Acceptability and Efficacy of an Emollient Containing Ceramide-Precursor Lipids and Moisturizing Factors for Atopic Dermatitis in Pediatric Patients

Abstract

BackgroundAtopic eczema or dermatitis (AD) is associated with atopy and is characterized by reduced skin hydration and an impaired skin barrier in the epidermis. We investigated the patient acceptability and efficacy of an emollient containing ceramide-precursor lipids and moisturizing factors (LMF) in AD.MethodsConsecutive AD patients were recruited. Swabs and cultures were obtained from the right antecubital fossa and the worst-affected eczematous area, and disease severity [according to the SCORing Atopic Dermatitis (SCORAD) Index], skin hydration, and transepidermal water loss (TEWL) were measured prior to and after 2 weeks’ use of the LMF moisturizer. The general acceptability of treatment was documented as being ‘very good’, ‘good’, ‘fair’, or ‘poor’.ResultsTwenty-four AD patients [mean age 13.8 (standard deviation 5.7) years] were recruited. Two thirds of the patients reported very good or good acceptability of the LMF moisturizer, whereas one third reported fair or poor acceptability. There were no inter-group differences in the pre-use clinical parameters of age, objective SCORAD score, pruritus score, sleep disturbance score, skin hydration, TEWL, topical corticosteroid use, oral antihistamine use, or acceptability of previously used proprietary emollients. However, patients in the fair/poor acceptability group were more likely to have Staphylococcus aureus colonization and to be female (odds ratio 13, 95 % confidence interval 1.7–99.4; p = 0.021). Following use of the LMF moisturizer, the objective SCORAD score, pruritus score, and sleep disturbance score were lower in the very good/good acceptability group than in the fair/poor acceptability group. The mean objective SCORAD score improved (from 31.5 to 25.7; p = 0.039) and skin hydration improved [from 30.7 arbitrary units (a.u.) to 36.0 a.u.; p = 0.021] in the very good/good acceptability group. When the data were analyzed for the strength of the agreement of the rating of acceptability, the κ values were 0.338 (fair) for use of body wash and 0.118 (poor) for use of emollients before and after the trial.ConclusionThe LMF moisturizer was considered acceptable by two thirds of the patients with AD. It seems that patients who found the moisturizer acceptable were less likely to be female or to be colonized by S. aureus before switching to the product, and they had less severe eczema, less pruritus, and less sleep disturbance after its use than patients who did not find the product acceptable. Gender and S. aureus colonization may have influenced the patient acceptability and clinical efficacy of the LMF moisturizer. The lack of agreement with regard to the acceptability of the moisturizer implies that there is room for parent/patient education to improve compliance.

Evaluation of a Pseudoceramide Moisturizer in Patients with Mild-to-Moderate Atopic Dermatitis

“…Standardization of TEWL measurements can be technically difficult and similar paradoxical findings have been reported in other moisturizer studies [13, 31, 34, 35]. Furthermore, SC hydration is a more sensitive measure of the skin barrier function than TEWL in AD patients [36], as the relationship between TEWL and skin dryness is complex, whereby changes in dryness do not necessarily reflect simultaneous changes in TEWL [37].…”

Topical application of a linoleic acid-ceramide containing moisturizer exhibit therapeutic and preventive benefits for psoriasis vulgaris: a randomized controlled trial

“…Clinical studies have demonstrated that topical moisturizer alone improves psoriasis . Previous studies have shown that both Cer and glycerol, ingredients in our moisturizer, increase SC hydration in normal and diseased skin . In addition, the activation of PPARγ by LA upregulates aquaporin 3 expression , which in turn increases skin hydration .…”

Comparative Effectiveness of Topical Drugs in Dermatologic Priority Diseases: Geometry of Randomized Trial Networks

“…Although we found high representation of comparisons with inactive controls, these may not be true placebos because they are not totally inactive despite their lack of active principle (Shamsudin and Fleischer, 2010). Indeed, applying excipients on the skin induces physiochemical modifications of the skin barrier, which were demonstrated with transepidermal water loss (Hon et al, 2013). We found the use of inactive controls particularly frequent in studies on CLEWs.…”