Tolerability of Topical Treatments for Atopic Dermatitis

Draelos, Zoe Diana; Feldman, Steven R.; Berman, Brian; Olivadoti, Melissa; Sierka, Debra; Tallman, Anna M.; Zielinski, Michael A.; Ports, William C.; Baldwin, Sheryl

doi:10.1007/s13555-019-0280-7

Cited by 24 publications

(23 citation statements)

References 84 publications

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“…Notably, the hands and fingers may be particularly prone to skin cracks in filaggrin mutation carriers and following intense use of topical corticosteroids . Moreover, the use of topical calcineurin and phosphodiesterase 4 inhibitors can cause a transient stinging pain and superimpose on the existing pain, particularly when the skin is cracked . Skin pain in AD has also been associated with excoriations following scratching, and it is therefore possible that the pain, to a high degree, is scratch‐evoked.…”

Section: Discussionmentioning

confidence: 99%

Pain severity and use of analgesic medication in adults with atopic dermatitis: a cross‐sectional study

Thyssen

Halling

et al. 2019

Br J Dermatol

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Summary Background Adult patients with atopic dermatitis (AD) report skin pain, but the relationship with disease severity, anatomical location and use of pain medication is unclear. Objectives To examine pain in adults with AD. Methods We performed a cross‐sectional study of nationwide healthcare data and survey data from the Danish Skin Cohort. In total, 3208 randomly selected adults from the general population and 3834 adults with a dermatologist‐verified diagnosis of AD present in adulthood were included. Patient‐Oriented SCORing Atopic Dermatitis determined AD severity, and numerical rating scales estimated the severity of pruritus and skin pain. Complete information on the use of analgesic medication was obtained from the Danish nationwide prescription registry. Results Respectively, 6·8%, 55·5%, 34·0% and 3·7% of the AD cohort reported that they were asymptomatic, or had mild, moderate or severe disease at the time of assessment. Skin pain was positively associated with AD severity and itch. Higher skin pain scores were observed in plantar, chest and palmar areas. Use of pain medication was not increased in patients with AD. Conclusions Patients with AD did not display increased use of pain medication, but few had severe disease. The close relationship observed between itch and pain highlights the potential benefits of established AD treatments to also reduce skin pain in AD. What's already known about this topic? There is increased awareness about skin pain being a significant burden of atopic dermatitis (AD). What does this study add? We found that skin pain is increased with AD severity and itch. The comparable use of pain medication in patients with AD and controls suggests that dermatological treatments reduce skin pain.

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Section: Discussionmentioning

confidence: 99%

Pain severity and use of analgesic medication in adults with atopic dermatitis: a cross‐sectional study

Thyssen

Halling

et al. 2019

Br J Dermatol

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“…38 Nevertheless, if an acute flare does occur, it is better to treat with anti-inflammatory topicals first as outlined below, instead of applying emollients to acute inflamed lesions. 39,40 Emollients are not always beneficial, as some can lead to other skin sensory adverse events such as burning, stinging or pruritus, especially if the emollients are used on inflamed skin. About 1/3 of adult AD patients have developed contact allergies to ingredients of their emollients and type IV sensitization to emulsifiers, preservatives and fragrances being the most common.…”

Section: Emollient Therapymentioning

confidence: 99%

ETFAD/EADV Eczema task force 2020 position paper on diagnosis and treatment of atopic dermatitis in adults and children

Wollenberg

Christen-Zäch

Taı̈eb

et al. 2020

Acad Dermatol Venereol

303

360

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Atopic dermatitis (AD) is a highly pruritic, chronic inflammatory skin disease. The diagnosis is made using evaluated clinical criteria. Disease activity and burden are best measured with a composite score, assessing both objective and subjective symptoms, such as SCORing Atopic Dermatitis (SCORAD). AD management must take into account clinical and pathogenic variabilities, the patient's age and also target flare prevention. Basic therapy includes hydrating and barrierstabilizing topical treatment universally applied, as well as avoiding specific and unspecific provocation factors. Visible skin lesions are treated with anti-inflammatory topical agents such as corticosteroids and calcineurin inhibitors (tacrolimus and pimecrolimus), which are preferred in sensitive locations. Topical tacrolimus and some mid-potency corticosteroids are proven agents for proactive therapy, which is defined as the long-term intermittent anti-inflammatory therapy of frequently relapsing skin areas. Systemic anti-inflammatory or immunosuppressive treatment is a rapidly changing † See Appendix section.

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“…Both inflammatory dermatoses and dermatological procedures expose cutaneous nerve endings, leading to the transmission of pain signals to the central nervous system 4‐6 . Psoriasis and eczema (AD and hand eczema [HE]) are complex, chronic, skin diseases associated with intense itching 7‐10 .…”

Section: Introductionmentioning

confidence: 99%

A spray containing extracts of oat plantlets and Uncaria tomentosa relieves pain associated with chronic inflammatory skin diseases and dermatological procedures

Reich

Estebaranz

Bahadoran

et al. 2020

Acad Dermatol Venereol

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Background Inflammation from skin conditions such as psoriasis, eczema‐like atopic dermatitis (AD) and hand eczema (HE) and following dermatological procedures (post‐acts) can result in intense itching and cutaneous pain. Dermo‐cosmetics containing plant extracts have been shown to reduce or alleviate these symptoms. Objectives Assessment of the tolerability and efficacy of a spray containing Rhealba\xAE Oat plantlets and Uncaria tomentosa extracts in adults and children with inflammatory skin diseases and after dermatological procedures. Methods Data from five open label studies were analysed (Study 1: adults with AD; Study 2: children with AD; Study 3: adults with psoriasis; Study 4: adults with HE; Study 5: adults who had undergone a dermatological procedure: laser, intense pulsed light, glycolic acid peeling, photodynamic therapy or cryotherapy procedure). In all studies, subjects could use the test product up to six times per day for symptom relief. Physical and functional signs of inflammation, treatment‐emergent adverse events (TEAEs), soothing effect, changes in quality of life, cutaneous pain and cosmetic acceptability were compared pre‐ and postapplication. Results A total of 176 subjects were enrolled across the five studies. Overall, investigators judged the dermatological tolerance of the test product containing Rhealba\xAE Oat plantlets extract and Uncaria tomentosa as good to excellent. All studies showed significant improvements in physical signs, reduction in itching and feeling of pain (P < 0.05). The soothing effect was evident after the first application. TEAEs were mostly mild, transient and occurred within the first few days of treatment. The majority of subjects reported improved QoL across the studies. Conclusions The dermo‐cosmetic spray containing Rhealba\xAE Oat plantlets extract and U. tomentosa was well tolerated and efficacious in providing relief of symptoms associated with cutaneous pain from inflammatory skin diseases and following dermatological procedures; however, further studies are needed to rule out alternative explanations of symptom reduction such as natural history and response biases.

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Tolerability of Topical Treatments for Atopic Dermatitis

Cited by 24 publications

References 84 publications

Pain severity and use of analgesic medication in adults with atopic dermatitis: a cross‐sectional study

Pain severity and use of analgesic medication in adults with atopic dermatitis: a cross‐sectional study

ETFAD/EADV Eczema task force 2020 position paper on diagnosis and treatment of atopic dermatitis in adults and children

A spray containing extracts of oat plantlets and Uncaria tomentosa relieves pain associated with chronic inflammatory skin diseases and dermatological procedures

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