for use in patients who are treated in those parts of the world.
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Both exposure of stratum corneum to neutral pH buffers and blockade of acidification mechanisms disturb cutaneous permeability barrier homeostasis and stratum corneum integrity/cohesion, but these approaches all introduce potentially confounding variables. To study the consequences of stratum corneum neutralization, independent of hydration, we applied two chemically unrelated superbases, 1,1,3,3-tetramethylguanidine or 1,8-diazabicyclo [5,4,0] undec-7-ene, in propylene glycol:ethanol (7:3) to hairless mouse skin and assessed whether discrete pH changes alone regulate cutaneous permeability barrier function and stratum corneum integrity/cohesion, as well as the responsible mechanisms. Both 1,1,3,3-tetramethylguanidine and 1,8-diazabicyclo [5,4,0] undec-7-ene applications increased skin surface pH in parallel with abnormalities in both barrier homeostasis and stratum corneum integrity/cohesion. The latter was attributable to rapid activation (<20 min) of serine proteases, assessed by in situ zymography, followed by serine-protease-mediated degradation of corneodesmosomes. Western blotting revealed degradation of desmoglein 1, a key corneodesmosome structural protein, in parallel with loss of corneodesmosomes. Coapplication of serine protease inhibitors with the superbase normalized stratum corneum integrity/cohesion. The superbases also delayed permeability barrier recovery, attributable to decreased beta-glucocerebrosidase activity, assessed zymographically, resulting in a lipid-processing defect on electron microscopy. These studies demonstrate unequivocally that stratum corneum neutralization alone provokes stratum corneum functional abnormalities, including aberrant permeability barrier homeostasis and decreased stratum corneum integrity/cohesion, as well as the mechanisms responsible for these abnormalities.
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Recent studies have provided new insights into the occurrence, causes, and pathogenetic consequences of changes in the skin pH in atopic dermatitis, particularly with respect to skin barrier function and colonization with Staphylococcus aureus. Growing evidence suggests an impaired release of proton donors, such as amino acids, urocanic acid, and lactic acid, to the stratum corneum in atopic dermatitis, as a result of reductions in filaggrin proteolysis and sweat secretion. In addition, an impaired formation of free fatty acids from sebaceous lipids and epidermal phospholipids seems to be involved. Because both lipid organization and lipid metabolism in the stratum corneum requires an acidic pH, these alterations might contribute to the disturbance of skin barrier function observed in atopic dermatitis. Furthermore, bacterial growth and virulence of S. aureus, as well as defensive host mechanisms, have increasingly been delineated as pH dependent, giving rise to a new understanding of the pathophysiology underlying increased skin colonization seen in atopic dermatitis.