Journal of Clinical and Aesthetic Dermatology

Skinfix 2018

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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S3 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY January 2018 • Volume 11 • Number 1 • Supplement T H E I M P O R TA N C E O F S K I N B A R R I E R M A I N T E N A N C E A N D R E PA I R O by Neal Bhatia MD; James Q. Del Rosso DO; Joshua Zeichner MD; and Brian Berman MD, PhD Dr. Bhatia is with Therapeutics Clinical Research in San Diego, California. Dr. Del Rosso is with JDR Dermatology Research and Thomas Dermatology in Las Vegas, Nevada. Dr. Zeichner is with the Icahn School of Medicine at Mount Sinai in New York, New York. Dr. Berman is with the Center for Clinical and Cosmetic Research in Aventura, Florida, and the University of Miami in Miami, Florida. J Clin Aesthet Dermatol. 2018;11(1 Suppl):S3–S8 Over the past several years, clinicians have come to appreciate the therapeutic value of using adjunctive skin care to maintain the structural and functional integrity of the epidermal barrier. Proper skin care is vital for the maintenance of healthy skin and in the management of a wide variety of cutaneous disorders. 1 A pivotal role of the epidermal barrier is maintenance of physiologic water flux, including optimal water content and gradient within the stratum corneum (SC), which is required to sustain single-cell desquamation, improve skin elasticity, and preserve smooth surface texture. 1–3 When water content within the SC is inadequate due to increased transepidermal water loss (TEWL), the activity of key epidermal enzymes involved in maintaining SC structure and function are reduced leading to adverse sequelae that manifest both visibly and symptomatically. 1–3 Many adverse changes occur in association with an uncorrected increase in TEWL and suboptimal SC enzyme function, both of which lead to xerotic and eczematous skin changes. These sequelae include increased skin rigidity with development of microfissuring and macrofissuring, abnormal desquamation with resultant scaling and flaking, triggering of cytokine release with production of inflammation, and epidermal thickening, which can cause hyperkeratosis and fissures. 1–3 Importantly, other activities of the SC, such as the antimicrobial barrier, can also be adversely affected by epidermal barrier dysfunctions secondary to increased TEWL. 1,4 TOPICAL FORMULATIONS AND INGREDIENT SELECTION FOR MANAGEMENT OF HEALTHY AND DISEASED SKIN The continued increase in information on normal epidermal barrier activity and implications of dysfunctions has uncovered functional and structural SC impairments present in a variety of common skin conditions, including xerosis, atopic dermatitis (AD), acne vulgaris (AV), rosacea, and psoriasis vulgaris, and with some therapies such as topical corticosteroids (TCS). 1,3,5–10 These barrier dysfunctions appear to correlate with clinical manifestations of several skin disorders. 1 Managing SC impairment and increased TEWL has been shown to be clinically relevant by contributing to disease improvement, reduction in the amount and/or duration of TCS use in AD, and to reduced signs and symptoms of cutaneous irritation associated with topical agents used to treat AV and rosacea. 1,11–14 The terms "natural" and "organic" are used very commonly, and often loosely, when describing selected ingredients in topical formulations. It is the perception of whether the ingredients are synthetic or harvested from a botanical or other organic source that often leads to the "natural" approach being inherently preferred by many patients. They often sense that natural ingredients have been used historically with favorable results and apparent safety. In fact, many ingredients that can be derived or extracted from natural sources appear to exhibit properties that support various barrier functions within the epidermis. When it comes to maintaining healthy skin, managing xerosis, and treating common skin conditions, such as eczematous dermatoses, there needs to be a more comprehensive understanding of how specific ingredients that are considered to be natural can facilitate epidermal barrier restoration or provide other benefits, such as anti- pruritic or antimicrobial effects. This article reviews ingredients used in selected topical formulations within a designated over- the-counter (OTC) skin care product line (Skinfix, Inc., Halifax, Nova Scotia) and presents data from three clinical studies evaluating individual products specifically formulated to target the management of common skin conditions (e.g., atopic dermatitis/eczematous dermatitis, keratosis pilaris, hand xerosis/dermatitis). EVALUATION OF INGREDIENTS USED IN DESIGNATED OTC TOPICAL FORMULATIONS The three topical formulations evaluated in the clinical studies we describe in this article incorporate selected ingredients that appear to provide specific modes of action (MOAs) helpful in the management of certain skin conditions (see clinical data section). All three of the topical formulations discussed are nonsteroidal, parabens-free, fragrance-free, phthalate-free, and lanolin-free. Table 1 depicts some of the major ingredients used and their purported The Importance of Skin Barrier Maintenance and Repair: Underlying Pathophysiology, Topical Formulations, Selected Natural Ingredients, and Clinical Study Outcomes FUNDING: Funding for this article was provided by Skinfix Inc. (Halifax, Nova Scotia) FINANCIAL DISCLOSURES: Dr. Bhatia is a consultant and advisory board member for Skinfix Inc., Halifax, Nova Scotia. Dr. Del Rosso served as a consultant and writer for this supplement. Dr. Zeichner is a consultant and advisory board member for Skinfix Inc., Halifax, Nova Scotia. Dr. Berman is an advisory board member for Skinfix Inc., Halifax, Nova Scotia. CORRESPONDENCE: James Q. Del Rosso, DO; Email: jqdelrosso@yahoo.com

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