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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S4 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 clinical effects, including allantoin, shea butter, bisabolol, lime pearl extract, willow bark extract, and colloidal oatmeal. 15–32 A variety of natural oils are also used in some formulations to improve skin texture and provide emollience and occlusivity (e.g., jojoba oil, soybean oil, sweet almond oil). 23 Sweet almond oil contains fatty acids (e.g., linoleic acid, palmitic acid, oleic acid) that can provide emollience. Designated OTC topical formulations in common dermatologic disorders: Results of three clinical studies. Study 1: Atopic dermatitis /eczematous dermatitis. An OTC anhydrous balm formulated for use in eczema- prone and eczema-affected skin was evaluated in adult subjects with atopic dermatitis or eczematous dermatitis (AD/ED). 33 The major ingredients of the balm formulation, referred to as eczema balm (EB; Skinfix Eczema Balm), are zinc oxide, colloidal oatmeal, allantoin, sweet almond oil, shea butter, soybean oil, jojoba oil, beeswax, petrolatum, paraffin, and tocopherol. Objective. The objective of this study was to compare the efficacy and safety of EB versus hydrocortisone 1% cream (HC 1%) in adult subjects with mild or moderate AD/ED. 33 Methodology. The study was a double-blind, single-center, randomized (1:1), controlled, four-week clinical trial. Subjects (N=37) applied a sufficient quantity of either EB (n=17) or HC 1% (n=20) twice daily to all areas affected with AD/ED and surrounding skin. Application was to be completed in the morning and evening to dry skin, especially after prior bathing. Subjects were evaluated at baseline, Week 2, and Week 4. Enrolled subjects. This study included adults (age range 18–65 years; mean age 45.9 years) of both sexes (75.7% female) with the following: Fitzpatrick Skin type I to IV (75.7% Caucasian); clinically evident mild or moderate AD/ED (defined by >10% total body surface area [BSA] affected); presence of at least TABLE 1: Selected major natural ingredients in topical formulations (brand over the counter products evaluated in three reviewed clinical trials) INGREDIENTS COMMENTS RELATED TO SOURCES AND EFFECTS Allantoin 15,16 • From botanical (comfey root) or animal sources via uric acid oxidation • Augments desquamation; increases extracellular matrix water content; promotes wound healing; has antipruritic and antioxidant effects with free radical scavenging Shea butter 17–20 • Contains Butryospermum parkii; imparts emolliency in several topical products, including agents used for seborrheic dermatitis • Assays of MeOH extract of defatted shea (Vitellaria paradoxa; Sapotaceae) kernels revealed structures of five triterpene glycosides with bioactive properties • Antioxidant and anti-inflammatory actions (in vitro) Bisabolol 21,22 • Natural sesquiterpene; primary essential oil of German chamomile • Anti-inflammatory, anti-irritant, and antioxidant properties • Used in topical products for sensitive skin and redness reduction Lime pearl extract 23–5 • Derived from caviar lime fruit (southern Australia); capsules within the fruit rich in amino acids, minerals, and alpha-hydroxyacids • Promotes exfoliation, physiologic desquamation, antioxidant effects • MOA appears to be activation of an intracellular keratinocyte membrane channel (TRPV 3 ); reduced intracellular pH stimulates increased cellular calcium release that activates more TRPV 3 channels resulting in enhanced desquamation Willow bark extract 26–27 • Derived from willow tree (Salix spp) rich in salicin and SA • SA exhibits desmolytic activity (disruption of desmosomes) leading to keratinocyte separation (desquamation, reduced hyperkeratosis) • Anti-inflammatory effects Colloidal oatmeal 28–32 • Fine-milled aqueous suspension from oat (Avena sativa) kernels • Avenanthramides (active moieties) shown to exhibit antioxidant, anti-inflammatory, antipruritic, barrier protectant/repair effects • Admixture of hydrophilic polysaccharides, lipids, proteins, flavonoids, minerals/ vitamins, and polyphenolic antioxidants • Shown to prevent sodium lauryl sulfate-induced irritation, mitigate signs and symptoms of AD, decrease burn-associated pruritus, reduce TEWL, and provide occlusivity • MOA includes inhibition of NF-kB activity with diminished production of pro-inflammatory cytokines and histamine release. MeOH: methanol; MOA: modes of action; TRPV 3 : intracellular keratinocyte membrane channel; SA: salycilic acid; AD: atopic dermatitis; TEWL: transepidermal water loss; NF-kB: nuclear factor kappa-light-chain-enhancer of activated B cells

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