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Gentle Cleansing and Moisturizing for Patients with Atopic Dermatitis and Sensitive Skin
Abstract
Atopic dermatitis is a common condition characterized by pruritus, inflammation, and dryness of the skin. Inflammation disrupts the barrier function of the stratum corneum, predisposing the skin to be dry, and increases susceptibility to irritants and secondary bacterial infection. Sensitive skin is common, reported by 40-50% of women and 30% of men in the US, Europe, and Japan. Basic requirements in managing eczema and sensitive skin include effective cleansers that do not compromise skin barrier integrity, alleviation of skin dryness, and restoration of skin barrier function through the use of therapeutic moisturizers. The selection of a skin cleanser is therefore an important part of managing these conditions. Studies have reported clinical improvement with the use of soap-free cleansers in combination with topical treatments. While topical corticosteroids and immunosuppressive agents are mainstays of treatment for atopic dermatitis, therapeutic moisturizers are important adjuncts. Moisturizers improve skin hydration, reduce susceptibility to irritation, restore the integrity of the stratum corneum, and enhance the efficacy of topical corticosteroids.
... Aloe, myrrh, and frankincense are common among Egyptians. Ancient Egyptians believed these products, particularly frankincense, had anti-aging properties and used them as anti-wrinkle creams [7]. Jain et al. (2009) also reported that men and women in Egypt used scented oils and ointments to clean and smooth their skin and mask body odor as early as 10,000 BC. ...
... For protection against the hot sun and dry winds, oils and creams were used [8]. Egyptian customs were exported and utilized by Greeks and Roman [7,9]. ...
... Crocodile excrement, white lead and chalk were commonly used by ladies to enhance the appearance of their skin. They also made face masks out of starch and eggs, which were thought to tighten the skin, reduce wrinkles, and keep the face looking youthful [7]. The term "cosmetic" comes from the Greek word "kosmetos," which means "adornment" or "ornament." ...
Moisturizers are one of the most widely used preparations in cosmetics and have been extensively used to soften the skin for consumers. Moisturizers work effectively in combating dry skin which may cause pain, tightness, itch, stinging, and/or tingling. The aim of this review is to evaluate published studies on the history, ingredients, preparation processes, characteristics, uses, and applications of moisturizers. Moisturizers bridge the gap between medicine and consumer goods by being used to make the skin more beautiful and healthy. In the future, in moisturizer therapy, the capacity to adapt specific agents to specific dermatological demands will be crucial. Cosmetically, moisturizers make the skin smooth by the mechanism of increasing the water content in the stratum corneum, hence exerting its most vital action, which is moisturizing action and maintaining a normal skin pH.
... 40 Topical corticosteroids and immunosuppressive agents are the mainstay of treatment together with adjunctive therapeutic moisturizers. 41 Very potent steroids must be used only in treating AD flares, and as improvement is observed, lowpotency steroids must be used instead with reduced frequency of applications. High-potency steroids ought to be avoided on thin skin, like face or skin folds. ...
... 40 Basic therapeutic modalities for managing AD and sensitive skin include effective cleansers that do not compromise skin barrier integrity and moisturizers/emollients that improve skin dryness and restore skin barrier function. 41 Emollients must ideally contain occlusive agents like lanolin, mineral oils, olive oil, petrolatum ceramide, paraffin, or silicone as they effectively retard transepidermal loss of moisture. 42 Emollients containing ceramides/pseudoceramides have also been found to positively enhance skin dryness and hydration. ...
... 40 As soaps have an irritant effect on skin in AD, syndets are an effective option for cleansing due to their mildness and hydrating properties. 21,41 Lastly, it is vital to protect skin from sun exposure by using broad-spectrum sunscreens. 41 ...
p class="abstract">Sensitive skin is a very commonly seen entity in current dermatological practice that has a significant impact on quality of life. The pathophysiology, classification, diagnosis, and treatment of sensitive skin have evolved over the years, with new studies trying to bring about new robust evidence about the same. The current consensus aims at providing a comprehensive overview on evidence and experience-based approaches for sensitive skin. A total of 35 experts in the field of clinical dermatology participated in expert group meetings organized via teleconference webinar. Current evidence elaborating various aspects like classification, diagnosis, and management of sensitive skin along with clinical experience of experts were discussed in detail. The prerequisites for selecting suitable products, importance of cosmeceuticals as adjunctive therapy and the need for avoiding triggering factors in individuals with sensitive skin as well as associated dermatological disorders were also described. In addition to medical history, physical examination and routine investigations, a draft checklist and its clinical relevance in accurately diagnosing sensitive skin were emphasized upon by the experts. The overall management encompasses avoidance of individual trigger factors, thorough topical therapy using mild, non-irritating ingredients along with adjunctive therapies like moisturizers, sunscreens, and cleansers. The “two-week” strategy was described to be a useful approach for treating sensitive skin. This review article provides a consensus clinical viewpoint of expert dermatologists for effective evaluation, differential diagnosis and appropriate pharmacological as well as non-pharmacological management of sensitive skin in Indian subjects.</p
... Instead, non-soap based surfactants and synthetic detergents (syndets) are often recommended for better tolerance, although this is based on only a few supportive clinical studies. 29,30 With the exception of bleach, which is discussed in detail below, data is limited on the addition of oils, emollients, and other related additives to bath water and their benefits for AD. 26,31 The quantity of emollient deposited on the skin via a bath additive is likely to be lower than that from direct application. ...
... Use of moisturizers A I 9-16, 18-21, 126 Bathing and bathing practices C III 23,24,26,28,30 Application of moisturizers after bathing B II 24,25 Limited use of non-soap cleansers C III [27][28][29][30] Against use of bath additives, acidic spring water C III 31,32,127 Wet wrap therapy B II [34][35][36][37][38][39][40][41] Use of topical corticosteroids (TCS) A I [42][43][44][45][46] Consideration of a variety of factors in TCS selection C III 49,128,129 Frequency of application B II [51][52][53] Proactive use of TCS for maintenance B II [54][55][56] Need for consideration of side effects with use A I Awareness of black box warning of TCIs C III [98][99][100][101] Routine monitoring of TCI blood levels not needed A I 102,103 Against routine use of topical antistaphylococcal treatments A I [110][111][112] Bleach baths and intranasal mupirocin for those with moderate to severe AD and clinical infection B II 113 Against use of topical antihistamines B II 42,[115][116][117] ...
... Use of moisturizers A I 9-16, 18-21, 126 Bathing and bathing practices C III 23,24,26,28,30 Application of moisturizers after bathing B II 24,25 Limited use of non-soap cleansers C III [27][28][29][30] Against use of bath additives, acidic spring water C III 31,32,127 Wet wrap therapy B II [34][35][36][37][38][39][40][41] Use of topical corticosteroids (TCS) A I [42][43][44][45][46] Consideration of a variety of factors in TCS selection C III 49,128,129 Frequency of application B II [51][52][53] Proactive use of TCS for maintenance B II [54][55][56] Need for consideration of side effects with use A I Awareness of black box warning of TCIs C III [98][99][100][101] Routine monitoring of TCI blood levels not needed A I 102,103 Against routine use of topical antistaphylococcal treatments A I [110][111][112] Bleach baths and intranasal mupirocin for those with moderate to severe AD and clinical infection B II 113 Against use of topical antihistamines B II 42,[115][116][117] ...
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.
... Gentle cleansing of the skin without further harming its barrier function and moisture content is therefore an important feature of body cleansers to be used regularly by atopic-prone skin sufferers; soap (ionic)-based cleansing products should be avoided for this purpose. 1,6 In addition, cleaners may unfavorably influence skin health via alterations of the skin microbiome. 7 Since the human skin microbiome contributes to maintaining the overall integrity of the skin barrier, 8,9 this outermost functional level of the skin consisting of living microbial communities should not be affected. ...
... The latter may significantly compromise the skin barrier integrity. 1,6 The pH of cleansers for subjects with atopic-prone skin should be in the physiological cutaneous range of about 5. 8 DCLC has a pH of 5.5, which explains why we observed a stable natural skin pH upon repeated use of DCLC. This is considered advantageous because an altered skin pH may affect the composition of the skin microbiome. ...
Background:
Gentle cleansing of the skin without further compromising its barrier function and moisture content, and being simultaneously devoid of adverse effects on the skin microbiome, are important features of body cleansers for atopic-prone skin sufferers. For this population, a new dexpanthenol-containing liquid cleanser (DCLC) was developed.
Methods:
Two prospective 4-week studies have been conducted. Study 1 investigated the effect of once-daily DCLC on stratum corneum (SC) hydration, transepidermal water loss (TEWL), skin pH, and skin microbiome (all on the volar forearm) in adult subjects with dry skin (N=44). Study 2 explored the cutaneous tolerability of DCLC and its effect on the microbiome biodiversity of the volar forearm skin in infants/children with atopic-prone skin (N=33, aged 6 months to 6 years). In the latter study, DCLC was applied 2-3 days/week in combination with an emollient applied at least twice-daily.
Results:
In Study 1, on day 29, the mean change in skin surface capacitance from baseline was significantly greater in the forearm test area treated with DCLC than in the contralateral test area (control) treated with water only (5.16 vs. 3.65 a.u.; p = 0.011), suggesting long-term SC hydration. DCLC use was not associated with changes in TEWL, skin pH, or microbiome biodiversity if compared to control. In Study 2, the 4-weeks' use of DCLC in combination with an emollient was well tolerated according to pediatrician skin assessment, and no flare-ups were recorded. The microbiome biodiversity did not shift during the study.
Conclusion:
These findings support the use of DCLC in subjects with atopic-prone skin.
... These ingredients reduce trans-epidermal water loss (TEWL) and increase the amount of water present in the horny layer of the skin. [4][5][6][7] The word "syndet" is derived from "synthetic" and "detergent." ...
... The erythema index was reduced significantly 72 hours after the patch test with creamy soap, which could be due to the presence of lanolin as an emollient agent in the formulation of this soap. 7,25 This trend was also noticed for syndent and glycerin soaps, although not statistically significant. ...
Background
Various tests have been carried out to determine the irritant potential of soaps/cleansers.
