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Chandrashekar BS, Luger T, Rajendran SC, Parathasaradhi A, Thomas J, Ganjoo A, Sharma
D, Damishetty R, Ruby N, Sujay V, Sriram S, Udare S, Shah D, Rajgopal J. Role of Actives in
Emollients in Atopic Dermatitis. J Dermatol & Skin Sci. 2024;6(1):16-23
Review Article Open Access
Page 16 of 23
Role of Actives in Emollients in Atopic Dermatitis
B. S. Chandrashekar1, Thomas Luger2, S. C. Rajendran3, Anchala Parathasaradhi4, Jayakar Thomas5,
Anil Ganjoo6, Divya Sharma7, Rajetha Damishetty8, Nazima Ruby9, Vijayalakshmi Sujay10, Snehal Sriram11,
Satish Udare12, Dhara Shah13, Jayesh Rajgopal*14
1Chief Dermatologist / Medical Director: Cutis, Academy of Cutaneous Sciences, Bengaluru
2Department of Dermatology, University of Muenster, Muenster, Germany
3Director and Senior Consultant Dermatologist at Cosmetic Skin Care Clinic, Koramangala, Bengaluru
4Senior Consultant Dermatologist at Anchala’s Skin Institute, Hyderabad
5Professor & Head, Chettinad Hospital and Research Institute, Chennai
6Director, Skinnovation Clinics, New Delhi
7Chief Consultant at Dr Divya’s Skin and Hair Solutions, Bangalore
8Additional Medical director, Oliva chain of 23 Hair and Skin Clinics
9Consultant Dermatologist, Radiant Skin Clinic, Bengaluru
10Consultant Dermatologist and Cosmetologist, Shree Skin and Cosmetic Clinic, Bengaluru
11Consultant and Head of Cosmetic Dermatology Department at Nahar Medical Center, Mumbai
12Medical Director of ‘Sparkle’ Skin and Aesthetic Centre, Vashi and ‘Disha Skin and Laser Institute’ Thane, Mumbai
13Head Medical Affairs, Mylan Pharmaceuticals Private Limited - A Viatris Company
14Senior Medical Manager, Mylan Pharmaceuticals Private Limited - A Viatris Company
Article Info
Article Notes
Received: April 15, 2024
Accepted: May 30, 2024
*Correspondence:
* Dr. Jayesh Rajgopal, Mylan Pharmaceuticals Private Limited -
A Viatris Company, Bengaluru, India; Orcid Id: 0009-0003-4251-
1394; Tel: (+91) 99771 38848;
Email: jayesh.rajgopal@viatris.com.
©2024 Rajgopal J. This article is distributed under the terms of
the Creative Commons Attribution 4.0 International License.
Keywords:
Atopic dermatitis
Emollients
Anti-inammatory
Atopic eczema
Emollient plus
Abstract
The prevalence of atopic dermas (AD) in India is 2.7% (age 6–7 years)
and 3.6% (age 13–14 years). Emollients remain mainstay treatment for atopic
dermas. The present review arcle focuses on the role of acve ingredients
in emollients towards the management of AD. Arcle were selected by
searching in database like Google Scholar and PubMed and were reviewed
by the authors. Daily use of emollients from birth may signicantly reduce
the incidence of AD in a high-risk populaon. Emollients with a variety of
acve ingredients to target AD pathophysiology have been developed which
contain acve ingredients like liquorice extract (an-inammatory and an-
pruric), niacinamide (restoraon of barrier funcon), sterols (restoraon of
barrier funcon), laureth-9-polydocanol (an-pruric), xylitol (microbiome
maintenance) and galacto-oligosaccharide (GOS) (microbiome maintenance).
Emollient plus may be a useful adjunct to pharmacological therapy in AD and
as maintenance therapy, providing rapid and signicant improvements in skin
moisture, epidermal barrier funcon, and signs and symptoms of AD.
