Marie Lodén

Improvement in skin barrier function in patients with atopic dermatitis after treatment with a moisturizing cream (Canoderm

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.

Barrier recovery and influence of irritant stimuli in skin treated with a moisturizing cream

Moisturizers are used daily by many people to alleviate symptoms of clinically and subjectively dry skin. Recent studies suggest that certain ingredients in creams may accelerate the recovery of a disrupted barrier and decrease the skin susceptibility to irritant stimuli. In the present single‐blind study, a moisturizing cream was tested for its influence both on barrier recovery in surfuctant‐damaged skin and on the susceptibility of normal skin to exposure to the irritant sodium lauryl sulphate (SLS). Parameters measured were transepidermal water loss (TEWL) and skin corneometer values, indicating degree of hydration. Treatment of surfactant‐damaged skin with the test cream for 14 days promoted barrier recovery, as observed as a decrease in TEWL. Skin corneometer values also normalized more rapidly during the treatment. In normal skin, use or the test cream significantly reduced TFWL after 14 days of treatment, and irritant reactions to SLS were, significantly decreased. Skin corneometer values increased after only 1 application and remained elevated after 14 days. In conclusion, the accelerated rate of recovery of surfactant‐damaged skin and the lower degree of SLS‐induced irritation in normal skin treated with the test cream may be of clinical relevance in attempts to reduce contact dermatitis due to irritant stimuli.

Changes in skin barrier function following long-term treatment with moisturizers, a randomized controlled trial

Background  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.

Treatment with a barrier-strengthening moisturizing cream delays relapse of atopic dermatitis: a prospective and randomized controlled clinical trial

Background  Standard treatment of atopic dermatitis (AD) is based on topical glucocorticosteroids or calcineurin inhibitors to treat flares combined with moisturizer treatment to alleviate dry skin symptoms. Patients with AD have an abnormal skin barrier function, and strategies for reducing the risks for eczema would be to repair the barrier or prevent barrier dysfunction.

Unexpected skin barrier influence from nonionic emulsifiers

Skin disorders are often treated with creams containing various active substances. The creams also contain emulsifiers, which are surface-active ingredients used to stabilize the emulsion. Emulsifiers are potential irritants and in the present study the influence of stearic acid, glyceryl stearate, PEG-2, -9, -40, and -100 stearate, steareth-2, -10 and -21 on normal as well as on irritated skin have been evaluated with non-invasive measurements. Test emulsions were created by incorporating 5% emulsifiers in a water/mineral oil mixture (50:50). The emulsions and their vehicle were then applied to normal skin for 48 h and to sodium lauryl sulfate (SLS) damaged skin for 17 h in aluminum chambers. Twenty-four hours after removal of the chambers the test sites were evaluated for degree of irritation. In normal skin, the emulsifiers induced significant differences in TEWL but not in skin blood flow. Five of the emulsifiers increased TEWL. In SLS-damaged skin an aggravation of the irritation was expected. However, no differences regarding skin blood flow was noted from the emulsifiers. Furthermore, three emulsifiers unexpectedly decreased TEWL. These results highlight the possibility of absorption of these emulsifiers into the lipid bilayer, which increase TEWL in normal skin and decrease TEWL in damaged skin.

Instrumental and dermatologist evaluation of the effect of glycerine and urea on dry skin in atopic dermatitis

Background/aims: Moisturising creams are useful treatment adjuncts in inflammatory dermatoses and have beneficial effects in the treatment of dry, scaly skin. The effects on dryness and skin permeability of a new moisturising cream with 20% glycerine was compared with its placebo and with a medicinally authorised cream with 4% urea (combined with 4% sodium chloride) in the treatment of dry skin.

A double-blind study comparing the effect of glycerin and urea on dry, eczematous skin in atopic patients.