Objectives
This study was carried out to compare the effects of four different soap formulations on biophysical parameters of the skin, including trans‐epidermal water loss (TEWL) and erythema index.
Methods
Four different soap formulations (creamy, glycerin containing, syndet, and traditional alkaline soaps) were studied. Twenty healthy volunteers were enrolled and 8% solutions (W/V) of the soaps made with distilled water, 20% sodium dodecyl sulfate (positive control) and water (negative control) were applied to their volar forearms as a single dose patch test. The patches remained on the sites for 4 hours. The skin TEWL and erythema index were measured before applying the patches and 24 and 72 hours after removal of them using TEWAmeter and Mexameter probes, respectively.
Results
Alkaline and creamy soaps caused a significant increase in TEWL 24 hours after patch removal. However, 72 hours after patch removal, this increase was significant only in case of alkaline soap (P‐value = 0.002). A decreasing trend in skin erythema was observed 24 and 72 hours after application of syndent, glycerin, and creamy soaps. In case of creamy soap, this decrease was significant 72 hours after patch removal (P‐value = 0.006).
Conclusion
Traditional alkaline soap increased TEWL and skin erythema, which are signs of prolonged damage to the skin barrier. However, the effects of other formulations were transient, and TEWL returned to baseline at 72 hours. Creamy soap even showed a relative protective effect (decrease in erythema index compared to baseline), probably due to the lanolin content of the formulation.
... The application of moisturizer soon after bathing is crucial for the further maintenance of hydration, because water easily evaporates from the skin, resulting in a higher transepidermal water loss 8 . The recommendations for bathing are summarized in Table 2 2,4,[9][10][11][12][13] . Generally, a maximum bathing frequency of once per day is recommended 2 . ...
... Nonsoap cleansers (e.g., syndets, aqueous solutions), which have a neutral or low pH and are less allergenic, nonirritating, and fragrance-free, are recommended. Soap-based cleansers, which have a high pH and contain surfactants, should be avoided, because they can cause dry skin, irritation, and contact dermatitis [11][12][13] . Antiseptic-containing cleansers are not recommended due to the limited duration of action of antiseptics and limited clinical data regarding their effectiveness 3 . ...
Background:
Since the treatment guidelines for atopic dermatitis (AD) were released by the Korean Atopic Dermatitis Association (KADA) work group in 2006, there have been several advances in AD management.
Objective:
We aimed to establish updated evidence- and experience-based treatment guidelines for Korean AD.
Methods:
We collected a database of references from relevant systematic AD reviews and guidelines regarding general AD management such as bathing and skin care, avoidance of exacerbating factors, education and psychosocial support, and the use of moisturizers and topical anti-inflammatory and antipruritic drugs. Evidence for each statement was graded and the strength of the recommendation for each statement classified. Thirty-nine KADA council members participated in three rounds of voting to establish an expert consensus of recommendations.
Results:
Basic AD treatment includes proper bathing and skin care, avoidance of exacerbating factors, proper education and psychosocial support, and use of moisturizers. The regular use of moisturizer has a steroid-sparing effect and reduces relapse episodes. The short- and long-term use of topical corticosteroids and calcineurin inhibitors improves AD symptoms and should be encouraged to use in an active and proactive treatment. Wet-wrap therapy can be used for rapid recovery of acute exacerbation. Topical antipruritic drugs cannot be recommended for the treatment of AD.
Conclusion:
This report provides up-to-date evidence- and experience-based treatment guidelines for AD regarding general management and topical treatment. In addition, the average agreement scores obtained by a panel of experts based on the Korean healthcare system and patient adherence are presented.
... In addition, the accelerated blood fow enhances the absorption of external irritants, increasing the likelihood of uncomfortable sensations such as itching, burning, or tingling [18]. Studies have demonstrated that the prevalence of sensitive skin is approximately 36.1% in China and around 50% in Japan, Europe, and the United States [19]. Te high prevalence and intrusive nature of sensitive skin signifcantly impact afected individuals, causing considerable distress. ...
Background. Acne is a prevalent skin disorder that primarily affects seborrheic areas. It occurs due to hair follicle obstruction and subsequent inflammation. Patients with acne often exhibit compromised skin barrier function and sensitivity, making treatment challenging. Objectives. This study aimed to investigate the occurrence of acne complicated by sensitive skin and explore the associated physiological changes. Methods. The lactic acid test and capsaicin test were employed to identify subjects with simple acne and those with acne and sensitive skin. Physiological characteristics were assessed in both groups. Two random groups were selected from the subjects with acne and sensitive skin. One group received treatment for acne alone, while the other group received combined treatment for acne and sensitive skin care. The efficacy and physiological function of the two groups were compared after treatment. Results. Among 170 acne patients, 99 were identified as having acne with sensitive skin. Patients with acne and sensitive skin exhibited significantly higher scores on the lactic acid test and capsaicin test compared to those with simple acne. They also showed increased transepidermal water loss (TEWL), decreased skin cuticle hydration (SCH), thinner epidermis, and thicker blood vessels. The group receiving combined treatment demonstrated a more significant reduction in the number of skin lesions and IGA scores compared to the group receiving treatment for acne alone. They also exhibited lower scores on the lactate and capsaicin tests, along with decreases in TEWL and increases in SCH. Conclusions. Acne with sensitive skin is highly prevalent and is associated with distinct physiological characteristics. Combined treatment targeting both acne and sensitive skin yields excellent clinical outcomes and improves skin’s physiological function. These findings underscore the importance of considering sensitive skin in the clinical management of acne.
... Thus, the researchers assumed that indoor exercise without sun exposure induced fewer exercise-related symptoms of AD. Based on these results, adolescents with AD should be encouraged to engage in indoor exercise for better health and lesser aggravation of AD symptoms [24]. ...
Background: Sweating and increased skin temperature caused by exercise can reduce physical activity and the willingness to exercise in adolescents with atopic dermatitis. This study was conducted to investigate the exercise load capacity of adolescents with atopic dermatitis and analyzed their exercise behavior and motivation. Methods: Adolescents with and without atopic dermatitis were assigned to the atopic dermatitis group and control group (n = 27 each). Both groups completed a cardiopulmonary exercise test and questionnaires to assess their exercise capacity, weekly exercise volume, exercise motivation, and self-efficacy, respectively. Results: The ratio of measured forced vital capacity to the predicted forced vital capacity and the peak oxygen consumption of the atopic dermatitis group were significantly lower than those of the control group. The Godin Leisure-Time Exercise Questionnaire scores of the atopic dermatitis group were significantly lower than those of the control group. As for the Behavioral Regulation in Exercise Questionnaire 2, the scores for the introjected and identified regulations of the atopic dermatitis group were significantly lower than those of the control group. Regarding the Multidimensional Self-Efficacy for Exercise Scale, the scheduling efficacy and total scores of the atopic dermatitis group were significantly lower than those of the control group. Conclusions: Adolescents with atopic dermatitis had lower peak exercise capacity and lower weekly exercise volume. Furthermore, they lacked the negative feelings toward inactivity and the self-confidence to plan regular exercise independently. The results of this study suggest that adolescents with atopic dermatitis should be encouraged to engage in regular indoor exercise.
... However, majority of the even natural skincare products aiming at the relief of the atopic dermatitis symptoms are developed using traditional and typically irritating preservative systems or antibacterial agents like benzyl alcohol [9,10], benzoic acid [11,12] and its sodium salts, glyceryl caprylate [13,14], caprylyl glycol [15,16], cinnamic acid and derivatives [17,18], salicylic acid and its salts [19,20] while being effective systems for maintaining the product, but often become a problem or harm to the user -causing loss of microbial diversity, causing the user to experience discomfort due to irritation. The study aims at checking the efficiency of the combined skincare routine of two formulations having been developed using a delicate preservation and lipid regeneration layer system to promote balanced skin-cell interactions and reduce homeostasis disorders in the form of skin barrier dysfunction or inflammation. ...
Atopic dermatitis is a chronic inflammatory skin disorder. However, careful skin care can help to control and alleviate everyday symptoms, such as very dry, irritated and red skin. The majority of the even natural skincare products aiming at the relief of the dermatitis symptoms are developed using traditional and typically irritating preservative systems being effective systems for maintaining the product often become a problem or harm to the user - causing loss of microbial diversity, causing the user to experience discomfort due to irritation. The study aims at checking the efficiency of the combined skincare routine of two formulations having been developed using a delicate preservation and lipid regeneration layer system to promote balanced skin-cell interactions and reduce homeostasis disorders in the form of skin barrier dysfunction or inflammation. Results show the overall decrease of all sensitive and visual symptoms. The most significant symptom reduction in the dimension of skin sensations was noted in burning/heat sensation and in the dimension of visible skin changes in extended vascular networking reduction. The results of the conducted study can be interpreted as indicating the beneficial effects of the use of nature-based skincare products in case of atopic dermatitis.
... It may be necessary to use cleansing balm, with soap and water cleansing, especially in patients with oily skin. 23 ...
Acne is a highly common skin disease especially among teenagers. Modern acne treatments are based also on the use of moisturizers, cleansers and sunscreens. In choosing the right cleanser, it is important to consider some aspects: the interaction between skin type and the cleanser, the optimal time and method of cleaning and the cosmetic perception of the patient. The aim of our review is to highlight the importance of choosing the most suitable topical dermocosmetics for the different skin types, as well as the most effective timing and method to combine dermocosmetics with the standard acne treatment. A search in literature for selected key words was performed using PubMed. Additional papers were identified based on author expertise. Treatment of acne patients should include education for proper daily skin hygiene, including protection from environmental damage. However, given the low number of clinical studies on cleansers, it is difficult to make reliable recommendations. The correct choice and use of topical dermocosmetics are fundamental in the management of acne patients. Daily use of moisturizers, cleansers and sunscreens can reduce both inflammatory and non‐inflammatory acne lesion counts and may be helpful for acne treatment if combined with specific drugs.
... It is possible that females use moisturizers more frequently than males because moisturizers can alleviate some cutaneous symptoms such as pruritus and dryness. 20 Nevertheless, the present study clearly demonstrates that both prevalence and severity of symptoms of facial sensitive skin are gender dependent in skindisease-free young Chinese. ...
