improvement in dryness, roughness, and itchiness using a
visual analog scale, and significant improvement (P<.05) in
mean scores for the Investigator's Global Assessment (IGA)
and Eczema Area and Severity Index (EASI) composite scores,
all resulting in a significant improvement of the Quality of Life
(QOL) Index. These studies support previous clinical observations
that the combination of colloidal oatmeal and emollient
oils is synergistic.4,5 In one investigation, researchers found
that baths with colloidal oatmeal in an oil form soothed and
cleansed the skin without irritation when used in 152 children
presenting with a range of inflammatory dermatoses.
Many attribute these positive effects on skin healing to the ability
of colloidal oatmeal to reduce TEWL in the skin, indicating an
improvement in the skin barrier. In a clinical study of 27 female
subjects using a colloidal oatmeal cream, TEWL values were
significantly reduced, comparable to the efficacy of a prescription
(RX) barrier emulsion. Applying these observed properties
to the skin care regimen of atopic skin showed a statistically
significant (P<.01) improvement in the IGA scores and EASI
composite scores, and in itch severity at weeks 2, 4, and 8 in
patients ranging from 12 to 60 years of age, demonstrating the
importance of proper skin care in the management of AD. These
results further translated into a significant improvement of the
QOL scores of enrolled patients.12
Most recent data are documented in an international, multicenter,
open-label, 12-week study conducted in Portugal,
Italy, and Greece in November 2010.33 The objective of the
study was to assess the efficacy of a soothing colloidal oatmeal
emollient cream to improve the signs of atopic skin. A
total of 99 patients with mild-to-moderate eczema, aged 6
months to adult, were enrolled in the study. More than 60%
of enrollees were aged 5 years and under. The study protocol
started with a 1-month washout period, and patients
with a score greater than T0 entered the study. The patients
applied the study medication to the affected eczema areas.
They were instructed to continue their normal skin regimen.
Evaluations were conducted at weeks 4, 8, and 12. Any patient
who had a score of 0 at the 1- or 2-month evaluation
did not enter the analysis. A total of 71 patients were used
in the efficacy analyses. At week 12, 100% of patients had
improvement in skin hydration, 96% had improvement in
pruritus, 82% had improvement in scaling, and 88% had improvement
in erythema. Scoring atopic dermatitis (SCORAD)
scores also improved. Overall, more than 90% of patients
had improvement in SCORAD at week 12. The mean percentage
improvement was 37% for children aged 5 years and
under, 58% for children and adolescents aged 6 to 20 years,
and 48% overall.
As the result of the study it was shown that regular use of colloidal
oatmeal cream has a corticosteroid-sparing effect as the inflammatory skin condition continued to improve. During the
washout period, patients averaged 5.5 grams of corticoids. After
4 weeks of using colloidal oatmeal cream, the measured
corticosteroid use declined by 39.4% (9.24 grams/patient). Sixty-
three percent of patients felt that they used fewer corticoids/
immunomodulators than prior to the start of the study.28-32
These are significant results when looking at the management
of any chronic skin condition that has to rely heavily on repeated
use of topical steroids for acute flare control and maintenance,
and shows that colloidal oatmeal deserves ongoing clinical research
and application in various inflammatory skin diseases.
Feverfew
Feverfew (Tanacetum parthenium) has, as the name implies,
traditionally been used to treat fever, headache, and arthritis.
More recently, experiments using human epidermal keratinocytes
have shown that its antioxidant, anti-inflammatory, and
anti-irritant properties are based on its inhibitory effects on
various pro-inflammatory enzymes and mediators including
5-lipooxygenase and phosphodiesterase as well as tumor necrosis
factor α (TNFα), IL-2, IL-4, and prostaglandin E2 (PGE2).
However, extracts from the plant that retain parthenolide are
unsuitable for topical use because they often cause significant
skin sensitization and irritation. This apparent limitation
to its use does not apply to the parthenolide-free feverfew
extract, which was specifically developed to allow the beneficial
use of feverfew in topical skin care products. This extract
has been refined to selectively collect the beneficial constituents
from feverfew while removing the sensitizing element.
The parthenolide-free feverfew extract has been proven to
induce neither phototoxic nor photoallergic responses when
applied to the skin in topical formulations.2,13,14 The following
examples of its clinical use are all based on the use of the
parthenolide-free feverfew extract.
This formulation has particularly shown efficacy in preventing
skin redness in volunteers in a dose-dependent manner.
Redness was induced by the topical application of methyl nicotinate,
which causes rapid vasodilatation of peripheral blood
capillaries mediated by prostaglandins. Topical administrations
of feverfew at different concentrations were all effective
at preventing redness with increased efficacy when higher
concentrations of feverfew were added.13 In response to these
encouraging results, feverfew has been evaluated for the treatment
of women with sensitive skin, resulting in significant
improvement in facial redness, roughness, and irritation.14
In another study, a moisturizer containing the extract and SPF
30 sunscreen were evaluated for the treatment of women aged
25 to 62 years with sensitive skin over 3 weeks with a similar
reduction of redness, dryness, and skin irritability, as well as
