About this Journal Submit a Manuscript Table of Contents
Dermatology Research and Practice
Volume 2012 (2012), Article ID 923134, 6 pages
http://dx.doi.org/10.1155/2012/923134
Review Article

Barrier-Restoring Therapies in Atopic Dermatitis: Current Approaches and Future Perspectives

1Pediatric Dermatology Unit, Schneider Children's Medical Center of Israel, 49202 Petach Tikva, Israel
2Department of Dermatology, Szold Health Center, Clalit Health Services, 84894 Beer-Sheva, Israel
3Sackler Faculty of Medicine, Tel Aviv University, 69978 Tel Aviv, Israel
4Medical School for International Health, Faculty of Medicine, Ben-Gurion University of the Negev, 84105 Beer-Sheva, Israel

Received 21 April 2012; Accepted 18 June 2012

Academic Editor: Georgios Stamatas

Copyright © 2012 Y. Valdman-Grinshpoun et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Linked References

  1. S. L. Chamlin, I. J. Frieden, M. L. Williams, and M. M. Chren, “Effects of atopic dermatitis on young American children and their families,” Pediatrics, vol. 114, no. 3, pp. 607–611, 2004. View at Publisher · View at Google Scholar · View at Scopus
  2. S. P. McKenna and L. C. Doward, “Quality of life of children with atopic dermatitis and their families,” Current Opinion in Allergy and Clinical Immunology, vol. 8, no. 3, pp. 228–231, 2008. View at Publisher · View at Google Scholar · View at Scopus
  3. A. C. Krakowski, L. F. Eichenfield, and M. A. Dohil, “Management of atopic dermatitis in the pediatric population,” Pediatrics, vol. 122, no. 4, pp. 812–824, 2008. View at Publisher · View at Google Scholar · View at Scopus
  4. P. M. Elias, L. C. Wood, and K. R. Feingold, “Epidermal pathogenesis of inflammatory dermatoses,” American Journal of Contact Dermatitis, vol. 10, no. 3, pp. 119–126, 1999. View at Publisher · View at Google Scholar · View at Scopus
  5. A. Taïeb, “Hypothesis: from epidermal barrier dysfunction to atopic disorders,” Contact Dermatitis, vol. 41, no. 4, pp. 177–180, 1999. View at Publisher · View at Google Scholar · View at Scopus
  6. S. Seidenari and G. Giusti, “Objective assessment of the skin of children affected by atopic dermatitis: a study of pH, capacitance and TEWL in eczematous and clinically uninvolved skin,” Acta Dermato-Venereologica, vol. 75, no. 6, pp. 429–433, 1995. View at Scopus
  7. E. Proksch, R. Fölster-Holst, and J. M. Jensen, “Skin barrier function, epidermal proliferation and differentiation in eczema,” Journal of Dermatological Science, vol. 43, no. 3, pp. 159–169, 2006. View at Publisher · View at Google Scholar · View at Scopus
  8. S. L. Chamlin, J. Kao, I. J. Frieden et al., “Ceramide-dominant barrier repair lipids alleviate childhood atopic dermatitis: changes in barrier function provide a sensitive indicator of disease activity,” Journal of the American Academy of Dermatology, vol. 47, no. 2, pp. 198–208, 2002. View at Publisher · View at Google Scholar · View at Scopus
  9. J. L. Sugarman, J. W. Fluhr, A. J. Fowler, T. Bruckner, T. L. Diepgen, and M. L. Williams, “The objective severity assessment of atopic dermatitis score: an objective measure using permeability barrier function and stratum corneum hydration with computer-assisted estimates for extent of disease,” Archives of Dermatology, vol. 139, no. 11, pp. 1417–1422, 2003. View at Publisher · View at Google Scholar · View at Scopus
  10. Z. Ya-Xian, T. Suetake, and H. Tagami, “Number of cell layers of the stratum corneum in normal skin relationship to the anatomical location an the body, age, sex and physical parameters,” Archives of Dermatological Research, vol. 291, no. 10, pp. 555–559, 1999. View at Scopus
