November 15, 2006 • Skin Disorders 33 Atopic Dermatitis ... · November 15, 2006 • Skin...
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November 15, 2006 • www.familypracticenews.com Skin Disorders 33 Atopic Dermatitis Tamed By Repair of Skin Barrier BY DAMIAN M C NAMARA Miami Bureau S AN A NTONIO — Treatment of atopic dermatitis in pediatric patients is shifting from symptom control to repair of the skin barrier function, Dr. Rebecca Lynn Smith said at a meeting of Skin Disease Education Foundation. “It used to be we treated flare-ups. Now we aim to repair the skin barrier with in- tegration of physiologic moisturizers,” she said. Physiologic moisturizers replace lost lipids, reduce transepidermal water loss, and calm inflammation, according to Dr. Smith, a dermatologist in private prac- tice in Fort Mill, S.C. A reliance on nonphysiologic moistur- izers, such as petrolatum, eased when the physiologic moisturizers MimyX (Stiefel Laboratories), Atopiclair (Chester Valley Pharmaceuticals), and EpiCeram (Ceragenix Pharma- ceuticals) became available. Non- physiologic products “sit on the skin like icing on a cake and pre- vent water loss. Physiologic mois- turizers are incorporated into the skin,” said Dr. Smith, who has a consulting agreement with Stiefel Laboratories. Skin barrier defects in atopic dermatitis include increased stra- tum corneum chymotryptic en- zyme, increased proteases, de- creased maturation of lamellar bodies, and decreased filaggrin. Palmitamide MEA (PEA) is an important component of MimyX nonsteroidal cream, Dr. Smith said. PEA is an essential fatty acid with anti-inflammatory properties. Researchers conducted a PEA study in which atopic patients applied PEA and Eu- cerin cream to their left wrist and forearm, and Eucerin cream only to their right wrist and arm. “After 2 weeks you can see the difference,” Dr. Smith said. An open-label, international study as- sessed 2,456 people aged 2-70 years with mild to moderate atopy treated with ad- junctive PEA cream. Results were present- ed as a poster by Dr. B. Eberien-Koeing and associates at the 2006 annual meeting of the American Academy of Dermatology. They assessed itching, erythema, scaling, dryness, lichenification, and excoriation. “With PEA cream everything significantly improved or was eliminated,” Dr. Smith said. Atopiclair cream contains the anti- inflammatory, antipruritic glycyrrhetinic acid, as well as sodium hyaluronate, a powerful hydrating agent. Physiologic moisturizers combined with common sense tips for management of atopic dermatitis can make a big dif- ference in quality of life for affected chil- dren, Dr. Smith said. “If we can stop these kids from itching and scratching, we can get their skin to heal. An important issue is sleep quality—they are up at night itch- ing and scratching.” A daily bath for children in lukewarm water is recommended, Dr. Smith said. Apply medications and moisturizers im- mediately afterward, and limit contact with suspected allergens or irritants. Anti- histamines are a treatment option. In- struct the parent or guardian keep the child cool and avoid excessive perspiration, dress them in cotton clothes, and file their fingernails, she suggested. Once atopic flare is under control, con- sider dilute bleach baths to prevent or treat infections. Add 1/8 cup of bleach to a half-full bathtub for a 5- to 15-minute soak twice a week. “I describe this as a clean, chlorinated pool to moms who are alarmed when I mention a bleach bath,” Dr. Smith said. “Make sure they rinse the [bleach] bath off when they are done.” SDEF and this news organization are wholly owned subsidiaries of Elsevier. ■ MimyX and Eucerin were applied for 2 weeks to the child’s left arm; only Eucerin to the right arm. STIEFEL LABORATORIES Atopic Dermatitis Pipeline Promising P ARIS — An investigational anti-inflam- matory drug shows promise in reducing the severity of mild to moderate atopic dermatitis, Dr. Karl Beutner said in a poster presentation at the annual meeting of the European Society for Dermatolog- ical Research. A total of 103 patients with mild to mod- erate atopic dermatitis (body surface area 3%-10%) were randomized to twice-daily treatment with 1% AN0128 (67 patients)— AN0128 has been shown to block inflam- matory cytokines in vitro—or the vehicle cream (36 patients) for 4 weeks, wrote Dr. Beutner, chief medical officer of Ana- cor Pharmaceuticals Inc. in Palo Alto, Calif. Subjects were evaluated with the six- point Investigator’s Static Global Assess- ment at baseline and on days 3, 7, 14, 28, and 35. With the ISGA, patients are rated as clear, almost clear, mild, moderate, se- vere, or very severe. Treatment success was defined as a rating of clear or almost clear. All other ratings were treatment failures. At the end of 4 weeks, 51% of the AN0128 group reached a level of clear or almost clear, vs. 37% of controls. —Kerri Wachter
Transcript of November 15, 2006 • Skin Disorders 33 Atopic Dermatitis ... · November 15, 2006 • Skin...
