The Importance of Acidification in Atopic Eczema:  An Underexplored Avenue for Treatment

Panther, David; Jacob, Sharon E.

doi:10.3390/jcm4050970

Cited by 76 publications

(60 citation statements)

References 50 publications

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“…pH 4) and containing a functioning buffer system were introduced to counteract an increased pH. Treatment with an acidic compared with a neutral cream inhibited the occurrence of atopic dermatitis‐like skin lesions and respiratory allergy in filaggrin‐deficient murine atopic dermatitis models . An emollient with a pH of 4.8 altered skin barrier and microbes in infants at risk for developing atopic dermatitis .…”

Section: Reducing Skin Ph As a Therapeutic Tool In Wound Healing Skimentioning

confidence: 99%

pH in nature, humans and skin

Proksch

2018

The Journal of Dermatology

416

273

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The pH plays an important physiological role in nature and humans. pH varies from 1 to 8 in human organs with tight regulation in blood and epithelia of barrier organs. The physiological pH of the stratum corneum is 4.1-5.8 and several mechanisms contribute to its formation: filaggrin degradation, fatty acid content, sodium-hydrogen exchanger (NHE1) activation and melanosome release. First, the acidic pH of the stratum corneum was considered to present an antimicrobial barrier preventing colonization (e.g. by Staphylococcus aureus and Malassezia). Later on, it was found that the pH influences skin barrier function, lipid synthesis and aggregation, epidermal differentiation and desquamation. Enzymes of ceramide metabolism (e.g. β-glucocerebrosidase or acid sphingomyelinase) as well as proteases (e.g. chymotryptic enzyme or cathepsin D linked to epidermal differentiation and desquamation) are regulated by the pH. Experimental disruption of the physical barrier leads to an increase of pH, returning to normal levels only after many hours. Inflammatory skin diseases and diseases with an involvement of the epidermis exhibit a disturbed skin barrier and an increased pH. This is known for atopic dermatitis, irritant contact dermatitis, ichthyosis, rosacea and acne, but also for aged and dry skin. Normalizing the pH by acidification through topical treatment helps to establish a physiological microbiota, to repair skin barrier, to induce epidermal differentiation and to reduce inflammation.

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Section: Reducing Skin Ph As a Therapeutic Tool In Wound Healing Skimentioning

confidence: 99%

pH in nature, humans and skin

Proksch

2018

The Journal of Dermatology

416

273

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“…Due to skin barrier dysfunction, patients with AD often have increased skin TEWL and alkaline skin pH . TEWL is known to increase after bathing due to a temporary increase in skin hydration followed by evaporation and water loss .…”

Section: Discussionmentioning

confidence: 99%

“…AD skin has therefore been shown to be more alkaline than normal skin, which promotes the activation of proteases that enhance skin transepidermal water loss (TEWL) and disrupt the normal skin flora . Epidermal alkalization has been shown to contribute to inflammation in AD, and so researchers are now exploring epidermal acidification as an approach to treating AD …”

Section: Introductionmentioning

confidence: 99%

Apple cider vinegar soaks [0.5%] as a treatment for atopic dermatitis do not improve skin barrier integrity

Luu

Flowers

Kellams

et al. 2019

Pediatric Dermatology

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Background/Objectives Atopic dermatitis (AD) is a common chronic inflammatory skin condition associated with high transepidermal water loss, high skin pH, and Staphylococcus aureus skin colonization. The treatment of AD with bath additives remains highly debated. Recent evidence suggests that dilute apple cider vinegar (ACV) may improve skin barrier integrity in AD, but its safety and efficacy are not well studied. This pilot split‐arm study analyzed the effect of dilute apple cider vinegar soaks on skin barrier integrity in patients with atopic dermatitis as measured by skin transepidermal water loss and skin pH. Methods A total of 22 subjects (11 AD and 11 healthy controls) were enrolled. Subjects soaked both of their forearms for 14 days, with one arm in dilute ACV (0.5% acetic acid) and the other in water 10 minutes daily. Transepidermal water loss and pH were measured pre‐ and post‐treatment. Results In both groups, transepidermal water loss increased and pH decreased at 0 minutes post‐ACV treatment, but these effects were not sustained at 60 minutes. In total, 72.7% (16/22) of subjects reported mild side effects from ACV with improvement after discontinuing the soaks. Conclusions Dilute ACV soaks have no significant effect on skin barrier integrity but caused skin irritation in a majority of subjects. Study limitations include analysis of a single brand, dilution, and application of ACV. Future studies are needed to explore whether lower concentrations of ACV soaks or other applications such as a leave‐on acidic ointment could improve skin barrier integrity in a safe, nonirritating way.

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“…In Summe scheint die Regulation des HautpH-Werts ein vielversprechender Ansatz zu sein, welcher jedoch bislang nicht ausreichend mit humanen Daten unterfüttert wurde. Es lohnt sich aber, diesen weiterzuverfolgen [3].…”

Section: Discussionunclassified

pH-neutrale Pflegeprodukte - ein wichtiger Baustein zur Aufrechterhaltung der Hauthomöostase?

Hedtrich¹

2018

Kompass Dermatol

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Background: Human skin surface has a physiologically acidic pH (pHss). In cases of increased pHss, the acidity of the skin can be restored by topical formulations. We tested a pH 5 oil-in-water (O/W) emulsion for pHss regeneration and stabilization. Methods: We performed 2 experiments with 10 female study subjects in each. In both experiments, 2D imaging with luminescent sensor foils was used to determine pHss. Alkalization was reached by washing the volar forearm with a soap bar and warm running tap water for 20 min. Experiment 1: after defining the baseline pHss, we alkalized the respective area and measured pHss over a duration of 5 h, while applying emulsion every hour. Experiment 2: study subjects used the emulsion twice daily for 1 week. Then, pHss was measured before and after 5 min of washing a treated and an untreated area on the volar forearm. Results: (1) 5 h after alkalization, the treated arm showed a significantly lower pHss than the untreated one (5.87 ± 0.03 vs. 6.05 ± 0.03); (2) after washing, the treated area had a significantly lower pHss than controls (6.13 ± 0.03 vs. 6.27 ± 0.05). Conclusions: The tested pH 5 O/W emulsion seems to improve regeneration and stabilization of pHss.

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The Importance of Acidification in Atopic Eczema: An Underexplored Avenue for Treatment

Cited by 76 publications

References 50 publications

pH in nature, humans and skin

pH in nature, humans and skin

Apple cider vinegar soaks [0.5%] as a treatment for atopic dermatitis do not improve skin barrier integrity

pH-neutrale Pflegeprodukte - ein wichtiger Baustein zur Aufrechterhaltung der Hauthomöostase?

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