Treatment with a barrier‐strengthening moisturizing cream delays relapse of atopic dermatitis: a prospective and randomized controlled clinical trial

Wirén, K.; Nohlgård, C.; Nyberg, Filippa; Holm, L. E.; Svensson, My; Johannesson, Anders; Wallberg, P; Berne, Berit; Edlund, Fredrik; Lodén, Marie

doi:10.1111/j.1468-3083.2009.03303.x

Cited by 138 publications

(150 citation statements)

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“…Sufficient moisturizing therapy can reduce the need for topical corticosteroids as well as increase the number of days between flares [53]. Pro-active therapy, which is now standard in clinical guidelines for the management of AD, includes daily use of moisturizer together with low-dose intermittent use of topical anti-inflammatory treatment.…”

Section: Skin Barrier Interventions In the Prevention Of Atopic Dermamentioning

confidence: 99%

Skin Barrier Dysfunction and the Atopic March

Clausen

Agner

Thomsen

2015

Curr Treat Options Allergy

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The atopic diseases: atopic dermatitis, asthma and allergic rhinoconjunctivitis are frequent diseases in the population occurring sequentially in the young (the atopic march). The discovery of filaggrin gene (FLG) mutations and impairments in the skin barrier as predisposing factors for atopic dermatitis and subsequent asthma and atopic sensitization in the context of eczema has improved our understanding of the atopic march. The atopic diseases can now be viewed upon as causally related conditions-rather than sequentially occurring manifestations of the same underlying atopic disease state-with atopic dermatitis and FLG mutations being a prerequisite for the development of the other atopic diseases, particularly asthma. This review discusses the role of the skin barrier function, particularly the role of FLG mutations, in the atopic march.

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Section: Skin Barrier Interventions In the Prevention Of Atopic Dermamentioning

confidence: 99%

Skin Barrier Dysfunction and the Atopic March

Clausen

Agner

Thomsen

2015

Curr Treat Options Allergy

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“…One trial by Wiren and colleagues 197 conducted in Sweden compared an emollient with 20% lipid content (Canoderm ® cream, ACO Hud) with no treatment until relapse or 6 months. All 55 adults with eczema who were recruited into the trial initially used the topical corticosteroid betamethasone (0.01%) for 3 weeks to induce remission.…”

Section: Lipid Emollientmentioning

confidence: 99%

“…Most of the 15 new trials 123,126,[190][191][192][193][194][195][196][197][198][199][200][201][202] looking at emollients reported after 2000 compared twice-daily treatment with an emollient (often applied concurrently with topical corticosteroid treatment) with treatment with topical corticosteroids alone, other emollients or, in one case, no treatment. Most trials had a treatment length of around 4-6 weeks and none of the trials gave treatment for > 2 months.…”

