Efficacy Of Emollients Research Articles

The Role of a Novel Generation of Emollients, 'Emollients Plus', in Atopic Dermatitis.

Emollients are the mainstay maintenance treatment for atopic dermatitis (AD). A novel generation of emollients, 'emollients plus', containing active, non-medicated substances, has softened the distinction between emollients and topical drugs. A literature search for selected key words was performed using PubMed. Additional papers were identified based on author expertise. Whilst the inclusion of five components of an ideal emollient has been proposed, no such consensus exists for emollients plus and they can vary markedly in their composition and modes of action for AD treatment. This could have a profound effect on their clinical efficacy. The efficacy of emollients plus in restoring and maintaining skin barrier function has been demonstrated on multiple levels, with evidence reported for their effects on the physical and biochemical, microbial, immunological, and neurosensory barriers. When selecting an appropriate AD treatment approach, the safety profiles of the available topical therapies must be carefully considered. There are several proposed treatment approaches for AD, including preventive, proactive, intermittent, and synergistic approaches. Emollients plus may be effective not only as maintenance therapy for AD, but also when used synergistically with anti-inflammatory pharmacological therapies.

Soluble CD14 in Breast Milk and Its Relation to Atopic Manifestations in Early Infancy.

Soluble CD14 (sCD14) is one of the immunomodulatory factors in breast milk (BM). Although it may be involved in the prevention of atopic symptoms and sensitization to both food and inhalant allergens, conflicting evidence exists concerning its protective effects. In this study, we investigated the relationship between sCD14 in colostrum and 1-month BM, and the development of atopic dermatitis (AD) and sensitization to food and aeroallergens at 9 months of age in infants who were exclusively or almost exclusively breastfed up to 4 months of age. BM samples were collected from lactating mothers who participated in a 2 × 2 factorial, randomized, nontreatment controlled trial study set in Tokyo, which looked at the efficacy of emollients and synbiotics in preventing AD and food allergy in children during the first year of life. A total of 258 colostrum samples and 269 1-month BM samples were analyzed. We found that one-month BM sCD14 levels in the AD group were significantly lower than in the non-AD group. Levels of sCD14 in 1-month BM were not related to allergen sensitization in the overall analysis, but egg white sensitization correlated inversely with 1-month BM sCD14 in infants without AD. The results suggest that sCD14 in BM may be involved in atopic manifestations in early infancy.

Skin Barrier Protection

The largest organ of the human body is the skin with its ~2 m2 surface area that envelopes the whole organism defining its physical border and which most importantly provides a barrier against internal organ dehydration and external penetration of noxious substances. The critical importance of the skin barrier is appreciated when it is lost such as in skin burns or compromised such as in atopic dermatitis, affecting the overall wellbeing of the individual. Moreover, it has been shown that the skin barrier function undergoes a maturation process during the first years of life. It is therefore of interest to identify skin care routines such as washing and bathing that would not be damaging to the skin barrier and if possible enhancing its protection. Furthermore, barrier enhancement aids in the prevention and treatment of certain conditions such as atopic dermatitis. Recent scientific discoveries in skin biology and formulation science have advanced the understanding of the regulatory mechanisms that control skin barrier homeostasis as well as our knowledge of skin-product interactions. Application of this knowledge has led to the design of appropriate skin care products and the design of tests that can demonstrate barrier-related benefits. This special issue of the Dermatology Research and Practice addresses these issues. The paper by L. Telofski et al. titled “The infant skin barrier: can we preserve, protect, and enhance the barrier?” provides an introduction to the recent findings on skin barrier maturation after birth that lasts for the first few years of life. The authors present on healthy skin barrier development as well as problems that can arise during infancy related to abnormal skin conditions and barrier integrity. They then discuss appropriate cleansing routines that should respect the distinct nature of infant skin and the use of emollients to protect and enhance the infant skin barrier function. In the paper titled “Management of patients with atopic dermatitis: the role of emollient therapy” by M. Mack Correa and J. Nebus, the authors discuss in more detail the use of emollients as baseline support therapy to the use of corticosteroids or calcineurin inhibitors. Prevention strategies are also presented and include appropriate skin care routines, avoiding allergic triggers, and regular use of emollients to improve the skin barrier function. Y. Valdman-Grinshpoun et al. present the dermatologist's point of view in treating and managing atopic dermatitis in their contribution titled “Barrier-restoring therapies in atopic dermatitis: current approaches and future perspectives.” This paper makes the link between skin barrier dysfunction and atopic dermatitis. It goes on to discuss the importance of skin barrier therapy approaches for its management including the use of corticosteroids and immunomodulators, as well as the potential requirement of short-term topical or systemic use of antibiotics in cases of infected lesions. Another barrier-related disease, contact dermatitis, is reviewed in the paper by Y. Yoshihisa and T. Shimizu titled “Metal allergy and systemic contact dermatitis: an overview.” Known metals common in our environment, such as nickel, cobalt, zinc, and chromium can result in allergic contact dermatitis. The authors present in vivo and in vitro diagnostic tests of metal sensitivity. Other aspects of skin barrier protection are covered by the following two papers: “Cleansing formulations that respect skin barrier integrity” by R. Walters et al. and “Methods to assess the protective efficacy of emollients against climatic and chemical aggressors” by R. Roure et al. The former presents information about innovations in mild surfactant technologies used in cleansing products. As cleansing is an everyday activity that brings these products in contact with the skin, it is important to understand what makes a surfactant potentially aggressive to the lipids of the stratum corneum that provide a large part of the skin's barrier function. The use of hydrophobically modified polymers as surfactants in skin cleansing products is being introduced to enhance the stability and size of micelles and therefore the mildness to the skin. The latter mentioned paper deals with in vivo skin protocols that are being used to assess the protective action of emollients on the skin. Such models simulate skin exposure to cold wind or to an irritant such as sodium lauryl sulfate. Data are then presented to demonstrate how these investigative methods can be used to show how exposures can impact skin barrier and skin protection. Georgios N. Stamatas Alex Zvulunov Paul Horowitz Gary L. Grove

Emollient therapy in atopic dermatitis

Atopic dermatitis (atopic eczema) has shown a marked increase in the last decade, affecting 10-15% of children. The clinical presentation is that of an itchy, dermatitic, dry skin which results from immunological dysfunction and includes changes in the noninvolved skin. These alterations include increased itchiness, morphological change, low sebum production, disturbance in water exchange correlated with impaired barrier function, loss of vascular regulation, and secondary staphylococcal colonization. The management of the disease includes both general and topical measures: moisturizers or emollients, antibacterial treatment and cortico-teroids. Humectants are widely used in emollients to increase or maintain the water content in the stratum corneum. The efficacy of emollients may be assessed by clinical and noninvasive methods which determine their effect on skin hydration or barrier function. It is clear that emollients have an important role in improving skin dryness, particularly in atopic dermatitis, often reducing the need for topical corticosteroids. In conclusion, emollients should be used prophylactically, as well as therapeutically, provided they are cosmetically acceptable to the patient and are used frequently.

Chapter III: Preventive activities. General aspects and the efficacy of emollients and moisturizers

Chapter III: Preventive activities. General aspects and the efficacy of emollients and moisturizers