Combination therapy improves the recovery of the skin barrier function: an experimental model using a contact allergy patch test combined with TEWL measurements

Are images worth a thousand words? A preliminary study testing a video for owner education in canine atopic dermatitis

BACKGROUND

Successful management of canine atopic dermatitis (cAD) is challenging and effective pet owner education is crucial to successful outcomes. However, there are limited proven educational strategies in this area. Our goal was to create an effective and engaging educational tool for owners of dogs with cAD.

HYPOTHESIS

Video-based education efficacy would be comparable to traditional verbal delivery. Secondary objectives included assessing client perception of the intervention, and determining if there were clinical benefits for the dogs and improved client adherence to treatment.

SUBJECTS

Twenty-nine dogs with cAD and their owners were recruited from a teaching hospital of a European veterinary medicine faculty.

MATERIALS AND METHODS

In this 8 week, prospective, randomised controlled study, clients in the control group (CG, n = 13) received verbal education and those in the intervention group (IG, n = 16) watched a video. Client knowledge was assessed at Day (D)0 and D56. Treatment adherence and perceived utility and appeal ratings were measured at D56. Clinical progress was assessed at D0 and D56 using CADESI-04 and PVAS10.

RESULTS

The differences found in the means of cAD knowledge score, clinical outcomes, utility and appeal ratings and owners' adherence score between groups were not statistically significant. A significant association between the outcome and the intervention group concerning education success [CG, six of 13 (46.15%); IG, 15 of 16 (93.75%)] was found (p = 0.01).

CONCLUSIONS AND CLINICAL RELEVANCE

Video-based instructions positively impacted owners' education and demonstrated their potential as a valuable tool. The authors believe that video-based education could be a time-efficient alternative for initial cAD education in veterinary clinics.

Hand dermatitis: a review of clinical features, prevention and treatment

Hand dermatitis is a socially significant health problem. This review provides a discussion on the clinical features and patterns as well as the differential diagnosis of hand dermatitis, because these are essential for proper diagnosis in clinical practice. The morphology, however, is poorly related to the etiology in chronic cases. In all cases of chronic hand dermatitis, a full diagnostic examination should be undertaken and the etiology should be clarified and addressed in the treatment concept, instead of just moving directly from a morphological diagnosis to therapy. Preventive measures should be included in the treatment concept according to etiology. A stepwise approach for escalating therapy is advised, including basic topical therapy, topical corticosteroids, calcineurin inhibitors, as well as phototherapy and systemic therapy with corticosteroids, alitretinoin, cyclosporine, methotrexate, azathioprine, and others.

External glucocorticosteroids: selection criteria in terms ofefficacy and safety

The article describes mechanisms of action as well as indications and adverse effects of topical glucocorticosteroids. It examines the pharmacological and pharmacokinetic properties of fluticasone propionate, an efficient external glucocorticosteroid having a high safety level and good cosmetic properties. The data of controlled Russian and international studies of the efficacy and safety of fluticasone propionate for the treatment of psoriasis, atopic dermatitis and eczema.

Rottlerin, a Specific Inhibitor of Protein Kinase C-delta, Impedes Barrier Repair Response by Increasing Intracellular Free Calcium

Several signals have been suggested in maintaining skin barrier homeostasis, but epidermal calcium ions are currently thought to be a main signaling factor. It is not clear, however, exactly how an intracellular calcium level decreases in response to the loss of an extracellular calcium gradient. In this study, we investigated the effects of several broad-type and isozyme-specific protein kinase C (PKC) inhibitors on epidermal permeability barrier recovery. Topical application of chelerythrine chloride, a broad-type PKC inhibitor, and rottlerin, a PKCdelta-specific inhibitor, significantly impeded the barrier recovery rate at 3 and 6 hours after barrier disruption. A significant decrease in the number and secretion of lamellar bodies was also observed at the inhibitor-treated site. Calcium ion-capture cytochemistry showed that the epidermal calcium gradient was rapidly reformed in inhibitor-treated skin, though recovery of the corresponding barrier function was not observed. In cultured keratinocytes treated with either inhibitor, increased intracellular calcium did not return to the baseline concentration after extracellular calcium decreased. These results suggest that PKC inhibitors, especially a PKCdelta-specific inhibitor, delay barrier recovery by affecting the intracellular calcium concentration after a loss of the extracellular calcium gradient. Furthermore, PKCdelta is important in controlling a decrease in intracellular calcium concentration.

