The role of modern emollients in prophylaxis of atopic dermatitis exacerbation during pollination season

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Abstract

BACKGROUND: Skin epidermal barrier impairment in patients with atopic dermatitis facilitates percutaneous penetration of allergens and leads to persistent skin inflammation in sensitized patients and even primary sensitization to the allergens. We hypothesized that the use of skincare products that restore the structure of the skin barrier may positively affect the disease course in patients with atopic dermatitis and pollen sensitization during the pollen season.

AIMS: This study aimed to investigate the clinical efficacy and safety of La Roche Posay formulas, i.e., Lipikar Syndet and Lipikar Baume AP+M, in the prevention of atopic dermatitis exacerbations in children and adults sensitized to different pollen allergens during the pollination season.

MATERIALS AND METHODS: Sixty patients aged 5–60 years with a clinical history of mild-to-moderate atopic dermatitis sensitized to different pollen allergens were enrolled in a single-center, simple, open, prospective comparative study, and they were divided into two groups. The main group used Lipikar Syndet and Baume AP+M daily together with standard atopic dermatitis treatment for 28 days during the pollen season of their clinically significant allergens. The control group received only standard therapy without any use of moisturizers. The study required three visits. At each visit, the severity of atopic dermatitis (SCORing atopic dermatitis [SCORAD] index), quality of life (Dermatology Life Quality Index/and Children’s Dermatology Life Quality Index), pruritus intensity (numerical rating scale), and corneometry were assessed. SCORAD changes were considered the primary endpoint of the study.

RESULTS: A significant decrease in SCORAD in the main group was registered by day 14 of the study (p <0.0001), whereas no significant changes in the SCORAD index were noted in the control group even by day 28. The SCORAD index in the main group was significantly lower than that in the control group (p=0.005) by day 28. For the secondary endpoints, the quality of life significantly improved by day 28 (p=0.0005), the intensity of pruritus significantly decreased (p <0.0001), and the level of skin hydration increased (p <0.0001) by day 14 in the main group compared with those in the control group. No adverse events were reported during the study.

CONCLUSIONS: Daily use of Lipikar Syndet and Lipikar Baume AP+M by patients with atopic dermatitis and pollen allergy during the pollen season significantly improved the atopic dermatitis course, reducing skin itching and improving skin hydration and patients’ quality of life. The use of these skincare products together with atopic dermatitis therapy helped reduce atopic dermatitis severity associated with direct skin contact with pollen allergens. This indicates a protective effect of Lipikar skincare products on the epidermal barrier function.

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About the authors

Alla O. Litovkina

National Research Center ― Institute of Immunology; Peoples’ Friendship University of Russia

Author for correspondence.
Email: dr.litovkina@gmail.com
ORCID iD: 0000-0002-5021-9276
SPIN-code: 2337-7930
Russian Federation, Moscow; Moscow

Evgeniy V. Smolnikov

National Research Center ― Institute of Immunology; Peoples’ Friendship University of Russia; National Research Nuclear University MEPhI (Moscow Engineering Physics Institute)

Email: qwertil2010@yandex.ru
ORCID iD: 0000-0003-1302-4178
SPIN-code: 4874-8100
Russian Federation, Moscow; Moscow; Moscow

Olga G. Elisyutina

National Research Center ― Institute of Immunology; Peoples’ Friendship University of Russia

Email: el-olga@yandex.ru
ORCID iD: 0000-0002-4609-2591
SPIN-code: 9567-1894

MD, Dr. Sci. (Med.)

