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PubMed2007

The steroid-sparing effect of an emollient therapy in infants with atopic dermatitis: a randomized controlled study.

BACKGROUND: No study has clearly demonstrated the steroid-sparing effect of emollients in the treatment of atopic dermatitis (AD). AIM: Evaluating the effect of an emollient containing oat extracts on the amount of topical corticosteroids used in infants with moderate to severe AD. STUDY DESIGN: During 6 weeks, 173 infants under 12 months old treated for inflammatory lesions by moderate- and/or high-potency topical corticosteroids randomly received the emollient or not (control group). METHODS: Evaluation of corticosteroid consumption by weighing the tubes, disease severity by the Scoring Atopic Dermatitis Index (SCORAD), and infants' and parents' quality of life by Infant's Dermatitis Quality of Life Index and Dermatitis Family Impact scores at D0, D21 and D42. RESULTS: Compared to the control group, the amount of moderate- and high-potency corticosteroids used in 6 weeks decreased by 7.5% (not significant) and 42% (p < 0.05), respectively, in the emollient group. The SCORAD index, and infants' and parents' quality of life significantly improved (p < 0.0001) in both groups. CONCLUSION: The emollient treatment significantly reduced the high-potency topical corticosteroid consumption in infants with AD.

Administration, Topical↗

PubMed1993

Effects of repeated application of emollient cream to premature neonates' skin.

OBJECTIVE: Emollient cream moisturizers are often used on premature newborns in neonatal intensive care units without accurate knowledge of the risks or benefits to the neonate. DESIGN: We prospectively compared premature neonates treated with a water-in-oil emollient cream for up to 16 days to untreated premature neonates. SETTING: The study was completed in a neonatal intensive care unit on neonates admitted for respiratory distress and/or possible sepsis. PATIENTS: Thirty-four neonates, between 29 and 36 weeks estimated gestational age, entered the study. INTERVENTIONS: One-half of the neonates were treated twice a day with an water-in-oil emollient cream, and the other half served as controls. OUTCOME MEASURES: The skin condition of the neonates' hands, feet, and abdomen was evaluated on entering the study and twice a week. Fungal cultures and quantitative bacterial cultures were obtained from the axilla and abdomen on entering the study and twice a week. RESULTS: The mean gestational age of the treated neonates was 32.3 weeks, whereas the mean gestational age of the control neonates was 32.5 weeks. The neonates treated with emollient cream demonstrated statistically less dermatitis of their hands (day 2 through day 11), their feet (day 2 through day 16), and their abdomen (day 7 through day 11). Fungal cultures and quantitative bacterial cultures of the abdomen and axilla were equivalent in both groups. CONCLUSIONS: These studies document that emollient cream moisturizer therapy of premature neonates decreases dermatitis without changing the microbiological flora.

Emollients↗

PubMed2005

Clobetasol propionate lotion, an efficient and safe alternative to clobetasol propionate emollient cream in subjects with moderate to severe plaque-type psoriasis.

BACKGROUND: Various formulations of clobetasol propionate are currently used to treat psoriasis due to its anti-inflammatory, anti-pruritic, vasoconstrictive and immunomodulating properties. OBJECTIVE: To assess the efficacy, safety and remission profile of clobetasol propionate lotion compared to that of clobetasol propionate emollient cream and lotion vehicle in subjects with moderate to severe plaque-type psoriasis. METHODS: Multicentre, investigator-blind, randomized, active- and vehicle-controlled, parallel-group study. RESULTS: A total of 192 subjects were treated: 82 with clobetasol propionate lotion, 81 with clobetasol propionate cream and 29 with the vehicle. Clobetasol propionate lotion was significantly more effective than vehicle lotion and was comparable in efficacy to the emollient cream after 4 weeks of treatment. Treatment success was higher for subjects in the clobetasol propionate lotion group than in the emollient cream group after 4 weeks of a treatment-free follow-up period. Clobetasol propionate lotion was safe and well tolerated. CONCLUSION: The present study demonstrates that clobetasol propionate lotion is an efficacious, safe and well-tolerated alternative to the currently available emollient cream formulation, while showing a better remission profile after 4 weeks of treatment-free follow-up period.