Introduction
Atopic dermatitis (AD) also known as atopic eczema (AE), is
1 It is characterized
1, and intense itch 1 and is often
2 It
3 and
1
As per the
5
Chandrashekar BS, Luger T, Rajendran SC, Parathasaradhi A, Thomas J, Ganjoo A, Sharma
D, Damishetty R, Ruby N, Sujay V, Sriram S, Udare S, Shah D, Rajgopal J. Role of Actives in
Emollients in Atopic Dermatitis. J Dermatol & Skin Sci. 2024;6(1):16-23
Journal of Dermatology and Skin Science
Page 17 of 23
2
2
8
10
with mild to moderate AD11
Methods
The relevant articles were searched on databases
New Pathogenic Concepts of AD
12
15 This
lesions in atopic dermatitis which are (i) an imbalance of
18
Figure 1: Mechanism of atopic dermas
Chandrashekar BS, Luger T, Rajendran SC, Parathasaradhi A, Thomas J, Ganjoo A, Sharma
D, Damishetty R, Ruby N, Sujay V, Sriram S, Udare S, Shah D, Rajgopal J. Role of Actives in
Emollients in Atopic Dermatitis. J Dermatol & Skin Sci. 2024;6(1):16-23
Journal of Dermatology and Skin Science
Page 18 of 23
18 A defective
18
20
21
22
23
Preventive Strategies and General Measures
2
addition, patient’s fears of side effects from corticosteroids
8,25 Emollients remain
2 Emollients
8
Rationale for Selected Active Ingredients in a
Novel Emollient Plus
28
10 Some of the
30
Figure 2: Components of Emollient plus
Chandrashekar BS, Luger T, Rajendran SC, Parathasaradhi A, Thomas J, Ganjoo A, Sharma
D, Damishetty R, Ruby N, Sujay V, Sriram S, Udare S, Shah D, Rajgopal J. Role of Actives in
Emollients in Atopic Dermatitis. J Dermatol & Skin Sci. 2024;6(1):16-23
Journal of Dermatology and Skin Science
Page 19 of 23
31
32
S. aureus33
ratio of total S. aureus
35
Mode of Action of the Components of Emollient
Plus
Liquorice extract
38
Niacinamide
Galacto-oligosaccharides (GOS)
dermatitis
Xylitol
10
the skin microbiome
Novel Emollient Plus in the Management of AD
10
Chandrashekar BS, Luger T, Rajendran SC, Parathasaradhi A, Thomas J, Ganjoo A, Sharma
D, Damishetty R, Ruby N, Sujay V, Sriram S, Udare S, Shah D, Rajgopal J. Role of Actives in
Emollients in Atopic Dermatitis. J Dermatol & Skin Sci. 2024;6(1):16-23
Journal of Dermatology and Skin Science
Page 20 of 23
Study design Objecves Paents Treatment Evaluaon Results
Study 1. Gasparri. 2019
Observaonal pilot study
(n=10 AD paents);
comparisons were made
between treated versus
non-treated areas on
each paent
Invesgate the
ecacy of Emollient
plus on skin
moisture, epidermal
barrier funcon,
and AD signs and
symptoms
Ten otherwise
healthy Caucasian
adults with clinical
signs of AD
Emollient plus
applied twice
daily to areas
of AD on one
side of the body,
with treated and
untreated areas for
comparison.
Performed at
baseline, 1, and 2
days aer the rst
applicaon of
Emollient plus, and
aer 7 and 21 days of
twice-daily treatment
Signicant reducon in
pruritus was seen versus
baseline (Day 1: 42.6%
reducon; Day 21: 40.7%
reducon) and versus
untreated areas. 80% of
paents were ‘sased’
or ‘very sased’ with
Emollient plus
Study 2. Quadri, et al. 2021 – Pre-clinical analysis
An in-vitro study, using a
tape-stripping mediated
skin barrier disrupon
model
Invesgate the
eect of Emollient
plus on skin barrier
recovery
N/A
Aer tape stripping,
epidermal cells
were treated with
either Emollient
plus or diluent
(control) and
cultured
Samples were
analyzed at 18 hours
(skin barrier integrity
analysis) or up to
120 hours (lipid
restoraon analysis)
Emollient plus
signicantly increased
epidermal thickness in
organ cultures.
Study 3: Quadri, et al. 2021 – Clinical analysis
Double-blind,
randomized,
placebo-
controlled study in
paents with mild-to-
moderate AD in clinical
remission
Evaluate the role
of Emollient plus
in hydraon and
vascularizaon of
the skin
Male (n=10) or
female (n=10)
between the
ages of 24 and
60 with mild- to-
moderate AD in
clinical remission
phase
Assigned to one
of two treatment
groups: Group 1:
n=10 (5 male),
Emollient plus once
daily Group 2: n=10
(5 male), placebo
once daily
Performed at
baseline, and aer
1 and 2 months of
once-daily treatment
with Emollient plus or
placebo
Aer 2 months of
treatment with
Emollient plus, a
signicant reducon in
epidermal thickness was
seen versus placebo
Study 4: Sparavigna, et al. 2019
Single center,
randomized, double-
blind study in paents
with mild AD
Primary objecve:
ecacy of Emollient
plus versus vehicle
on pruritus
Paents were male
or female aged 24–50
years (mean age: 40
years) with mild AD
(SCORAD <25)
Emollient plus
(n=58 forearms)
or vehicle (n=39
forearms) applied
twice daily to the
le or right forearm
for 28 days
Performed at
baseline, and aer
14 and
28 days of treatment
with Emollient plus or
vehicle
Signicant reducon of
pruritus compared with
baseline (T14 d: 53%,
p<0.05; T28 d: 89%,
p<0.05) and with vehicle
(T14 d: 53% vs 23%,
p<0.05; T28 d:
89% vs 60%, p<0.05,
respecvely)
Study 5: Gasparri, et al. 2021
Monocentric, open study
in subjects predisposed
to AD
Evaluate the
changes in skin
microbiome aer 28
days of treatment
versus baseline in
Emollient plus -
treated areas
Eleven paents
considered
predisposed to AD:
very dry skin; ≥1
episode of dermas
during life; skin
prone to irritaon/
erythema;
and
frequent itching
Emollient plus was
applied twice daily
between the neck
and shoulders for
28 days
To assess alpha
microbiome diversity,
bacterial DNA
was extracted from
treated areas at
baseline and aer 28
days of treatment
Microbial diversity
improved in the majority
of subjects following 28
days of treatment with
Emollient plus.
