© johnson & johnson gmbh 2014 not for reproduction without permission of copyright holder the...

© Johnson &

Johnson Gm

bH 2014Not for Reproduction without Permission of Copyright Holder

The Role of Topical Moisturizers in Managing Compromised

Skin

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Johnson Gm


• Natural protective barrier from• physical injury• pathogenic microbes• chemical agents• UV radiation• extreme temperatures

• Helps to restrict fluid and water loss

• Sensory perception: temperature, pressure, touch and pain

• Temperature regulation of the body

Skin Function

1. Irving V: Caring for and protecting the skin of pre-term neonates. J Wound Care 2001, 10:253-6.2. Nikolovski J, Stamatas GN, Kollias N, Wiegand BC: Barrier function and water-holding and transport properties of infant stratum corneum are different from adult and continue to develop through the first year of life. J Invest Dermatol 2008, 128:1728-36.

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Bricks & Mortar

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The Infant Skin Barrier: Can We Preserve, Protect, and Enhance the Barrier? Lorena S. Telofski, A. PeterMorello III, M. CatherineMack Correa, and Georgios N. Stamatas; Dermatology Research and Practice Volume 2012, Article ID 198789, 18 pages doi:10.1155/2012/198789

Infant vs Adult Skin

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L.S Telosfski et al. Dermatology Research and Practice, vol 2012 G.N. Stamatas et al. International Journal of Cosmetic Science, 2011, 33, 17-24

↗ permeability

↗ water retention

SKIN PARAMETER ADULT INFANT

Surface Microrelief lines Less dense More dense

Cell size Corneocytes (SC) Larger Smaller

Granular Keratinocytes Larger Less dense

SmallerMore densely packed

Thickness Stratum corneum Thicker~ 10µm

Thinner~ 7µm

Epidermis Thicker Thinner (-20% vs adult)

Dermal structure

Dermal papillae (density, size, morphology)

Less homogenous More homogenous

Distinction between papillary and reticular dermis

Present Absent

Structure

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↘ UV protection

NMF: Natural moisturizing factor

↗ skin hydration

↗ dryness

↘ hydro-lipid film protection


Water content Stratum corneum Lower Higher (in older infants)

Drier at birth

Inter-personal variability Lower Higher

NMF Natural moisturizing factor concentration

Higher Lower

Surface lipids Sebum Higher Lower(7-10 month-old

infant)

Collagen Fiber density Higher (young adult)

Lower

Melanin Density Higher Lower

Composition


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↗ potential infections

TEWL: Trans-epidermal water loss

↗ water evaporation


Protective barrier

Skin barrier function Competent Competent – still maturing

TEWL Trans-epidermal water loss Lower Higher

Water handling Rate of water absorption Lower Higher

Rate of water desorption Lower Higher

Cell proliferation

Turnover rate Lower Higher

pH Surface pH Lower More alkaline(newborn only)

Function


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Role of skin lipids

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G.N. Stamatas et al. International Journal of Cosmetic Science, 2011, 33, 17-24

• Babies are born with skin pH close to neutral: 6.6 - 7.5

• Adults have a much more acidic skin with pH values: 4.5 - 6.7

• Acidic skin pH affects several activities:

• Maturation and maintenance of the epidermal permeability barrier

• Control of the desquamation process

• Regulation of bacterial proliferation on the skin

Importance of proper pH

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Epidermal Barrier Dysfunction in Atopic Dermatitis. Michael J. Cork, et al., Journal of Investigative Dermatology (2009) Vol 129

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Healthy Barrier Function

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Oats in Skincare

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Attributes of Oats in Skin Care

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ECZEMA (N=33)

SENILE SKIN

WINTER ITCH

SENILE PRURITUS

PH

NORMAL pH RANGE 4.2-5.5

pH LEVEL IMMEDIATELY AFTER TREATMENT WITH COLLOIDAL OATMEAL

pH

LE

VE

L B

EF

OR

E T

RE

AT

ME

NT

Grais M. AMA Arch Derm Syphilol.1953;68(4):402-407.

pH measured on forearm

(N=33)

(N=16)

(N=14)

Buffering Capacity of Colloidal Oatmeal Restores the pH of Damaged Skin to Within the Normal Range

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Avenanthramides

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Vollhardt J, Fielder DA, Redmont MJ. Identification and cosmetic application of powerful anti-irritant constituents of oat grain. XXI IFSCC International Congress 2000, Berlin. Proceedings; 395-402.