Administration, Topical↗

PubMed2006

A cost-utility analysis of pimecrolimus vs. topical corticosteroids and emollients for the treatment of mild and moderate atopic eczema.

BACKGROUND: Conventional treatments for atopic eczema include topical corticosteroids (TCS) and emollients. Pimecrolimus, an immunosuppressant, was licensed in the U.K. in 2003 as an alternative treatment of mild to moderate atopic eczema. OBJECTIVES: To assess the cost-utility of pimecrolimus as a treatment for mild and moderate atopic eczema when compared with conventional treatments which use TCS and emollients. METHODS: A Markov state-transition model was developed to represent the cyclical nature of atopic eczema and provide an economic analysis of cost-utility for treatment alternatives from the perspective of a third party payer (U.K. National Health Service). A range of methods was used to obtain data for transition probabilities, costs and quality of life. These included a systematic review of published effectiveness data, expert opinion, and a utility study conducted by the authors. Separate cohort analyses were modelled to distinguish between children and adult populations and between differing treatment patterns for facial and body eczema. One-way sensitivity analyses and probabilistic sensitivity analysis (using Monte-Carlo simulation) were performed. RESULTS: Baseline cost-utility outputs from the model show that, in all tested scenarios, TCS dominate pimecrolimus (i.e. TCS are both cheaper and more effective). However, the differences in benefits between treatments output by the model are very small. Sensitivity analyses highlight the importance of cost variations in pimecrolimus. Where pimecrolimus is compared with emollient only it is probably cost effective at a willingness-to-pay threshold of 30 000 UK pounds per quality-adjusted life year. CONCLUSIONS: There are likely to be few situations in which the use of pimecrolimus for the treatment of atopic eczema can be justified on economic grounds. Exceptions are likely to be in cases where TCS have been shown to be ineffective, unacceptable due to adverse events, or where a patient is unwilling to accept TCS treatment despite appropriate education and support and emollient alone is the alternative clinical option.

Adult↗

PubMed2005

Novel approach to the treatment of hyperpigmented photodamaged skin: 4% hydroquinone/0.3% retinol versus tretinoin 0.05% emollient cream.

BACKGROUND: Mild to moderately photodamaged skin is characterized by dyspigmentation, fine wrinkles, and tactile roughness. An optimal approach to the topical treatment of photoaging would simultaneously address all appearance issues. OBJECTIVE: This study was undertaken to evaluate the effect of 4% hydroquinone and 0.3% retinol in photoaging. MATERIALS AND METHODS: A 16-week study was designed to evaluate the efficacy and tolerance of a single cream containing prescription topical 4% hydroquinone for dyspigmentation and the cosmeceutical 0.3% retinol for fine wrinkles in an emollient vehicle for tactile roughness. This novel formulation was compared with 0.05% tretinoin emollient cream, the standard against which all other topical photoaging treatments are compared. Investigator assessments, subject assessments, and photography represented the evaluation end points. RESULTS: The cosmeceutical emollient 4% hydroquinone/0.3% retinol cream more effectively diminished the collective signs of photodamage than 0.05% tretinoin emollient cream in terms of dyspigmentation, fine wrinkles, and tactile roughness in 16 weeks. CONCLUSION: Combination therapy of hydroquinone and retinol may improve photoaging-associated hyperpigmentation.

Administration, Topical↗

PubMed1994

Efficacies of a barrier cream and an afterwork emollient cream against cutting fluid dermatitis in metalworkers: a prospective study.