Background:
While clinical signs, symptoms, as well as etiology of sensitive skin in general populations have been extensively studied over the last decades, characteristics of sensitive skin in normal subjects, particularly gender-related characteristics, still remain unknown.
Objective:
In the present study, we characterize facial sensitive skin in normal young Chinese.
Subjects and methods:
A questionnaire was given to each participant aged 10-30 years. Clinical signs, symptoms, and associated trigger factors of facial sensitive skin were compared in normal young Chinese males versus females.
Results:
After excluding subjects with pre-existing skin disorders, 475 females and 429 males out of 954 responders were included in the analyzes. Prevalence of self-reported facial sensitive skin was significantly higher in females than in males. Yet, while more females experienced various symptoms, symptoms were more severe in males than in females. However, both the prevalence and severity of clinical signs were similar in females and males. Skin care products appeared to be the major contributors to facial sensitive skin in both genders. Moreover, it appeared that females were more sensitive to environmental factors such as low humidity and sun-exposure while males were more sensitive to emotional factors. Taken together, these results demonstrate that characteristics of sensitive skin are associated with gender, while the underlying mechanisms remain to be explored.
Conclusions:
There are gender differences in prevalence, symptoms, and trigger factors of facial sensitive skin in normal young Chinese.
... For instance, the impairment of stratum corneum barrier functions observed in cutaneous disorders such as psoriasis, ichthyosis, atopic skin and contact dermatitis has been linked to skin dryness [112]. Environmental chemicals, low humidity, low temperature, normal aging process and psychological stress all modulate skin dryness and barrier homeostasis causing high susceptibility to irritancy and secondary bacterial infections [113]. By inducing superficial and deep layer changes, cosmetic products like moisturizing creams have been used to facilitate stratum corneum hydration in order to prevent skin dryness and also as adjuncts in the treatment of some skin disorders [112,114,115]. ...
... Muizzuddin et al reported that the use during 8 weeks of cosmetics containing a minimal concentration of preservatives and surfactantfree provoke a change in the characteristics of sensitive skin improving the skin barrier, bringing to the skin a reactivity similar to that of normal skin [33]. It was demonstrated that soap-free cleansers combined with topical treatment improve the status of patients with sensitive skin [34]. Proper skin hydration helps to recover and maintain the skin protection barrier. ...
Синдром чутливої шкіри (СЧШ) є поширеним дерматологічним захворюванням у багатьох етнічних групах. Він уражує частіше жінок, ніж чоловіків, і має тенденцію до поліпшення перебігу в процесі старіння. СЧШ може асоціюватися з іншими шкірними захворюваннями, такими як себорейний дерматит, атиповий псоріаз, розацеа, періоральний дерматит та атопічний дерматит. Погіршити його перебіг можуть також зовнішні чинники, приміром, неадекватне використання косметики, і фактори навколишнього середовища та способу життя. Фізіопатологію синдрому чутливої шкіри не з’ясовано повністю, але, очевидно, основними його причинами є дефекти у бар’єрній функції шкіри, а також посилення нейросенсорної стимуляції. Діагноз повинні встановлювати обережно, оскільки він залежить лише від інформації пацієнта. Після виключення інших супутніх дерматитів можна використовувати запитувальник, а також результати фізичних досліджень, які допоможуть встановити діагноз. Алергійні стани, для яких характерні подібні симптоми, також повинні бути виключені. Лікування передбачає призначення глюкокортикоїдів або інгібітора кальциневрину в гострий період, косметичний же догляд має фокусуватися на спеціально розроблених для чутливої шкіри засобах, гідратації та захисті від сонця.
... CeraVe Cleanser, Valeant). 31 Nonfoaming cleansers may contain water, glycerin, cetyl alcohol, stearyl alcohol, sodium lauryl sulfate, and occasionally propylene glycol. The sodium lauryl sulfate functions as the surfactant and the glycerin, cetyl alcohol, and stearyl alcohol leave behind a thin moisturizing film on the skin surface. ...
Two of the most important skin care categories with profound dermatologic implications are cleansers and moisturizers. Cleansers are composed of alkaline soaps or the less barrier-damaging synthetic detergents, known as syndets. The lower skin irritation and dryness found with syndets are related to their reduced tendency to cause protein denaturation due to the charge density of protein-bound micelle-like surfactant aggregates. Many cleansing formulations are available for purchase to meet hygiene needs varying by sex, age, ethnicity, occupation, environment, personal preferences, and the presence or absence of skin disease. This discussion covers the science of skin cleansing.
... Рекомендується також використовувати гіпоалергенні миючі засоби без запаху, які не містять мила (nonsoap) з нейтральним або з низьким рН. Адже мило складається з поверхнево-активних речовин, які взаємодіють з білками і ліпідами рогового шару шкіри і, таким чином, пошкоджують його, викликаючи сухість та подразнення [23]. Більшість сортів мила мають лужну рН, тоді як нормальна рН шкіри становить від 4 до 5,5. ...
Резюме.
У даній статті описуються підходи до ведення дітей з атопічним дерматитом (АД) різного ступеню тяжкості, а саме можливості застосуванні немедикаментозних засобів (зволожуючих засобів, ванн, вологого обгортання та ін.). Атопічний дерматит – це захворювання, що супроводжується вираженим свербінням, має хронічний перебіг та вражає до 25% дитячої популяції. Ксероз є однією із основних клінічних особливостей АД, що призводить до порушення епідермального бар’єру. В лікуванні ксерозу та з метою попередження трансепідермальної втрати вологи перш за все застосовують топічні зволожуючі засоби, які містять різні пом’якшуючі речовини та/або компоненти, що посилюють бар’єрну функцію шкіри. Більшість з них містять воду, яка забезпечує лише короткочасний зволожуючий ефект, проте інші компоненти забезпечують основні переваги того чи іншого препарату.
Емоленти повинні бути основою місцевого лікування при легких формах захворювання та займати важливе місце в терапії середнього та тяжкого ступеня хвороби. Вони також є вкрай необхідним компонентом в лікуванні та профілактиці загострень. Тому, слід пам’ятати, що зволожуючі засоби – це суттєва складова та невід’ємна ланка в терапії AД, особливо в дитячій популяції.
Навіть сьогодні бракує систематичних досліджень для визначення оптимальної кількості й частоти застосування зволожуючих засобів. Прийнято вважати, що емоленти необхідно застосовувати таким чином, щоб явища ксерозу були мінімальними. Традиційні зволожуючі засоби випускаються у формі кремів, мазей, масел, гелів і лосьйонів. Більшість сучасних мазей мають велику перевагу, що не містять консервантів, які при нанесенні на пошкоджену шкіру можуть викликати печію та бути занадто жирними для хворих на AД. Лосьйони містять більший відсоток води, яка швидко випаровується, тому їх не рекомендується застосовувати у пацієнтів з вираженим ксерозом.
Клінічні випробування щодо порівняння конкретних зволожуючих засобів нечисленні, а опубліковані дані й досі не продемонстрували переваг одного емоленту над іншим. У нашій клініці також є тривалий досвід застосування емолентів у дітей, хворих на АД, у тому числі, дітей раннього віку. Найчастіше у своїй практиці ми використовуємо Топікрем, Фізіогель та Ойлатум. Для того, щоб проаналізувати ефективність кожного з них, ми виділили 24 дитини віком від 6 місяців до 2 років з встановленим діагнозом атопічний дерматит, період ремісії та порівну розділили їх на три групи. Період спостереження тривав 14 днів. Оцінка ефективності проводилась за допомогою індексу SCORAD, завдяки якому визначали не тільки об’єктивні критерії, але й проводили суб’єктивний аналіз порушення сну та вираженості свербіння. У ході проведеного дослідження, точніше клінічного спостереження, яке відносить до ІІІ рівня доказовості (С), нам вдалося ще раз продемонструвати високу ефективність зволожуючих засобів. Аналізуючи отримані результати, перш за все, хочемо підкреслити хорошу клінічну ефективність усіх трьох емолентів.
Таким чином, вибір зволожуючого засобу – це виключно індивідуальний підхід, адже ідеальний засіб повинен бути безпечним, ефективним, доступним, не містити шкідливих добавок, ароматизаторів та інших потенційно сенсибілізуючих агентів.
... Although cleansers and detergents are probable irritants and should be circumvented by AD patients, some cleansers may be useful as hygienic measures for the skin. [75][76][77] Certain environmental factors such as humidity, temperature, and fabric texture might also irritate the skin. For example, an air-conditioned environment with mild humidity may minimize the propensity of perspiration and thus moderate skin irritancy. ...
Atopic dermatitis (AD) is a common, chronic skin inflammatory disorder characterized by perivascular infiltration of immunoglobulin E (IgE), T lymphocytes, and mast cells. The key factors responsible for the pathophysiology of this disease are immunological disorders and defects in epidermal barrier properties. Pruritus, intense itching, psychological stress, deprived physical and mental performance, and sleep disturbance are the hallmark features of this dermatological disorder. Preventive interventions such as educational programs, avoidance of allergens, and exclusive care toward the skin could play a partial role in suppressing the symptoms. Based on the available clinical evidence, topical corticosteroids (TCs) are among the most commonly prescribed agents; however, these should be selected with care. In cases of steroid phobia, persistent adverse effects or chronic use, topical calcineurin inhibitors can be considered as a promising adjunct to TCs. Recent advances in the pharmacotherapeutic paradigm of atopic diseases exploring the therapeutic dominance of nanocarrier-mediated delivery is also discussed in this evidence-based review with regard to the treatment of AD. The present review summarizes the available clinical evidence, highlighting the current and emerging trends in the treatment of AD and providing evidence-based recommendations for the clinicians and health care professionals. Available evidence for the management of pediatric and adult atopic dermatitis (AD; atopic eczema) of all severities is explored. The management of other types of dermatitis, such as irritant contact dermatitis, seborrheic dermatitis, neurodermatitis, perioral dermatitis, stasis dermatitis, and allergic contact dermatitis are outside the scope of current review article. The presented studies were appraised using a unified system called the "Strength of Recommendation Taxonomy (SORT)", which was developed by the editors of several US family medicine and primary care journals (i.e., American Family Physician, Family Medicine, Journal of Family Practice, and BMJ USA).1 The searched studies were graded using a 3-point scale based on the quality of methodology (e.g., randomized control trial, case control series, clinical cohort studies, case series, etc.) and key emphasis of the trial (i.e., diagnosis, treatment/prevention/ screening, or prognosis) as follows: I. Good-quality patient-oriented evidence (i.e., evidence assessing consequences that matter to patients: mortality, morbidity, improvement in signs and symptom, quality of life, and socioeconomic factors); II. Limited-quality patient-oriented evidence; and III. Other evidence such as consensus guidelines, expert opinion, case control trial, or disease-related information. Recommendations for nonpharmacological and pharmacological approaches were established based on the best available evidence and are graded as follows: A. Recommendations based on consistent and good-quality patient-oriented evidence; B. Recommendations based on inconsistent or limited-quality patient-oriented evidence; and C. Recommendations based on consensus, expert opinion, case control evidence, or disease-related information.
