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Pediatric Department Sardjito Hospital/FK UGM Yogyakarta
Healthy Skin
Allergen
s
Allergen
s
corneocyt
es
Cornified cell
envelope
H2O
H2O
H2O
lipids
Harding 2004
H2O
H2O
H2O
H2O
H2O
H2O
Keratin
macrofibrils
H2O
H2O
H2O
H2O
H2O
Intracellular
humectantants
(natural moisturising
factor)
Pathogenesis of AD
Eczema is an
inflammatory condition
of the skin
In eczema, the lipid
layer is defective
causing:
Water loss
Cracks in the outer layer
of skin (stratum corneum)
Penetration of allergens
and irritants
Cork MJ. (1997) The importance of skin barrier function. J of Dermatological Treatment (1997) 8, S7-13
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d
ly
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skin eruption
DIAGNOSIS
History
Atopic eczema mostly
appears in childhood
Before the age of 5 years in
85% of cases
Present in 15-20% of
children and 2-10% of
adults
Commonly there is a family
history of eczema or allergy
Beltrani VS, Boguneiwicz M (2003). Dermatology Online Journal, 9(2):1
National Collaborating Centre for Womens and Childrens Health (2007) Atopic eczema in children:
management of atopic eczema in children from birth up to the age of 12 years. Clinical Guideline December
2007 (NICE Eczema Full Guideline) www.nice.org.uk
Uehara M, Kimura C. Descendant family history of atopic dermatitis. Acta Derm Venereol 1993; 73:62-63
Eczema triggers
Eczema can be triggered or exacerbated by
many factors:3
Foods like cow's milk, eggs, peanuts, tree nuts,
wheat, soya, fish and shellfish
Environmental triggers, such as tree or grass
pollens and airborne mould spores
Dander and saliva of cats, dogs and other furry
pets
House dust mites that live in warm, damp places
(such as mattresses, carpets and soft furnishings)
Ezcema
Acute
eczema/dermatitis ;
is characterized by :
pruritus, weeping
&crusting erythema;
(redness of the skin
usually with ill define
border)
vesiculation.
Chronic
eczema/dermatitis,
is characterized by : pruritus,
xerosis, lichenification;
(leathery thickened state ,with
increase skin markings)
hyperkeratosis fissuring .
Scabies
HIV associated dermatitis
Dermatophytosis
Malignancies
Dermatitis herpetiformis
Pemphigus foliaceus
Graft-versus-host disease
Dermatomyositis
Immunodeficiencies
Wiskott-Aldrich syndrome
Severe combined immunodeficiency
syndrome
Hyper-IgE syndrome
Metabolic Disorders
Zinc deficiency
Pyridoxine (vitamin B6) and niacin
Multiple carboxylase deficiency
Phenylketonuria
MANAGEMENT
Principle
Target for
skin care
Eczem
a
Target for
anti
inflammato
ry
Treatment Strategy in AD
Mild
Dry
skin
Emolient
Moderate
Severe
Flare
REACTIVE
PROACTIVE
SUBCLINICAL INFLAMMATION
Mild or breakthrough
symptom
Continue routine daily care
Apply low to mid-potent topical
corticosteroid to rash area
Use antihistamine to relieve itch
If symptom persist: increase potency
of topical steroids
If symptom persists:
Consider superimposed infection
Exclude poor compliance and exposure
to irritants
EVIDENCE
Study of the
anti-inflammatory
activity -of Stimutex-As
+ Saccharide
Isomerate on the skin
Clotilde Verdy
Biopredic International
Rennes, France.
July, 2000
Method
To determine Interleukin 1 released
from the stripped human skin, as a
marker of the anti-inflammatory
activity of Stimutex-As + Saccharide
Isomerate.
Method
A human skin fragment was taken after
abdominal plastic surgery.
The skin was stripped and incubated 18
hours in the presence of
Control
Dexamethasone
Stimutex-As + Saccharide Isomerate
Conclusion
Stimutex-As + Saccharide Isomerate
demonstrates anti-inflammatory
activity comparable to
dexamethasone, a moderately
potent steroid.
Smith W
Dermac Laboratory Inc.
Connecticut US
Method
Test creams containing 1.5% of active
ingredient were evaluated on their
moisture retention efficacy under different
relative humidity levels at 37oC.
Control
Urea
Glycerin
Saccharide Isomerate
Saccharid
e
Isomerate
Conclusion
Saccharide isomerate regulates and
retains moisture in the skin at all
humidity levels.
The efficacy of saccharide isomerate
has been tested and proven to be
superior to urea and glycerin.
Objective
This study was performed to
investigate the safety and efficacy of
Stimutex-As + Saccharide Isomerate
in children under two years old with
mild to moderate atopic dermatitis
Method
63 children were entered for a 28-day trial.
Ages between 0.5 to 23 months.
Mild to moderate atopic dermatitis.
Stimutex-As + Saccharide Isomerate was
applied twice a day.
Method
The severity of the disease was
measured using a dermatological
score.
Erythema;
Edema/papulation/induration;
Excoriation;
Anti-pruritus effect.
Erythema score
Erythema
Clear
p value
Baseline
25.4%
After 7 days
36.5%
After 28 days
88.9%
##
p<0.0001%
p<0.001%
Edema/papulation/induration score
Induration
Clear
p value
Baseline
30.2%
After 7 days
47.6%
After 28 days
92.6%
##
p<0.0001%
p<0.001%
Excoriation score
Excoriation
Clear
p value
Baseline
28.6%
After 7 days
69.8%
After 28 days
98.1%
##
p<0.0001%
p<0.002%
Assessment of Pruritus
Pruritus
Clear
p value
Baseline
46%
After 7 days
61.9%
After 28 days
94.3%
##
p<0.0001%
p<0.001%
Baseline
After
7 days
After
28 days
Erythema
25.4%
36.5%
88.9%
Edema/papulation/
induration
30.2%
47.6%
92.6%
Excoriation
28.6%
69.8%
98.1%
Anti-pruritus effect
46.0%
61.9%
94.3%
Safety Profile
There were no serious adverse
events reported except for 2 cases of
erythema which were treated with
topical steroids.
Conclusion
All investigation parameters significantly
improved after application of Stimutex-As
+ Saccharide Isomerate.
Stimutex-As + Saccharide Isomerate is
able to significantly alleviate the
symptoms of atopic dermatitis e.g.
Erythema;
Edema/papulation/induration;
Excoriation;
Anti-pruritus effect.
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