Study 6: Sparavigna, et al. 2020
Open-label, single-
arm, intervenonal,
mulcentre study in
paents previously
treated with
pimecrolimus
Primary objecve:
Evaluate the me to
are, dened as the
me to next disease
exacerbaon
One hundred and
one paents, both
genders aged >12
years with
mild-to-moderate
AD (IGA=2
or 3),
who had responded
successfully to 1%
pimecrolimus cream
Emollient plus was
applied twice daily
for 4 months
Performed at
baseline, and aer
14 days, then every
month for 4 months
Emollient plus aer 1%
pimecrolimus, was able
to maintain regression
of are-up to at least 4
months in 99% of the
paents. Percentage of
paents who had an IGA
of 2 decreased over me
from 17% at baseline to
2% at Month 4.
Table 1: Studies with novel emollient plus
Chandrashekar BS, Luger T, Rajendran SC, Parathasaradhi A, Thomas J, Ganjoo A, Sharma
D, Damishetty R, Ruby N, Sujay V, Sriram S, Udare S, Shah D, Rajgopal J. Role of Actives in
Emollients in Atopic Dermatitis. J Dermatol & Skin Sci. 2024;6(1):16-23
Journal of Dermatology and Skin Science
Page 21 of 23
To date, no
50
51
52
mild to moderate AD11
11
11
Limitations of the Studies
Patients with AD often have increased penetration
53
53 Farnesol has been reported
55
Conclusions
cream, ointment or lotion depends on the environmental
Acknowledgements
Funding
Data Availability Statement
References
Lancet.
Indian J Dermatol.
JAAD
Int.
Am J Pharm Educ.
Chandrashekar BS, Luger T, Rajendran SC, Parathasaradhi A, Thomas J, Ganjoo A, Sharma
D, Damishetty R, Ruby N, Sujay V, Sriram S, Udare S, Shah D, Rajgopal J. Role of Actives in
Emollients in Atopic Dermatitis. J Dermatol & Skin Sci. 2024;6(1):16-23
Journal of Dermatology and Skin Science
Page 22 of 23
Clin Cosmet Investig Dermatol.
J Invest
Dermatol.
J Eur Acad Dermatol Venereol.
J Eur Acad Dermatol
Venereol.
Lancet.
Clin
Cosmet Investig Dermatol.
J Eur Acad
Dermatol Venereol.
Allergy Asthma Proc.
Arch Immunol Ther Exp (Warsz).
J Dermatol
Sci.
J Allergy Clin
Immunol.
J Allergy Clin Immunol.
Allergol
Int.
ISRN Allergy.
J Allergy Clin Immunol.
Am J Pathol.
Exp Dermatol.
Proc Natl Acad Sci
U S A.
J Invest Dermatol.
and betamethasone on the skin barrier in patients with atopic
Journal of allergy and clinical immunology.
Ann Dermatol.
Cochrane Database Syst Rev.
Semin Cutan Med Surg.
Drugs Context.
Steroids.
J Dermatolog Treat.
Current Drug Delivery.
Cutis.
J
Dermatol Sci.
J Dermatol Sci.
Curr
Med Res Opin.
Evid Based Complement
Alternat Med.
Molecules.
Int J Mol Sci.
Dig Dis Sci.
Antioxidants (Basel).
Advance
Research in Dermatology & Cosmetics (ARDC).
Chandrashekar BS, Luger T, Rajendran SC, Parathasaradhi A, Thomas J, Ganjoo A, Sharma
D, Damishetty R, Ruby N, Sujay V, Sriram S, Udare S, Shah D, Rajgopal J. Role of Actives in
Emollients in Atopic Dermatitis. J Dermatol & Skin Sci. 2024;6(1):16-23
Journal of Dermatology and Skin Science
Page 23 of 23
Front Microbiol.
Molecules.
Frontiers in
Nutrition.
N Engl J Med.
Acta Derm Venereol.
Skin Pharmacol Physiol.
24th World Congress of Dermatology,
Milan, Italy.
J Plast Pathol Dermatol.
J Hum
Hypertens.
Cochrane Database Syst Rev.
Pediatrics.
Am J Clin
Dermatol.
Contact Dermatitis.
Allergy.
J Eur
Acad Dermatol Venereol.
