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USE MOISTUZIER IN ACTOPIC DERMATITIS DISEASE

Atopic dermatitis is a very common pathology, especially in young children, which is often recurrent. Moisturizing the skin is an very important treatment step for treating atopic dermatitis both in acute and chronic conditions. Good moisturizing helps to improve dry and itchy skin symptoms, restores skin barrier function, helps reduce the duration and level of corticosteroid using.

  1. Introduction

Atopic dermatitis is a acute, subacute or chronic disease and usually recurrence. Most cases appear in childhood. Typical symptoms are dry skin lesions accompanied by itching. The disease has an family heteditary factor and often appears in people with other allergic diseases such as asthma, allergic rhinitis. Diagnosis is not difficult, based on mainly clinical symptoms, IgE blood levels often rise in actopic dermatitis.

The causes of atopic dermatitis are well unknown, but there are some factors that are thought to take the main role in the pathogenesis, include in genetic, immune, infection, and damage of barrier factor.

The normal skin structure include in many layers of cells linked together by binders such as cement layers that form a protective barrier of skin, preventing dehydration and penetration of foreign substances and bacteria into the body. In atopic dermatitis, because there are  decrease in the production of filaggrin, loricrin and in skin cell adhesives, so dehydration, making the skin dry is increased. In addition, the skin barrier can also be damaged by the protease enzymes of house dust mites and Staphylocuccus aureus.

Successful management of atopic dermatitis involves counseling patients and families about the disease, reducing its signs and symptoms, preventing and reducing the severity and frequency of recurring. Treatment includes in education on avoiding factors of prosperity, skin care, and drug treatment.

Moisturizing the skin is an especially important treatment step for atopic dermatitis both in acute and chronic conditions. Good moisturizing helps to improve dry and itchy skin symptoms, restores skin barrier function, helps reduce the duration and level of corticosteroid using.

  1. Moistuzier in actopic dermatitis

2.1. What is the moistuzier?

Moisturizers are substances that help maintain moisture of skin by preventing transepidermal water loss and restore the natural moisturizing and lipid layer in the skin.

2.2. The mechanism of action of moisturizing

Moisturizer group Mechanism Ingredient
Anti-inflammatory effect inhibit the production of proinflammatory prostanoids by blocking cyclooxygenase activity thus have a soothing effect on inflamed skin Glycerrhetinic acid, palmitoylethanolamine, natural lipid of skin (ceramide)
Humectant effect attract water from two sources, from the dermis into the epidermis and in humid conditions from the environment Glycerin sorbitol, urea, hyaluronic acid
Occlusive effect create a hydrophobic barrier over the skin, contribute to the matrix between corneocytes, so block the loss of water from the skin Lanolin, petrolatum, mineral oil, zinc oxid
Emollient effect hydrate and improve the skin softness, flexibility, and smoothness. The effect fills the gap between keratinocytes, preventing allergens and irritant factor penetrating in to skin Ceramid, propylene glycol, isopropyl palminate, palm oil, coconut oil,butter oil,  and wool fat

2.3. The main types of moisturizers

  • Ointment:

Solid form, containing 80% oil, 20% water

Preventing dehydration on the skin, particularly useful in low humidity (< 60%) environment

Disadvantages: causes clogged pores so it is often selected for thick skin such as palms, feet. It is greasy, glossy look following application

  • Cream:

A mixture of the drug in water or another liquid, usually 1: 1

Less greasy and glossy

Disadvantages: often has stabilizers and preservatives to separate ingredients so it can cause skin irritation and allergic reactions

  • Lotion:

A mixture of oil and water with water is the main ingredient

Not greasy and  glossy

Disadvantages: moisturizing effect is not high, short time because water dehydration quickly, so it is often used for patients with mild dry skin condition.

2.The role of moistuzier in atopic dermatitis

Reduce inflammation, reduce itching, dry skin:

– Soften skin structure, reduce itching, dry skin.

– Create a protective layer to help retain water, prevent evaporation of water through the skin.

– Restore skin protective barrier, inhibits the penetration of irritating factors

Reduce duration and frequency of corticoid use:

– Prolonged corticosteroids have many risks and side effects such as hirsutism, skin atrophy, vasodilation, acne …

– Some studies show that using moisturizers combination with corticosteroids significantly improves clinical symptoms and shortens treatment time for patients.

