Use of Moisturizers in Atopic Dermatitis

Use of Moisturizers in Atopic Dermatitis

Dr. MOH. IFNUDIN. SpKK.

INTRODUCTION

Atopic dermatitis (AD) is one of the many terms used to describe the form of a skin disorder that often occurs. The word comes from Greek atopy atopos which means out of place. DA is also known as atopic eczema, infantile eczema, disseminated neurodermatitis and prurigo diasthique. In 1930 Hill and Sulzberg is a scholar who introduced the term to describe atopic dermatitis skin condition characterized by chronicity of the disease, the superficial location, the presence of inflammatory reactions and itchy.

Atopic dermatitis occurs in 15% of the population of children - children and associated with high levels of IgE in these patients so that suspected immunological factors play a role in DA. DA Sufferers usually have a family history of allergy or atopy, but it got too manifestation of atopic diseases such as: Asthma, Hay fever or rhinitis allergica. DA lesions can get worse in cold weather and dry conditions. The number of people with AD in the United States reached 15 million people, of which 60% of which occurred in under 12 years of age. DA is very rare in old age (over 50 years). DA can occur in infants, the young age of these infants suffer, then the manifestation of DA that appears in the form of patches - red spots that can occur at all and usually on the face, scalp and folding legs that can be accompanied by the formation of crust.

Atopic dermatitis have a close connection with immunological factors. In AD patients there is a high-IgE levels than in normal people, and the patient's blood smear was obtained peninggkatan number of eosinophils. Jam factor immunology, DA is also influenced by genetic factors. Ueahara study on 270 patients with DA showed 60% of DA on DA panderit these offspring.

In DA there is a change characteristic of normal skin. DA manifestations may include: pruritus which is the main complaint people with DA, xerosis (dry skin), keratosis pilaris, ichthosis vulgaris, pityriasis alba and Dannie morgan skinfold. DA apart people with dry skin are also susceptible to virus infection, bateria and fungi. This situation can occur because of the DA occurs ganggua barrier function (barrier) skin. Disorder is caused partly by sweating dysfunction, the occurrence of Trans Epidermal Water Loss (TEWL) and skin fat changes.

The management of DA to the form of systemic treatment and medication that is topical.Systemic therapy with use: antihistamines, corticosteroids, interferon, cyclporin, tacrolimus, antibiotics, and phototherapy. Baiasanya topical therapies are intended to overcome the skin manifestation that occurs in the form of moisturizers and topical corticosteroids.

Dry skin condition on the DA will increase the itching and the skin becomes vulnerable to infection, so that one of the therapy of atopic dermatitis should also aim to overcome these skin dryness. Giving moisturizing skin is expected to overcome the drought that occurred so that buffer to reduce complaints and skin complications are common.

Writing scientific papers will address the dry skin condition that occurs in atopic dermatitis, DA treatment in general and the provision of moisturizer as one form of therapy on DA.

ON SYSTEM skin barrier of atopic dermatitis

The outermost layer of skin is a layer as thick as approximately 10-15 corneum which serves as a barrier against excessive water discharge. Corneum layer is the top layer of skin barrier and a top layer composed of corneocytes are arranged like a braid, on the sidelines - there is webbing between intercellular fat, the skin under normal conditions depending on the 2 factors and environmental conditions of the skin condition itself.Damage from koerneum layer will increase water loss from the skin so the skin will become dry as it did in the DA.

Corneum layer buffer diganbarkan as the composition of the brick wall where brick marupakan corneocytes and intercellular lipid mixture resembles cement. In the corneocytes are natural moisturizing factor (NMF), which bind water so that the corneocytes become "bloated" this prevents the occurrence of fissures or cracks in between the corneocytes. Elasticity of skin depends on the content of the water, healthy skin has a high water content.

Extracellular fat in a layer of corneum is an important factor in maintaining the water content. Fats are composed of over 40% of ceramide, about 25% fatty acids and 20% cholesterol. Ganngguan the three components of the intercellular fat dapart cause skin barrier dysfunction. For example, the provision of lovastatin which is a cholesterol synthesis inhibitor when given topically will disturb the skin barrier function. There is no one single type of fat that secra can maintain skin barrier function, so that normal levels of each - each type of fat ekstraeluler is vital to maintaining skin barrier function. In DA disruption in the lining corneum barrier function.

Dry skin (xerosis) is one of the symptoms of DA caused a decrease ole corneum water content in layers that can cause deskuamasi of corneocytes. Rawling and his colleagues showed that patients with abnormally dry skin, where an increase in fat-free adam and decreased levels of Ceramide. Several studies have shown that the incidence of dry skin on the DA because there is a change levels of ceramide. Other research has shown that the ability to maintain kadae definisis water is not followed by the definition of ceramide. Xerosis on DA may be caused by changes in intercellular lipid lamellar structure in the corneum layer resulting in increased evaporation of water through a layer of corneum or known by TEWL. Reduced water content causes the corneocytes shrink, forming a gap of which can serve as the entrance for substance - and elergen irritant.

