Steroid-Free Emollient Formulations Reduce Symptoms of Eczema and Improve Quality of Life
May 2014 | Volume 13 | Issue 5 | Original Article | 589 | Copyright © May 2014
Teresa M. Weber PhD,a Michael J. Babcock MD,b James H. Herndon Jr. MD,c Alexander W. Filbry PhD,d Ulrich Scherdin PhD,d and Frank Rippke MDd
aResearch and Development, Beiersdorf Inc, Wilton, CT
bColorado Springs Dermatology, Colorado Springs, CO
cDermatology Center of Dallas, Dallas, TX
dResearch and Development, Beiersdorf AG, Hamburg, Germany
Two over-the-counter products have been clinically tested for efficacy and tolerability in the treatment of atopic dermatitis. Study 1 evaluated a daily maintenance Body Cream (Eucerin Eczema Relief Body Crème) applied twice daily for 14 days, followed by treatment withdrawal for 5 days (regression period) in subjects with a history of atopic dermatitis. Study 2 evaluated an acute treatment (Eucerin Eczema Relief Instant Therapy [Instant Therapy]) for active atopic dermatitis lesions administered for 14 days.
Skin barrier function, hydration, tolerability, and relief of symptoms were assessed at baseline, day 7, and day 14. Study 2 also measured itch relief and treatment impact on work, social activities, and sleep.
Body Cream significantly improved skin hydration and barrier function (P<.001) at 14 days, with improvements persisting through the 5-day regression phase. Itching was significantly improved in 93.8% of subjects (P<.001).
Instant Therapy treatment of atopic dermatitis lesions significantly improved skin hydration and barrier function, as well as symptoms of erythema, pruritus, excoriation, and lichenification, with rapid improvement of itch reported within minutes of the first treatment application. Instant Therapy significantly reduced itch intensity and frequency, and demonstrated beneficial improvements in subjects’ quality of life. Body Cream and Instant Therapy were both safe and well tolerated. J Drugs Dermatol.
Eczema is a group of chronic relapsing inflammatory conditions, with atopic dermatitis being its most common form.1-4 Around 10% to 20% of children are affected by atopic dermatitis, which also occurs in 1% to 3% of adults.5
Atopic dermatitis is characterized by dry, itchy, and inflamed skin, running an undulating course of flares and remissions.1 Lesions typically occur due to changes in the immune response and a compromised skin barrier, resulting in intense itching and scratching behaviors that exacerbate the primary lesion.4 This skin irritation may adversely affect patients’ quality of life (QoL) through sleep deprivation, and patients are at increased risk for developing psychiatric and psychological conditions.4,6
Three clinical phases of atopic dermatitis have been described. In the acute phase, pruritic, erythematous, weeping, and serous exudates are typically observed.4 The subacute phase is characterized by dry, pruritic, scaly skin, and erythematous papules and plaques.2,4 Chronic atopic dermatitis results from prolonged uncontrolled disease. Repetitive scratching and long-standing inflammation causes lichenification and hyperlinearity 4 Adult atopic dermatitis tends to be drier and more lichenified than infantile atopic dermatitis.6
Immunologic dysfunction and inflammation, with local T lymphocyte infiltration and edema, are the main pathogenic features of atopic dermatitis. Itching in acute-phase atopic dermatitis is thought to be mediated by release of interleukin 31 induced by Th2 lymphocytes.4 In contrast, chronic atopic dermatitis is Th1 lymphocyte–mediated, reducing filaggrin gene activation and skin barrier function.4 Filaggrin gene mutations and decreased skin ceramide content compromise skin barrier structure and function, resulting in moisture loss and excessive skin dryness.3,5,7 It is important to note that clinically unaffected skin—such as that observed between the acute flares—may also show pathological changes including subclinical inflammation and epidermal hyperplasia.2,4,5
Because atopic dermatitis is not curable, treatment is aimed at soothing the skin, preventing itching, flares, scratching, and further irritation.3,8 Another therapeutic goal is repair of the skin barrier in order to preserve skin hydration and reduce skin dryness, and consequently to reduce susceptibility