  11. P. M. Elias, “Epidermal lipids, barrier function, and desquamation,” Journal of Investigative Dermatology, vol. 80, pp. 44s–49s, 1983. View at Scopus
  12. P. M. Elias and K. R. Feingold, “Does the tail wag the dog? Role of the barrier in the pathogenesis of inflammatory dermatoses and therapeutic implications,” Archives of Dermatology, vol. 137, no. 8, pp. 1079–1081, 2001. View at Scopus
  13. D. J. Bibel, R. Aly, and H. R. Shinefield, “Antimicrobial activity of sphingosines,” Journal of Investigative Dermatology, vol. 98, no. 3, pp. 269–273, 1992. View at Scopus
  14. S. J. Miller, R. Aly, H. R. Shinefeld, and P. M. Elias, “In vitro and in vivo antistaphylococcal activity of human stratum corneum lipids,” Archives of Dermatology, vol. 124, no. 2, pp. 209–215, 1988. View at Scopus
  15. Y. Ohnishi, N. Okino, M. Ito, and S. Imayama, “Ceramidase activity in bacterial skin flora as a possible cause of ceramide deficiency in atopic dermatitis,” Clinical and Diagnostic Laboratory Immunology, vol. 6, no. 1, pp. 101–104, 1999. View at Scopus
  16. P. M. Elias, “The skin barrier as an innate immune element,” Seminars in Immunopathology, vol. 29, no. 1, pp. 3–14, 2007. View at Publisher · View at Google Scholar · View at Scopus
  17. J. Arikawa, M. Ishibashi, M. Kawashima, Y. Takagi, Y. Ichikawa, and G. Imokawa, “Decreased levels of sphingosine, a natural antimicrobial agent, may be associated with vulnerability of the stratum corneum from patients with atopic dermatitis to colonization by Staphylococcus aureus,” Journal of Investigative Dermatology, vol. 119, no. 2, pp. 433–439, 2002. View at Publisher · View at Google Scholar · View at Scopus
  18. A. Di Nardo, P. Wertz, A. Giannetti, and S. Seidenari, “Ceramide and cholesterol composition of the skin of patients with atopic dermatitis,” Acta Dermato-Venereologica, vol. 78, no. 1, pp. 27–30, 1998. View at Publisher · View at Google Scholar · View at Scopus
  19. O. Macheleidt, H. W. Kaiser, and K. Sandhoff, “Deficiency of epidermal protein-bound ω-hydroxyceramides in atopic dermatitis,” Journal of Investigative Dermatology, vol. 119, no. 1, pp. 166–173, 2002. View at Publisher · View at Google Scholar · View at Scopus
  20. W. Watson and S. Kapur, “Atopic dermatitis,” Allergy, Asthma and Clinical Immunology, vol. 7, 1, article S4, 2011. View at Publisher · View at Google Scholar
  21. P. M. Elias, “Therapeutic implications of a barrier-based pathogenesis of atopic dermatitis,” Annals of Dermatology, vol. 22, no. 3, pp. 245–254, 2010. View at Publisher · View at Google Scholar · View at Scopus
  22. B. S. Baker, “The role of microorganisms in atopic dermatitis,” Clinical and Experimental Immunology, vol. 144, no. 1, pp. 1–9, 2006. View at Publisher · View at Google Scholar · View at Scopus
  23. D. Y. M. Leung, M. Boguniewicz, M. D. Howell, I. Nomura, and Q. A. Hamid, “New insights into atopic dermatitis,” Journal of Clinical Investigation, vol. 113, no. 5, pp. 651–657, 2004. View at Publisher · View at Google Scholar · View at Scopus
  24. A. C. Krakowski and M. A. Dohil, “Topical therapy in pediatric atopic dermatitis,” Seminars in Cutaneous Medicine and Surgery, vol. 27, no. 2, pp. 161–167, 2008. View at Publisher · View at Google Scholar · View at Scopus
  25. P. Y. Ong, “Emerging drugs for atopic dermatitis,” Expert Opinion on Emerging Drugs, vol. 14, no. 1, pp. 165–179, 2009. View at Publisher · View at Google Scholar · View at Scopus
  26. J. F. Stalder, “Hydration cutaneous et atopic,” Annales de Dermatologie et de Venereologie, vol. 129, pp. 147–151, 2002.
