Comparative Trial of 5% Dexpanthenol in Water-in-Oil Formulation With 1% Hydrocortisone Ointment in the Treatment of Childhood Atopic Dermatitis: A Pilot Study
March 2012 | Volume 11 | Issue 3 | Original Article | 366 | Copyright © March 2012
Montree Udompataikul MD, Dipenn Limpa-o-vart MD
Skin Center, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
Abstract
Background: Atopic dermatitis (AD) is a common chronic relapsing disease particularly affecting children. The emollient used for protection of skin barrier function is the standard treatment for patients with AD. Currently, there is a growing interest in the use of nonsteroidal anti-inflammatory agents such as dexpanthenol (vitamin B5) as an alternative treatment.
Objective: To compare the effectiveness of 5% dexpanthenol (DT) ointment with 1% hydrocortisone (HC) ointment in childhood AD therapy.
Method: Patients were treated topically with 5% DT ointment on the right side of the body and 1% HC ointment on the other side twice daily for 4 weeks. The clinical responses were evaluated by SCORAD (Scoring Atopic Dermatitis index) with statistical analysis using paired t-test.
Result: Of the 30 children enrolled, 26 completed the protocol; mean age was 7.19 years. The average baseline SCORAD score of the DT-treated side and the HC-treated side was 30.95 and 30.54, respectively. There was no statistically significant difference in SCORAD score reduction between the 2 agents. The edematous score of the HC-treated side exhibited faster resolution than that of the DT-treated side, with a statistically significant difference at week 1 and without a statistically significant difference at weeks 2 to 4. The lichenification response rate of HC treatment was more rapid than that of DT treatment; however, there was no statistical group difference. No adverse events were observed with either agent.
Conclusion: The effectiveness of 5% DT ointment is equal to that of 1% HC ointment. DT ointment may be used as alternative treatment in mild to moderate childhood AD therapy.
J Drugs Dermatol. 2012;11(3):366-374.
INTRODUCTION
A topic dermatitis (AD) is a chronic relapsing inflammatory dermatosis that is present more commonly in childhood. The prevalence of AD has been increasing, particularly in developed countries. The prevalence of childhood AD is
10% to 20% in the general population.1,2 The etiology of AD may
be due to the interaction of multiple factors, such as genetics,
immune deviation, and epidermal barrier function disturbance.3,4
Management of AD consists of a combination of anti-inflammatory medications in conjunction with skin barrier function
protection and avoidance of aggravating factors.5 Intermittent
application of topical corticosteroid as an anti-inflammatory
agent in addition to emollients has been considered as standard therapy for patients with AD of mild to moderate severity.
However, there have been considerable adverse events associated with long-term corticosteroid usage, such as skin atrophy,
striae, telangiecstasia, and hypertrichosis.6
Whether topical calcineurin inhibitors, such as tacrolimus and
pimecrolimus, have potential to induce malignancy remains unclear6 Nevertheless, the FDA has approved label revisions for these
agents, including a second-line indication and enhanced warnings.
The warning statement recommends avoiding long-term usage in
all patients and limited usage in children older than 2 years of age.7
Recently, there has been an emerging interest in the use of
emollients containing nonsteroidal anti-inflammatory agents,
such as licochalcone A, vitamin B, aloe vera, chamomile, cucumber, and arnica, as an alternative treatment.8,9 However,
these agents should be clinically assessed before they can be
recommended for AD therapy.9
Dexpanthenol (DT), an alcoholic analog of pantothenic acid,10
is a topical agent with good skin penetration when administered in water-in-oil emulsions. 11 Pantothenic acid is essential