Russian Federation, Moscow; Moscow

Elena S. Fedenko

National Research Center ― Institute of Immunology

Email: efedks@gmail.com
ORCID iD: 0000-0003-3358-5087
SPIN-code: 5012-7242

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

References

  1. Federal clinical guidelines for the management of patients with atopic dermatitis. Moscow: Russian Society of Dermatovenerologists and Cosmetologists, Russian Association of Allergologist and Clinical Immunologist, Union of Pediatricians of Russia, National Alliance of Dermatovenerologists and Cosmetologists; 2021. Available from: https://cr.minzdrav.gov.ru/recomend/265_2. Accessed: 05.02.2023.
  2. Wollenberg A, Christen-Zäch S, Taieb A, et al. ETFAD/EADV Eczema task force 2020 position paper on diagnosis and treatment of atopic dermatitis in adults and children. J Eur Acad Dermatol Venereol. 2020;34(12):2717–2744. doi: 10.1111/jdv.16892
  3. Barbarot S, Auziere S, Gadkari A, et al. Epidemiology of atopic dermatitis in adults: Results from an international survey. Allergy. 2018;73(6):1284–1293. doi: 10.1111/all.13401
  4. Bylund S, Kobyletzki LB, Svalstedt M, et al. Prevalence and incidence of atopic dermatitis: A systematic review. Acta Derm Venereol. 2020;100(12):adv00160. doi: 10.2340/00015555-3510
  5. Arkwright PD, Koplin JJ. Impact of a decade of research into atopic dermatitis. J Allergy Clin Immunol Pract. 2023;11(1):63–71. doi: 10.1016/j.jaip.2022.09.021
  6. Ständer S. Atopic dermatitis. N Engl J Med. 2021;384(12): 1136–1143. doi: 10.1056/NEJMra2023911
  7. Li H, Zhang Z, Zhang H, et al. Update on the pathogenesis and therapy of atopic dermatitis. Clin Rev Allergy Immunol. 2021;61(3):324–338. doi: 10.1007/s12016-021-08880-3
  8. Stefanovic N, Irvine AD, Flohr C. The role of the environment and exposome in atopic dermatitis. Curr Treat Options Allergy. 2021;8(3):222–241. doi: 10.1007/s40521-021-00289-9
  9. Kita H. How are airborne allergens remembered by the immune system? J Allergy Clin Immunol. 2022;149(6):1940–1942. doi: 10.1016/j.jaci.2022.02.014
  10. Chevigné A, Jacquet A. Emerging roles of the protease allergen Der p 1 in house dust mite-induced airway inflammation. J Allergy Clin Immunol. 2018;142(2):398–400. doi: 10.1016/j.jaci.2018.05.027
  11. Serhan N, Basso L, Sibilano R, et al. House dust mites activate nociceptor-mast cell clusters to drive type 2 skin inflammation. Nat Immunol. 2019;20(11):1435–1443. doi: 10.1038/s41590-019-0493-z
  12. Nakamura Y, Miyata M, Shimokawa N, et al. House dust mite allergen Der f 1 can induce the activation of latent TGF-beta via its protease activity. FEBS Lett. 2009;583(12):2088–2092. doi: 10.1016/j.febslet.2009.05
  13. Nygaard U, Hvid M, Johansen C, et al. TSLP, IL-31, IL-33 and sST2 are new biomarkers in endophenotypic profiling of adult and childhood atopic dermatitis. J Eur Acad Dermatol Venereol. 2016;30(11):1930–1938. doi: 10.1111/jdv.13679
  14. Endo K, Hizawa T, Fukuzumi T, et al. Keeping dogs indoor aggravates infantile atopic dermatitis. Arerugi. 1999;48(12):1309–1315.
  15. Jaworek AK, Szafraniec K, Jaworek M, et al. Cat allergy as a source intensification of atopic dermatitis in adult patients. Adv Exp Med Biol. 2020;(1251):39–47. doi: 10.1007/5584_2019_451
  16. Pónyai G, Hidvégi B, Németh I, et al. Contact and aeroallergens in adulthood atopic dermatitis. J Eur Acad Dermatol Venereol. 2008;22(11):1346–1355. doi: 10.1111/j.1468-3083.2008.02886.x
  17. Nankervis H, Pynn EV, Boyle RJ, et al. House dust mite reduction and avoidance measures for treating eczema. Cochrane Database Syst Rev. 2015;1(1):CD008426. doi: 10.1002/14651858.CD008426.pub2
  18. Werfel T, Heratizadeh A, Niebuhr M, et al. Exacerbation of atopic dermatitis on grass pollen exposure in an environmental challenge chamber. J Allergy Clin Immunol. 2015;136(1):96–103.e9. doi: 10.1016/j.jaci.2015.04.015