  27. C. Charman, C. Chambers, and H. Williams, “Measuring atopic dermatitis severity in randomized controlled clinical trials: what exactly are we measuring?” Journal of Investigative Dermatology, vol. 120, no. 6, pp. 932–941, 2003. View at Publisher · View at Google Scholar · View at Scopus
  28. C. Holden, J. English, C. Hoare et al., “Advised best practice for the use of emollients in eczema and other dry skin conditions,” Journal of Dermatological Treatment, vol. 13, no. 3, pp. 103–106, 2002. View at Publisher · View at Google Scholar · View at Scopus
  29. M. Lodén, “The skin barrier and use of moisturizers in atopic dermatitis,” Clinics in Dermatology, vol. 21, no. 2, pp. 145–157, 2003. View at Publisher · View at Google Scholar · View at Scopus
  30. R. Ghadially, L. Halkier-Sorensen, and P. M. Elias, “Effects of petrolatum on stratum corneum structure and function,” Journal of the American Academy of Dermatology, vol. 26, no. 3, pp. 387–396, 1992. View at Scopus
  31. W. M. Macharia, G. M. Anabwani, and D. M. Owili, “Effects of skin contactants on evolution of atopic dermatitis in children: a case control study,” Tropical Doctor, vol. 21, no. 3, pp. 104–106, 1991. View at Scopus
  32. A. J. Nopper, K. A. Horii, S. Sookdeo-Drost, T. H. Wang, A. J. Mancini, and A. T. Lane, “Topical ointment therapy benefits premature infants,” Journal of Pediatrics, vol. 128, no. 5 I, pp. 660–669, 1996. View at Publisher · View at Google Scholar · View at Scopus
  33. G. L. Darmstadt, S. K. Saha, A. S. M. N. U. Ahmed et al., “Effect of topical emollient treatment of preterm neonates in Bangladesh on invasion of pathogens into the bloodstream,” Pediatric Research, vol. 61, no. 5, pp. 588–593, 2007. View at Publisher · View at Google Scholar · View at Scopus
  34. G. L. Darmstadt, N. Badrawi, P. A. Law et al., “Topically applied sunflower seed oil prevents invasive bacterial infections in preterm infants in Egypt: a randomized, controlled clinical trial,” Pediatric Infectious Disease Journal, vol. 23, no. 8, pp. 719–725, 2004. View at Publisher · View at Google Scholar · View at Scopus
  35. G. L. Darmstadt, S. K. Saha, A. S. M. N. U. Ahmed et al., “Effect of skin barrier therapy on neonatal mortality rates in preterm infants in bangladesh: a randomized, controlled, clinical trial,” Pediatrics, vol. 121, no. 3, pp. 522–529, 2008. View at Publisher · View at Google Scholar · View at Scopus
  36. G. L. Darmstadt, S. K. Saha, A. S. M. N. U. Ahmed et al., “Effect of topical treatment with skin barrier-enhancing emollients on nosocomial infections in preterm infants in Bangladesh: a randomised controlled trial,” The Lancet, vol. 365, no. 9464, pp. 1039–1045, 2005. View at Publisher · View at Google Scholar · View at Scopus
  37. E. L. Simpson, T. M. Berry, P. A. Brown, and J. M. Hanifin, “A pilot study of emollient therapy for the primary prevention of atopic dermatitis,” Journal of the American Academy of Dermatology, vol. 63, no. 4, pp. 587–593, 2010. View at Publisher · View at Google Scholar · View at Scopus
  38. J. Szczepanowska, A. Reich, and J. C. Szepietowski, “Emollients improve treatment results with topical corticosteroids in childhood atopic dermatitis: a randomized comparative study,” Pediatric Allergy and Immunology, vol. 19, no. 7, pp. 614–618, 2008. View at Publisher · View at Google Scholar · View at Scopus
  39. M. J. Cork, J. Britton, L. Butler, S. Young, R. Murphy, and S. G. Keohane, “Comparison of parent knowledge, therapy utilization and severity of atopic eczema before and after explanation and demonstration of topical therapies by a specialist dermatology nurse,” British Journal of Dermatology, vol. 149, no. 3, pp. 582–589, 2003. View at Publisher · View at Google Scholar · View at Scopus
  40. P. M. Elias, “Epilogue: fixing the barrier—theory and rational deployment,” in Skin Barrier, P. M. Elias and K. R. Feingold, Eds., pp. 591–600, Taylor & Francis, New York, NY, USA, 2006.
