A functional mechanistic study of the effect of emollients on the structure and function of the skin barrier

Summary Background Preventing relapses of atopic dermatitis (AD) through the regular use of topical products to repair the skin barrier defect is an emerging concept. It is still unclear if some commonly used emollients exert a positive effect on the skin barrier. Objectives To determine the skin ba...

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Veröffentlicht in:British journal of dermatology (1951) 2016-11, Vol.175 (5), p.1011-1019
Hauptverfasser: Danby, S.G., Chalmers, J., Brown, K., Williams, H.C., Cork, M.J.
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Sprache:eng
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Zusammenfassung:Summary Background Preventing relapses of atopic dermatitis (AD) through the regular use of topical products to repair the skin barrier defect is an emerging concept. It is still unclear if some commonly used emollients exert a positive effect on the skin barrier. Objectives To determine the skin barrier effects of emollients commonly prescribed in the U.K. Materials and methods Two cohorts of volunteers with quiescent AD undertook observer‐blind forearm‐controlled studies. The first cohort (18 volunteers) treated the volar side of one forearm with two fingertip units of Doublebase™ gel twice daily for 4 weeks. The second cohort (19 volunteers) undertook the same regimen using Diprobase® cream. Transepidermal water loss (TEWL), stratum corneum integrity and hydration, skin surface pH and redness were determined at the test sites before and after treatment. Results Neither Diprobase® cream nor Doublebase™ gel significantly affected the underlying skin barrier function. Both emollients were associated with significantly increased skin surface pH immediately after application (by 0·8 ± 0·19 and 1·0 ± 0·18 units, respectively), and no erythema. Diprobase® cream artificially and transiently (6 h) improved permeability barrier function by 2·9–3·1 g m−2 h−1 TEWL and increased skin hydration by 6·0–6·2 units. Doublebase™ gel, containing humectants, was associated with a greater (between 10·1 and 13·0 units during the first 6 h) and more sustained increase in hydration, lasting more than 12 h following repeated use. Conclusions Diprobase® cream and Doublebase™ gel are not associated with skin barrier harm and appear to be appropriate for AD treatment. While displaying emollient properties, neither formulation displayed an ability to actively improve sustained skin barrier function. What's already known about this topic? A skin barrier defect is a primary event in the development of atopic dermatitis (AD). Topical therapy to correct this skin barrier defect may prevent AD relapses. Not all emollients exert a positive effect on the skin barrier. The use of aqueous cream BP, for example, damages the skin barrier. What does this study add? We provide evidence that, in contrast to aqueous cream BP, two commonly prescribed emollients exert no negative effects on the skin barrier, and are therefore suitable for further clinical testing in AD prevention trials. We also highlight that while these ancillary treatments display clinically important ‘emollient’ properties they
ISSN:0007-0963
1365-2133
DOI:10.1111/bjd.14684