Therapeutic Focus: Atopic Dermatitis


New Research Closes In On Personalized AD Therapy

New research on skin lipids may pave the way toward personalized therapies for atopic dermatitis. Researchers can now identify the precise lipids found in the skin of people who have atopic dermatitis, and compare them to people with healthy skin. A type of tape can pull some lipids off a person’s skin; allow testing of them with the use of a mass spectrometer; and have the results compared to the skin lipid profiles of generally healthy patients.

With this information, researchers may be able to determine what lipids are deficient and develop topical compounds to replace them — either individually, or with compounds that could aid groups of people who share similar lipid profiles.

“This has the potential to remove any guess work that might have existed in the past regarding the correct combination of lipids required to improve skin health,” said Arup Indri, an associate professor in the College of Pharmacy at Oregon State University, in a news release. “This may be of value not only to patients with atopic dermatitis or other skin diseases, but even for normal individuals who simply want their skin to be more healthy, well hydrated, and resistant to aging.”

The findings appear in the British Journal of Dermatology. The researchers have applied for patents and are working with university officials to begin the process of licensing and commercialization.

The researchers also discovered a clear link between atopic dermatitis, altered lipid profiles, and some types of bacterial infections such as Staphylococcus aureus. Staph infections may both lead to atopic dermatitis problems and make people more prone to further infections — a cycle of skin inflammation that can disrupt the skin microbiome.

This research has been supported by the Atopic Dermatitis Research Network, funded by the National Institutes of Health and the Oregon Nanoscience and Microtechnologies Institute. Collaborators on the research are from the Oregon Health & Science University, OSU’s Linus Pauling Institute, the University of Rochester Medical Center, National Jewish Health, and Rho, Inc.

Intramuscular Flu Shots May Mitigate Staph Risk In AD Patients

Staphylococcus colonization of atopic dermatitis patients’ skin is associated with a weaker response to intradermal flu shots, according to a new study, which suggests that intramuscular flu vaccines may be more effective in this group.

The research, funded by the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, is being published online in the Journal of Allergy and Clinical Immunology.

Researchers evaluated 202 patients with atopic dermatitis, and 134 control patients, vaccinating 136 of them with intradermal vaccines and the rest with intramuscular vaccines. The vaccines included proteins from three strains of influenza (influenza B, H1N1 and H3N2). They assessed response to the vaccine 28 days after vaccination by measuring levels of various antibodies in the blood. Eighty-four (42 percent) of the atopic dermatitis patients had positive skin swabs for Staphylococcus aureus colonization.

Overall, the atopic dermatitis patients responded similarly to the non-atopic patients to both intramuscular (IM) and intradermal (ID) vaccines. However, a significant difference was seen in patients with atopic dermatitis who were colonized with Staphylococcus aureus and vaccinated against influenza B. Only 11 percent of patients given the ID vaccine developed protection against influenza B compared to 47 percent who received the IM vaccine. The intradermal vaccine also generated less protection against H1N1 and H3N2 strains of influenza, but these differences were not statistically significant.

Researchers are not certain whether the Staphylococcus aureus bacteria caused the lower protection rate or is merely a marker of a poorer immune response. Previous research, however, has shown that Staphylococcus aureus infections can cause immune cells to retreat from the skin and that toxins secreted by Staphylococcus can inhibit the action of antibody-secreting B cells.

Cochrane Review: All Moisturizers Created Equally for Eczema

No one moisturizer is better than another when it comes to relieving the symptoms of eczema, according to a new Cochrane Review. Overall, most moisturizers show beneficial effects for eczema, work better with active treatment, prolong time to flare, and reduce the number of flares and amount of topical corticosteroids needed to achieve similar reductions in eczema severity.

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The researchers reviewed 77 studies (6603 participants, mean age: 18.6 years, mean duration: 6.7 weeks). Of these, almost a third of the studies reported how people assessed their eczema. Only 13 assessed satisfaction with the moisturizer. The studies mostly evaluated physician-assessed eczema severity (65 studies). Other outcomes addressed were skin barrier function (29 studies), flare prevention (16), quality of life (10), and corticosteroid use (8).

Moisturizers reduced eczema severity compared with no moisturizer (three studies), but the reduction was too small to be considered important enough for a patient, according to the physicians. Moreover, there were fewer flares (two studies) and less topical corticosteroids were needed (two studies).

Participants thought Atopiclair (containing glycyrrhetinic acid) was more than four times more effective in improving eczema-severity than the vehicle, i.e. carrier (three studies). However, the physicians did not find a difference considered important enough for a patient. Atopiclair led to greater reduction of itch (four studies), more frequent satisfaction (two studies), and fewer flares (three studies). The number of reported adverse events was similar in each group, the review found.

Four studies evaluated urea-containing cream. Participants using urea reported skin improvement more often than those using placebo (one study). Satisfaction ratings were comparably positive between the two groups (one study). In addition, urea-containing cream improved dryness more often (physician assessment) (one study) and led to fewer flares (one study), but more adverse events were reported in this group.

Three studies assessed glycerol-containing moisturizer versus vehicle or placebo. More participants in the glycerol group considered their skin to be improved (one study), as did the physicians, but this was not considered important enough for patients. There was no difference in the number of adverse events reported in these studies.

Four studies investigated oat-containing moisturizers versus no treatment or vehicle. No differences between groups were observed for participant assessment of improvement (one study), satisfaction (one study), or physician-assessed improvement (three studies). However, fewer flares were reported in the oat group (one study), and less topical corticosteroids were needed (two studies). Oat creams caused more adverse events.

Participants considered moisturizers more than twice as effective in improving eczema than placebo, vehicle, or no moisturizer (five studies) and more effective on itch (seven studies). Participants in both treatment arms reported comparable satisfaction (three studies). The physicians, reported that moisturizers decreased eczema severity more than the control (12 studies) and led to fewer flares (six studies). There were no differences between the groups in the number of adverse events reported.

Topical corticosteroids were more effective in improving eczema when used together with a moisturizer, rather than alone, according to the physicians (three studies) and also reduced the number of flares (one study). Patients also preferred the combination. There was no difference in the number of adverse events reported.


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About Practical Dermatology

Practical Dermatology is the monthly publication that provides coverage of medical care, cosmetic advancements, and practice management for clinicians in the field. With straight-forward, how-to advice from experts in various fields, we strive to enhance quality of care and improve the daily operation of dermatology practices.