Abstract
Dead Sea (DS) mud and water are known for their unique composition of minerals, and for their therapeutic properties on inflammatory skin diseases. The objective of the study was to evaluate the efficacy of an emollient cream enriched with DS water in children with atopic dermatitis (AD). Eighty six AD children were randomized in a double-blind controlled study to receive twice-daily topical treatment with a body cream enriched with DS minerals (TP) compared to two types of control: 1) DM, DS minerals with lower DS water concentrations than TP, and 2) an emollient (E) with no DS minerals. Efficacy was assessed by a change in clinical skin severity scores: SCORing Atopic Dermatitis (SCORAD), investigator’s global assessment (IGA) and patient global assessment (PGA) as well as by objective physiological parameters: transepidermal water loss (TEWL), stratum corneum hydration (SCH), affected body surface area (BSA) and Objective Severity Assessment of Atopic Dermatitis (OSAAD). The total length of the trial was 12 weeks divided to 6 visits at weeks 0, 2, 4, 6, 8, 12. The study showed that both TP and DM creams improved OSAAD scores. Only TP improved TEWL and SCH. TP was the most effective regarding TEWL, SCH and OSAAD compared to DM and E. Treatment with E decreased more significantly IGA score compared to TP. Although within each treatment group significant improvements in SCH, BSA, SCORAD, IGA and PGA were observed, the reduction in BSA, SCORAD and PGA was not significantly different among the groups. Our results clearly show the benefits of TP as a leave on-skin emulsion enrich with DS water in terms of skin barrier function. Thus, TP can serve as an effective adjuvant treatment for AD skin as well as for its maintenance.
Highlights
Atopic dermatitis (AD) is a frequent Th2-mediated inflammatory disease, which occurs in persons of all ages but is more common in children, with the prevalence rate of around 10% to 20%
Efficacy was assessed by a change in clinical skin severity scores: SCORing Atopic Dermatitis (SCORAD), investigator’s global assessment (IGA) and patient global assessment (PGA) as well as by objective physiological parameters: transepidermal water loss (TEWL), stratum corneum hydration (SCH), affected body surface area (BSA) and Objective Severity Assessment of Atopic Dermatitis (OSAAD)
AD is a barrier disease in which antigens and irritants might penetrate non-lesional skin, trigger or worsen the dermatitis and lead to infections. [27,28] Due to their delicate and vulnerable skin and defective barrier function both in lesional and clinically uninvolved-appearing skin [4,29], atopic children are exposed to higher risk of local adverse effects and systemic absorption through the epidermis [30]
Summary
Atopic dermatitis (AD) is a frequent Th2-mediated inflammatory disease, which occurs in persons of all ages but is more common in children, with the prevalence rate of around 10% to 20%. DS minerals (i.e. DS mud and DS water) composition is especially rich in magnesium, calcium, sodium, potassium, zinc, strontium, sulphides and bromides [12,13]. Some of these minerals are known to influence signal transduction and cell metabolism: it has been demonstrated that Mg2+ ions inhibit the antigen-presenting function of human epidermal Langerhans cells in vivo and in vitro [14,15]. Bathing in a magnesium-rich Dead Sea salt solution improves skin barrier function, enhances skin hydration, and reduces inflamemation in atopic dry skin [16].
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