Combination Therapy Improves the Recovery of the Skin Barrier Function: An Experimental Model Using a Contact Allergy Patch Test Combined with TEWL Measurements

Abstract

Background: Nickel (Ni) allergic contact dermatitis (ACD) alters the skin barrier. Objective: Our aim was to compare the efficacy of combination therapies on ACD, using a topical corticosteroid and a corneotherapy agent (barrier cream), with that of a single therapy with corticosteroids. Methods: On day 1, 3 Ni test patches were applied on each forearm of 14 Ni-patch-test-positive females. Four contained 5% Ni and 2 physiological saline. Either topical corticosteroid or barrier cream were matched with the combination of both products on 3 of the 4 Ni ACD. The fourth was not treated. Clinical scoring, transepidermal water loss (TEWL) and stratum corneum (SC) capacitance were measured before (day 1) and after (days 4–8) ACD. Results: The combination therapy showed a significant decrease in TEWL values and an increase in SC capacitance. Conclusion: Combining a topical corticosteroid with corneotherapy agents prevents the delay in the healing process of skin barrier disruption due to ACD.

Comparison of the Effects of Daily Applications between Topical Corticosteroid and Tacrolimus Ointments on Normal Skin: Evaluation with Noninvasive Methods

“…Thus, a suppressive effect of topical steroid on the synthesis of intercellular lipids and keratohyalin-derived natural moisturizing factors might have been responsible for the decreased water-holding function of the SC after the treatment with betamethasone-17-valerate ointment. Moreover, Hachem et al [15]reported that combination of a topical corticosteroid with a corneotherapy agent (barrier cream) prevented the delay in the healing process of skin barrier disruption due to allergic contact dermatitis.…”

Safety and Efficacy of Fluticasone Propionate in the Topical Treatment of Skin Diseases

“…In addition, potential novel indications of FP corresponding to the beneficial effect on skin barrier disruption caused by nickelinduced allergic contact dermatitis come to horizon [66,67]. Studies about FP are accumulating, and results suggest an increased overall therapeutic potential in terms of efficacy and tolerability due to its increased affinity and improved GR pharmacokinetics.…”

Effectiveness of skin protection creams as a preventive measure in occupational dermatitis: a critical update according to criteria of evidence-based medicine

“…In vivo methods in humans are mostly based on assessment of the reduction either of a known contact sensitisation or of irritant and inflammatory changes in the skin when a barrier cream or moisturiser is used before application of the irritant [20,26,47,50,56] or allergen [28,45] in relation to an area of skin that was not pre-treated . Over the past years, this irritation test was modified by duration [56,57], concurrent application of two irritants instead of one [58], the use of a set of four standard irritants [19] or by change of the test area, e.g.…”

“…of a paper, which had already been published 4 years ago [53], is almost impossible. With regard to aspects of safety, allergic reactions to contents of skin protective creams, such as preservatives, might also play a role [27], but it is unclear if the various in vitro and in vivo methods [10,15,19,20,21,22,26,28,31,36,37,39,40,45,47,50,51,56,57,58,59,61] used are suitable to simulate real workplace conditions and whether these test results can be related to a real occupational exposure. With regard to aspects of safety, allergic reactions to contents of skin protective creams, such as preservatives, might also play a role [27], but it is unclear if the various in vitro and in vivo methods [10,15,19,20,21,22,26,28,31,36,37,39,40,45,47,50,51,56,57,58,…”