N o v e m b e r 1 5 , 2 0 0 6 • w w w. f a m i l y p r a c t i c e n ew s . c o m Skin Disorders 33
Atopic Dermatitis TamedBy Repair of Skin Barrier
B Y D A M I A N M C N A M A R A
Miami Bureau
S A N A N T O N I O — Treatment of atopicdermatitis in pediatric patients is shiftingfrom symptom control to repair of theskin barrier function, Dr. Rebecca LynnSmith said at a meeting of Skin DiseaseEducation Foundation.
“It used to be we treated flare-ups. Nowwe aim to repair the skin barrier with in-tegration of physiologic moisturizers,”she said. Physiologic moisturizers replacelost lipids, reduce transepidermal waterloss, and calm inflammation, according toDr. Smith, a dermatologist in private prac-tice in Fort Mill, S.C.
A reliance on nonphysiologic moistur-izers, such as petrolatum, eased when thephysiologic moisturizers MimyX (StiefelLaboratories), Atopiclair (ChesterValley Pharmaceuticals), andEpiCeram (Ceragenix Pharma-ceuticals) became available. Non-physiologic products “sit on theskin like icing on a cake and pre-vent water loss. Physiologic mois-turizers are incorporated into theskin,” said Dr. Smith, who has aconsulting agreement with StiefelLaboratories.
Skin barrier defects in atopicdermatitis include increased stra-tum corneum chymotryptic en-zyme, increased proteases, de-creased maturation of lamellarbodies, and decreased filaggrin.
Palmitamide MEA (PEA) is an importantcomponent of MimyX nonsteroidal cream,Dr. Smith said. PEA is an essential fattyacid with anti-inflammatory properties.
Researchers conducted a PEA study inwhich atopic patients applied PEA and Eu-cerin cream to their left wrist and forearm,and Eucerin cream only to their rightwrist and arm. “After 2 weeks you can seethe difference,” Dr. Smith said.
An open-label, international study as-sessed 2,456 people aged 2-70 years withmild to moderate atopy treated with ad-junctive PEA cream. Results were present-ed as a poster by Dr. B. Eberien-Koeing andassociates at the 2006 annual meeting ofthe American Academy of Dermatology.They assessed itching, erythema, scaling,
dryness, lichenification, and excoriation.“With PEA cream everything significantlyimproved or was eliminated,” Dr. Smithsaid.
Atopiclair cream contains the anti-inflammatory, antipruritic glycyrrhetinicacid, as well as sodium hyaluronate, apowerful hydrating agent.
Physiologic moisturizers combinedwith common sense tips for managementof atopic dermatitis can make a big dif-ference in quality of life for affected chil-dren, Dr. Smith said. “If we can stop thesekids from itching and scratching, we canget their skin to heal. An important issueis sleep quality—they are up at night itch-ing and scratching.”
A daily bath for children in lukewarmwater is recommended, Dr. Smith said.Apply medications and moisturizers im-
mediately afterward, and limit contactwith suspected allergens or irritants. Anti-histamines are a treatment option. In-struct the parent or guardian keep thechild cool and avoid excessive perspiration,dress them in cotton clothes, and file theirfingernails, she suggested.
Once atopic flare is under control, con-sider dilute bleach baths to prevent ortreat infections. Add 1/8 cup of bleach toa half-full bathtub for a 5- to 15-minutesoak twice a week. “I describe this as aclean, chlorinated pool to moms who arealarmed when I mention a bleach bath,”Dr. Smith said. “Make sure they rinse the[bleach] bath off when they are done.”
SDEF and this news organization arewholly owned subsidiaries of Elsevier. ■
MimyX and Eucerin were applied for 2 weeks tothe child’s left arm; only Eucerin to the right arm.
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Atopic Dermatitis Pipeline PromisingPA R I S — An investigational anti-inflam-matory drug shows promise in reducingthe severity of mild to moderate atopicdermatitis, Dr. Karl Beutner said in aposter presentation at the annual meetingof the European Society for Dermatolog-ical Research.
A total of 103 patients with mild to mod-erate atopic dermatitis (body surface area3%-10%) were randomized to twice-dailytreatment with 1% AN0128 (67 patients)—AN0128 has been shown to block inflam-matory cytokines in vitro—or the vehiclecream (36 patients) for 4 weeks, wrote
Dr. Beutner, chief medical officer of Ana-cor Pharmaceuticals Inc. in Palo Alto, Calif.
Subjects were evaluated with the six-point Investigator’s Static Global Assess-ment at baseline and on days 3, 7, 14, 28,and 35. With the ISGA, patients are ratedas clear, almost clear, mild, moderate, se-vere, or very severe. Treatment success wasdefined as a rating of clear or almost clear.All other ratings were treatment failures.
At the end of 4 weeks, 51% of theAN0128 group reached a level of clear oralmost clear, vs. 37% of controls.
—Kerri Wachter
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