We compared the point prevalence of cutting fluid dermatitis and transepidermal water vapour loss (TEWL) changes in groups of new machinists who (a) used a barrier cream; (b) used an afterwork emollient cream; and (c) did not use any cream (controls) over a 6-month period. All machinists handled cutting fluid (neat mineral oil) during their work. There was no significant difference in the prevalence of cutting fluid dermatitis in the 3 groups throughout the study period. The prevalence of cutting fluid dermatitis in all groups increased rapidly during the first 6 weeks and thereafter remained steady throughout the remainder of the study period. The prevalence of cutting fluid dermatitis was slightly lower in machinists using afterwork emollient cream compared to those using barrier cream and controls (not significant). The differences in the mean TEWL changes during the study period among the 3 groups were also not statistically significant. The mean TEWL values in the 3 groups increased rapidly during the first 6 weeks of exposure to cutting fluids and thereafter remained fairly constant throughout the remainder of the study period. Barrier cream and afterwork emollient cream did not appear to have any significant effect against either cutting fluid dermatitis or TEWL changes in machinists exposed to cutting fluid. However, afterwork emollient cream appeared clinically to help reduce the prevalence of cutting fluid irritation.

Adolescent↗

PubMed2005

The management of dry skin with topical emollients--recent perspectives.

Dry skin (xerosis) is a common symptom of a number of chronic skin diseases, such as atopic dermatitis, but can also be caused by environmental factors, such as cold weather and frequent showering. The condition can cause unsightliness of the skin, discomfort, itching, and can have a negative impact on patients' quality of life. This article will cover recent developments in the understanding of xerosis and its management with emollients. The stratum corneum consists of corneocytes and lipid-enriched intercellular bilayers. These are both produced from keratinocytes in a process called epidermal differentiation. Disturbed epidermal differentiation, resulting in the impairment of stratum corneum intercellular lipid bilayers and natural moisturizing factor, is the root cause of xerosis. The constituent ingredients of emollients should, therefore, address the different factors that contribute to dry skin and, most importantly, attempt to restore epidermal differentiation. The use of lipids, physiological lipids, humectants and antipruritics will help to restore the lipid lamellae, improve skin hydration, skin elasticity and prevent itching. The ideal emollient will include these ingredients plus an agent to support epidermal differentiation. Selecting the correct emollient product and using it regularly are vital factors in the management of xerosis.

Cell Differentiation↗

PubMed2006

Emollient foam in topical drug delivery.

Foams offer an innovative and more convenient means of topical drug delivery. The successful introduction of hydroalcoholic foams paved the way for the development of a new generation of foam products that provide skin barrier build-up and hydration. Such foams, designated as emollient foams consist of oil-in-water or water-in-oil emulsions with necessary excipients, such as non-ionic surfactants, gelling agents and foam adjuvants. Emollient foams can carry a broad variety of topical drugs, including water-soluble, oil-soluble and suspended active agents. This paper reviews emollient foam compositions and their physicochemical properties. It further accounts for the usability and functional advantages of emollient foam as a vehicle of topical drugs, including: i) improved usability, which affects treatment, compliance and, consequently, improves therapeutic results; ii) safety; iii) controllable drug delivery; iv) skin barrier build-up and hydration; and v) enhanced clinical efficacy.

Administration, Topical↗

PubMed2004

A new multifunctional, shine-enhancing emollient: PPG-3 benzyl ether myristate.

A new emollient ester--Crodamol STS (INCI name: PPG-3 Benzyl Ether Myristate) has been developed and characterized. This special non-volatile emollient is safe to use and provides silicone-like feel and multiple cosmetic functionality. It is a liquid with a viscosity about 100 cps at room temperature. It has a high refractive index--1.4696, which enhances hair shine, contributes to high gloss in lip products, and reduces whitening effect of fatty alcohols and silica in anti-perspirants/deodorants applications. This emollient has high solubility of UV filters, low skin-spreading factor, and good pigment wetting behavior, which are preferable in sunscreen and make-up formulas to enhance the pigment localization and improve SPF value. In this paper, the chemical structure, physical properties, and various cosmetic applications of the emollient will be discussed. Especially, an objective hair shine (luster) test method (color image analysis) has been established and applied to study the enhancement in hair shine by Crodamol STS in hair spray and hair gel formulations. The objective measurements in hair shine showed good agreement with the results obtained from subjective evaluations. The substantivity of Crodamol STS on hair surface, which was delivered from a rinse-off cream, was also determined by a solvent extraction method.

