P6772Impact of water temperature and cleanser selection on skin condition

Vickie Foy, Unilever R&D, Trumbull, CT, United States; Anthony Cece, MS,Unilever R&D, Trumbull, CT, United States; Li Feng, PhD, Unilever R&D,Trumbull, CT, United States; Phil McGoff, MS, Unilever R&D, Trumbull, CT,United States; Shuliang Zhang, PhD, Unilever R&D, Trumbull, CT, United States;Stacy Hawkins, PhD, Unilever R&D, Trumbull, CT, United States

Irritation potential with daily cleansing is influenced by a variety of factors,including the overall mildness of the cleanser, cleanser pH, water temperature,duration of washing, water hardness, etc. Although the recommendation to avoidvery high temperatures during washing is well accepted, there is little informa-tion available on temperature impact to cleanser mildness. Much of the work todate in this area has been on harsh surfactant systems, and not linked withrealistic consumer usage shower temperatures. The goal of this research was tounderstand the effects of temperature under realistic consumer usage settings insubjects with varying degree of clinical dryness, to compare mildness of arelatively harsher bodywash (REGBW e an isotropic bodywash with betaine) to alipid-rich moisturizing bodywash with glycinate (LMBWG). Forty-two healthyfemale subjects, Fitzpatrick skin type I-III, ages 20-59, provided informed consentto participate in this IRB-approved, 5-day controlled application leg wash study.Subjects underwent a 4-day conditioning phase before the study by replacingtheir normal cleansers with the REGBW. Subjects’ legs were washed undercontrolled conditions three times daily through day 4, twice on day 5 for a totalof 14 washes. Leg washes consisted of one minute wetting, 30 second lather/30second retention, and 8 minutes of rinsing. Expert visual evaluation of dryness,transepidermal water loss (TEWL), and skin hydration measurements wereobtained at baseline and throughout the study. Subjects were divided into twoskin condition groups: (1) low to no clinical dryness, (2) moderate clinicaldryness. For each subject group, half of the subjects washed at 90 degrees(LOW), and half at 1038F (AVG). Based on consumer usage these would beconsidered on the low and average range of normal shower temperatures. Theimpact to mildness with temperature change was greater in the moderate drynessgroup. Further, the LMBWG was significantly milder compared to the REGBW inboth dryness groups. This observation is contrary to the conventional belief thatlower temperature is always better for skin. Potential mechanisms includeenhancement of exfoliation of dry flakes and/or better removal of surfactantsat the AVG temperature. More work is needed to understand these effects further.From this research, it is clear that the use of a milder cleanser is better for skinunder both temperature conditions studied here.

APRIL 20

ponsored by Unilever R&D.

100% is s

P6223Improvement of skin barrier function in atopic dermatitis patients with anew moisturizer containing a ceramide precursor

Eric Simpson, MD, Department of Dermatology, Oregon Health and ScienceUniversity, Portland, OR, United States; Arne B€ohling, PhD, proDERM,Schenefeld/Hamburg, Germany; Catherine Bosc, MMSc, Galderma Research andDevelopment, SNC, Biot, France; Nabil Kerrouche, MMSc, Galderma Researchand Development, SNC, Biot, France; Stephan Bielfeldt, MMSc, proDERM,Schenefeld/Hamburg, Germany

Background: Atopic dermatitis (AD) involves skin barrier abnormalities and insuf-ficient ceramides in the stratum corneum (SC).

Objective: To measure the effects of a moisturizer (CRM; Cetaphil� Restoradermskin restoring moisturizer; Galderma Laboratories, L.P.) containing a ceramideprecursor in improving skin barrier function in patients with controlled AD.

Methods: In this randomized, intraindividual comparison, investigator-blindedstudy, CRM was applied to 1 leg for 27 days (other leg remained as untreatedcontrol). Evaluations included TEWL (transepidermal water loss), skin hydration bycorneometry, dryness severity, Raman spectroscopy, and collection of adverseevents.

Results: After 4 weeks of treatment, results showed a significantly greater reductionof TEWL and clinical dryness scores in the CRM-treated than untreated area, and asignificantly greater increase of skin hydration for CRM compared with untreatedcontrol (all P\.01). A higher level of ceramide, natural moisturizing factor (NMF),pyrrolidine carboxylic acid (PCA), and water content was observed in the SC forCRM than for the control. There were no related adverse events (AEs).

Conclusion: Skin barrier function and hydration were significantly improved afterCRM treatment.

a Research and Development, SNC.