A systematic review of contact dermatitis treatment and prevention

BACKGROUND

Contact dermatitis (CD) is a common occupational disease. There have been no systematic reviews of CD treatment or prevention.

METHODS

Multiple databases were systematically searched. Using independent double review and published quality review criteria, articles were rated as good, fair, or poor. Treatment benefit data were tabulated and conclusions were based on the rated strength of published evidence.

RESULTS

In all, 49 studies met inclusion criteria. Barrier creams containing dimethicone or perfluoropolyethers, cotton liners, and softened fabrics prevent irritant CD. Lipid-rich moisturizers both prevent and treat irritant CD. Topical skin protectant and quaternium 18 bentonite (organoclay) prevent rhus dermatitis. Diethylenetriamine pentaacetic acid (chelator) cream prevents nickel, chrome, and copper dermatitis. Potent or moderately potent steroids effectively treat allergic CD. There were no macrolide immunomodulator trials that met inclusion criteria. This review did not include studies of children, animals, or non-English language publications.

CONCLUSIONS

A limited number of interventions effectively prevent or treat irritant and allergic CD, but well-controlled, outcome-blinded studies, particularly in the area of allergic CD prevention are needed.

Safety and Efficacy of Fluticasone Propionate in the Topical Treatment of Skin Diseases

Fluticasone propionate - the first carbothioate corticosteroid - has been classified as a potent anti-inflammatory drug for dermatological use. It is available as 0.05% cream and 0.005% ointment formulations for the acute and maintenance treatment of patients with dermatological disorders such as atopic dermatitis, psoriasis and vitiligo. This glucocorticoid is characterized by high lipophilicity, high glucocorticoid receptor binding and activation, and a rapid metabolic turnover in skin. Although skin blanching following fluticasone propionate exceeds that of corticosteroids of medium strength, several clinical trials demonstrate a low potential for cutaneous and systemic side-effects, even in difficult-to-treat areas like the face, the eyelids and intertriginous areas. Even among paediatric patients with atopic dermatitis, fluticasone propionate proved to be safe and effective. These pharmacological and clinical properties are reflected by the high therapeutic index of this glucocorticoid.

Acute cutaneous barrier disruption activates epidermal p44/42 and p38 mitogen-activated protein kinases in human and hairless guinea pig skin

Acute cutaneous barrier disruption of the skin elicits various homeostatic repair responses in the epidermis. Although several candidates for the signaling mechanisms that induce these responses have been reported, e.g. the calcium and ion concentration, peroxisome proliferator-activated receptor-alpha, and TNF-alpha signaling mediated by sphingomyelinases, the exact nature of the signals remains undertermined. Therefore, assuming that an important group of serine/threonine-signaling kinases, mitogen- and SAPK/JNK, might link the barrier disruption to the subsequent homeostatic responses, the activation of three MAPKs in hairless guinea pig or in human skin after barrier disruption was investigated. The epidermal barrier was insulated with tape stripping or organic solvents, and Western blotting, and immune complex kinase assay. In the skin of hairless guinea pigs, p44/42 MAPK and p38 MAPK, but nor SAPK/JNK, were continued to be activated for at least 180 min. The activation of p44/42 which positively correlated with the number of tape strippings, whereas K+ sucrose solution suppressed its activation. The activation of p44/42 MAPK was also induced by treatment of the skin with organic solvents. In similar fashion, p44/42 and p38 MAPKs were found to be activated in human skin after tape stripping. These results for strongly suggest that the activation of p44/42 and p38 MAPKs links the stimuli of barrier disruption to the subsequent homeostatic responses to repair the barrier defect.

Effectiveness of skin protection creams as a preventive measure in occupational dermatitis: a critical update according to criteria of evidence-based medicine

OBJECTIVES

This study attempts to assess the evidence of the generally recommended three-step programme of skin protection in the prevention of occupational skin disease.

METHODS

The following clinical questions, representative of critical appraisal of this preventive measurement, were generated: (1) Can a skincare regimen effectively reduce or eliminate work-related poor skin conditions? (2) Do protective creams prevent harmful substances from penetrating and adhering to the skin? (3) Is the differentiation between pre-exposure and post-exposure products justified by reliable data? Answers were generated according to the method used in evidence-based medicine by searching the literature, critically appraising the results and applying the results to the clinical questions. For our search we decided to use PubMed as the most convenient access to Medline and because, in contrast to other databases, this access is available free of charge.

