A Dead Sea Water-Enriched Body Cream Improves Skin Severity Scores in Children with Atopic Dermatitis

Meital Portugal-Cohen, Miriam Oron, Efrat Merrik, Ze’evi Ma’or, Dan Ben-Amitai, Hagai Yogev, Alex Zvulunov

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DOI: 10.4236/jcdsa.2011.13012                

Abstract

Dead Sea (DS) mud and water are known for their unique composition of minerals, and for their therapeutic properties on inflammatory skin diseases. The objective of the study was to evaluate the efficacy of an emollient cream enriched with DS water in children with atopic dermatitis (AD). Eighty six AD children were randomized in a double-blind controlled study to receive twice-daily topical treatment with a body cream enriched with DS minerals (TP) compared to two types of control: 1) DM, DS minerals with lower DS water concentrations than TP, and 2) an emollient (E) with no DS minerals. Efficacy was assessed by a change in clinical skin severity scores: SCORing Atopic Dermatitis (SCORAD), investigator’s global assessment (IGA) and patient global assessment (PGA) as well as by objective physiological parameters: transepidermal water loss (TEWL), stratum corneum hydration (SCH), affected body surface area (BSA) and Objective Severity Assessment of Atopic Dermatitis (OSAAD). The total length of the trial was 12 weeks divided to 6 visits at weeks 0, 2, 4, 6, 8, 12. The study showed that both TP and DM creams improved OSAAD scores. Only TP improved TEWL and SCH. TP was the most effective regarding TEWL, SCH and OSAAD compared to DM and E. Treatment with E decreased more significantly IGA score compared to TP. Although within each treatment group significant improvements in SCH, BSA, SCORAD, IGA and PGA were observed, the reduction in BSA, SCORAD and PGA was not significantly different among the groups. Our results clearly show the benefits of TP as a leave on-skin emulsion enrich with DS water in terms of skin barrier function. Thus, TP can serve as an effective adjuvant treatment for AD skin as well as for its maintenance.

Keywords

Atopic Dermatitis, Dead Sea Minerals, Skin Barrier Function, Leave-on Skin Preparation