Galderm

13

P6878Methotrexate-responsive endogenous eczema: A multicenter analysis of 41patients

Kun Sen Chen, MBBCh, Glan Clwyd Hospital, Rhyl, United Kingdom; PaulYesudian, MD, Glan Clwyd Hospital, Rhyl, United Kingdom

Background: Methotrexate (MTX) is a treatment option for endogenous eczema(EE). We conducted a retrospective review to evaluate the types of MTX-responsiveeczema, treatments before MTX, side effects of MTX and reasons for discontinuingit.

Methods: We analyzed 41 case notes (male:female ¼ 27:14, mean age 49.1 years,range 18e83 years) from 4 district hospitals with chronic EE who achievedadequate control with MTX. Results: The types of EE that responded to MTXwere atopic eczema (n ¼ 28, 68.3%), pompholyx (n ¼ 3, 7.3%), discoid eczema(n ¼ 2, 4.9%) and unclassified EE (n ¼ 8, 19.5%). The duration of eczema rangedfrom 2 to 62 years (mean 24.6 years). Failed treatments before MTX includedphototherapy (n ¼ 14, 34.1%), cyclosporin (n ¼ 30, 73.2%, mean duration 21.4months, range 2e98 months), mycophenolate mofetil (n ¼ 9, 22.0%, meanduration 7.0 months, range 1e12 months) and azathioprine (n ¼ 7, 17.1%, meanduration 6.5 months, range 1e36 months). The median number of failedtreatments before MTX was 2 (range 1e4). MTX was administered orally(n ¼ 34, 82.9%) or subcutaneously (n ¼ 7, 17.1%) once a week. The effectivedose ranged from 10 to 25 mg/week (median, 20 mg/week). The treatmentduration ranged from 2 to 93 months (mean, 22.9 months). Mean reduction frombaseline in white blood cell, neutrophil and lymphocyte counts duringestablished MTX treatment with adequate control were -1.30 3 109/L(P \ .00005), -0.90 3 109/L (P \ .0011), and -0.35 3 109/L (P \ .00005),respectively. Seventeen patients (41.5%) encountered side effects (3 patients had[1 side effect), including nausea (n ¼ 4, 9.8%, all resolved after switching tosubcutaneous MTX), raised liver enzymes (n ¼ 3, 7.3%), raised procollagen typeIII aminoterminal peptide (n ¼ 3, 7.3%), raised creatinine (n ¼ 3, 7.3%) andothers (n ¼ 6, 14.6%). MTX was stopped (twice in 1 patient) in 11 patients(26.8%) due to patient choice (n ¼ 5, 12.2%), reduced response (n ¼ 3, 7.3%),side effects (n ¼ 3, 7.3%) and non-attendance of follow-up appointments(n ¼ 1, 2.4%).

Conclusion: MTX is a viable treatment option for atopic eczema, pompholyx,discoid eczema or other unclassified EE uncontrolled with other systemic immuno-suppressants. Most patients (n¼ 15, 36.6%) require a dose of 20mg/week to achieveadequate control. 17 patients (41.5%) had at least 12 months of adequate control.Subcutaneous MTX may be better tolerated by patients who develop nausea on oralMTX.

cial support: None identified.

Commer

P6918Novel use of a cooling pillow for treatment of severe head and neck atopicdermatitis

Kachiu C. Lee, MD, MPH, Brown University, Providence, RI, United States;Dennis West, PhD, Dennis West, Chicago, IL, United States; Jaimee Holbrook,MD, Northwestern University, Chicago, IL, United States; Mary Kwasny, PhD,Northwestern University, Chicago, IL, United States; Peter Lio, MD,Northwestern University, Chicago, IL, United States

Atopic dermatitis (AD) is symptomatically characterized by severe itching,redness, and scaling of the affected skin, and often has a profound negativeimpact on quality of life. Along with standard medical therapies, environmentalmodification by avoiding known and potential irritants is often encouraged. Suchrecommendations include maintaining an optimal body temperature by avoidingexcessive sweating, especially during nighttime sleep. In a randomized, double-blind study pilot study, we investigated the use of the Chillow, a water-filled,naturally cooling pillow, for use in patients with severe head and neck AD. Sevenadults (median age, 34 [range, 19-56]) with moderate to severe AD of the headand neck (Investigator’s Global Assessment (IGA) score of [3 at time ofenrollment) were randomized at baseline to either the intervention group:nightly use of the Chillow for 2 weeks; or the control group: no change in pillowduring 2-week study period. Quality of sleep was assessed with the PittsburghSleep Quality Index survey at both baseline and the 2-week follow-up. Severity ofAD was measured using the IGA. There was no difference between the control orexperimental groups with regards to severity of AD or quality of sleep. However,there was a trend towards improvement in sleep quality and severity of AD in theintervention group in those with moderate to severe head and neck AD. Oursmall sample size (n ¼ 7) may have been too small to assess for statisticalsignificance.

cial support: None identified.

Commer

J AM ACAD DERMATOL AB77