... Neither water alone nor as tringents are recommended for cleansing. 10 We recommend that tepid water should be used for bathing or showering and the duration of the cleansing ritual should be limited to 20 minutes or less. Patting of the skin as opposed to rubbing is also preferred, as to not induce further trauma. ...
Victoria R Dimitriades, Elizabeth Wisner Division of Allergy/Immunology, Department of Pediatrics, Louisiana State University Health Sciences Center, Children's Hospital of New Orleans, New Orleans, LA, USAAbstract: Atopic dermatitis (AD) is a chronic, inflammatory skin condition which affects millions of people worldwide. It is most commonly seen in children but may also progress into adulthood. Management of this complex disease requires a multi-pronged approach which can address the myriad of issues which underscore its development. Avoidance of triggering factors is imperative in establishing consistent control of skin irritation while daily moisturization can be very effective in skin barrier repair and maintenance. Judicious use of anti-inflammatory medications has been shown to make a significant impact on both treatment as well as prevention of disease. Unfortunately, pruritus, a key feature of AD, has proven much harder to control. Finally, awareness of the risks of colonization and infection in patients with AD should be incorporated into their surveillance and management plans. While our understanding has progressed greatly regarding this disease, further research is still needed regarding future directions for both treatment and prevention. Keywords: atopic dermatitis, eczema, treatment, corticosteroids, antipruritic
... Xerosis is a medical condition in which skin dehydration is accompanied by persistent itching. It might be caused by excessive washing or defects in genes that are important for maintaining the skin-barrier function (23). Dry skin can directly cause pruritus, and in many cases, it is also one of the symptoms of chronic itch conditions, such as atopic dermatitis, cholestatic pruritus, and uremic pruritus. ...
The itch-scratch reflex serves as a protective mechanism in everyday life. However, chronic persistent itching can be devastating. Despite the clinical importance of the itch sensation, its mechanism remains elusive. In the past decade, substantial progress has been made to uncover the mystery of itching. Here, we review the molecules, cells, and circuits known to mediate the itch sensation, which, coupled with advances in understanding the pathophysiology of chronic itching conditions, will hopefully contribute to the development of new anti-itch therapies. Expected final online publication date for the Annual Review of Biophysics Volume 43 is May 06, 2014. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.
... Children need to have approximately 250 g of emollient per week applied topically and adults 500 g of emollient per week (NICE 2007). Skin cleansers often complement management (Cheong 2009). The cornerstones of treatment are topical corticosteroid preparations (TCS) to reduce inflammation and itch. ...
AimsA discussion on the reasons educational interventions about eczema, by nurses, are successful, with the subsequent development of a theoretical framework to guide nurses to become effective patient educators.Background
Effective child and parent education is the key to successful self-management of eczema. When diagnosed, children and parents should learn to understand the condition through clear explanations, seeing treatment demonstrations and have ongoing support to learn practical skills to control eczema. Dermatology nurses provide these services, but no one has proposed a framework of the concepts underpinning their successful eczema educational interventions.DesignA discussion paper.Data SourcesA literature search of online databases was undertaken utilizing terms ‘eczema OR atopic dermatitis’, ‘education’, ‘parent’, ‘nurs*’, ‘framework’, ‘knowledge’, motivation’, in Scopus, CINAHL, Web of Science, Medline and Pubmed. Limits were English language and 2003–2013.Implications for NursingThe framework can inform discussion on child and parent education, provide a scaffold for future research and guide non-specialist nurses, internationally, in providing consistent patient education about eczema.Conclusion
Founded on an understanding of knowledge, the framework utilizes essential elements of cognitive psychology and social cognitive theory leading to successful self-management of eczema. This framework may prove useful as a basis for future research in child and parent education, globally, in the healthcare community. A framework has been created to help nurses understand the essential elements of the learning processes at the foundation of effective child and parent education. The framework serves to explain the improved outcomes reported in previous nurse-led eczema educational interventions.
... In clinical settings, a moisturiser is the main strategy used to prevent skin tears as it decreases the magnitude of external forces such as friction and shear forces by relieving the itching caused by dry skin and reducing susceptibility to irritation on the skin surface (42,43). However, Hunter et al. reported that 42% of patients developed skin tears despite management with moisturisers (43). ...
The identification of appropriate skin tear prevention guidelines for the elderly requires clinicians to focus on local risk factors such as structural alterations of the epidermis and dermis related to skin tears. The aim of this cross-sectional study is to explore the prevalence of skin tears and to explore skin properties related to skin tears in elderly Japanese patients at a long-term medical facility. After doing the prevalence study, 18 participants with skin tears and 18 without were recruited and an evaluation of their skin properties using 20-MHz ultrasonography, skin blotting and also Corneometer CM-825, Skin-pH-meterPH905, VapoMeter, Moisture Meter-D and CutometerMPA580 was undertaken. A total of 410 patients were examined, the median age was 87 years and 73·2% were women. The prevalence of skin tears was 3·9%, and 50% of skin tears occurred on the dorsal forearm. The changes in skin properties associated with skin tears included increased low-echogenic pixels (LEP) by 20-MHz ultrasonography, decreased type IV collagen and matrix metalloproteinase-2, and increased tumour necrosis factor-α by skin blotting. In conclusion, this study suggests that increased dermal LEP, including solar elastosis, may represent a risk factor for skin tears; this indicates that skin tear risk factors might not only represent chronological ageing but also photoageing.
... Conflicting views about cleansing the skin in patients with AD are proposed. Some authors suggested that the dry skin of patients with AD could not tolerate soaps and frequent baths [10,11]. In contrast, even normal of skin of AD is colonized by Staphylococcus aureus, so frequent baths, regular use of soap or antiseptic soap to remove crusts, scales, dirt, and organisms on the skin are suggested by some authors [12]. ...
Patients with atopic dermatitis (AD) have increased susceptibility to irritants. Some patients have questions about types of water for bathing or skin cleansing.
We studied the pH of water from various sources to give an overview for physicians to recommend patients with AD.
Water from various sources was collected for measurement of the pH using a pH meter and pH-indicator strips.
Bottled drinking still water had pH between 6.9 and 7.5 while the sparkling type had pH between 4.9 and 5.5. Water derived from home water filters had an approximate pH of 7.5 as same as tap water. Swimming pool water had had pH between 7.2 and 7.5 while seawater had a pH of 8. Normal saline and distilled water had pH of 5.4 and 5.7, respectively. Facial mineral water had pH between 7.5 and 8, while facial makeup removing water had an acidic pH.
Normal saline, distilled water, bottled sparkling water and facial makeup removing water had similar pH to that of normal skin of normal people. However, other factors including benefits of mineral substances in the water in terms of bacteriostatic and anti-inflammation should be considered in the selection of cleansing water.
... Mild diaper dermatitis can be prevented or treated by changing diapers frequently, using gentle cleansers to remove feces, and by keeping skin dry [168,[198][199][200]. Regular bathing can help hydrate skin and stimulate skin debridement [201]. In addition, use of warm vs hot water, shorter baths that incorporate a mild moisturizing cleanser, gentle, dry patting and immediate application of a moisturizer may help improve barrier function [125,202,203]. ...
Skin is considered as the border defining the limits of the body from the external world and functions as a barrier between the two. In this capacity, it has evolved to be an integral part of the innate and adaptive immune system. Although many reviews have described skin inflammation and processes that lead to its clinical manifestations, we are not aware of any reviews that have focused on immunological activity occurring in the absence of any visual inflammatory cues. In this review, we discuss the importance of subclinical inflammation in human skin and its relevance to innate immune surveillance under physiologic conditions. Reactive oxygen species generated by metabolic processes, ultraviolet radiation or oxidizers may damage cells, initiating proinflammatory cascades. In addition to serving as structural skin components, keratinocytes have significant immunological activity: they secrete proinflammatory cytokines and mediators, including interleukin (IL)-1α, IL-6, IL-10, tumor necrosis factor-α and granulocyte-macrophage colony-stimulating factor. Infant skin is particularly susceptible to irritation, inflammation and infection, since skin barrier function is not fully developed after birth and continues to mature throughout the first few years of life. Non-invasive methods such as fluorescence spectroscopy, spectral imaging and diffuse reflectance spectroscopy, as well as minimally invasive tape stripping, can be used to assess subclinical inflammatory markers in vivo, including erythema, epidermal cell proliferation rate and cytokine concentrations. Appropriately formulated skin care products may help maintain skin barrier integrity and enhance its capacity. In the future, assessment of subclinical inflammation may help clinicians prevent acute or chronic inflammatory conditions of the skin.
... 68 Reduction in stratum corneum lipids (e.g., ceramides) 69 and filaggrin defects 70 are some, but probably not all, barrier defects in AD skin. Moisturizers play an important part in the management of AD 71 and can help to reduce pruritus. 72 Emollients may serve as steroid-sparing agents. ...
