ARTICLE: Colloidal Oatmeal Part II: Atopic Dermatitis in Special Populations and Clinical Efficacy and Tolerance Beyond Eczema

October 2020 | Volume 19 | Issue 10 | Supplement Individual Articles | s8 | Copyright © October 2020


Published online September 23, 2020

Blair Allais MD, Adam Friedman MD FAAD

Department of Dermatology, George Washington School of Medicine and Health Sciences, Washington, DC

Among patients treated with EGFR inhibitors, up to 90% have experienced papulopustular eruptions.19 The rash usually developed in the first 2–4 weeks after initiation of therapy as pruritic and tender erythematous papules and pustules on the scalp, face, neck, chest, and back.20 Interestingly, there is a relationship between the development of the rash and the response to chemotherapy and ultimate survival.21 Pruritus is another common adverse event with EGFRIs, affecting up to 54.9% of patients based on particular EGFRI treatment, and which can have a significant impact on quality of life.22 Alexandrescu et al reported treatment with colloidal oatmeal of 11 patients with a rash induced by cetuximab, erlotinib, panitumumab, and sorafenib. Colloidal oatmeal was applied three times a day for 7 days. The overall response rate was 100%, with a complete response of 60%. The authors argue that the observed eruptions in these patients may represent an inflammatory reaction to EGFR inhibitors, thus explaining the response to colloidal oatmeal given its anti-inflammatory properties.23 An additional study in Taiwan studied the benefit of colloidal oatmeal in a sample of 30 patients with dermatologic toxicities associated with EGFR inhibition. Patients applied colloidal oatmeal three to five times a day for 4 consecutive weeks. Dermatologic toxicity severity, body surface area involvement, and pruritus all improved at 4 weeks with no adverse events reported.24 Unlike more potent topical treatments such as topical steroids, metronidazole, erythromycin, salicylic acid, and benzoyl peroxide, colloidal oatmeal is not associated with any toxicity.23

Radiation therapy is used in the treatment of various forms of cancer and is associated with acute and chronic skin changes. Early skin reactions usually occur within days to weeks, initially manifesting as transient to generalized erythema. If the cumulative radiation dose reaches 20 gray, dry desquamation can develop characterized by pruritus, scaling, and flaking of the skin.25 Colloidal oatmeal has been studied as a treatment for radiation-induced skin reactions. In a study of 24 patients undergoing radical radiotherapy for anal cancer, patients were randomized to treatment with either colloidal oatmeal or aqueous cream. Skin reactions for both cohorts were comparable, but the colloidal oatmeal cohort had an appreciable response with regards to epidermal regeneration at follow up.26 As treatments for cancer continue to evolve, so must treatments for their cutaneous adverse effects. Colloidal oatmeal has shown promise with an excellent safety profile.

CONCLUSIONS

In Part II of this two-part series, we examined the diverse range of clinical applications of colloidal oatmeal. Colloidal oatmeal has been shown to be beneficial in the treatment of atopic dermatitis in African American patients. It also has been shown to be of benefit in the treatment of hand dermatitis, xerosis, psoriasis, skin manifestations of diabetes, and in the treatment of cutaneous adverse effects associated with oncologic therapies. This wide-ranging efficacy and use is backed by proven safety and tolerability, making colloidal oatmeal an ideal treatment option in many case scenarios.

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