Negar Foolad

Prebiotics and probiotics: the prevention and reduction in severity of atopic dermatitis in children.

The purpose of this review was to identify whether supplementation with prebiotics and/or probiotics help prevent the development or reduce the severity of atopic dermatitis in children less than three years of age. Since 1997, immunostimulatory supplements, such as prebiotics and probiotics, have been investigated. Various supplementations include probiotics (single strain or mix), probiotics with formula, probiotics mix with prebiotics, and prebiotics. In this narrative review, we examined 13 key articles on prebiotics and/or probiotics, and their effects on infant atopic dermatitis. Among the selected studies, a total of 3,023 participants received supplements or placebo. Eight out of the 13 (61.5%) studies reported a significant effect on the prevention of atopic dermatitis after supplementation with probiotics and/or prebiotics. Five out of the 13 (38.5%) studies indicated significant reduction in the severity of atopic dermatitis after supplementation. Based on the available studies, supplementation with certain probiotics (Lactobacillus rhamnosus GG) appears to be an effective approach for the prevention and reduction in severity of atopic dermatitis. A mix of specific probiotic strains prevented atopic dermatitis among infants. Based on studies with prebiotics, there was a long-term reduction in the incidence of atopic dermatitis. Supplementation with prebiotics and probiotics appears useful for the reduction in the severity of atopic dermatitis. Additional interventional studies exploring prebiotics and probiotics are imperative before recommendations can be made.

Sweat lipid mediator profiling: a noninvasive approach for cutaneous research

Recent advances in analytical and sweat collection techniques provide new opportunities to identify noninvasive biomarkers for the study of skin inflammation and repair. This study aims to characterize the lipid mediator profile including oxygenated lipids, endocannabinoids, and ceramides/sphingoid bases in sweat and identify differences in these profiles between sweat collected from nonlesional sites on the unflared volar forearm of subjects with and without atopic dermatitis (AD). Adapting routine procedures developed for plasma analysis, over 100 lipid mediators were profiled using LC-MS/MS and 58 lipid mediators were detected in sweat. Lipid mediator concentrations were not affected by sampling or storage conditions. Increases in concentrations of C30–C40 [NS] and [NdS] ceramides, and C18:1 sphingosine, were observed in the sweat of study participants with AD despite no differences being observed in transepidermal water loss between study groups, and this effect was strongest in men (P < 0.05, one-way ANOVA with Tukey’s post hoc HSD). No differences in oxylipins and endocannabinoids were observed between study groups. Sweat mediator profiling may therefore provide a noninvasive diagnostic for AD prior to the presentation of clinical signs.

Comparing the effect of bleach and water baths on skin barrier function in atopic dermatitis: a split-body randomized controlled trial†

DEAR EDITOR, Atopic dermatitis (AD) is a chronic inflammatory skin disease associated with defective epidermal barrier function, characterized by decreased stratum corneum (SC) hydration, and increased transepidermal water loss (TEWL) and pH. Staphylococcus aureus skin colonization is present in nearly all cases of AD exacerbation and correlates with disease severity, suggesting an infection–inflammation cycle. The use of a sodium hypochlorite (bleach) bath alone and as an adjunct to intranasal mupirocin ointment is associated with a reduction in AD severity, and decreases annual skin infection cases 10-fold. In a Cochrane review on various interventions to reduce S. aureus colonization, including oral antibiotics, topical steroids and antibiotic ointments, only bleach bath showed a significant improvement in AD severity. Bleach bath appears to be a low-cost and effective adjuvant treatment for AD, and is recommended by the American Academy of Dermatology and American Academy of Allergy, Asthma and Immunology, particularly for patients with moderate-to-severe AD and frequent bacterial infections. Although bleach bath is generally well-tolerated, with no existing report on skin irritation, it may be difficult to convince patients and parents that a potential irritant is beneficial for the sensitive skin of patients with AD. The goal of this study was to compare the effect of bleach bath vs. water bath exposure on skin barrier function by measuring SC hydration, TEWL and pH in patients with AD and healthy subjects. The study was approved by the institutional review board of University of California, Davis (# 523979). The study was registered on ClinicalTrials.gov (NCT02594969). Ten patients with concurrent AD (mean age 26 3 years, range 12 0–45 0) and 10 healthy subjects (mean age 28 5 years, range 22 0– 34 0) were enrolled between 2014 and 2015. The entire study was performed at University of California, Davis. Demographic data are summarized in Table 1. Testing was conducted on the volar surfaces of the forearms, a commonly used study site for topical applications. AD severity was determined by the global eczema area severity index (EASI) and modified local EASI for upper limbs. Each patient served as their own control and a priori binary randomization was performed to determine which forearm would receive tap water or 0 005% dilute hypochlorite solution bath exposure. The randomization was performed prior to recruitment by the study coordinator, and stored in sealed envelopes that were not opened until the patient was recruited by the investigators. Participants remained blinded to the water or dilute hypochlorite immersion. Each arm was immersed for 10 min. None of the patients bathed or applied topical moisturizers or medications for 12 h prior to the study session. Skin barrier function parameters, including hydration (MoistureMeter SC; Delfin Technologies, Stamford, CT, U.S.A.), TEWL (Tewameter; Courage and Khazaka, Cologne, Germany) and pH (Dry Skin pH Meter; Hanna Instruments, Woonsocket, RI, U.S.A.), were measured at baseline, immediately postimmersion, and 15, 30 and 60 min postimmersion. Patients were asked to report skin discomfort, including itching, burning or pain during the 10-min immersion and throughout the postimmersion period. All recruited patients completed the study. A priori power analysis showed that evaluation of 10 patients with AD and 10 healthy controls would yield > 90% power at a = 0 05 to detect a difference of 15% in TEWL (primary end point) after bleach immersion compared with water immersion. Intraand interindividual comparisons were performed by ANOVA with a paired analysis performed for intraindividual comparisons.