Separated oat fractions tested in a skin erythema model/Patients received 1.5 MED of UVB/Products applied 24 hours after irradiation/Clinical erythema evaluation 24 hours after product application

% of redness attenuation per gram afterUV irradiation. Measure 24h after application

Avenanthramides

Flavonoids

Saponins

0 50 100 150 200 250

The avenanthramide fraction is the most effective oat component in reducing UV-induced redness 24 hours after dermal application

Avenanthramides vs other oat fractions

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Avenanthramides: Inhibition of Markers Related to Topical Skin Irritation

IL-8

Rel

ease

(pg/

mL)

from

Ker

atino

cyte

s

150

180

210

240

270

UnstimulatedAvenanthramide (μg/mL)

Stimulated 1 10 100

IL-8=interleukin-8.

Wallo W, et al. Poster presented at: 65th annual meeting of the AAD. February 2-6, 2007; Washington, DC.

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Oat Lipids

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Composition of Oat Lipids• Total lipid content of oats: from 2%–11.8%

dry weight

• Triglycerides

• Phospholipids

• Lecithin

• Glycolipids

• Free fatty acids

– Oleic, Linoleic, Palmitic, Stearic

Zhou M, et al. J American Oil Chem Soc. 1999;76(2):159-169.

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Oat Oil Reduces TEWL Compared to Control Sites

Potter RC et al. US Patent 5620692. April 15, 1997.

TEWL=transepidermal water loss.

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Whole Oat Oil Lipid Class Composition

Southall M, et al. The Dermatologist. September 2012 (suppl):1-4.

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Colloidal Oatmeal Cream vs Rx Barrier Emulsion for Improving Skin Barrier in Moderate-to-Severe Dry Skin

-35

-15

-20

-30

4

-25

9

Days

1 7

Perc

ent M

ean

Redu

ction

inW

ater

Los

s

RegressionPeriod

Colloidal Oatmeal Cream Rx Skin Barrier Emulsion

Nebus J, et al. J Am Acad Dermatol. 2011;64:AB71.

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Effectiveness of a colloidal oat lotion vs vehicle for the relief of dry, itchy skin

A Randomized, Double-Blind Bilateral Controlled Study to Evaluate the Effectiveness of an Oatmeal Containing Lotion vs Vehicle for the Relief of Dry, Itchy Skin, data on file.

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*Colloidal oatmeal with ceramides and dexpanthenol.Wallo W, et al. Poster presented at: 65th annual meeting of the AAD; February 2–6, 2007; Washington DC.

Colloidal Oatmeal Bath* in the Treatment of Dry and Sensitive Skin in Atopic Dermatitis

0

1.2

Before After

Itching

Burning

Gra

ding

Sco

re

0.2

0.6

1.0

0.4

0.8

4-week, investigator-blinded, crossover study (N=25)

50%

67%

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Dermatologist Assessment: EASI Composite Score (ages 12–60 years)

EASI=eczema area and severity index .

*Significant improvement (P<0.001).

Fowler JF, et al. J Drugs Dermatol. 2012;11(7):804-807.

Daily Oat-based Skin Care Regimen for Atopic Skin: EASI Composite Score

0

6

2

8

EASI

(Mea

n)

Baseline Week 8Week 2 Week 4

4

*

*

*

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Nebus J, Wallo W, Eichenfeld L, MD; Poster presented at the 34th Annual Meeting of the Society of Pediatric Dermatology. July 2008

Evaluating the Tolerance and Safety of a Colloidal Oat and Ceramide containing Moisturizing Cream and Oatmeal containing Moisturizing Wash in Babies and Children with Atopic Dermatitis

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*Assessment of AVEENO® Eczema Therapy Moisturizing Cream through a multi-centric clinical study on infants, children and adults with Atopic dermatitis. (n=71 patients in total aged 6 months to adult; topical steroid data based on n=19 patients who previously used topical steroids during the washout period).

Assessment of a Colloidal Oatmeal and Ceramide containing Moisturizing Cream through a multi-centric clinical study on infants, children and adults with AD*

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Obrigada

Danke

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Tack

Gracias

THANK YOU !

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© johnson & johnson gmbh 2014 not for reproduction without permission of copyright holder the...

Documents

johnson johnson gmbh

infant skin barrier

compromised skin slide

infant vs adult skin

body skin function

water loss sensory perception

stamatas dermatology

skin of preterm neonates