Transcript Document

The Role of Topical Moisturizers
in Managing Compromised Skin
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Skin Function
• Natural protective barrier from
• physical injury
• pathogenic microbes
• chemical agents
• UV radiation
• extreme temperatures
• Helps to restrict fluid and water loss
• Sensory perception: temperature,
pressure, touch and pain
• Temperature regulation of the body
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1. Irving V: Caring for and protecting the skin of pre-term neonates. J Wound Care 2001, 10:253-6.
2. Nikolovski J, Stamatas GN, Kollias N, Wiegand BC: Barrier function and water-holding and transport properties of infant
stratum corneum are different from adult and continue to develop through the first year of life. J Invest
Dermatol 2008, 128:1728-36.
Bricks & Mortar
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Infant vs Adult Skin
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The Infant Skin Barrier: Can We Preserve, Protect, and Enhance the Barrier? Lorena S. Telofski, A. PeterMorello III, M. CatherineMack
Correa, and Georgios N. Stamatas; Dermatology Research and Practice Volume 2012, Article ID 198789, 18 pages doi:10.1155/2012/198789
Structure
SKIN PARAMETER
ADULT
INFANT
More dense
Surface
Microrelief lines
Less dense
Cell size
Corneocytes (SC)
Larger
Smaller
Granular Keratinocytes
Larger Less
dense
Smaller
More densely packed
Thickness
Stratum corneum
Epidermis
Dermal
structure
Thicker
~ 10µm
Thicker
Dermal papillae
Less homogenous
(density, size, morphology)
Distinction between
papillary and reticular
dermis
Present
Thinner
~ 7µm
Thinner (-20% vs adult)
↗ water retention
↗ permeability
More homogenous
Absent
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© Johnson & Johnson GmbH 2014
L.S Telosfski et al. Dermatology Research and Practice, vol 2012
G.N. Stamatas et al. International Journal of Cosmetic Science, 2011, 33, 17-24
Composition
SKIN PARAMETER
Water content
NMF
Surface lipids
Stratum corneum
ADULT
Lower
INFANT
Higher (in older
infants)
Drier at birth
Higher
Inter-personal variability
Lower
Natural moisturizing factor
concentration
Higher
Lower
Higher
Lower
(7-10 month-old
infant)
Lower
Sebum
Collagen
Fiber density
Melanin
Density
Higher (young
adult)
Higher
Lower
↗ skin hydration
↗ dryness
↘ hydro-lipid film
protection
↘ UV protection
NMF: Natural
moisturizing factor
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© Johnson & Johnson GmbH 2014
L.S Telosfski et al. Dermatology Research and Practice, vol 2012
G.N. Stamatas et al. International Journal of Cosmetic Science, 2011, 33, 17-24
Function
SKIN PARAMETER
ADULT
INFANT
Protective
barrier
Skin barrier function
Competent
Competent –
still maturing
TEWL
Trans-epidermal water loss
Lower
Higher
Water handling
Rate of water absorption
Lower
Higher
Rate of water desorption
Lower
Higher
Cell
proliferation
Turnover rate
Lower
Higher
pH
Surface pH
Lower
More alkaline
(newborn only)
↗ water
evaporation
↗ potential
infections
TEWL:
Transepidermal
water loss
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© Johnson & Johnson GmbH 2014
L.S Telosfski et al. Dermatology Research and Practice, vol 2012
G.N. Stamatas et al. International Journal of Cosmetic Science, 2011, 33, 17-24
Role of skin lipids
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Importance of proper pH
• Babies are born with skin pH close to neutral: 6.6 - 7.5
• Adults have a much more acidic skin with pH values: 4.5 - 6.7
• Acidic skin pH affects several activities:
• Maturation and maintenance of the epidermal
permeability barrier
• Control of the desquamation process
• Regulation of bacterial proliferation on the skin
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G.N. Stamatas et al. International Journal of Cosmetic Science, 2011, 33, 17-24
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Epidermal Barrier Dysfunction in Atopic Dermatitis. Michael J. Cork, et al., Journal of Investigative Dermatology (2009) Vol 129
Healthy Barrier Function
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© Johnson & Johnson GmbH 2014
L.S Telosfski et al. Dermatology Research and Practice, vol 2012
G.N. Stamatas et al. International Journal of Cosmetic Science, 2011, 33, 17-24
Oats in Skincare
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Attributes of Oats in Skin Care
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Buffering Capacity of Colloidal Oatmeal Restores
the pH of Damaged Skin to Within the Normal Range
ECZEMA (N=33)
WINTER ITCH
(N=16)
SENILE SKIN
(N=14)
pH measured on
forearm
pH LEVEL IMMEDIATELY
AFTER TREATMENT WITH
COLLOIDAL OATMEAL
PH
SENILE PRURITUS
pH LEVEL BEFORE TREATMENT
(N=33)
NORMAL pH RANGE
4.2-5.5
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Grais M. AMA Arch Derm Syphilol.1953;68(4):402-407.