Benzyl Compounds↗

PubMedDate not supplied

Study of sensory properties of emollients used in cosmetics and their correlation with physicochemical properties.

Eight liquid emollients (mineral oil, sunflower oil, squalane, decyl oleate, isopropyl myristate, octyldodecanol, dimethicone, and cyclomethicone) were characterized by instrumental and sensory methods and evaluated to determine the relationship between sensory and instrumental measures. Sensory analysis was carried out by a panel of 14 assessors, who evaluated the following attributes: difficulty of spreading, gloss, residue, stickiness, slipperiness, softness, and oiliness. The physicochemical properties measured were spreadability (at one-half minute and at one minute), viscosity, and superficial tension. Data collected were statistically analyzed by analysis of variance (ANOVA), principal component analysis (PCA), and linear partial least squares regression analysis (PLS). In consideration of their physicochemical characteristics, the studied emollients were sorted into three groups, in which the silicones distinctly separate from the rest. Sensory characteristics enabled the discrimination of four groups of emollients where, besides the two silicones, isopropyl myristate was also differentiated. PLS revealed that emollient sensory attributes could be well predicted by instrumental measurements.

Cosmetics↗

PubMedDate not supplied

After-work emollient creams: effects on irritant skin reactions.

In this study, the influence of 4 after-work emollients on the healing of irritant skin reactions of varying intensity was assessed. To this end 5 patch tests with sodium lauryl sulphate (SLS) 2.5 g/v% were performed on the volar side of the forearm of 30 healthy Caucasian volunteers. Patch tests were removed after 12 h (group A, n = 10), 24 h (group B, n = 10) or 48 h (group C, n = 10). Then standard amounts of the emollients were applicated to the induced skin reactions, twice daily for a period of 5 days. One skin site served as a control. Skin sites were evaluated before, during and after the test period using laser Doppler flow measurements, skin vapor loss measurements and a visual scoring system. In all groups, data obtained from the skin sites treated with the emollients did not differ significantly from the data obtained from the control site. Thus, skin regeneration of the irritant skin reactions was not really enhanced by the application of these preparations. Further investigations on after-work emollient creams with physiologically better adapted constituents are necessary.

Adult↗

PubMed2005

Long-term efficacy and safety of tretinoin emollient cream 0.05% in the treatment of photodamaged facial skin: a two-year, randomized, placebo-controlled trial.

BACKGROUND: Long-term (>1 year) placebo-controlled studies of tretinoin in the treatment of photodamaged skin have not been conducted. Recently, we conducted a 2-year placebo-controlled study of tretinoin emollient cream 0.05%, including histopathologic assessment of safety and analysis of markers of collagen deposition. OBJECTIVE: The objective of the study was to determine the long-term safety and efficacy of tretinoin emollient cream 0.05% in the treatment of moderate to severe facial photodamage. METHODS: A total of 204 subjects were treated with tretinoin or placebo (vehicle emollient cream) applied to the entire face once a day for up to 2 years. Clinical and histologic effects were assessed at regularly scheduled clinic visits. RESULTS: Treatment with tretinoin resulted in significantly greater improvement relative to placebo in clinical signs of photodamage (fine and coarse wrinkling, mottled hyperpigmentation, lentigines, and sallowness), overall photodamage severity, and investigator's global assessment of clinical response (p<0.05). Histologic evaluation showed no increase in keratinocytic or melanocytic atypia, dermal elastosis, or untoward effects on stratum corneum following treatment with tretinoin compared with placebo. Immunohistochemistry studies, conducted at three study centers, showed a significant increase relative to placebo in facial procollagen 1C terminal, a marker for procollagen synthesis, at month 12 (p=0.0074). CONCLUSION: Long-term treatment with tretinoin emollient cream 0.05% is safe and effective in subjects with moderate to severe facial photodamage.

