Dermatitis®

Moisturizers possibly improve atopic dermatitis (AD) by restoration of skin barrier, although some have detrimental effects.

The aim of the study was to estimate the effects of several routine moisturizers on barrier functions.

This is a randomized, forearm-controlled, observer-blind study. Patients older than 12 years with clear to moderate AD were randomized to 1 of 4 moisturizers (Cetaphil Cream, Aveeno Eczema Therapy Moisturizing Cream, CeraVe Moisturizing Cream, Vaseline) applied to nonlesional skin of 1 forearm and no moisturizer to the opposite forearm for 4 weeks. Transepidermal water loss (TEWL), capacitance, pH, and TEWL after tape stripping were evaluated at weeks 0 and 4. In addition, participants without AD underwent baseline measurements only.

Twenty patients with AD completed the study. Baseline measurements between the AD group and 10 non-AD controls were similar. After the intervention (AD group), mean TEWL improved in the treated forearm and worsened in the untreated one, but the difference was not significant. There was no significant change in pH or in TEWL after tape stripping. Capacitance significantly improved in the moisturizer forearm. The study was underpowered as recruitment fell short.

The effects of moisturizers on nonlesional AD skin were small and need to be addressed when powering future studies. Broadening investigations beyond the classic barrier properties might be useful in future studies.

Although there is much interest in social media about topical steroid withdrawal, little is known about what happens to people who cease long-term topical steroid use.

The aim of this study was to examine outcomes in adults with a history of atopic dermatitis who were concerned about topical steroid withdrawal and decided to stop using topical steroids.

Twenty-four participants were recruited from an Australian online support group, and they were emailed a series of questionnaires over 2 years.

Stopping topical steroid use had a large impact on the participants' quality of life for many months. Overall, participants' incidence and severity of symptoms decreased over the study period, and their Dermatology Quality of Life index scores improved. The majority reported their skin symptoms either had resolved or had only a small effect on their lives 2 years later. However, individuals' quality of life scores fluctuated, and in every questionnaire, large ranges in scores were seen, demonstrating that the experiences of participants differed considerably.

Counseling patients who are considering discontinuing long-term use of topical steroids regarding their prognosis is difficult as outcomes vary. However, many will improve significantly over the first 2 years.

The ideal patient-reported outcome measure to assess sleep disturbance in atopic dermatitis (AD) has not been determined.

We sought to determine the measurement properties of the Patient-Reported Outcomes Measurement Information System^® (PROMIS^®) Itch Questionnaire Mood and Sleep (PIQ-MS), Sleep Disturbance (SD), Sleep-Related Impairment (SRI), and Epworth Sleepiness Scale (ESS) in adults with AD.

A prospective dermatology practice-based study was performed using questionnaires and evaluation by a dermatologist (n=611).

PIQ-MS, PROMIS SD, SRI, and ESS had good convergent validity with intensity and frequency of sleep disturbance, Patient-Oriented Eczema Measure, Eczema Area and Severity Index, total and objective-Scoring AD, Numerical Rating Scale of worst-itch and average-itch, and Dermatology Life Quality Index. PIQ-MS had significantly better correlations with other severity measures than the other sleep measures (Fisher z-scores, P≤0.007). PIQ-MS, and to lesser extent PROMIS SD, PROMIS SRI and ESS had good discriminant validity. All four sleep assessments showed fair responsiveness to change of severity of sleep-disturbance, AD and itch. PIQ-MS had the best reliability. PIQ-MS, PROMIS SD, SRI and ESS showed good internal consistency and were feasible for use in clinical practice.

PIQ-MS, followed by PROMIS SD, had the best construct validity and reliability in adult AD.

The use of disinfectants is crucial to preventing the spread of nosocomial infections in health care workers. As many as 25 applications of hand disinfectants is a realistic default value during a working day. However, alcohol-based hand disinfectants may weaken skin barrier function and induce dryness and eczema, which decrease their acceptance.

To evaluate the effect of ethanol-containing disinfectants with 5% urea on skin barrier function and on sensitivity to an irritant soap (sodium lauryl sulfate [SLS]).

Twenty healthy volunteers treated one of their forearms twice daily for 17 days with an ethanol-containing gel with 5% urea. Two types of gels with urea were tested. Treatment was randomized to left or right forearm, and the contralateral forearm served as untreated control. Transepidermal water loss, skin capacitance (dryness), and sensitivity to SLS were evaluated.

Twice-daily application of the urea-containing ethanol gels lowered transepidermal water loss, prevented dryness, and reduced sensitivity to SLS compared with the untreated control skin.

Improved barrier function using this ethanol gel with urea may have relevance in daily disinfectant procedures.