Atopic dermatitis is a common, pruritic, inflammatory skin disorder. Chronic, localized, or even generalized pruritus is the diagnostic hallmark of atopic dermatitis, and its management remains a challenge for physicians. The threshold for itch and alloknesis is markedly reduced in these patients, and infections can promote exacerbation and thereby increase the itch. Modern management consists of anti-inflammatory, occasionally antiseptic, as well as antipruritic therapies to address the epidermal barrier as well as immunomodulation or infection. Mild forms of atopic dermatitis may be controlled with topical therapies, but moderate-to-severe forms often require a combination of systemic treatments consisting of antipruritic and immunosuppressive drugs, phototherapy, and topical compounds. In addition, patient education and a therapeutic regimen to help the patient cope with the itch and eczema are important adjuvant strategies for optimized long-term management. This review highlights various topical, systemic, and complementary and alternative therapies, as well as provide a therapeutic ladder for optimized long-term control of itch in atopic dermatitis.
Eczematous diseases (contact dermatitis, atopic dermatitis, hand eczema) are among the most frequent findings in dermatological clinical practice. A large body of evidence exists on structural and functional skin barrier damage in eczematous diseases, and on the importance of interventions aimed to repair such damage. While there is substantial agreement on pharmacological treatment, more sparse data are available on role, indications and usefulness of topical non-pharmacological treatments, despite significant research and progress in the composition and technology of emollients, cleansers and barrier creams significantly changed and expanded the functional activities of these products. This often leads to inadequate prescription and/or use, which increase individual and social costs of the disease and make the products useless or, in some cases, even counterproductive. This consensus document, discussed and compiled in a series of meetings by a group of Italian dermatologists experienced in the field of eczematous diseases, summarizes epidemiology and clinical features of the nosological entities of the "eczema family", illustrates the chemical/biochemical structure of emollients, cleansers and barrier creams, and aims to help physicians to exploit the full potential of available products, by providing a detailed but practical guide on characteristics, indications and correct use of non-pharmacological treatments currently available for eczematous diseases.
Atopic dermatitis is an inflammatory skin disease that is chronic and relapsing. This is a skin disorder that causes very itchy reddish papules which can be excoriated and lichenified. Atopic dermatitis in infants has a significant emotional and economic impact on the life of their family. Identification of risk factors that caused atopic dermatitis is important to prevent relapse of the lesion. Management of atopic dermatitis is corticosteroid as first line therapy, but use of moisturizer is also important to prevent relapse. Maintaining skin moisture is very important, so it is necessary to educate the patient’s parents to always keep the baby’s skin moist, so that the relapse can be prevented.
This article deals with skin care of sensitive, irritated skin. Application of the daily basic skin care products improves the effectiveness of treatment and quality of life of patients with sensitive skin.
Systemic sclerosis (SSc) is a connective tissue disease characterized by progressive fibrosis of the skin and internal organs and has significant clinical sequelae. Management of SSc cutaneous disease remains challenging and often is driven by extracutaneous manifestations. Methotrexate is the typical first-line therapy for patients with early progressive cutaneous disease. However, in patients with diffuse progressive skin disease and inflammatory arthritis, methotrexate or rituximab monotherapy should be considered. First-line therapy for patients with concomitant myositis includes methotrexate or intravenous immunoglobulin (IVIG). For patients with both cutaneous findings and interstitial lung disease, studies have suggested the efficacy of mycophenolate mofetil or rituximab. Second-line therapies, including UVA-1 phototherapy, IVIG, or rituximab, can be considered in patients with disease refractory to first-line treatments. Clinical trials investigating the utility of emerging therapies such as abatacept and tocilizumab in the treatment of SSc are under way, and preliminary results are promising. Nonetheless, all patients with SSc benefit from a gentle skin-care regimen to alleviate pruritis, which is a commonly reported symptom. Additional cutaneous manifestations of SSc include telangiectasias, calcinosis cutis, microstomia, and Raynaud's phenomenon. Telangiectasia may be managed with camouflage techniques, pulse dye laser, and intense pulse light. Calcinosis cutis therapy is guided by the size of the calcium deposits, although treatment options are limited. Mouth augmentation and oral stretching exercises are recommended for patients with reduced oral aperture. Raynaud's phenomenon is treated with a combination of lifestyle modification and calcium channel blockers, such as amlodipine. Overall, SSc is a clinically heterogenous disease that affects multiple organ systems. Providers should assess extracutaneous involvement and use evidence-based recommendations to select the most appropriate therapy for patients with SSc.
Primary immunodeficiency Disorders (PIDD) are a varied group of heritable disorders characterized by defects in components of the innate and/or adaptive arms of the immune system. Although diagnosing these disorders is often challenging, the skin is a readily accessible and easily assessable organ that may provide clues to a diagnosis of PIDD. Specifically, many immunodeficiencies are associated with characteristic cutaneous eruptions that, based on their morphology, distribution and symptomatology, may suggest a specific underlying diagnosis. This review will discuss an approach to identifying and managing PIDDs that typically present with eczematous dermatitis.
Sensitive skin has traditionally been viewed as a cosmetic problem or as a purely psychosomatic alteration with a major subjective component. Different studies of its pathophysiologic etiology, however, have shown it to be a complex entity that several authors now consider to be a neurodermatological syndrome. Because of this complexity, skin sensitivity can be difficult to diagnose and treat, particularly considering that it may present with another disease. Simple tools applicable to clinical practice are thus necessary to identify and manage this disease as an independent entity. In this study, we perform a practical review of the most recent scientific advances in the area of sensitive skin that justify it being considered an individual entity, and provide tools for its identification and treatment. We propose diagnostic and treatment algorithms based on evidence from the literature and our experience and expertise.
Resumen
Tradicionalmente, la piel sensible se ha considerado como un problema cosmético o como una alteración puramente psicosomática con un fuerte componente subjetivo. Sin embargo, diversos estudios científicos sobre sus procesos fisiopatológicos y su etiopatogenia han demostrado que se trata de una entidad compleja que ya diversos autores consideran un síndrome neurodermatológico. Sus características hacen que su diagnóstico y tratamiento puedan resultar complicados en la práctica clínica habitual, siendo necesarias herramientas sencillas que se puedan usar de rutina, tanto para identificar esta entidad, que puede presentarse acompañada de otra patología, como para su manejo independiente. En este trabajo realizamos una revisión práctica de los avances científicos más recientes el campo de la piel sensible que justifican su consideración individual y ofrecen herramientas para identificarla y tratarla. Proponemos algoritmos de diagnóstico y de tratamiento basados en las evidencias de la literatura y en la opinión de los expertos que firman este artículo.
Atopic eczema or atopic dermatitis affects 15–20% of children in the UK and these figures appear to be rising ( Hoare et al, 2000 ; Fennessy et al, 2000 ; Ruzicka et al, 2013 ; Williams et al, 1994 ). This condition affects so many school-aged children, negatively impacting the quality of life for both the children and their families ( Hoare et al, 2000 ). Not only is it a disease causing dry skin but it can also lead to skin damage and infection, pain, insomnia and the social stigma of a skin disease ( Hoare et al, 2000 ). Although treatment and guidelines seem to have remained unchanged since the NICE 2017 guidelines, there is a real emphasis on accurate physical and mental assessment of the child with atopic eczema ( NICE, 2018 ). The role of school nurses is important as they can empower children to take control of their condition, reduce flare-ups and cope with the physical and psychological impacts of the disease.
Introduction: Atopic dermatitis (AD) is one of the most common childhood skin disorders. Multiple mechanisms contribute to the pathology of AD and treatment approaches are directed at these processes.
Areas covered: The purpose of this review is to discuss the chemical treatment options for pediatric atopic dermatitis, including immunomodulators and small molecule inhibitors. A systematic literature search was conducted, and publications were reviewed for applicable treatment guidelines.
Expert opinion: Topical therapy is first-line for pediatric atopic dermatitis. Providers should work closely with patients and caregivers to promote the success of topical treatments. In disease refractory to topical treatments, systemic agents may be considered. Clinical trials are ongoing for the use of biologics in the treatment of pediatric AD. When choosing the most appropriate treatment, physicians should consider the drug efficacy, potential adverse effects, patient adherence, and quality of life for both patients and caregivers. Additional studies are required to determine the safest and most effective doses for systemic therapy in childhood AD.
Резюме.
Новонароджені зазвичай мають множинні захворювання, які, можливо, збільшують ймовірність неврологічних порушень.
Мета дослідження полягала в тому, щоб визначити частоту ушкоджень головного мозку (ВШК і ПВЛ) в загальному, у тому числі у тих, що вижили, недоношених дітей, а також, оцінити результати неврологічного розвитку в цих новонароджених у віці 2 рокі життя.
Матеріали і методи: Ми проаналізували захворюваність ВШК серед недоношених новонароджених на основі статистичних щорічників показників Міністерства охорони здоров'я, а також з статистичної форми 32а в Республіці Молдова і в Інституті Матері і Дитини (ІМР) за період 2000-2014 рр. Ми також проаналізували журнали відділення інтенсивної терапії новонароджених ІМР, щоб визначити частоту ВШК у недоношених дітей і виживання дітей, які перенесли цю патологію. Крім того, було проведено ретроспективне дослідження 99 недоношених дітей, які перенесли ВШК і ПВЛ, і спостерігалися в катамнезі.
Результати. Згідно зі статистикою Міністерства охорони здоров'я, за період 2002-2014 рр., спостерігалося коливання частоти ВШК з двома піками: у 2003 р. (46,6 / 1000) та 2009 р. (48,8 / 1000). Найбільше число дітей, у яких діагностовано ВШК, було зареєстровано в ІМР у 2006 році (130 дітей - 23,55% випадків) і в 2008 році (134 дітей - 22,55% випадків). З 2012 року відзначається стійке зниження захворюваності на ВШК. 90 (22,01%) з 409 спостережуваних в катамнезі новонароджених мали ВШК і 9 (2,20%) - ПВЛ. Новонароджені з ВШК 3-го ступеня і ПВЛ частіше мали сепсис з раннім початком і менінгіт.
Висновки. За досліджуваний період часу ми виявили зниження на 39,8% захворюваності на ВШК в республіці і на 27,76% в ІМР. У віці 2-х років життя діти, які перенесли в неонатальному періоді 3-тю ступінь ВШК і ПВЛ, страждають, в основному, від рухових порушень (у 42,86% і 66,67% випадків відповідно), а також від тяжкої неврологічної патології в 40-60% випадків.
Background:
Patch testing is the gold standard for diagnosing allergic contact dermatitis in children.