Avenanthramides
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Avenanthramides vs other oat fractions
The avenanthramide fraction is the most effective oat component in reducing
UV-induced redness 24 hours after dermal application
Avenanthramides
Flavonoids
Saponins
0
50
100
150
200
250
% of redness attenuation per gram after
UV irradiation. Measure 24h after application
Vollhardt J, Fielder DA, Redmont MJ. Identification and cosmetic application of powerful anti-irritant constituents
of oat grain. XXI IFSCC International Congress 2000, Berlin. Proceedings; 395-402.
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Separated oat fractions tested in a skin erythema model/Patients received 1.5 MED of UVB/Products
applied 24 hours after irradiation/Clinical erythema evaluation 24 hours after product application
Avenanthramides: Inhibition of Markers Related to
Topical Skin Irritation
IL-8 Release (pg/mL)
from Keratinocytes
270
240
210
180
150
Unstimulated Stimulated
1
10
100
Avenanthramide (μg/mL)
Wallo W, et al. Poster presented at: 65th annual meeting of the AAD. February 2-6, 2007; Washington, DC.
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IL-8=interleukin-8.
Oat Lipids
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Composition of Oat Lipids
•
Total lipid content of oats: from 2%–11.8%
dry weight
•
Triglycerides
•
Phospholipids
•
Lecithin
•
Glycolipids
•
Free fatty acids
– Oleic, Linoleic, Palmitic, Stearic
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Zhou M, et al. J American Oil Chem Soc. 1999;76(2):159-169.
Oat Oil Reduces TEWL Compared to Control Sites
Potter RC et al. US Patent 5620692. April 15, 1997.
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TEWL=transepidermal water loss.
Whole Oat Oil Lipid Class Composition
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Southall M, et al. The Dermatologist. September 2012 (suppl):1-4.
Clinical Evidence Supporting the Use of
Oat-Containing Products in Skin Care
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Colloidal Oatmeal Cream vs Rx Barrier Emulsion for
Improving Skin Barrier in Moderate-to-Severe Dry Skin
Colloidal Oatmeal Cream
Rx Skin Barrier Emulsion
Percent Mean Reduction in
Water Loss
-15
Regression
Period
-20
-25
-30
1
4
7
9
Days
Nebus J, et al. J Am Acad Dermatol. 2011;64:AB71.
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-35
Effectiveness of a colloidal oat lotion vs
vehicle for the relief of dry, itchy skin
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A Randomized, Double-Blind Bilateral Controlled Study to Evaluate the Effectiveness of an Oatmeal Containing Lotion vs
Vehicle for the Relief of Dry, Itchy Skin, data on file.
Colloidal Oatmeal Bath* in the Treatment of
Dry and Sensitive Skin in Atopic Dermatitis
4-week, investigator-blinded, crossover study (N=25)
1.2
Grading Score
1.0
50%
0.8
Itching
0.6
Burning
0.4
67%
0.2
Before
After
*Colloidal oatmeal with ceramides and dexpanthenol.
Wallo W, et al. Poster presented at: 65th annual meeting of the AAD; February 2–6, 2007; Washington DC.
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0
Daily Oat-based Skin Care Regimen for
Atopic Skin: EASI Composite Score
Dermatologist Assessment: EASI Composite Score (ages 12–60 years)
8
EASI (Mean)
6
4
*
*
*
2
Baseline
Week 2
Week 4
Week 8
EASI=eczema area and severity index .
*Significant improvement (P<0.001).
Fowler JF, et al. J Drugs Dermatol. 2012;11(7):804-807.
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0
Evaluating the Tolerance and Safety of a Colloidal Oat and Ceramide containing
Moisturizing Cream and Oatmeal containing Moisturizing Wash in Babies and
Children with Atopic Dermatitis
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Nebus J, Wallo W, Eichenfeld L, MD; Poster presented at the 34th Annual Meeting of the Society of Pediatric
Dermatology. July 2008
Assessment of a Colloidal Oatmeal and Ceramide containing Moisturizing Cream
through a multi-centric clinical study on infants, children and adults with AD*
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*Assessment of AVEENO® Eczema Therapy Moisturizing Cream through a multi-centric clinical study on infants,
children and adults with Atopic dermatitis. (n=71 patients in total aged 6 months to adult; topical steroid data based
on n=19 patients who previously used topical steroids during the washout period).
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