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	J. Callen, S. Chamlin, L. F. Eichenfield, et al., “A Systematic Review of the Safety of Topical Therapies for Atopic Dermatitis,” British Journal of Dermatology, Vol. 156, No. 2, 2007, pp. 203-221. doi:10.1111/j.1365-2133.2006.07538.x
[2]	D. Y. Leung and T. Bieber, “Atopic Dermatitis,” Lancet, 361, 2003, 151-160. doi:10.1016/S0140-6736(03)12193-9
[3]	M. Loden, A. C. Andersson and M. Lindberg, “Improvement in Skin Barrier Function in Patients with Atopic Dermatitis after Treatment with a Moisturizing Cream (Canoderm),” British Journal of Dermatology, Vol. 140, No. 2, 1999, pp. 264-267. doi:10.1046/j.1365-2133.1999.02660.x
[4]	M. Breternitz, D. Kowatzki, M. Langenauer, P. Elsner and J. W. Fluhr, “Placebo-Controlled, Double-Blind, Randomized, Prospective Study of a Glycerol-Based Emollient on Eczematous Skin in Atopic Dermatitis: Biophysical and Clinical Evaluation,” Skin Pharmacology and Physiology, Vol. 21, No. 1, 2008, pp. 39-45. doi:10.1159/000111134
[5]	D. Y. Leung, “Atopic Dermatitis: New Insights and Opportunities for Therapeutic Intervention,” Journal of Allergy and Clinical Immunology, Vol. 105, No. 5, 2000, pp. 860-876. doi:10.1067/mai.2000.106484
[6]	I. Angelova-Fischer, A. Bauer, U. C. Hipler, et al., “The Objective Severity Assessment of Atopic Dermatitis (OSAAD) Score: Validity, Reliability and Sensitivity in Adult Patients with Atopic Dermatitis,” British Journal of Dermatology, Vol. 153, No. 4, 2005, pp. 767-773. doi:10.1111/j.1365-2133.2005.06697.x
[7]	E. A. Holm, H. C. Wulf, L. Thomassen and G. B. Jemec, “Instrumental Assessment of Atopic Eczema: Validation of Transepidermal Water Loss, Stratum Corneum Hydration, Erythema, Scaling, and Edema,” Journal of the American Academy of Dermatology, Vol. 55, No. 5, 2006, pp. 772-780. doi:10.1016/j.jaad.2006.03.036
[8]	J. L. Sugarman, J. W. Fluhr, A. J. Fowler, T. Bruckner, T. L. Diepgen and M. L. Williams, “The Objective Severity Assessment of Atopic Dermatitis Score: An Objective Measure Using Permeability Barrier Function and Stratum Corneum Hydration with Computer-Assisted Estimates for Extent of Disease,” Archives of Dermatology, Vol. 139, No. 11, 2003, pp. 1417-1422. doi:10.1001/archderm.139.11.1417
[9]	S. Halevy and S. Sukenik, “Different Modalities of Spa Therapy for Skin Diseases at the Dead Sea Area,” Archives of Dermatology, Vol. 134, No. 11, 1998, pp. 1416-1420. doi:10.1001/archderm.134.11.1416
[10]	E. Hodak, A. B. Gottlieb, T. Segal, et al., “Climatotherapy at the Dead Sea is a Remittive Therapy for Psoriasis: Combined Effects on Epidermal and Immunologic Activation,” Journal of the American Academy of Dermatology, Vol. 49, No. 3, 2003, pp. 451-457. doi:10.1067/S0190-9622(03)00916-2
[11]	S. W. Moses, M. David, E. Goldhammer, A. Tal and S. Sukenik, “The Dead Sea, a Unique Natural Health Resort,” The Israel Medical Association Journal, Vol. 8, No. 7, 2006, pp. 483-488.
[12]	A. Deters, E. Schnetz, M. Schmidt and A. Hensel, “Effects of Zinc Histidine and Zinc Sulfate on Natural Human Keratinocytes,” Forsch Komplementarmed Klass Naturheilkd, Vol. 10, No. 1, 2003, pp. 19-25. doi:10.1159/000069903
[13]	Z. Ma’or, Y. Henis, Y. Alon, E. Orlov, K. B. Sorensen and A. Oren, “Antimicrobial Properties of Dead Sea Black Mineral Mud,” International Journal of Dermatology, Vol. 45, No. 5, 2006, pp. 504-511. doi:10.1111/j.1365-4632.2005.02621.x
[14]	M. Denda, C. Katagiri, T. Hirao, N. Maruyama and M. Takahashi, “Some Magnesium Salts and a Mixture of Magnesium and Calcium Salts Accelerate Skin Barrier Recovery,” Archives of Dermatological Research, Vol. 291, No. 10, 1999, pp. 560-563. doi:10.1007/s004030050454
[15]	C. M. Schempp, H. C. Dittmar, D. Hummler, et al., “Magnesium Ions Inhibit the Antigen-Presenting Function of Human Epidermal Langerhans Cells in Vivo and in Vitro. Involvement of ATPase, HLA-DR, B7 Molecules, and Cytokines,” Journal of Investigative Dermatology, Vol. 115, No. 4, 2000, pp. 680-686. doi:10.1046/j.1523-1747.2000.00090.x