Objective:
To present a 10-year retrospective review of pediatric patch testing at our institution.
Methods:
Data from patients 18 years or younger who presented for patch testing from February 1, 2005, to May 31, 2015, were entered into a database. Patch testing was performed according to North American Contact Dermatitis Group standards. A positive reaction was defined as any allergen for which the patient had a 1+ or greater reaction and provided avoidance information.
Results:
A total of 157 patients with a mean (SD) age of 12.3 (4.1) years were evaluated. The 2 most frequent allergens were nickel and cobalt. Most patients were referred by dermatologists for suspected allergic contact dermatitis (72.3%). Dermatitis was present for more than 2 years in most cases (n = 67 [46.2%]), from 6 months to 2 years (n = 49 [33.8%]), and for less than 6 months (n = 29 [20.0%]). Males were more likely to have a positive reaction to fragrance mix 1 compared with females (P = .02). No significant association was found between age and allergen sensitivity. Those with a history of atopy were more likely to have a positive reaction to cobalt (P = .008) and chromium (P = .03). Sixty patients (38.2%) returned for follow-up, and 37 (60.7%) reported improvement; most (n = 54 [88.5%]) were being treated with topical corticosteroids.
Conclusion:
Our study of pediatric patch testing can provide information regarding common allergens in children, which can enhance patient care. Primary care practitioners may benefit from awareness of patch testing as an alternative to prescribing systemic immunosuppressants.
Sensitive skin is a widely reported condition where there is subjective cutaneous hyper-reactivity to environmental factors. Progress has been made in many aspects of the background science that will help clinicians in their management of patients presenting with the condition. This new text sums up the advances in thinking on pathophysiology, classification, methods of investigation, and the different susceptibilities of different types of skin.
Atopic dermatitis is a common skin disease characterized by eczematous eruptions and impaired skin barrier function. Patients, as well as their families, frequently report reductions in quality of life. Pruritus, lack of sleep, and impaired social functioning all contribute to this reduction. A skincare regimen of gentle cleansing and daily moisturization is integral to managing atopic dermatitis. While there are a multitude of reports supporting the use of moisturizers, there is a paucity regarding the use of cleansers, especially cleansers formulated with ingredients known to improve skin hydration. A clinical study was conducted to assess the tolerability and cosmetic acceptability of a body wash formulated with the filaggrin break-down products arginine and pyrrolidone carboxylic acid in subjects with atopic dermatitis-prone skin (Cetaphil® RestoraDerm® Body Wash). The results of this study indicate that Cetaphil RestoraDerm Body Wash was well tolerated, reduced itch, improved quality of life, and was well-liked by subjects with atopic dermatitis-prone skin.
J Drugs Dermatol. 2014;13(9):1108-1111.
Patients with atopic dermatitis (AD) have chronic dry skin to which they frequently apply skin care products containing preservatives, and they are predisposed to developing cutaneous delayed-type hypersensitivity.
We sought to compare the rates of positive patch test reactions to allergens on the North American Contact Dermatitis Group (NACDG) standard tray among patients with and without AD and to assess whether atopic patients in our database were more likely to patch test positive to preservatives.
A total of 2453 patients underwent patch testing to the NACDG standard screening series. The incidence of positive patch test reaction among patients with AD (n = 342) and without AD (n = 2111) was assessed. Statistical analysis was done using a χ(2) test.
Compared with nonatopic patients, patients with AD were statistically more likely to have positive patch tests. AD was associated with contact hypersensitivity to quaternium-15, imidazolidinyl urea, DMDM hydantoin, and 2-bromo-2-nitropropane-1,3-diol but not to parabens, formaldehyde, or diazolidinyl urea.
Only patients suspected of having allergic contact dermatitis were tested. Our population was geographically limited to metropolitan Kansas City, MO, and metropolitan New York City, NY.
Patients with AD should avoid the use of skin care products preserved with formaldehyde releasers.
Epidemiologic studies indicate that ever larger numbers of people report having sensitive skin, for which a European prevalence of 50% is estimated. Sensitive skin is characterized by hyperreactivity, with manifestations varying in relation to many factors. The pathogenesis of this disorder is poorly understood, although studies point to a biophysical mechanism. Objective diagnosis of sensitive skin is difficult, as information comes mainly from the patient's report of symptoms in the absence of effective, strongly predictive tests because of great interindividual variability in skin sensitivity. Substances that trigger a reaction in hypersensitive skin also vary greatly. The impact of this syndrome on quality of life is considerable and patients often present psychiatric symptoms; therefore, dermatologists should explore this possibility when taking a patient's history. Patient cooperation and physician persistence are both essential for treating sensitive skin.
Epidemiologic studies indicate that ever larger numbers of people report having sensitive skin, for which a European prevalence of 50% is estimated. Sensitive skin is characterized by hyperreactivity, with manifestations varying in relation to many factors. The pathogenesis of this disorder is poorly understood, although studies point to a biophysical mechanism. Objective diagnosis of sensitive skin is difficult, as information comes mainly from the patient's report of symptoms in the absence of effective, strongly predictive tests because of great interindividual variability in skin sensitivity. Substances that trigger a reaction in hypersensitive skin also vary greatly. The impact of this syndrome on quality of life is considerable and patients often present psychiatric symptoms; therefore, dermatologists should explore this possibility when taking a patient's history. Patient cooperation and physician persistence are both essential for treating sensitive skin.
Emollients and moisturizing creams are used to break the dry skin cycle and to maintain the smoothness of the skin. The term ‘moisturizer’ is often used synonymously with emollient, but moisturizers often contain humectants in order to hydrate the stratum corneum. Dryness is frequently linked to an impaired barrier function observed, for example, in atopic skin, psoriasis, ichthyosis, and contact dermatitis.
Dryness and skin barrier disorders are not a single entity, but are characterized by differences in chemistry and morphology in the epidermis. Large differences also exist between moisturizing creams. Moisturizers have multiple functions apart from moistening the skin. Similar to other actives, the efficacy is likely to depend on the dosage, where compliance is a great challenge faced in the management of skin diseases. Strong odor from ingredients and greasy compositions may be disagreeable to the patients. Furthermore, low pH and sensory reactions, from lactic acid and urea for example, may reduce patient acceptance. Once applied to the skin, the ingredients can stay on the surface, be absorbed into the skin, be metabolized, or disappear from the surface by evaporation, sloughing off, or by contact with other materials.
In addition to substances considered as actives, e.g. fats and humectants, moisturizers contain substances conventionally considered as excipients (e.g. emulsifiers, antioxidants, preservatives). Recent findings indicate that actives and excipients may have more pronounced effects in the skin than previously considered. Some formulations may deteriorate the skin condition, whereas others improve the clinical appearance and skin barrier function. For example, emulsifiers may weaken the barrier. On the other hand, petrolatum has an immediate barrier-repairing effect in delipidized stratum corneum. Moreover, one ceramide-dominant lipid mixture improved atopic dermatitis and decreased transepidermal water loss (TEWL) in an open-label study in children. In double-blind studies moisturizers with urea have been shown to reduce TEWL in atopic and ichthyotic patients. Urea also makes normal and atopic skin less susceptible against irritation to sodium laurilsulfate. Treatments improving the barrier function may reduce the likelihood of further aggravation of the disease.
In order to have optimum effect it is conceivable that moisturizers should be tailored with respect to the epidermal abnormality. New biochemical approaches and non-invasive instruments will increase our understanding of skin barrier disorders and facilitate optimum treatments. The chemistry and function of dry skin and moisturizers is a challenging subject for the practicing dermatologist, as well as for the chemist developing these agents in the pharmaceutical/cosmetic industry.
There is a growing awareness that some individuals exhibit heightened skin sensitivity, particularly on the face, and have a high incidence of adverse reactions to cosmetics and toiletries.
To carry out an epidemiological study to assess the prevalence of sensitive skin and cosmetic-related adverse events in a U.K. population, and to examine possible factors that may be associated with sensitive skin.
Self-assessment questionnaires were sent out to 3300 women and 500 men, randomly selected, who were over the age of 18 years and lived within a 10-mile radius of High Wycombe (Bucks.). Fifty non-responder women were also questioned by telephone to ensure that the postal responders were representative of the population as a whole.
The response rates were 62% for women and 52% for men, with the incidence of self-reported skin sensitivity being 51.4% and 38.2%, respectively. Ten per cent of women and 5.8% of men described themselves as having very sensitive skin. Fifty-seven per cent of women and 31.4% of men had experienced an adverse reaction to a personal product at some stage in their lives, with 23% of women and 13.8% of men having had a problem in the last 12 months. Among the women, symptoms of cosmetic-induced subjective sensory skin discomfort (burning, stinging, itching etc.) occurred more commonly in the sensitive skin cohort (53%) than in those who regarded themselves as non-sensitive (17%). An atopic diathesis in women did not appear to be a predictive factor for sensitive skin, the incidence of self-perceived sensitive skin being equivalent for atopics (49%) and non-atopics (51%). Furthermore, some 34% of atopic women described themselves as being non-sensitive. Nevertheless, the incidence of atopy was higher among the women in the sensitive skin group (49%) than among those in the non-sensitive group (27%). Dry skin and a predilection for blushing/flushing were associated factors for sensitive skin.
Our survey indicates that sensitive facial skin is a common problem for women and men in the U.K. and points to the need for the development of personal products designed for this skin phenotype.
It is currently fashionable to consider atopic dermatitis (AD), like other inflammatory dermatoses, as immunologic in pathogenesis ("inside-outside" hypothesis). Accordingly, topical glucocorticoids and other immunosuppressive agents are mainstays of therapy, but the risk of toxicity from these agents is not insignificant, particularly in children. Alternatively, because stratum corneum (SC) permeability barrier function is also abnormal in AD, it has been hypothesized that the barrier abnormality could drive disease activity. Yet commonly used emollients and moisturizers do not correct the SC ceramide deficiency, the putative cause of the barrier abnormality.
We assessed the efficacy of a newly developed, ceramide-dominant, physiologic lipid-based emollient, when substituted for currently used moisturizers, in 24 children who were also receiving standard therapy for stubborn-to-recalcitrant AD.
