positive trends; however, conclusive evidence on long-lasting results is lacking.21 Rather than allergen avoidance in infants, stimulation of allergen tolerance by controlled exposure may be a more productive strategy, together with optimizing skin barrier properties and function.3,23-28 A therapeutic strategy to prevent allergy could be developed by focusing on safe skin treatment, oral tolerance induction and environmental controls including lifestyle changes.29
Benefits of the Use of Natural Oils for Skin Moisturization
Vegetable oils can be derived by different methods such as distillation, or solvent extraction from roots, stems, and leaves. Based on their properties two categories can be distinguished: Fixed oils and essential oils.30 An overwhelming proportion of herbal and vegetable oils exist for various skin conditions compared to the inadequate proportion of studies pertaining to oils.30 Robust studies of plant oils efficacy in AD are particularly limited;30 a literature review on vegetable oils for pruritus selected 29 publications. Of these, the following articles concentrated on clinical trials: Two on moisturizers containing Cocos nucifera, two on Sunflower oleo distillate, one research paper on Helianthus annuus, and two reviews on Ricinus communis and on Sclerocarya birrea containing moisturizer.30 Ahn and colleagues concluded plant oils have the potential to alleviate pruritus when used as a component in a moisturizer.30
Evangelista et al.31 studied the effect of full body-applied topical virgin coconut oil compared to mineral oil on pediatric patients with AD for 8 weeks. The results at 8 weeks were analyzed based on the SCORAD index, TEWL, and skin capacitance values.31 The topically applied virgin coconut oil showed efficacy in all three categories; the study conclusions suggested that virgin coconut’s efficacy resulted from its anti-inflammatory activity.31
Another study compared the effects of extra virgin coconut oil as a moisturizer in individuals with dry skin to those of mineral oil; the study concluded both were equally effective and safe.32 Sunflower seed oil was proposed as an effective moisturizing agent, either in direct topical application33 or incorporated in a topical as an active ingredient.34,35
Sunflower oil distillate is a by-product of the original oil extracted by molecular distillation. It contains 90% essential fatty acids, mainly oleic and linoleic acids, as well as 5% phytosterols and1% vitamin E.34 As an agonist of the peroxisome proliferator activated receptor-alpha (PPARα), sunflower oil distillate decreases inflammation, restores filaggrin expression, activates ceramides 3, and regulates kallikrein expression.34
Two clinical studies used 2% sunflower oleo distillate (SOD) emollient in AD-affected pediatric patients; results from both studies demonstrated that the emollient improved skin condition and AD symptoms.34,35
Another clinical study evaluated the topical corticosteroid (TCS) sparing effect when using a SOD-containing emollient and TCS. Eighty-six pediatric patients with AD, aged 4 months to 4 years, were allocated to one of the five treatment groups (3).36 More favorable results were shown in the groups that applied the 2% SOD emollient, showing a corticosteroid-sparing effect for the group where a TCS was applied every other day in combination with the emollient, versus TCS application twice a day (Table 4).36
In 2011, a further clinical study was conducted, which included 80 atopic children allocated to two groups.37 Group A applied a TCS and group B applied the 2% sunflower oleo distillate emollient cream, twice a day. SCORAD (SCORing Atopic Dermatitis) was determined at baseline, 1 week, and 3 weeks, with quality of life scored at baseline and at week 3.37 Results demonstrated the emollient improved skin condition and patients’ quality of life comparable to those patients treated with a TCS.37