  41. M. Q. M. Man, K. R. Feingold, C. R. Thornfeldt, and P. M. Elias, “Optimization of physiological lipid mixtures for barrier repair,” Journal of Investigative Dermatology, vol. 106, no. 5, pp. 1096–1101, 1996. View at Scopus
  42. J. L. Sugarman, “The epidermal barrier in atopic dermatitis,” Seminars in Cutaneous Medicine and Surgery, vol. 27, no. 2, pp. 108–114, 2008. View at Publisher · View at Google Scholar · View at Scopus
  43. M. J. Cork, S. G. Danby, Y. Vasilopoulos et al., “Epidermal barrier dysfunction in atopic dermatitis,” Journal of Investigative Dermatology, vol. 129, no. 8, pp. 1892–1908, 2009. View at Publisher · View at Google Scholar · View at Scopus
  44. P. M. Elias, Y. Hatano, and M. L. Williams, “Basis for the barrier abnormality in atopic dermatitis: outside-inside-outside pathogenic mechanisms,” Journal of Allergy and Clinical Immunology, vol. 121, no. 6, pp. 1337–1343, 2008. View at Publisher · View at Google Scholar · View at Scopus
  45. P. M. Elias, “Barrier-repair therapy for atopic dermatitis: corrective lipid biochemical therapy,” Expert Review of Dermatology, vol. 3, no. 4, pp. 441–452, 2008. View at Publisher · View at Google Scholar · View at Scopus
  46. J. L. Sugarman and L. C. Parish, “Efficacy of a lipid-based barrier repair formulation in moderate-to-severe pediatric atopic dermatitis,” Journal of Drugs in Dermatology, vol. 8, no. 12, pp. 1106–1111, 2009. View at Scopus
  47. L. H. Kircik, J. Q. Del Rosso, and D. O. Faocd, “Nonsteroidal treatment of atopic dermatitis in pediatric patients with ceramide-dominant topical emulsion formulated with an optimized ratio of physiological lipids,” The Journal of Clinical and Aesthetic Dermatology, vol. 4, no. 12, pp. 25–31, 2011.
  48. S. Grether-Beck, I. Felsner, H. Brenden et al., “Urea uptake enhances barrier function and antimicrobial defense in humans by regulating epidermal gene expression,” Journal of Investigative Dermatology, vol. 132, no. 6, pp. 1561–1572, 2012. View at Publisher · View at Google Scholar
  49. J. L. Sugarman and L. J. Parish, “A topical physiologic lipid-based, barrier repair formulation (Epiceram cream) is highly effective monotherapy for moderate-to-severe pediatric atopic dermatitis: a multicenter, investigator blinded trial comparing a barrier repair formulation,” Journal of Investigative Dermatology, vol. 128, article s54, 2008.
  50. M. Man, M. Hupe, D. Mackenzie et al., “A topical Chinese herbal mixture improves epidermal permeability barrier function in normal murine skin,” Experimental Dermatology, vol. 20, no. 3, pp. 285–288, 2011. View at Publisher · View at Google Scholar · View at Scopus
  51. J. Reuter, C. Huyke, H. Scheuvens et al., “Skin tolerance of a new bath oil containing St. John's wort extract,” Skin Pharmacology and Physiology, vol. 21, no. 6, pp. 306–311, 2008. View at Publisher · View at Google Scholar · View at Scopus
  52. G. N. Stamatas, J. de Sterke, M. Hauser, O. von Stetten, and A. van der Pol, “Lipid uptake and skin occlusion following topical application of oils on adult and infant skin,” Journal of Dermatological Science, vol. 50, no. 2, pp. 135–142, 2008. View at Publisher · View at Google Scholar · View at Scopus
  53. A. Patzelt, J. Lademann, H. Richter et al., “In vivo investigations on the penetration of various oils and their influence on the skin barrier,” Skin Research and Technology, vol. 18, no. 3, pp. 364–369, 2012. View at Publisher · View at Google Scholar
  54. A. L. C. Agero and V. M. Verallo-Rowell, “A randomized double-blind controlled trial comparing extra virgin coconut oil with mineral oil as a moisturizer for mild to moderate xerosis,” Dermatitis, vol. 15, no. 3, pp. 109–116, 2004. View at Scopus
  55. E. Proksch, H. P. Nissen, M. Bremgartner, and C. Urquhart, “Bathing in a magnesium-rich Dead Sea salt solution improves skin barrier function, enhances skin hydration, and reduces inflammation in atopic dry skin,” International Journal of Dermatology, vol. 44, no. 2, pp. 151–157, 2005. View at Publisher · View at Google Scholar · View at Scopus