Effect of Microneedle Pretreatment on Topical Anesthesia: A Randomized Clinical Trial

Effect of Microneedle Pretreatment on Topical Anesthesia: A Randomized Clinical Trial Microneedles are microscopic needles capable of creating microchannels through the stratum corneum to improve transdermal drug delivery.1-3 Microneedles have been shown1,2,4-6 to enhance the delivery of topical anesthetics with use of in vitro and animal models. In this split-body, randomized clinical trial, we investigated whether pretreatment with microneedles enhanced the anesthetic effect produced by topical lidocaine cream, 4%.

Effect of Expedited Microneedle-Assisted Photodynamic Therapy for Field Treatment of Actinic Keratoses: A Randomized Clinical Trial

Importance Photodynamic therapy (PDT) is an effective and cosmetically favorable treatment modality for actinic keratoses (AKs). However, prolonged incubation times and pain associated with treatment are burdensome to the patient and a hindrance to widespread use of PDT as standard field therapy for AK. Objective To evaluate efficacy and pain associated with microneedle expedited PDT. Design, Setting, and Participants The Microneedle Photodynamic Therapy II (MNPDT-II) study was a randomized, single-blinded, split-face controlled, 2-arm clinical trial. Thirty-three participants with AK on the face were recruited in a university dermatology outpatient clinic from 2015 to 2016, and 32 participants completed the study. Interventions Participants were randomized into 2 incubations arms, either 10-minute or 20-minute aminolevulinic acid (ALA) incubation times, after pretreatment with a microneedle roller (200 um) vs a sham roller. They were blinded to the laterality of microneedle and sham roller assignments. After incubation, they were exposed to blue light (Blu-U, Dusa Pharmaceuticals) for 1000 seconds for a total fluence of 10 J/cm2. Main Outcomes and Measures The primary outcome was to quantitatively measure AK resolution, and the secondary outcome was to assess pain associated with microneedle pretreatment. Results Thirty-three individuals were recruited and randomized to either the 20-minute or the 10-minute incubation arm. Thirty-two participants completed the study with a mean follow-up time of 34.5 days in the 20-minute group, and 30.2 days in the 10-minute group. For the 20-minute incubation arm, average AK clearance was 76% vs 58% on the sham side (P < .01), including 3 patients with complete clearance, although not statistically significant (P = .25). Pain assessment on the visual analog scale (VAS) during blue light illumination was not significantly different between the microneedle and sham sides (0.7 and 0.4; P = .28), respectively. For the 10-minute incubation arm AK clearance for the microneedle pretreated side was 43% compared with 38% on the sham side (P = .66). Pain during the blue light exposure was not significantly different between the microneedle and sham sides, 4.5 mm and 3.4 mm (P = .21), respectively. Conclusions and Relevance Photodynamic therapy with microneedle pretreatment at a 20-minute ALA incubation time significantly improved AK clearance with efficacy similar to that of a conventional 1-hour ALA incubation time. The additional advantage to expedited treatment was that the procedure was virtually painless. However, expedited exposure of a 10-minute ALA incubation time did not reach significantly different AK clearance from the sham control. Trial Registration clinicaltrials.gov Identifier: NCT02594644

Objective volumetric grading of postacne scarring.

