Skin Barrier Function Repair Is the Next Step in Atopic Dermatitis Treatment

SAN ANTONIO — Treatment of atopic dermatitis in pediatric patients is shifting from symptom control to repair of the skin barrier function, Dr. Rebecca Lynn Smith said at a meeting of Skin Disease Education Foundation.

"It used to be we treated flare-ups. Now we aim to repair the skin barrier with integration of physiologic moisturizers," she said. Physiologic moisturizers can replace lost lipids, reduce transepidermal water loss, and calm inflammation associated with atopic dermatitis, according to Dr. Smith, a dermatologist in private practice in Fort Mill, S.C.

A reliance on nonphysiologic moisturizers such as petrolatum, eased when the physiologic moisturizers MimyX (Stiefel Laboratories), Atopiclair (Chester Valley Pharmaceuticals), and EpiCeram (Ceragenix Pharmaceuticals) became available. Nonphysiologic products "sit on the skin like icing on a cake and prevent further water loss. Physiologic moisturizers are incorporated into the skin," said Dr. Smith, who has a consulting agreement with Stiefel Laboratories.

Skin barrier defects in atopic dermatitis include increased stratum corneum chymotryptic enzyme, increased proteases, decreased maturation of lamellar bodies, and decreased filaggrin.

Palmitamide MEA (PEA) is an important component of MimyX nonsteroidal cream, Dr. Smith said. PEA is naturally occurring, essential fatty acid with anti-inflammatory properties. The product can increase levels of PEA in deficient atopic skin up to 900%, she said.

Researchers conducted a PEA study in which patients served as their own controls. Atopic patients applied PEA and Eucerin cream to their left wrist and forearm, and Eucerin cream only to their right wrist and arm. "After 2 weeks you can see the difference," Dr. Smith said.

An open-label, international study assessed 2,456 people aged 2–70 years with mild to moderate atopy treated with adjunctive PEA cream. Results were presented as a poster by Dr. B. Eberien-Koeing and associates at the 2006 annual meeting of the American Academy of Dermatology. They assessed itching, erythema, scaling, dryness, lichenification, and excoriation. "With PEA cream everything significantly improved or was eliminated," Dr. Smith said.

Atopiclair cream also contains the anti-inflammatory, antipruritic glycyrrhetinic acid. The cream contains sodium hyaluronate, which hydrates by retaining 1,000 times its weight in water, she said.

Physiologic moisturizers, combined with some common sense clinical tips for management of atopic dermatitis, can make a big difference in quality of life for affected children, Dr. Smith said. "If we can stop these kids from itching and scratching, we can get their skin to heal."

A daily bath for children in lukewarm water is recommended, Dr. Smith said. Apply medications and moisturizers immediately afterward, and limit contact with suspected allergens or irritants. Antihistamines are a treatment option. Instruct the parent or guardian to keep the child cool, dress them in cotton clothes, and file the child's fingernails, Dr. Smith suggested.

Once atopic flare is under control, consider diluted bleach baths to prevent or treat infections. Add 1/8 cup of bleach to a half-full bathtub for a 5–15 minute soak twice a week. "I describe this as a clean, chlorinated pool to moms who are alarmed when I mention a bleach bath," Dr. Smith said. "Make sure they rinse the [bleach] bath off when they are done."

SDEF and this newspaper are wholly owned subsidiaries of Elsevier.

Atopic dermatitis flare is seen on right arm, where patient used Eucerin cream alone for 2 weeks. Stiefel Laboratories

Written by: Damian McNamara

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