[16]	E. Proksch, H. P. Nissen, M. Bremgartner and C. Urquhart, “Bathing in a Magnesium-Rich Dead Sea Salt Solution Improves Skin Barrier Function, Enhances Skin Hydration, and Reduces Inflammation in Atopic Dry Skin,” International Journal of Dermatology, Vol. 44, No. 2, 2005, pp. 151-157. doi:10.1111/j.1365-4632.2005.02079.x
[17]	M. Iwata, T. Takebayashi, H. Ohta, R. E. Alcalde, Y. Itano and T. Matsumura, “Zinc Accumulation and Metallothionein Gene Expression in the Proliferating Epidermis during Wound Healing in Mouse Skin,” Histochemistry and Cell Biology, Vol. 112, No. 4, 1999, pp. 283-290. doi:10.1007/s004180050449
[18]	A. Nissenbaum, J. Rullkotter and Y. Yechieli, “Are the Curative Properties of ‘Black Mud’ from the Dead Sea Due to the Presence of Bitumen (Asphalt) or Other Types of Organic Matter?” Environ Geochemistry Health, Vol. 24, No. 4, 2002, pp. 327-335. doi:10.1023/A:1020559717754
[19]	W. Diezel, E. Schulz, J. Laskowski, et al., “Magnesium Ions: Topical Application and Inhibition of the Croton Oil-Induced Inflammation,” Zschr. Hautkrh, Vol. 69, 1994, pp. 759-760.
[20]	J. Shani, S. Barak, D. Levi, et al., “Skin Penetration of Minerals in Psoriatics and Guinea-Pigs Bathing in Hypertonic Salt Solutions,” Pharmacology Research Communications, Vol. 17, No. 6, 1985, pp. 501-512. doi:10.1016/0031-6989(85)90123-7
[21]	M. Speich and B. Bousquet, “Magnesium: Recent Data on Metabolism, Exploration, Pathology and Therapeutics,” Magnesium-Bulletin, Vol. 13, No. 4, 1991, pp. 116-121.
[22]	M. Portugal-Cohen, Y. Soroka, Z. Ma’or, et al., “Protective Effects of a Cream Containing Dead Sea Minerals against UVB-Induced Stress in Human Skin,” Experimental Dermatology, Vol. 18, No. 9, 2009, pp. 781-788. doi:10.1111/j.1600-0625.2009.00865.x
[23]	J. M. R. G. Hanifin, “Diagnostic Features of Atopic Dermatitis,” Acta Dermato-Venereologica, Vol. 92, 1980, pp. 44-47.
[24]	V. Rogiers, “EEMCO Guidance for the Assessment of Transepidermal Water Loss in Cosmetic Sciences,” Skin Pharmacology and Applied Skin Physiology, Vol. 14, No. 2, 2001, pp. 117-128. doi:10.1159/000056341
[25]	E. Berardesca, J. L. Leveque and P. Masson, “EEMCO Guidance for the Measurement of Skin Microcirculation,” Skin Pharmacology and Applied Skin Physiology, Vol. 15, No. 6, 2002, pp. 442-456. doi:10.1159/000066451
[26]	Anonym, “Severity Scoring of Atopic Dermatitis: The SCORAD Index. Consensus Report of the European Task Force on Atopic Dermatitis,” Dermatology, Vol. 186, No. 1, 1993, pp. 23-31.
[27]	M. J. Choi and H. I. Maibach, “Role of Ceramides in Barrier Function of Healthy and Diseased Skin,” American Journal of Clinical Dermatology, Vol. 6, No. 4, 2005, pp. 215-223. doi:10.2165/00128071-200506040-00002
[28]	H. Matsuki, K. Kiyokane, T. Matsuki, S. Sato and G. Imokawa, “Recharacterization of the Nonlesional Dry Skin in Atopic Dermatitis through Disrupted Barrier Function,” Exogenous Dermatology, Vol. 3, No. 6, 2004, pp. 282-292. doi:10.1159/000091909
[29]	E. Proksch, J. M. Jensen and P. M. Elias, “Skin Lipids and Epidermal Differentiation in Atopic Dermatitis,” Clinics in Dermatology, Vol. 21, No. 2, 2003, pp. 134-144. doi:10.1016/S0738-081X(02)00370-X
[30]	D. Staab, D. Pariser, A. B. Gottlieb, et al., “Low Systemic Absorption and Good Tolerability of Pimecrolimus, Administered as 1% Cream (Elidel) in Infants with Atopic Dermatitis—A Multicenter, 3-Week, Open-Label Study,” Pediatric Dermatology, Vol. 22, No. 5, 2005, pp. 465-471. doi:10.1111/j.1525-1470.2005.00128.x
[31]	M. Hata, Y. Tokura, M. Takigawa, et al., “Assessment of Epidermal Barrier Function by Photoacoustic Spectrometry in Relation to Its Importance in the Pathogenesis of Atopic Dermatitis,” Laboratory Investigation, Vol. 82, No. 11, 2002, pp. 1451-1461.
[32]	P. Pommier, F. Gomez, M. P. Sunyach, A. D’Hombres, C. Carrie and X. Montbarbon, “Phase III Randomized Trial of Calendula Officinalis Compared with Trolamine for the Prevention of Acute Dermatitis during Irradiation for Breast Cancer,” Journal of Clinical Oncology, Vol. 22, No. 8, 2004, pp. 1447-1453. doi:10.1200/JCO.2004.07.063
[33]	Y. Soroka, Z. Ma’or, Y. Leshem, et al., “Aged Keratin- ocyte Phenotyping: Morphology, Biochemical Markers and Effects of Dead Sea Minerals,” Exogenous Dermatology, Vol. 43, No. 10, 2008, pp. 947-957. doi:10.1016/j.exger.2008.08.003