Similar to corticosteroids: Botanicals, lipids and antioxidants could alleviate symptoms of atopic eczema – Review
These ingredients include liquorice, chamomile, comfrey, oatmeal and cannabinoids; essential lipids, such as ceramide and linoleic acid; moisturising compounds, including urea, arginine and lactic acid; and antioxidants, such as vitamin E, a new review reports.
The potency of some of the listed active ingredients is comparable to low- to medium-potency corticosteroids and yields high treatment compliance, tolerability and reduced corticosteroid use.
These promising results were documented in the paper titled A Review of Moisturizing Additives for Atopic Dermatitis, published in the journal Cosmetics.
“Children with atopic eczema are at risk of cutaneous infections. Atopic dermatitis was also found to be associated with poorer quality of life. The epidermal barrier plays a pivotal role in atopic eczema pathogenesis.
“Topical corticosteroids are the first-line anti-inflammatory treatment for atopic dermatitis. However, chronic usage of topical corticosteroids may further lead to skin barrier defects by inhibiting epidermal proliferation, differentiation, and lipid production,” said the researchers.
Therefore, the team aimed to review the current understanding of atopic eczema, and the mechanism of action, safety, and efficacy of common active ingredients found to be beneficial in alleviating its symptoms.
They analysed studies and trials focusing on moisturisers that include phytochemicals, natural moisturising factors, essential fatty acids, endocannabinoids and antioxidants in electronic databases. The review then elucidated the science behind these derma cosmetics.
Active ingredients to observe
The scientists categorised the studies according to the bioactive used – liquorice, chamomile, comfrey, colloidal oatmeal, natural moisturising factors, ceramides and fatty acids, endocannabidiol and furfuryl derivatives.
Liquorice, the root of the Glycyrrhiza species, has produced almost 400 compounds. Common ingredients used in dermatology are Licochalcone A, glycyrrhetinic acid and glycyrrhizin. Studies conducted by S. Wananukul et al. (2013), I. Angelova-Fischer et al. (2014) and M. Udompataikul et al. (2011), for instance, proved the positive anti-inflammatory results of topical, semi-solid formulations with Licochalcone A.
Chamomile also has a longstanding history in treating dry and inflammatory skin disorders due to its anti-inflammatory, anti-histaminic, mildly astringent, soothing and healing properties. These features were documented in studies by researchers like R. Dawid-Pac (2013) and S.H. Lee et al. (2010). However, a small percentage of the population could induce allergic reactions. Nonetheless, chamomile could still be meaningful as an active ingredient in cosmeceutical and pharmaceutical applications.
Comfrey, a herb native to the UK but available in other parts of Europe, North America and North Asia, has been used to soothe irritated and inflamed tissue, promote wound healing and reduce osteoarticular inflammation. The positive effects were reported in numerous studies, like B. Salehi et al. (2019), C. Staiger (2013), R. Koll et al. (2004), M. Kucera et al. (2004) and H. G. Predel et al. (2005). However, it is not for oral consumption due to its impact on liver toxicity.
Colloidal oatmeal is another ingredient widely recognised to alleviate atopic dermatitis by topical lotion. A study on 50 subjects with severely dry skin conducted by O. Ilnytska et al. (2016) showed major improvement within three weeks of treatment. Overall, the colloidal oatmeal could induce repair in the skin barrier and protect against irritants by halting water loss from the epidermis. Phytochemicals in oatmeal like saponin could also contribute to maintaining the skin pH by solubilising dirt, oil and sebaceous secretions, according to T.A. Lisante et al. (2017).
Other ingredients to observe include ceramides, fatty acids, endocannabinoid systems, furfuryl derivatives and antioxidants. Specifically, endocannabinoid systems have gained academic attention through in vivo and in vitro studies. Its efficacy could potentially reduce the need for topical corticosteroids and improve the patients’ quality of life through sleep.
Overall, the current review managed to identify viable ingredients to alleviate the hallmarks of eczema. However, most study designs provided insufficient clinical evidence, small sample sizes and did not highlight a single active agent on its own.
“More head-to-head clinical trials, homogenisation of clinical outcomes and improvement of the study designs will provide better insight into the clinical roles of active ingredients in moisturisers,” concluded the team.
The current work was funded by the Fundamental Research Grant Scheme under the Malaysian Ministry of Education.
“A Review of Moisturizing Additives for Atopic Dermatitis”
Authors: Vicentsia Vienna Vanessa et al.
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