– Evidence: studies in children (Grimalt, 2007, Szczepanowska, 2008) and adults (Eberlein, 2008) have shown that moisturizing using reduces the duration of corticoid use in patients with atopic dermatitis. A number of other studies using moisturizing maintenance on patients who have achieved cure from corticosteroids (Berth-Jones, 2003) and (Glazenburg, 2007) show results that reduce the frequency of corticoid reuse for these patients.

Maintain and prevent relapses:

– The moisturizers are quite safe and almost no side effects, so they can be used as a long-term maintenance therapy.

– Moisturizers help maintain optimal hydration and rehabitiate skin barrier function disorders, reduce dryness and excessive irritation. Studies recommend using moisturizer at least 2 times a day with or without disease.

Prophylaxis of atopic dermatitis in infants at high risk: a study of infants aged 1-7 days with high risk factors for atopic dermatitis, such as affacted father or mother. Apply moisturizer 2 times / day, monitor and assess patients in months 1,6,12,24. The results showed that no side effects were noted, the percentage of children with atopic dermatitis was 5%, significantly less than the rate described in the literature (50-70%).

2.5.Use moisturizers in atopic dermatitis

Choose the ideal moisturizer:

– Maintain the ideal moisture of the skin, pH similar to natural skin

– Safe for long-term use, does not contain fragrance, does not cause irritation

– Convenient, effective, and aesthetically and economically appropriate

Moisturizers application method:

– Choose moisturizers which are suitable for each individual, the hurting position and but the degree of skin dryness.

– Should be used at least 2-3 times / day, increasing the number of times if the skin is dry.

– Use right after shower 3-5 minutes to maintain moisture in skin.

– In the acute lesion, topical corticosteroids should be used to quickly relieve symptoms. Applying moisturizers before applying topical corticosteroids helps increase the skin’s ability to absorb the drug.

– The amount of moisturizer used for adults is 500-600g / week, children 250-300g / week.

– Use maintained daily even without symptoms.

3.Conclusion

Atopic dermatitis is a burden for children and parents because the disease has a high frequency, persistent progress, affecting to the psychology and quality of life of children and their families. Moisturizers play an important role as a basic treatment step in managing atopic dermatitis. The right use of moisturizers and careful counseling for parents is an important part in the successful treatment of atopic dermatitis.

REFERENCES

  1. Lodén, M. (2003). The skin barrier and use of moisturizers in atopic dermatitis. Clinics in Dermatology, 21(2), 145–157.
  2. Giam, Y. C., Hebert, A. A., Dizon, M. V., Van Bever, H., Tiongco-Recto, M., Kim, K.-H., … Luk, D. C. K. (2016). A review on the role of moisturizers for atopic dermatitis. Asia Pacific Allergy, 6(2), 120.
  3. Horimukai, K., Morita, K., Narita, M., Kondo, M., Kitazawa, H., Nozaki, M., … Ohya, Y. (2014). Application of moisturizer to neonates prevents development of atopic dermatitis. Journal of Allergy and Clinical Immunology, 134(4), 824–830.e6.
  4. Hon, K. L., Kung, J. S. C., Ng, W. G. G., & Leung, T. F. (2018). Emollient treatment of atopic dermatitis: latest evidence and clinical considerations. Drugs in Context, 7, 1–14.
  5. Thomsen, S.F., Atopic Dermatitis: Natural History, Diagnosis, and Treatment.ISRN Allergy, 2014. 2014: p. 1-7.
  6. . Tollefson, M.M. and A.L. Bruckner, Atopic Dermatitis: Skin-Directed Management.Pediatrics, 2014. 134(6): p. e1735-e1744.
  7. . Kim, M.J., et al., Prevalence of Atopic Dermatitis among Korean Adults Visiting Health Service Center of the Catholic Medical Center in Seoul Metropolitan Area, Korea.Journal of Korean Medical Science, 2010. 25(12): p. 1828.
  8. Leung, D.Y.M., New Insights into Atopic Dermatitis: Role of Skin Barrier and Immune Dysregulation.Allergology International, 2013. 62(2): p. 151-161.

                                                                                                                                       Author: Dr. Hoàng Thị Hoài

Publisher: Social Work Department