RESULTS

To investigate the efficacy of barrier creams as pre-exposure skin protectors various in vitro and in vivo test methods have been developed. Over the past years the test techniques have been improved in order to adopt a real workplace situation. Efforts for standardisation of evaluation criteria have been made, too. Nevertheless, there is a lack of placebo-controlled, randomised clinical trials evaluating the benefit of these products in the prevention of occupational contact dermatitis under real workplace conditions. The literature data are conflicting; some publications report on the positive aspects of skin protection, whereas others stress the negative ones.

CONCLUSION

Not enough data have been accumulated for one to prove the benefit of skin protection measures under real workplace condition. Up to now, it is almost unclear if the various in vitro and in vivo methods used are suitable to simulate real workplace conditions and if these test results can be related to real occupational exposure. For the evidence-based recommendation of skin protection, further studies, especially under daily working conditions evaluating the contribution of each single element of skincare programme (products, frequency of application and education programme) are needed.

Comparison of the effects of daily applications between topical corticosteroid and tacrolimus ointments on normal skin: evaluation with noninvasive methods

OBJECTIVE

To evaluate the skin changes of the neck of normal individuals after repeated applications of moderate-strength corticosteroid or tracrolimus ointment for 3 weeks by use of noninvasive biophysical measurements.

METHODS

A 0.12% betamethasone-17-valerate ointment or a 0.1% tacrolimus ointment was applied to the right side of the neck of 8 adult volunteers twice daily for 3 weeks together with control petrolatum applied to the left side of the neck for comparison. Biophysical skin measurements were performed on the neck skin before, 1 and 3 weeks after the start of the treatment and 1 week after the cessation of the treatment.

RESULTS

A decrease in hygroscopicity and water-holding capacity of the stratum corneum (SC) when evaluated with the in vivo water sorption-desorption test was found on the corticosteroid-ointment-treated side after 3 weeks of the treatment as compared with the petrolatum-treated side. The erythematous reaction to a topically applied 0.1% aqueous solution of methyl nicotinate, a vasodilator, appeared more slowly on the corticosteroid-ointment-treated skin than on the control skin. No such changes were observed on the skin treated with 0.1% tacrolimus ointment.

CONCLUSION

Tacrolimus appears to cause few if any functional changes in the SC of healthy human skin because of its poor permeability into skin with an intact barrier function.

Efficacy of topical corticosteroids in nickel-induced contact allergy

In this study we used the nickel contact allergy patch (CAP) test to investigate the effect of topical corticosteroids on allergic contact dermatitis (ACD). On day 1, three CAP tests were applied for 48 h on the forearms of 20 female volunteers with a known nickel ACD. CAP of the right forearm contained 5% nickel, and of the left forearm physiological saline. Clinical scoring, transepidermal water loss and skin hydration were measured on day 1 before CAP application, on day 4 (0, 2 and 6 h) after ACD and from days 5 to 8 (0 h). A topical corticosteroid and its vehicle were applied twice daily starting from day 4 on two ACD sites. Transepidermal water loss values were significantly decreased on the topical-corticosteroid-treated sites in the early phase of ACD (day 4, 6 h after the first application) while clinical efficacy showed significant improvement on days 7 and 8. The vehicle was found to improve skin hydration only on day 8. In conclusion the topical corticosteroid improved the skin barrier function in the early inflammatory phase of ACD (day 4, 6 h). The lack of improvement in transepidermal water loss in the later phase of ACD might be accounted for by the secondary effects of the corticosteroid on proliferation and differentiation of keratinocytes.

Beneficial effects of a skin tolerance-tested moisturizing cream on the barrier function in experimentally-elicited irritant and allergic contact dermatitis

In experimentally-induced irritant (ICD) and allergic (ACD) contact dermatitis, an oil-in-water (o/w) cream was applied to investigate its effects on a disturbed barrier function compared to untreated physiological barrier repair. Transepidermal water loss (TEWL) measurements were performed. Before the start of the experiments, the skin tolerance of the cream was examined, revealing the non-irritating characteristics of the ingredients and the absence of any contact allergic patch test reaction. In the ICD study, sodium lauryl sulfate (SLS) patches were applied to the forearms of young female volunteers. Consequently, it was observed that repeated cream application (14 days, 2x/day) significantly improved the TEWL of SLS-damaged skin, leading to a complete recovery on day 15. In the ACD study, disruption of skin barrier function was obtained by a nickel-mediated contact allergy patch (CAP) test. The cream was then applied 2x/day for 4 consecutive days. Assessment of TEWL clearly showed that recovery of the disrupted skin significantly improved after cream application in comparison to untreated barrier repair.