Administration, Topical↗

PubMed2003

Emollients and the response of facial skin to a cold environment.

BACKGROUND: It is debated whether the use of emollients, in cold weather, constitutes a protective factor or a risk factor for frostbite. OBJECTIVES: To compare the effects of two emollients [oil in water (O/W) and petrolatum] on facial skin in response to cold exposure. METHODS: Fifteen volunteers participated in the experiment, consisting of 60 min in a cold room (-5 degrees C), preceded and followed by 30 min of acclimatization at room temperature. In the cold room, O/W was applied on one cheek and petrolatum on the other. The cheeks were exposed to wind, produced by a fan, to cool further the skin by the wind chill index. Skin temperature, redness, and transepidermal water loss (TEWL) were measured on both cheeks. RESULTS: Facial skin treated with O/W was significantly colder (up to 1.3 degrees C) than facial skin treated with petrolatum, but the difference disappeared within 20 min. Agreement between temperature measurements and subjective thermal sensations was poor (Cohen's kappa = -0.13). At no point did the paired skin redness and the paired TEWL values vary significantly. The TEWL levels were significantly lower 30 min after the cold exposure than before, but had reached pre-exposure levels the following day. CONCLUSIONS: This study demonstrates that for a duration exposure of 20 min, facial skin treated with O/W achieves a lower temperature than facial skin treated with petrolatum. The two emollients had in all other aspects the same effect on the response of facial skin to cold.

Adult↗

PubMed1998

Clobetasol propionate emollient 0.05% in the treatment of atopic dermatitis.

A 4-week, double-blind, randomized clinical trial, comparing the efficacy and safety of clobetasol propionate emollient cream 0.05% and its vehicle, was conducted at four private dermatology clinics in 81 non-hospitalized patients (> or = 12 years old) with moderate-to-severe atopic dermatitis covering 2% or more of their body surface. All patients had at least one lesion 2 cm or more in diameter. Three signs/symptoms of target lesions (erythema, pruritus, and induration/papulation) were scored by investigators on a scale of 0-3 (in 0.5-point increments; 0 = absent, 1 = mild, 2 = moderate, and 3 = severe); the total of the three scores had to be > or = 6 for patients to qualify for study entry. Patients were excluded if they were immunocompromised, pregnant, or nursing; had skin atrophy, telangiectasia or striae in skin areas to be treated; or had received topical treatments for atopic dermatitis within 1 week prestudy, intramuscular triamcinolone within 6 weeks prestudy, or long-term systemic corticosteroid usage within 6 months prestudy. Patients were randomized in a 1:1 ratio to receive either clobetasol propionate emollient 0.05% twice daily (n = 41), or the emollient vehicle twice daily (n = 40), for 4 weeks. A fingertip unit, equaling approximately 0.5 g in males and 0.43 g in females (enough to cover approximately 2% of the body), was used to measure and apply a thin film of study drug to the affected areas. The efficacy was evaluated by investigators and patients on days 4, 8, 15, and 29 after initiation of therapy, and 2 weeks after the end of treatment (day 43). Investigators performed a physician's gross assessment based on the percentage improvement of the target lesion. They also rated changes from baseline in mean severity scores for six individual signs/symptoms (erythema, pruritus, induration/papulation, lichenification, erosion/oozing/crusting, and scaling/dryness) and for total signs/symptoms according to the severity scoring system described above. Patients rated their response to treatment as excellent, good, fair, poor, or worse. Laboratory assessments were made on days 15, 29, and (if necessary) day 43.

Administration, Topical↗

PubMed2000

Thermal effects of emollients on facial skin in the cold.