Moisturizing creams have beneficial effects in the treatment of dry, scaly skin, but they may induce adverse skin reactions. In a randomized double-blind study, 197 patients with atopic dermatitis were treated with one of the following: a new moisturizing cream with 20% glycerin, its cream base without glycerin as placebo, or a cream with 4% urea and 4% sodium chloride. The patients were asked to apply the cream at least once daily for 30 days. Adverse skin reactions and changes in skin dryness were assessed by the patient and a dermatologist. Adverse skin reactions such as smarting (a sharp local superficial sensation) were felt significantly less among patients using the 20% glycerin cream compared with the urea-saline cream, because 10% of the patients judged the smarting as severe or moderate when using glycerin cream, whereas 24% did so using urea-saline cream (p < 0.0006). No differences were found regarding skin reactions such as stinging, itching and dryness/irritation. The study showed equal effects on skin dryness as judged by the patients and the dermatologist. In conclusion, a glycerin containing cream appears to be a suitable alternative to urea/sodium chloride in the treatment of atopic dry skin.

Biophysical characterization of skin damage and recovery after exposure to different surfactants

The majority of adverse skin reactions to personal‐care products are presumed to be caused by irritant substances, like surfactants. In this study, different aspects of the irritant reaction after a single exposure to 8 surfactants were characterized during 2 weeks. Solutions of 2% sodium lauryl sulfate, 5% sodium C12‐15 pareth sulfate, 5% sodium cocoyl isethionate, 10% disodium laureth sulfosuccinate, 10% sodium cocoamphoacetate, 10% cocamide DEA, 10% cocamidopropyl betaine and 10% lauryl glucoside, respectively, were applied to the forearm of 12 volunteers. Clinical assessment, an evaporimeter, a laser Doppler flowmeter and a corneometer were used for evaluation. The surfactants induced different degrees of irritation. Erythema, transepidermal water loss and skin blood flow exhibited a similar time course, which seemed to be inversely related to the delayed scaling and reduced skin capacitance. The mechanism of the damaging effect of the surfactants seems to be similar, although some minor differences were noted.

The effect of 4 barrier creams on the absorption of water, benzene, and formaldehyde into excised human skin

The effect of 4 bonier creams on the absorption of (3H)‐water (12C)‐benzene and (14C)‐formaldehyde into excised human skin was studied. The control skin unit the barrier cream treated skin were exposed to the test substance for 0.5 hr. whereupon the amount absorbed was determined. The results indicated that the experimental cream “Water harrier” reduced the absorption of water and benzene but not formaldehyde Kerodex 71 cream slightly reduced the absorption of benzene and formaldehyde. The harrier creams Petrogard and “Solvent barrier” did not affect the absorption of any of the substances studied. The use of these creams against percutaneous absorption is questioned.

The irritation potential and reservoir effect of mild soaps

Identification and reduction of external noxious factors is one key point in the strategy for the treatment and reduction of contact dermatitis. A wide variety of soaps on the market are claimed to be suitable for the use on sensitive skin due to their mildness. The aim of the present study was to illustrate possible differences in the irritation potential of 8 products and to investigate whether surfactant residues may form an irritant reservoir on the skin. The study was double‐blind, randomized using healthy human volunteers. The inherent capacity of the products to induce irritation was determined using conventional patch test technique, whereas detection of potential surfactant residues on the skin was done using a methodology developed in the 1960s for detection of the corticosteroid reservoir in the stratum corneum. The method comprised the release of active substance from the stratum corneum reservoir by occlusion of the skin with an aluminium chamber, followed by evaluation of the biological response. In the present study, the soap‐treated area was rinsed with water and then occluded. Instrumental measurements of the transepidermal water loss and superficial skin blood flow served as indicators of the injurious effects of the products. The results showed large differences in irritation potential between the products, and some of them demonstrated considerable damaging effect. Moreover, the study proved the presence of barrier‐impairing residues on the skin after rinsing with water. Subclinical skin damage can make the skin vulnerable to further irritation and delay recovery of chronic irritant contact dermatitis.