Section: Studiesmentioning

confidence: 99%

Scoping systematic review of treatments for eczema

Nankervis

Kim

Delamere

et al. 2016

Programme Grants Appl Res

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BackgroundEczema is a very common chronic inflammatory skin condition.ObjectivesTo update the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) systematic review of treatments for atopic eczema, published in 2000, and to inform health-care professionals, commissioners and patients about key treatment developments and research gaps.Data sourcesElectronic databases including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Skin Group Specialised Register, Latin American and Caribbean Health Sciences Literature (LILACS), Allied and Complementary Medicine Database (AMED) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from the end of 2000 to 31 August 2013. Retrieved articles were used to identify further randomised controlled trials (RCTs).Review methodsStudies were filtered according to inclusion criteria and agreed by consensus in cases of uncertainty. Abstracts were excluded and non-English-language papers were screened by international colleagues and data were extracted. Only RCTs of treatments for eczema were included, as other forms of evidence are associated with higher risks of bias. Inclusion criteria for studies included availability of data relevant to the therapeutic management of eczema; mention of randomisation; comparison of two or more treatments; and prospective data collection. Participants of all ages were included. Eczema diagnosis was determined by a clinician or according to published diagnostic criteria. The risk of bias was assessed using the Cochrane Collaboration risk-of-bias tool. We used a standardised approach to summarising the data and the assessment of risk of bias and we made a clear distinction between what the studies found and our own interpretation of study findings.ResultsOf 7198 references screened, 287 new trials were identified spanning 92 treatments. Trial reporting was generally poor (randomisation method: 2% high, 36% low, 62% unclear risk of bias; allocation concealment: 3% high, 15% low, 82% unclear risk of bias; blinding of the intervention: 15% high, 28% low, 57% unclear risk of bias). Only 22 (8%) trials were considered to be at low risk of bias for all three criteria. There was reasonable evidence of benefit for the topical medications tacrolimus, pimecrolimus and various corticosteroids (with tacrolimus superior to pimecrolimus and corticosteroids) for both treatment and flare prevention; oral ciclosporin; oral azathioprine; narrow band ultraviolet B (UVB) light; Atopiclair™ and education. There was reasonable evidence to suggest no clinically useful benefit for twice-daily compared with once-daily topical corticosteroids; corticosteroids containing antibiotics for non-infected eczema; probiotics; evening primrose and borage oil; ion-exchange water softeners; protease inhibitor SRD441 (Serentis Ltd); furfuryl palmitate in emollient; cipamfylline cream; andMycobacterium vaccaevaccine. Additional research evidence is needed for emollients, bath additives, antibacterials, specialist clothing and complementary and alternative therapies. There was no RCT evidence for topical corticosteroid dilution, impregnated bandages, soap avoidance, bathing frequency or allergy testing.LimitationsThe large scope of the review coupled with the heterogeneity of outcomes precluded formal meta-analyses. Our conclusions are still limited by a profusion of small, poorly reported studies.ConclusionsAlthough the evidence base of RCTs has increased considerably since the last NIHR HTA systematic review, the field is still severely hampered by poor design and reporting problems including failure to register trials and declare primary outcomes, small sample size, short follow-up duration and poor reporting of risk of bias. Key areas for further research identified by the review include the optimum use of emollients, bathing frequency, wash products, allergy testing and antiseptic treatments. Perhaps the greatest benefit identified is the use of twice weekly anti-inflammatory treatment to maintain disease remission. More studies need to be conducted in a primary care setting where most people with eczema are seen in the UK. Future studies need to use the same core set of outcomes that capture patient symptoms, clinical signs, quality of life and the chronic nature of the disease.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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“…While in human medicine, this aspect of the disease has been known for a long time and topical use of emollients and moisturizers is the mainstay of therapy, 27 in dogs, skin barrier repair is a novel area of research. Skin barrier impairment in dogs with AD has been described ultrastructurally, 28 chemically, 29,30 and functionally 31 through the measurement of transepidermal water loss (TEWL), yet the exact significance of it is still an object of controversy.…”

Section: Skin Barrier Repair Treatmentsmentioning

confidence: 99%

An update on the treatment of canine atopic dermatitis

Marsella¹

2012

VMRR

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Remarkable progress has been made in recent years concerning our understanding of the pathogenesis of canine atopic dermatitis (AD). As our understanding improves, the therapeutic approach evolves. Of utmost importance is the documentation of skin barrier impairment in canine AD: ceramides deficiency leads to increased permeability and increased allergen penetration and sensitization. It is currently unknown whether this dysfunction is primary and genetically inherited or secondary to inflammation but it is accepted that skin barrier deficiency plays an important role in either starting or minimally exacerbating canine AD. Thus, the therapeutic approach has changed from focusing on the control of the inflammation to a combined approach that includes therapies aimed at skin barrier repair. The issue of skin barrier repair has been addressed both with oral administration of essential fatty acids and the topical application of products containing a combination of ceramides and fatty acids. These strategies are most helpful as adjunctive treatments and would be best used in young patients that have not developed chronic skin changes. Importantly, treatment for canine AD is multimodal and tailored to the individual patient, the age, and the duration of the disease. Client education plays an important role in explaining the importance of a long-term approach to minimize flare-ups and, in this context, topical therapy to correct skin barrier can be of great benefit. This is an area still in infancy and much work is needed to identify the best formulation. In human medicine, long-term use of moisturizers can have a profound effect on skin barrier and gene expression of proteins involved in skin barrier. This effect is variable depending on the formulation used. It is reasonable to speculate that the same may be true in dogs; thus, it is very important to identify the correct ingredients and formulation to use.

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Treatment with a barrier‐strengthening moisturizing cream delays relapse of atopic dermatitis: a prospective and randomized controlled clinical trial

Abstract: Maintenance treatment with a barrier-improving urea moisturizer on previous eczematous areas reduced the risk of relapse to approximately one third of that of no treatment.

Cited by 138 publications

References 42 publications

Skin Barrier Dysfunction and the Atopic March

Skin Barrier Dysfunction and the Atopic March

Scoping systematic review of treatments for eczema

An update on the treatment of canine atopic dermatitis

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