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Repair skin barrier in treating hand dermatitis.

Repairing skin barrier dysfunction due to environmental exposures and endogenous factors is essential for the optimal management of hand dermatitis.

The dysfunction also may be iatrogenic, which adds to morbidity by making the underlying eczema much harder to treat, Dr. Joseph F. Fowler Jr. explained at the women's and pediatric dermatology seminar sponsored by Skin Disease Education Foundation (SDEF).

Age, stress, ultraviolet radiation, low humidity, skin disease, and genetic factors can all lead to epidermal injury and inflammation, which may result in development of damage to the stratum corneum and dermis, causing a vicious cycle of further injury, noted Dr. Fowler of the University of Louisville (Ky.) and president of the North American Contact Dermatitis Group.

Strategies for repairing the skin barrier start with first-generation occlusive moisturizers such as petrolatum to block transepidermal water loss and to let the epidermis heal itself, he noted.

Second-generation moisturizers add emollients and humectants to bind water and lipids for temporary barrier improvement. Today's "regular" moisturizers offer occlusive and humectant activity, he explained. They are useful in situations of mild xerosis or transient subcutaneous damage in which normal healing processes are able to cope with the damage. They are not so effective for patients with prolonged subcutaneous damage, inflammation, or poor inherent repair ability (such as those with atopy).

Another barrier repair strategy is to use hydroxy acids or niacinamide to stimulate desquamation and skin repair, he added.

The newest products, third-generation moisturizers, have occlusive and humectant properties but also add ingredients to provide the raw materials for stimulating barrier repair and for anti-inflammatory effects.

Colloidal oatmeal is a third-generation moisturizer. Colloidal oatmeal products contain lipids such as linoleic acid, have an anti-inflammatory effect, and generally are free of common allergens such as preservatives.

MimyX, a cream containing palmitamide monoethanolamine (PEA), helps restore the skin barrier by mimicking the composition of skin barrier lipids (PEA, triglycerides, phospholipids, squalene, and phytosterol), according to data from Stiefel Laboratories, which markets MimyX. The PEA/lipid cream also mimics the lamellar structure of the skin barrier through a patented process, Dr. Fowler noted.

He recommended starting treatment for hand dermatitis with a class I or II topical steroid, plus adjunctive therapy with MimyX cream applied at least three times daily, or adjunctive therapy with high-strength (30%-40%) urea foam or lotion for hyperkeratotic, "psoriasiform" hand eczema.

Other options for initial adjunct therapy include a 12% ammonium lactate lotion or cream, which supports the epidermis and glycosaminoglycans in the dermis. Emollient effects from Eletone or Atopiclair creams may help, and other moisturizers may be useful for barrier repair, Dr. Fowler added. Tetrix is a new topical specifically promoted as a "barrier-repair" product, with early data showing some ability to block allergy to nickel and fragrances.

Disclosures: Dr. Fowler has been a consultant, speaker, or investigator for several companies that make skin care products and treatments, including Stiefel Laboratories.

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Title Annotation:DERMATOLOGY
Author:Boschert, Sherry
Publication:Internal Medicine News
Geographic Code:1USA
Date:Feb 15, 2010
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