All subjects continued prior therapy (eg, topical tacrolimus or corticosteroids), only substituting the barrier repair emollient for their prior moisturizer. Follow-up evaluations, which included severity scoring of atopic dermatitis (SCORAD) values and several biophysical measures of SC function, were performed every 3 weeks for 20 to 21 weeks.
SCORAD values improved significantly in 22 of 24 patients by 3 weeks, with further progressive improvement in all patients between 6 and 20 or 21 weeks. Transepidermal water loss levels (TEWL), which were elevated over involved and uninvolved areas at entry, decreased in parallel with SCORAD scores and continued to decline even after SCORAD scores plateaued. Both SC integrity (cohesion) and hydration also improved slowly but significantly during therapy. Finally, the ultrastructure of the SC, treated with ceramide-dominant emollient, revealed extracellular lamellar membranes, which were largely absent in baseline SC samples.
These studies suggest that (1) a ceramide-dominant, barrier repair emollient represents a safe, useful adjunct to the treatment of childhood AD and (2) TEWL is at least as sensitive an indicator of fluctuations in AD disease activity as are SCORAD values. These studies support the outside-inside hypothesis as a component of pathogenesis in AD and other inflammatory dermatoses that are accompanied by a barrier abnormality.
Atopic dermatitis (AD) lesions are characterized by differences in the activation state of endothelial cells and vascular smooth muscle cells and the release of inflammatory mediators by and toward the vasculature. The vascular system, including endothelial cells and smooth muscle cells, is ultimately involved in clinical symptoms of AD, such as erythema, edema, leukocyte recruitment, and white dermographism. Various mediators and bidirectional neurovascular interactions regulate the inflammatory response during AD. T cell-endothelial cell interactions are a crucial component to establish acute AD. Various immune cells, including monocytes and mast cells, communicate with the endothelium by releasing inflammatory mediators, thereby stimulating inflammatory mediator release from activated endothelial cells. The process of adhesion, tethering, and transmigration of infiltrating cells is a highly regulated and an active communication process between endothelial cells and leukocytes. Endothelial cells play a pivotal role in the pathophysiology of AD and represent future targets for the treatment of AD.
This study evaluated the knowledge, attitudes and practices of Southeast Asian dermatologists in the management of atopic dermatitis (AD).
A questionnaire survey of 255 dermatologists in Indonesia, Malaysia, the Philippines, Singapore, Thailand and Vietnam.
Familiarity with diagnostic criteria varied considerably. The usage of moisturisers by the respondents from Vietnam and Indonesia was significantly less frequent than the other countries. Most respondents (91% to 100%) used topical corticosteroids in children with mild-to-moderately severe dermatitis. Some respondents in the Philippines (17% to 19%) and Vietnam (11% to 25%) only used topical corticosteroids for severe disease. For infected eczema, most respondents would prescribe systemic antibiotics for mild-to-moderate infection. A minority in the Philippines (14%) and Vietnam (11%) did so only for severe infection. The top 4 systemic antibiotics prescribed most frequently were: erythromycin, cloxacillin, cephalosporin and amoxicillin/clavulanic acid. In Indonesia, a large proportion of the respondents (47%) prescribed amoxicillin most frequently. The majority of respondents (60% to 100%) prescribed both sedating and non-sedating oral antihistamines. Most respondents used oral corticosteroids to treat severe AD. Some in Malaysia, Singapore and Vietnam used cyclosporin (7% to 58%), azathioprine (5% to 31%) and methotrexate (5% to 14%). With the exception of those in Singapore, the majority of respondents (71% to 97%) did not use phototherapy.
Familiarity with diagnostic criteria, the early and judicious use of moisturisers and topical corticosteroids, as well as the treatment of Staphylococcus aureus superinfection with penicillinase-stable antibiotics should be emphasised in this region.
Treatment goals for atopic dermatitis consist of attempting to eliminate inflammation and infection, hydrating the skin, controlling pruritus, and avoiding exacerbative factors. The aim of this study was to evaluate the effects of adding a moisturizing regimen to a low-potency topical corticosteroid lotion regimen in the treatment of atopic dermatitis. This controlled, randomized, investigator-masked 3-week study was undertaken to compare twice-daily applications of desonide lotion 0.05% alone with twice-daily applications of desonide lotion 0.05% plus three-times-daily applications of a moisturizing cream. The efficacy variables assessed included erythema, dryness or scaling, pruritus, excoriations, lichenification, oozing or crusting, and induration or papules. Administration of desonide lotion alone created statistically significant improvement in total sign and symptom scores. The addition of a moisturizer to the treatment regimen produced additional statistically significant improvement in total sign and symptom scores, physicians' global assessments of improvement, and most of the individual efficacy variables. Results of this study suggest that the addition of a moisturizer to a low-potency corticosteroid lotion in separate regimens was effective in treating the signs and symptoms of mild-to-moderate atopic dermatitis.
The thickness of, and number of cell layers in, the stratum corneum and the living epidermis were determined on frozen sections of washed and unwashed skin from normal and atopic individuals of both sexes. The stratum corneum of atopic patients was thinner and had fewer layers of dead cells and intercellular lipid than normal, although the living epidermis was thicker. Regular washing with soap and water had no appreciable effect on the dimensions of the living epidermis of either group but caused a reduction in the number of cell layers and the amount of sudanophilic material in the stratum corneum of both. In atopic patients little surface lipid remained, suggesting that washing with soap and water may be detrimental to the barrier function of the stratum corneum in such patients.
One hundred and thirty patients with atopic dermatitis, who had used no soap for at least a month, were allowed to use common toilet soaps when having a shower to keep the skin clean. Immediately after bathing, the skin lesions and areas of dry skin were treated with topical medications.When soap was used in this way topically applied medications were found to be more effective than before the use of soap.After I week, 119(91.5%)of the 130 patients showed a considerable improvement of the skin lesions.After 5 weeks, most patients had a progressive improvement of eczema.Deterioration of eczema or dry skin did not occur.
In order to qualify as a case of atopic dermatitis, we propose that an individual must have an itchy skin condition plus three or more of the following: history of flexural involvement, a history of asthma/hay fever, a history of a generalized dry skin, onset of rash under the age of 2 years, or visible flexural dermatitis. When tested in an independent sample of 200 consecutive dermatology outpatients of all ages, this arrangement of the diagnostic criteria achieved 69% sensitivity and 96% specificity when validated against physician's diagnosis. Based on the findings of this first exercise, minor modifications in the wording of the criteria were undertaken, and these were tested on a sample of 114 consecutive children attending out-patient paediatric dermatology clinics. Overall discrimination improved, with a sensitivity of 85% and specificity of 96%. The simplified criteria are easy to use, take under 2 min per patient to ascertain, and do not require subjects to undress. These two independent validation studies suggest that the newly proposed criteria for atopic dermatitis perform reasonably well in hospital out-patient patients. Further validation in community settings and in developing countries is needed.
The effectiveness of an emollient as an adjunct to topical corticosteroid therapy for the treatment of mild to moderate atopic dermatitis was studied for 3 weeks in 25 children 3 to 15 years of age in comparison with corticosteroid therapy alone. The adjunctive regimen of a once-daily application each of hydrocortisone 2.5% cream and of a water-in-oil cream was equivalent in efficacy to the comparative regimen of twice-daily applications of hydrocortisone 2.5% cream. Both treatment regimens elicited significant improvement in skin condition by day 7 ( p < 0.005) and further significant improvement by day 14 (p < 0.005). No significant differences between the two treatment regimens were observed in the rates of improvement (p > 0.545) or in the reductions in mean lesion size (p > 0.98). No differences were observed in parental evaluations, except for ease of application where a slight preference was expressed for the hydrocortisone 2.5% cream preparation (p < 0.038). We conclude that emollient adjunctive therapy offers a steroid-sparing alternative to topical corticosteroids alone in the treatment of mild to moderate atopic dermatitis.
Patients with atopic skin show a defective barrier function both in rough and in clinically normal skin, with an increasing risk of developing contact dermatitis. Moisturizing creams are often used in the treatment of dry skin. The purpose of this study was to investigate the influence of treatment with a urea-containing moisturizer on the barrier properties of atopic skin. Fifteen patients with atopic dermatitis treated one of their forearms twice daily for 20 days with a moisturizing cream. Skin capacitance and transepidermal water loss (TEWL) were measured at the start of the study and after 10 and 20 days. On day 21 the skin was exposed to sodium lauryl sulphate (SLS) and on day 22 the irritant reaction was measured non-invasively. Skin capacitance was significantly increased by the treatment, indicating increased skin hydration. The water barrier function, as reflected by TEWL values, tended to improve (P = 0.07), and the skin susceptibility to SLS was significantly reduced, as measured by TEWL and superficial skin blood flow (P < 0.05). Thus, it seems that certain moisturizers could improve skin barrier function in atopics and reduce skin susceptibility to irritants. The mechanism and the clinical relevance need further investigation.
We evaluated the emollient use and bathing habits of children with atopic eczema (AE) managed at the paediatric dermatology clinic of a university teaching hospital, using children with noneczematous skin diseases as controls. Disease severity of AE in the preceding 12 months was evaluated by the Nottingham Eczema Severity Score. Three-quarters of patients with or without eczema preferred showering to bathing. Patients with AE were more likely to use bath oils than soap and to use emollients after a bath/shower. Review cases, however, were more likely to take a shower and for a longer time (10-30 min) than first-visit eczema patients. These habits did not vary with season or disease severity. Emulsifying ointment was the most commonly used agent for the bath/shower. Most patients applied emollient immediately after a bath/shower. However there were still significant proportions of AE patients who used soap (40% of first-visit vs. 27% of review cases) and who did not apply emollients after a bath/shower (25% of first-visit vs. 23% of review cases). It is important to determine whether this problem is due to inadequate patient education or whether other factors lead to poor compliance.