Ointments are traditionally used in Finland for protection against facial frostbite. Recent epidemiological reports showed unexpectedly, however, that the use of ointments is a statistically considerable risk factor for frostbite of the face and ears. The effects of 4 different emollients on facial temperature were studied in 46 acute cold exposures. The voluntary test persons sat in a cold chamber after emollients were applied thickly on half of the face, while the other half acted as an untreated control. Thermistors and an infrared scanner were used to measure skin temperature of symmetrical areas of the face. The thermal sensations on the corresponding sites were also recorded. Test emollients more often had an objectively cooling than a warming effect on facial skin. However, white petrolatum often produced a subjectively warming skin sensation. "Protective" ointments may cause a false sensation of safety, leading to increased risk of frostbite due to neglect of other protective measures.

Adult↗

PubMed2004

Tazarotene 0.1% cream versus tretinoin 0.05% emollient cream in the treatment of photodamaged facial skin: a multicenter, double-blind, randomized, parallel-group study.

OBJECTIVES: To compare the efficacy and tolerability of tazarotene 0.1% cream and tretinoin 0.05% emollient cream in the treatment of photodamaged facial skin. METHODS: Subjects were eligible to enroll in this multicenter, double-blind, randomized, parallel-group study if they had at least mild levels of facial fine wrinkling and mottled hyperpigmentation, and at least moderate levels of one of these. Subjects were randomly assigned to apply either tazarotene cream or tretinoin emollient cream to their faces once each evening for 24 weeks. RESULTS: A total of 173 subjects were enrolled, of whom 157 completed. All significant between-group differences in efficacy measures were in favor of tazarotene - for fine wrinkling at the study endpoint and, at earlier timepoints, for treatment success (> or =50% global improvement), and the overall integrated assessment of photodamage, mottled hyperpigmentation, and coarse wrinkling. Both products were comparable in terms of cosmetic acceptability and tolerability except that tazarotene was associated with a transiently higher incidence of a burning sensation on the skin (in the first week of treatment but not thereafter). CONCLUSIONS: Tazarotene 0.1% cream can offer superior efficacy over tretinoin 0.05% emollient cream in the treatment of facial photodamage, particularly with respect to the speed of improvement.

Administration, Topical↗

PubMed1993

Efficacy of topical 5% liquor carbonis detergens vs. its emollient base in the treatment of psoriasis.

Tar has been a mainstay in the treatment of psoriasis for centuries, but despite its widespread use, there is little evidence supporting its clinical efficacy without the combined use of ultraviolet radiation. The purpose of this study was to compare psoriasis improvement rates in patients using 5% liquor carbonis detergens (LCD) in an emollient base with the emollient base alone. Eighteen patients completed a randomized, bilaterally controlled, double-blind study. Emollient-treated plaques showed a mean improvement of 35.3% by 4 weeks of treatment, and LCD therapy produced a mean improvement of 48.7%, a difference which was statistically significant.

Adult↗

PubMed1994

Photoprotective action of emollients in ultraviolet therapy of psoriasis.

An in vitro technique was used to measure the monochromatic protection factors of all emollients available on prescription. The action spectra for ultraviolet erythema and erythema in psoralen-sensitized skin were used to calculate, for each emollient, erythema protection factors relevant to UVB phototherapy and psoralen photochemotherapy, respectively. Of the 40 products tested, 22 (55%) had a UVB erythema protection factor > 1.2 at an application density of 2 microliters/cm2, and 31 (78%) at an application density of 4 microliters/cm2. Fewer products, 25% at 2 microliters/cm2 and 50% at 4 microliters/cm2, had a psoralen erythema protection factor > 1.2. A protection factor of 1.2 is equivalent to a reduction in ultraviolet dose of 17%, and is thus likely to be of clinical importance. These results allow a choice of emollient products which may improve response by increasing transmission of radiation through psoriasis scale without a concomitant decrease in transmission due to a sunscreening action.

Emollients↗