Colloidal Oatmeal Formulations as Adjunct Treatments in Atopic Dermatitis

July 2012 | Volume 11 | Issue 7 | Original Article | 804 | Copyright © July 2012

Abstract
Colloidal oatmeal has been used for decades to soothe and ameliorate atopic dermatitis and other pruritic and/or xerotic dermatoses. In-vitro and/or in-vivo studies have confirmed the anti-inflammatory, barrier repair, and moisturizing properties of this compound. A broad set of studies has been conducted in recent years to assess the effects of colloidal oatmeal as adjunct treatment in the management of atopic dermatitis (AD). This paper will review these studies. In these investigations, patients in all age groups (3 months to 60 years) with mild to moderate atopic dermatitis were included and allowed to continue their prescribed topical medications. These studies found that the daily use of moisturizers and/or cleansers containing colloidal oatmeal significantly improved many clinical outcomes of atopic dermatitis from baseline: investigator's assessment (IGA), eczema area and severity index (EASI), itch, dryness, and quality of life indices. Safety results showed that the formulations were well tolerated in babies, children, and adults with AD.

J Drugs Dermatol. 2012;11(7):804-807.

INTRODUCTION

Atopic dermatitis (AD), or atopic eczema, is a chronic skin disorder with a high prevalence in children. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), 10% to 20% of all children suffer from AD. In many children, AD tends to resolve by 2 years of age, but in 60% of them some symptoms will continue into adulthood.1 About 65% of patients develop AD within the first 12 months of life and 90% within the first 5 years. In 2004, approximately 15 million patients in the United States were affected by AD; this accounted for $154 million in AD prescription drugs or 15% of total direct costs, which is over $1 billion per year.1
Atopic dermatitis has a complex pathogenesis but there is increased evidence that a genetically-impaired skin barrier plays a primary role in its development.2,3 Mutations in the filaggrin gene, in particular, are strongly associated with AD (42% of FLG heterozygotes develop the disease).2 The protein filaggrin is important for the correct formation of the stratum corneum barrier and filaggrin deficiency produces increased barrier permeability and other stratum corneum abnormalities.3 Indeed, several clinical studies have found skin barrier defects and dry skin in both lesional and clinically normal skin of AD patients: increased transepidermal water loss (TEWL) and pH,4 and decreased skin hydration.4,5 A reduced content of ceramides in the stratum corneum has also been shown in both lesional and nonlesional skin.6
The defective barrier allows penetration of irritants and antigens, which lead to the release of cytokines, causing secondary skin inflammation.7 Skin inflammation can also derive in part from decreased stratum corneum hydration (xerosis).8 These biological changes ultimately lead to the clinical manifestations of pruritus and eczema, which are key diagnostic criteria for AD. Intense pruritus is an initial symptom; this triggers scratching, which in turns generates an increased immune response that leads to the development of eczematous lesions.9
Thus, soothing of pruritus, restoration of skin barrier and stratum corneum hydration, and reduction of inflammation are critical for the amelioration of AD and for an improved quality of life. Moisturization and barrier protection are paramount to prevent entrance of noxious agents into the skin, and to reduce pruritus and thus scratching.10,11 In fact, the Consensus Conference on Pediatric Atopic Dermatitis suggested that emollients (ointments and creams in particular) can be used as first-line agents in the management of AD12 and can be steroidsparing.10,11 The regular use of emollients in AD has also been recommended by the PRACTALL consensus report.13

Oatmeal Properties

Colloidal oatmeal is approved by the Food and Drug Administration (FDA) as a skin protectant drug for over-the-counter (OTC) use. One of its approved labelings is that it can "temporarily protect and help relieve minor skin irritation and itching due to eczema."14 Colloidal oatmeal is produced as a fine powder from the grinding and processing of whole oat grains and it contains various dermatological active compounds with moisturizing, protective, anti-inflammatory, antioxidant, soothing, buffering, and cleansing properties.15,16