Atopic dermatitis (AD) is a recurring inflammatory skin disease, characterized by marked pruritus, which usually develops in early childhood. AD is associated with a wide array of symptoms, including itching, dryness, erythema, crusted lesions, and superficial inflammation. Topical steroid cream or ointment with proper washing is a primary treatment approach for AD. Nonsoap-based personal washing or syndet bars containing synthetic detergents or surfactants are milder than soaps; thus, they are widely used by patients with a variety of skin conditions, including AD. The primary goals of this study were to determine the compatibility of syndet bar use with the therapy of AD and the potential benefits of syndet bars compared with subjects' usual cleansing products, mostly soap bars. In this evaluation, 50 subjects (14 subjects were aged < or =15 years) with mild AD on a stable treatment regimen were recruited and asked to use 1 of 2 syndet bars as part of their normal shower routine for 28 days. The severity of eczematous lesions, skin condition (dryness, erythema, texture), and hydration were evaluated at baseline and after 28 days of syndet application by investigators and subjects. Syndet bar use reduced the severity of eczematous lesions, improved skin condition, and maintained hydration. Overall, the results of this study indicate that syndet formulations are compatible with the therapy of AD.
Controlled clinical studies have provided strong evidence that moisturizers not only enhance the efficacy of topical corticosteroids in patients with atopic dermatitis but also may prevent disease reexacerbation. Furthermore, moisturizers have been shown to have a steroid-sparing effect both in patients with atopic dermatitis and in those with psoriasis. In particular, certain lipid-dominant moisturizers have been shown to significantly (P<.05) improve the condition of the skin based on objectively assessed changes in clinical parameters when used by patients with various dermatoses. Although further research is warranted, moisturizers represent a valuable first-line treatment option for many dermatologic diseases and confer a number of important therapeutic benefits beyond mere cosmetic effects.
In a survey commissioned by Core-Create, Inc, and conducted by Harris Interactive, 422 subjects in the United States with chronic dermatologic diseases provided feedback regarding information and recommendations provided to them by their dermatologist on the use of moisturizers and cleansers. In particular, the survey results revealed that there is widespread underuse of these products in patients with common cutaneous disorders. The vast majority of patients wish that their dermatologist would provide more information about moisturizers and cleansers; additionally, they would like their dermatologist to recommend a specific product for them to use. What's more, patients want to know if a moisturizer or cleanser will do more than merely provide symptomatic relief. Patient education was confirmed as a critical factor in promoting patient compliance as evidenced by the fact that subjects were 4 times more likely to follow their physician's direction when the role of the products was explained to them than when no explanation was provided. In addition, it was found that overall patient satisfaction with the care received from their dermatologist is driven by communication.
Background: In the USA, Europe and Japan 40 to 50% of women report that they have sensitive skin, defined as abnormal sub-clinical sensory responses to drugs, cosmetics and toiletries in the absence of visible signs of irritation. Itching, burning, stinging and tightness are the commonest complaints, which mainly afflict women. Manufacturers of skin care products have made available a large variety of products which are designed for persons with sensitive skin. Such products are not required by regulatory agencies to submit evidence of safety and efficacy, allowing marketers to make claims that are often exaggerated, irrational and even preposterous. The consumer with self-assessed sensitive skin has no way of judging which products are likely to be most beneficial and least harmful. The marketplace is awash with products for which there is no evidence that the rosy claims have been substantiated by appropriate testing procedures. There is no internationally accepted consensus regarding the criteria which define sensitive skin. Many papers have been published in the last 15 years, mainly originating from industry, which express widely differing views regarding what constitutes sensitive skin. For some, any adverse reaction to a product topically applied to sensitive skin, including breakouts, redness, scaling etc., a panoply of adverse reactions which is virtually meaningless. Others include environmental factors as causative, including cold, dry wind, heat and high humidity, solar radiation, etc., which add to the manifest complexities of the subject.
The subtle dryness of the skin surrounding the lesions of atopic dermatitis (AD) is called atopic dry skin or atopic xerosis (AX). AX is more susceptible to the development of AD skin lesions under various environmental stimuli than the clinically normal skin of the people who have or have had or will have AD, which might be called normal atopic skin (NAS) that shows no functional differences as compared to the skin of normal individuals. Routine histopathologic studies of AX that involve the invasive procedures of biopsy are not so helpful in clarifying the underlying pathogenesis. Modern, noninvasive biophysical instrumentation provides rich and quantitative information about various functional aspects of skin. The stratum corneum (SC) of AX reveals not only decreased hydration but also mildly impaired barrier function demonstrable as an increase in transepidermal water loss, elevated pH values, and an increased turnover rate of the SC consisting of thick layers of smaller-sized corneocytes. These data suggest that AX is related to mildly increased epidermal proliferation as a result of the presence of subclinical cutaneous inflammation. Although AX skin does not display any impairment in the recovery of barrier function after physical skin irritation by tape-stripping, it produces a much more severe, long-lasting inflammatory response together with a delay in barrier repair after chemical irritation such as that induced by sodium lauryl sulphate. The SC of AX is biochemically characterized by reduction in the amounts of ceramides, especially ceramide I, sebum lipids, and water-soluble amino acids. None of these changes in SC functions are seen in NAS, which includes not only the normal-looking skin of AD patients long after regression of all active lesions but also of latent atopic skin such as neonates who later develop AD. This suggests that all of the observed functional as well as biochemical abnormalities of AX are a reflection of subclinical inflammation. The presence of the underlying inflammation in AX also differentiates it from senile xerosis. The mildly impaired SC functions of AX can be improved by daily repeated applications of effective moisturizers, i.e., corneotherapy, which is effective in preventing the exacerbating progression of AX to AD resulting from inadvertent scratching of the skin that facilitates the penetration of environmental allergens into the skin. The biophysical confirmation of such efficacy of moisturizers, including cosmetic bases on the mildly impaired barrier function and decreased water-holding capacity of the SC of AX, definitely substantiates the importance of skin care for the cosmetic skin problems that affect every individual in the cold and dry season ranging from late autumn to early spring.
Moisturizers are commonly used by patients with dry skin conditions as well as people with healthy skin. Previous studies on short-term treatment have shown that moisturizers can weaken or strengthen skin barrier function and also influence skin barrier recovery. However, knowledge of the effects on skin barrier function of long-term treatment with moisturizers is still scarce.
To investigate the impact of long-term treatment with moisturizers on the barrier function of normal skin, as measured by transepidermal water loss (TEWL) and susceptibility to an irritant, and to relate those effects to the composition of the designed experimental moisturizers.
Volunteers (n = 78) were randomized into five groups. Each group treated one volar forearm for 7 weeks with one of the following preparations: (i) one of three simplified creams, containing only a few ingredients in order to minimize the complexity of the system; (ii) a lipid-free gel; (iii) one ordinary cream, containing 5% urea, which has previously been shown to decrease TEWL. The lipids in the simplified creams were either hydrocarbons or vegetable triglyceride oil, and one of them also contained 5% urea. After 7 weeks, treated and control forearms were exposed for 24 h to sodium lauryl sulfate (SLS) using a patch test. TEWL, blood flow and skin capacitance of both SLS-exposed and undamaged skin were evaluated 24 h after removal of patches. Additionally, a 24-h irritancy patch test of all test preparations was performed on 11 volunteers in order to check their possible acute irritancy potential.
Changes were found in the barrier function of normal skin after 7 weeks of treatment with the test preparations. The simplified creams and the lipid-free gel increased TEWL and skin response to SLS, while the ordinary cream had the opposite effect. One of the simplified creams also decreased skin capacitance. All test preparations were shown to be nonirritant, both by short-term irritancy patch test and by measurement of blood flow after long-term treatment.
Moisturizers influence the skin barrier function of normal skin, as measured by TEWL and susceptibility to SLS. Moreover, the effect on skin barrier function is determined by the composition of the moisturizer. The ingredients which influence the skin barrier function need to be identified, and the mechanism clarified at the molecular level.
Atopic eczema/dermatitis from the aspects of immunologic background, genetics, skin barrier dysfunction, IgE receptors, and triggers of AD (including allergens, microorganisms, and autoantigens) is described. Also reviewed are diagnostic procedures, treatment modalities with topical treatment (emollients, topical corticosteroids, topical calcineurin inhibitors, wet wrap therapy, and topical antimicrobial therapy), systemic management (antimicrobials, systemic corticosteroids, cyclosporine A, azathioprine, antihistamines), and phototherapy. Primary and secondary prevention are discussed and the role of the different cell receptors and their up-and down-regulation in this setting are emphasized.
The skin of atopic dermatitis (AD) patients exhibits a striking susceptibility to colonization and infection with Staphylococcus aureus. This review summarizes our understanding about the role of S. aureus in AD. Indeed, S. aureus colonization is both a cause and a consequence of allergic skin inflammation. The mechanisms that allergic skin inflammation of AD promotes the increase of S. aureus colonization include skin barrier dysfunction, increased synthesis of the extracellular matrix adhesins for S. aureus, and defective innate immune responses due to decreased production of endogenous antimicrobial peptides. On the other hand, the exotoxins secreted by S. aureus are superantigens. Staphylococcal superantigens (SsAgs) may penetrate the skin barrier and contribute to the persistence and exacerbation of allergic skin inflammation in AD through the stimulation of massive T cells, the role of allergens, direct stimulation of antigen-presenting cells and keratinocytes, the expansion of skin-homing cutaneous lymphocyte-associated antigen-positive T cells, and the augmentation of allergen-induced skin inflammation. SsAgs also induce corticosteroid resistance. In therapeutic interventions, anti-inflammatory therapy alone is very effective in reducing S. aureus colonization on the skin, but antibiotic treatment alone is unable to improve the allergic skin inflammation of AD. Therefore, we recommend the combination therapy of anti-inflammatory drugs and antibiotics in the AD patients with secondary bacterial infection, exacerbated AD, or poorly controlled AD. However, when AD is well controlled by anti-inflammatory drugs alone, we do not recommend the antibiotic therapy.
A controlled comparison of skin cleansers in Dermatologists should advise patients on the use of mois-photoaged skin turizers and cleansers, as well as irritants to avoid
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A comprehensive management guide for atopic dermatitis. to irritation, restore the integrity of the stratum corneum, and
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Ceramide-dominant barrier repair lipids Acknowledgments alleviate childhood atopic dermatitis: changes in barrier function provide a sensitive indicator of disease activity The author has received lecture grants from Galderma and honoraria for 198-208 participation in the SENSE Advisory
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A controlled comparison of skin cleansers in photoaged skin
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