The Effect of Desonide Hydrogel on Pruritus Associated With Atopic Dermatitis
June 2014 | Volume 13 | Issue 6 | Original Article | 725 | Copyright © 2014
Leon H. Kircik MD FAAD
Indiana University School of Medicine, Indianapolis, IN
Icahn School of Medicine at Mount Sinai, New York, NY
Physicians Skin Care, PLLC, Louisville, KY
Itch is a common and troubling symptom of atopic dermatitis.
It is not mediated by histamine, and standard anti-itch therapies, therefore,
have limited benefit for most AD patients. Instead, anti-inflammatory agents
are used to reduce inflammation and therefore improve associated itch. Studies
confirm that long-term use of corticosteroids can lead to a reduction in pruritus.
A pilot study was designed to assess the effects of one week of twice-daily application
of desonide hydrogel 0.05% for the treatment of atopic dermatitis. Active treatment was
associated with significant improvements in IGA scores at day 3 and
day 7 (mean score 0.55, 75.83% improvement from Baseline;
P<.0001) and pruritus VAS scores at day 3 and day 7 (mean 6.35-point,
86.61% reduction in VAS scores; P<.0001). Treatment with the convenient,
hydrating hydrogel formulation is effective and associated with an improvement in subjects’ quality of life.
J Drugs Dermatol. 2014;13(6):725-728.
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Atopic dermatitis (AD) or eczema is a common inflammatory skin disease with a relapsing remitting course. Clinically, it is marked by xerosis and prutitus.1 Current estimates suggest that up to 20% of children2 and 10% of adults3 have eczema. While prevalence data are sometimes disputed, it is thought that the disease is becoming more common.4
Disruption of the epidermal barrier, as indicated by a reduction in skin hydration5 and an increase in transepidermal water loss (TEWL)4,6 is characteristic of AD. Data suggest that TEWL correlate with clinical severity of AD.4,7 Whether abnormal skin barrier function is a cause of atopic dermatitis or a consequence of the disease remains controversial.6 Increasingly, researchers and clinicians recognize that disrupted barrier function contributes not only to the xerotic and pruritic manifestations of AD, but also to the inflammatory cascade that underlies the disease.8 These evolving concepts of AD now indicate to clinicians that epidermal moisturization, which was long advocated as a measure to provide symptomatic relief of eczema, may actually help to address the underlying pathogenesis of the disease.
Topical corticosteroids remain the mainstay of AD therapy, because they confer anti-inflammatory effects. 9 Among the various dosage forms of corticosteroids on the market, ointment-based formulations continue to be widely used in dermatology, due to their perceived occlusive and hydrating properties. However, many patients and/or their parents/caregivers dislike the difficult and messy application of ointments, especially on hairy areas or large body surfaces. Novel formulations of dermatologic therapies offer additional options for prescribers and their patients, including foams, sprays, shampoos, scalp-specific topical solutions, and non-alcohol based gels that may provide hydrating and moisturizing effects. Among these is the hydrogel, a mostly water-based, non-irritating, non-greasy vehicle that is shown to moisturize the skin and achieve a high degree of patient satisfaction. It was found in one study to offer several key benefits, as perceived by patients: being easy to apply and spread, quickly-absorbing, and comfortable under clothing and make-up.10
Specifically, desonide hydrogel 0.05% (Desonate, Bayer Dermatology) has been shown effective for the management of pediatric atopic dermatitis, 11 and was shown to have comparable efficacy to desonide ointment but greater patient acceptance than the ointment in studies involving pediatric and adult AD patients.12 However, few studies have investigated the short-term efficacy of desonide hydrogel 0.05% and its effects on the pruritus associated with AD.
While the repair of epidermal barrier is of the utmost importance in the treatment of atopic dermatitis, most of the penetration enhancers in vehicles of topical steroids may actually cause worsening of impaired epidermal barrier.13 Hydrogel vehicle is anecdotally known to be moisturizing and hydrating, however, empirical evidence is limited regarding these properties. A recent study showed that hydrogel vehicle produced a statistically significant improvement in skin hydration from baseline, whereas comparator lotion did not. Hydrogel did not