  19. Fölster-Holst R, Galecka J, Weißmantel S, et al. Birch pollen influence the severity of atopic eczema--prospective clinical cohort pilot study and ex vivo penetration study. Clin Cosmet Investig Dermatol. 2015;(8):539–548. doi: 10.2147/CCID.S81700
  20. Meyer-Hoffert U. Reddish, scaly, and itchy: How proteases and their inhibitors contribute to inflammatory skin diseases. Arch Immunol Ther Exp (Warsz). 2009;57(5):345–354. doi: 10.1007/s00005-009-0045-6
  21. Gilles S, Mariani V, Bryce M, et al. Pollen allergens do not come alone: Pollen associated lipid mediators (PALMS) shift the human immune systems towards a T(H)2-dominated response. Allergy Asthma Clin Immunol. 2009;5(1):3. doi: 10.1186/1710-1492-5-3
  22. De Bruin-Weller M, Gadkari A, Auziere S, et al. The patient-reported disease burden in adults with atopic dermatitis: A cross-sectional study in Europe and Canada. J Eur Acad Dermatol Venereol. 2020;34(5):1026–1036. doi: 10.1111/jdv.16003
  23. Severity scoring of atopic dermatitis: The SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology. 1993;186(1):23–31. doi: 10.1159/000247298
  24. Finlay AY, Khan GK. Dermatology life quality index (DLQI)-- a simple practical measure for routine clinical use. Clin Exp Dermatol. 1994;19(3):210–216. doi: 10.1111/j.1365-2230.1994.tb01167.x
  25. Van Zuuren EJ, Fedorowicz Z, Christensen R, et al. Emollients and moisturisers for eczema. Cochrane Database Syst Rev. 2017;2(2):CD012119. doi: 10.1002/14651858.CD012119.pub2
  26. Danby SG, Andrew PV, Kay LJ, et al. Enhancement of stratum corneum lipid structure improves skin barrier function and protects against irritation in adults with dry, eczema-prone skin. Br J Dermatol. 2022;186(5):875–886. doi: 10.1111/bjd.20955
  27. Meinke MC, Patzelt A, Richter H, et al. Prevention of follicular penetration: Barrier-enhancing formulations against the penetration of pollen allergens into hair follicles. Skin Pharmacol Physiol. 2011;24(3):144–150. doi: 10.1159/000323018
  28. Lademann J, Patzelt A, Richter H, et al. Comparison of two in vitro models for the analysis of follicular penetration and its prevention by barrier emulsions. Eur J Pharm Biopharm. 2009;72(3):600–604. doi: 10.1016/j.ejpb.2009.02.003
  29. Billmann-Eberwein C, Rippke F, Ruzicka T, et al. Modulation of atopy patch test reactions by topical treatment of human skin with a fatty acid-rich emollient. Skin Pharmacol Appl Skin Physiol. 2002;15(2):100–104. doi: 10.1159/000049396
  30. Elisyutina O, Lupinek C, Fedenko E, et al. IgE-reactivity profiles to allergen molecules in Russian children with and without symptoms of allergy revealed by micro-array analysis. Pediatr Allergy Immunol. 2021;32(2):251–263. doi: 10.1111/pai.13354

Supplementary files

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2. Fig. 1. SCORAD dynamics at three timepoints: а ― in patients of Group 1; b ― in patients of Group 2; с ― comparison of indicators in groups 1 and 2. Д0, Д14, Д28 ― study days 0; 14th and 28th. a

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3. Fig. 2. DLQI dynamics at three timepoints: а ― in patients of Group 1; b ― in patients of Group 2; с ― comparison of indicators in groups 1 and 2. Д0, Д14, Д28 ― study days 0; 14th and 28th.

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4. Fig. 3. Comparison of skin itch intensity (NRS points) in Group 1 and Group 2 at three timepoints. Д0, Д14, Д28 ― study days 0; 14th and 28th.

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5. Fig. 4. Comparison of skin hydration levels (corneometry) in Group 1 and Group 2 at three timepoints. Д0, Д14, Д28 ― study days 0; 14th and 28th.

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