Workshop: skin barrier treatments

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Psoriasis, seborrhoea, ichthyosis Alphosyl lotion Allantoin Coal tar Scale reduction Calmurid Urea Lactic acid Dry, hyperkeratosis Dermadrate Urea Lactic acid Dry, hyperkeratosis Egoderm ointment Ichthammol (Ammonium bituminosulfonate) Zinc oxide Petrolatum Dry fissured skin Hamilton dry skin treatment Urea Petrolatum Dry skin Nutraplus Urea Dry, hyperkeratosis Urecare / Urederm Urea Dry, hyperkeratosis Soap Made by reacting fats with sodium hydroxide (lye), which produces a strongly alkaline product. Washing with soap disturbs barrier function by extracting lipids, increasing TEWL and pH. May be particularly important given that dogs already have more neutral skin pH than humans. Actives and actions Lanolin Stable emulsion of water and wool wax (esters, fatty acids and high mole’ wt alcohol) Absorbed into skin, softens it and prevents drying Can be used as a carrier to deliver drugs SQ Petrolatum Paraffin Glycerin Propylene glycol Urea Lactic acid Colloidal oatmeal Allantoin Condensation products Imidazolidinyl urea Diazolidinyl urea Ichthammol (Ammonium bituminosulfonate) Also acts as occlusive agent Occlusive agents. Forms hydrophobic layer on skin surface (but petrolatum may penetrate into superficial SC) which traps water in epidermis below Humectants/hygroscopic agents Draw water from deeper dermis into St. corneum May have some keratolytic effect by increasing desquamation, due to improved St. C hydration Sulphonated shale oil. It has anti-inflammatory, bactericidal and fungicidal properties. Zinc oxide Calamine (ZnO mixed with 1% iron oxide) Used for insect bite, rash from contact irritants, but no firm evidence exists to support claims Whilst there are a large number of available products there is a lot of direct duplication (i.e. different products share the same active ingredient list) and the actions of all of the actives can really be divided into 2 broad classes: Occlusive agents and Humectants (hygroscopic agents) Despite the extensive range available there is no need to stock more than one example of a particular active ingredient combination. In our practice we commonly use the following for topical use at changing / improving barrier function: 2
Allergroom Episoothe (Aloveen) Alpha Keri Bath Oil Hydraderm Oral EFA’s The most common use is on dry scaly skin and in areas of significant lichenification. Examples will be shown during the discussion. More recently a new class of products has been produced which contain ceramides, cholesterol, phytosphingosine and free fatty acids, ± occlusives petrolatum &/ glycerin. The rationale of these products is to act as lipid replacement moisturizers, correcting the lipid abnormalities that may occur in Atopic dermatitis. There is very little (no) published data to support the claims of restoring St. corneum function. There is a range of veterinary products that contain similar actives but they are not yet available in Australia. Further Reading Rosenkrantz, W. Practical Applications of Topical Therapy for Allergic, Infectious and Seborrheic Disorders. 2006. Clin Tech Small Anim Pract 21: 106-116 Sugarman, J.L. The Epidermal Barrier in Atopic Dermatitis. Semin Cutan Med Surg. 2008 27: 108-114 3
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Workshop: skin barrier treatments

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