REFERENCES 1. Freed GL, Dunham KM, Switalski KE, Jones MD Jr, McGuinness GA, Research Advisory Committee of the American Board of Pediatrics. Recently trained general pediatricians: perspectives on residency training and scope of practice. Pediatrics. 2009;123(Suppl 1):S38-S43. 2. Sellheyer K, Bergfeld WF. A retrospective biopsy study of the clinical diagnostic accuracy of common skin diseases by different specialties compared with dermatology. J Am Acad Dermatol. 2005;52(5):823-830. 3. Prindaville B, Antaya RJ, Siegfried EC. Pediatric dermatology: past, present, and future. Pediatr Dermatol. 2015;32:1-12. 4. Valderas JM, Starfield B, Forrest CB, Rajmil L, Roland M, Sibbald B. Routine care provided by specialists to children and adolescents in the United States (2002-2006). BMC Health Serv Res. 2009;9:221. 5. Wilmer EN, Gustafson CJ, Ahn CS, Davis SA, Feldman SR, Huang WW. Most common dermatologic conditions encountered by dermatologists and nondermatologists. Cutis. 2014; 94(6):285-292.

Objective assessment of isotretinoin-associated cheilitis: Isotretinoin Cheilitis Grading Scale

Abstract Importance: Isotretinoin remains an effective treatment for severe acne. Despite its effectiveness, it includes many side effects, of which cheilitis is the most common. Objective: To develop an objective grading scale for assessment of isotretinoin-associated cheilitis. Design: Cross-sectional clinical grading study. Setting: UC Davis Dermatology clinic. Participants: Subjects were older than 18 years old and actively treated with oral isotretinoin. Exposures: Oral Isotretinoin. Main outcomes and measures: We developed an Isotretinoin Cheilitis Grading Scale (ICGS) incorporating the following four characteristics: erythema, scale/crust, fissures and inflammation of the commissures. Three board-certified dermatologists independently graded photographs of the subjects. Results: The Kendall’s coefficient of concordance (KCC) for the ICGS was 0.88 (p < 0.0001). The Kendall’s coefficient was ≥0.72 (p < 0.0001) for each of the four characteristics included in the grading scale. An image-based measurement for lip roughness statistically significantly correlated with the lip scale/crusting assessment (r = 0.52, p < 0.05). Conclusion and relevance: The ICGS is reproducible and relatively simple to use. It can be incorporated as an objective tool to aid in the assessment of isotretinoin associated cheilitis.

Effects of atopic dermatitis and gender on sebum lipid mediator and fatty acid profiles

Skin disease alters cutaneous lipid mediator metabolism, and if skin secretions contain evidence of these changes, they may constitute useful clinical matrices with low associated subject burden. The influences of skin diseases on sebum lipid mediators are understudied. Here, sebum oxylipins, endocannabinoids, sphingolipids, and fatty acids were quantified from the non-lesional bilateral cheeks of subjects with and without quiescent atopic dermatitis (AD) using LC-MS/MS and GC-MS. AD decreased C36 [NS] and [NdS] ceramide concentrations. Compared to males, females demonstrated increased concentrations of oxylipin alcohols and ketones, and saturated and monounsaturated non-esterified fatty acids, as well as decreased concentrations of C42 [NS] and [NdS] ceramides. Additionally, contemporaneously collected sweat lipid mediator profiles were distinct, with sebum showing higher concentrations of most targets, but fewer highly polar lipids. Therefore, AD and gender appear to alter sebum lipid metabolism even in non-lesional skin of quiescent subjects.

The use of facial modeling and analysis to objectively quantify facial redness

The reproducible evaluation of facial redness is critical to the assessment of erythematotelangiectatic rosacea. Assessments have typically focused on the use of photography with the use of semi‐quantitative grading scales based on evaluator rating. However, few studies have utilized computer‐based algorithms to evaluate facial redness.

Prospective, randomized, double-blind assessment of topical bakuchiol and retinol for facial photoageing

Bakuchiol is a phytochemical that has demonstrated cutaneous antiageing effects when applied topically. Early studies have suggested that bakuchiol is a functional analogue of topical retinoids, as both compounds have been shown to induce similar gene expression in the skin and lead to improvement of cutaneous photodamage. No in vivo studies have compared the two compounds for efficacy and side‐effects.