Different types of emollient cream exhibit diverse physiological effects on the skin barrier in adults with atopic dermatitis

Abstract

Background. Eczema (atopic dermatitis; AD) is a very common itchy skin condition affecting 1 in 5 children and up to 1 in 10 adults worldwide. The skin of eczema sufferers is prone to redness, irritation and dryness because it does not form an effective barrier, i.e. the ability of the skin to stop irritants, allergens and microorganisms getting into the body. Skin barrier dysfunction is a hallmark of AD. The regular and liberal (600 g/week for an adult) use of emollients is recommended for all patients with eczema), even between episodes of itching and redness, to soften and soothe the skin. In England alone, almost 9 million prescriptions for emollient creams were issued in 2018, at a cost of over £50 million. Despite this widespread use, relatively little is known about how commonly prescribed emollient creams affect the skin's barrier, and thus the role of moisturizers in AD development and progression remains unclear. We set out to compare three different types of emollient cream and a no-treatment control. Aim. To compare the barrier-strengthening properties of a new moisturizer containing urea and glycerol (urea-glycerol cream; UGC), with those of a glycerolcontaining moisturizer (glycerol cream; GC), a simple paraffin cream (PC) with no humectant, and a no-treatment control (NTC). Methods. This was an observer-blinded prospective Phase 2 within-subject multilateral single-centre randomized controlled trial in adults with AD (Clinical Trials #NCT03901144). The intervention involved 4 weeks of treatment, twice daily, with the three products applied to one of four areas on the forearms the (the fourth area was the untreated control, randomized allocation). Skin properties [dryness, transepidermal water loss (TEWL), hydration and natural moisturizing factor (NMF) levels] were assessed before, during and after treatment to see what happened to the skin's barrier. The primary outcome was skin sensitivity to the irritant sodium lauryl sulfate (SLS) after treatment. We performed tests on the skin before and after treatment to see what happened to the skin's barrier. Results. In total, 49 patients were randomized, completed treatment and included in the analysis. UGC significantly reduced the response to SLS as indicated by a reduction in TEWL compared with NTC (À9.0 g/m 2 /h; 95% CI À12.56 to À5.49),

Emollients for prevention of atopic dermatitis: 5‐year findings from the BEEP randomized trial

“…35 The IPD included 35 Not all emollients are the same in terms of their effects on the skin barrier. 37 It is still possible that some emollients could reduce or delay AD development as the role of epithelial barrier disruption in the development of allergic disorders is quite convincing. 38 Perhaps barrier enhancement would work in a low-risk rather than high-risk population or perhaps only when combined with enhanced skin care such as reduced bathing and soap avoidance, but the evidence for benefit so far has been disappointing.…”

Moisturizer in Patients with Inflammatory Skin Diseases

“…In addition, a moisturizer helps to maintain and restore skin flexibility by blocking the evaporation of moisture, and induces uniform exfoliation of old dead skin cells to maintain a smooth skin surface [ 6 ]. When the moisturizer functions properly in the skin, the skin maintains homeostasis despite changes in the external environment, so that the stratum corneum can maintain proper hydration [ 7 ]. After applying a moisturizer to damaged skin, the skin barrier is restored through the four-step process that follows [ 8 ].…”

“…Various factors can affect the effectiveness of the emollient, such as the type of emollient, the number of times of application, and the start time, so it is difficult to conclude yet. A new large randomized controlled trial, Prevention of Eczema by a Barrier Lipid Equilibrium Strategy (PEBBLES), which controlled for these factors, is currently underway [ 7 , 74 ].…”

Systematic review and network meta‐analysis of different types of emollient for the prevention of atopic dermatitis in infants

“…Several studies 12,17–26 have also investigated the prophylactic effect of the early emollient application on the development of AD in infants; however, the early application of emollients for the prevention of AD is currently being debated 27–30 . More importantly, a recent study reported that different types of emollient cream exhibit diverse physiological effects on the skin barrier in AD subjects 31 …”

“…[27][28][29][30] More importantly, a recent study reported that different types of emollient cream exhibit diverse physiological effects on the skin barrier in AD subjects. 31 Therefore, we performed this systematic review and network meta-analysis to answer two questions as follows: (a) whether the early application of emollients in infancy can effectively prevent the later development of AD and (b) which types of emollients may be the optimal option for preventing the development of AD in infants.…”