  56. M. Portugal-Cohen, M. Oron, E. Merrik et al., “A dead sea water-enriched body cream improves skin severity scores in children with atopic dermatitis,” Journal of Cosmetics, Dermatological Sciences and Applications, vol. 1, no. 3, pp. 71–78, 2011. View at Publisher · View at Google Scholar
  57. T. Bieber, “Atopic dermatitis,” The New England Journal of Medicine, vol. 358, no. 14, pp. 1483–1430, 2008. View at Publisher · View at Google Scholar · View at Scopus
  58. M. Löwenberg, C. Stahn, D. W. Hommes, and F. Buttgereit, “Novel insights into mechanisms of glucocorticoid action and the development of new glucocorticoid receptor ligands,” Steroids, vol. 73, no. 9-10, pp. 1025–1029, 2008. View at Publisher · View at Google Scholar · View at Scopus
  59. M. Toyoda, M. Nakamura, T. Makino, T. Hino, M. Kagoura, and M. Morohashi, “Nerve growth factor and substance P are useful plasma markers of disease activity in atopic dermatitis,” British Journal of Dermatology, vol. 147, no. 1, pp. 71–79, 2002. View at Publisher · View at Google Scholar · View at Scopus
  60. J. Yamaguchi, M. Aihara, Y. Kobayashi, T. Kambara, and Z. Ikezawa, “Quantitative analysis of nerve growth factor (NGF) in the atopic dermatitis and psoriasis horny layer and effect of treatment on NGF in atopic dermatitis,” Journal of Dermatological Science, vol. 53, no. 1, pp. 48–54, 2009. View at Publisher · View at Google Scholar · View at Scopus
  61. S. Hoffjan and J. T. Epplen, “The genetics of atopic dermatitis: recent findings and future options,” Journal of Molecular Medicine, vol. 83, no. 9, pp. 682–692, 2005. View at Publisher · View at Google Scholar · View at Scopus
  62. T. Hultsch, A. Kapp, and J. Spergel, “Immunomodulation and safety of topical calcineurin inhibitors for the treatment of atopic dermatitis,” Dermatology, vol. 211, no. 2, pp. 174–187, 2005. View at Publisher · View at Google Scholar · View at Scopus
  63. J. S. Kao, J. W. Fluhr, M. Q. Man et al., “Short-term glucocorticoid treatment compromises both permeability barrier homeostasis and stratum corneum integrity: Inhibition of epidermal lipid synthesis accounts for functional abnormalities,” Journal of Investigative Dermatology, vol. 120, no. 3, pp. 456–464, 2003. View at Publisher · View at Google Scholar · View at Scopus
  64. M. Kim, M. Jung, S. P. Hong et al., “Topical calcineurin inhibitors compromise stratum corneum integrity, epidermal permeability and antimicrobial barrier function,” Experimental Dermatology, vol. 19, no. 6, pp. 501–510, 2010. View at Publisher · View at Google Scholar · View at Scopus
  65. P. M. Schlievert, L. C. Case, K. L. Strandberg, B. B. Abrams, and D. Y. M. Leung, “Superantigen profile of Staphylococcus aureus isolates from patients with steroid-resistant atopic dermatitis,” Clinical Infectious Diseases, vol. 46, no. 10, pp. 1562–1567, 2008. View at Publisher · View at Google Scholar · View at Scopus
  66. K. M. Aberg, M. Q. Man, R. L. Gallo et al., “Co-regulation and interdependence of the mammalian epidermal permeability and antimicrobial barriers,” Journal of Investigative Dermatology, vol. 128, no. 4, pp. 917–925, 2008. View at Publisher · View at Google Scholar · View at Scopus
  67. C. Vestergaard, M. Hvid, C. Johansen, K. Kemp, B. Deleuran, and M. Deleuran, “Inflammation-induced alterations in the skin barrier function: implications in atopic dermatitis,” Chemical Immunology and Allergy, vol. 96, pp. 77–80, 2012. View at Publisher · View at Google Scholar
  68. R. Nazarian and J. M. Weinberg, “AN-2728, a PDE4 inhibitor for the potential topical treatment of psoriasis and atopic dermatitis,” Current Opinion in Investigational Drugs, vol. 10, no. 11, pp. 1236–1242, 2009. View at Scopus
  69. R. Bissonnette, Y. Poulin, Y. Zhou, et al., “Efficacy and safety of topical WBI-1001 in patients with mild to severe atopic dermatitis: results from a 12-week, multicentre, randomized, placebo-controlled double-blind trial,” British Journal of Dermatology, vol. 166, no. 4, pp. 853–860, 2012. View at Publisher · View at Google Scholar
  70. J. H. Yang, “Topical application of fucoidan improves atopic dermatitis symptoms in NC/Ngamice,” Phytotherapy Research. In press. View at Publisher · View at Google Scholar