Shafer and Kragballe trying to find out the relationship between the definition of intercellular fat in the corneum layer and the occurrence of dry skin, both graduate research shows that in AD patients corneum layer decreased ceramide levels are real.Based on this, the definition of ceramide regarded as an important factor for the occurrence of dry skin in AD patients. This is in line with research conducted by Baradesca and Maicbach which showed an increase in TEWL and decreased water binding capacity corneum layer caused by changes in intracellular lipid content.

GENERAL TREATMENT atopic dermatitis

DA pengbatan success requires a systemic approach that eliputi sticking the skin, topical corticosteroids and find and stop the trigger factors such as irritants, allergens, infectious agents and stresoe emotional. Many factors such as the extent of lesions, trigger factor, which can cause symptoms of atopic dermatitis to be complex, so that treatment in each patient is different - different. In patients who can not be treated with conventional medicine, alternative anti-inflammatory and immunomodulatory can be used.

Skin hydration

DA Patients mostly have dry skin which can increase the severity of the disease with the onset of skin fissures or cracks. Use a moisturizer for dry skin in atopic dermatitis is necessary, this will be discussed further.

Topical glucocorticoid treatment

Topical Glucocorticoids through his work as an anti-inflammatory treatment is the basis eksematosa lesions. Patients should be given an explanation of its consumer and side effects. The use of high potency glucocorticoids should be avoided in advance, genetalia and intertriginous areas, in the area - this area is recommended to use a low potency glucocorticoid. Initial treatment consisted of 1% hydrocortisone ointment applied 2 times per day on the lesions on the face and folding.

Glucocorticoids potential is very high (ultrahigh-potency) is only used in areas that occur likenifikasi and in the short term, should not be on the face or folding. The potential is to be used for long-term regional body and extremities.

Side effects of topical glucocorticoids depending on the level of potency and duration of use. It is important to remember that the higher the higher the potential side effects. To minimize side effects of topical glucocorticoid use, things - the following important consideration: age, place of lesion, extent of lesion, type of preparations and methods of application.

● Age

For children - children with mild to moderate eczema can be used hydrocortisone 1%.Hydrocortisone 1% does not cause systemic side effects through absorption. Stronger preparations are not recommended for infants at the beginning of nursing. In older children potency topical steroids are necessary to shorten the usage. In adults, mild potency topical corticosteroid use is usually not cause systemic or local side effects.Preparations with a potentially strong and powerful should be used in a short time.

● Location

Absorption of corticosteroids will increase the region face daily newspaper. Side effects caused a permanent telangiectasia, so that the area - this area is recommended hydrocortisone 1%. The use of topical steroids that long on the area around the eyes can cause glaucoma, so must be careful - careful especially in patients who have a family history or herself suffering from glaucoma. In young adults also need to be careful - careful in the use of topical steroids are more potent because it may cause strie atrophicae in areas - areas such as breasts, adomen, upper arm and thigh.

● The extent of lesion

The potential for systemic absorption increased at a widespread eczema. The main risk is the pituitary adrenal axis suppression that can affect growth in children - children. It is important to monitor the number, strength, and size of the tube every time the patient control, so there is no excessive doses or deficiency.

● Types of Preparations

generally ointment (ointment) is better than the cream. Absorption ointment is better, and the incidence of irritant and hypersensitivity little more, because the material - there are more preservatives in creams.

● Method of application

treatment should not be more than twice a day, the preparations that are new or have never used once daily is recommended oiled first. The amount used varies between individuals, it is recommended to use the size of a fingertip in which patients equated to 0.5 g.

Identification and Elimination factor triggers

DA sufferers are more susceptible to irritants than normal individuals, so it is important to identify and eliminate factors - factors that triggers that can cause itching, such as soap or detergent, materials - chemicals, tobacco, exposure to light and humidity.

Food and aeroalergen such as house dust, fungi and plant extracts can be causing exacerbation of DA. Avoidance of material - the material could heal skin lesions. Infants and children - more children meliki food allergies, while in adults more allergic to aeroallergen.

Although emotional stress does not directly cause the DA, but can cause exacerbation of the disease. DA sufferers often experience frustration or stress which can increase itching and scratching. Psychological evaluation or counseling should be given to people who mempnyai difficulty overcoming emotional triggers.

Antibiotics against staphylococci can help treat patients infected with S. aureus is a common pathogen. Macrodile erythromycin and azithromycin and clarithromycin new as is usually useful in patients that do not contain S. aureus resistant. For this type of macrodile resisiten S.aureus which can be given dicloxacilin, oxacillin, or cloxacillin. The first-generation cephalosporins are also effective for staphylosporins and streptococci.Mupicorin used topically for treatment of lesions - lesions of impetigo bleak, even in patients with secondary infection panggunaan more widely used systemic antibiotics.

Pruritus

Treatment of itching in the DA should know basic disease. To reduce inflammation and skin dryness given glikokortikoid topical and skin hydration which can reduce the itching. Allergen should be eliminated. Systemic antihistamines may be given as hydroxyzine hydrochloride and hyphenhydramine, but this therapy is not effective without the other DA therapy. hydrochloride which has the effect of tricyclic and inhibit receptor antidepresen H and H with a dose of 10-75 mg orally at night in adult patients can be given if the itching that is especially. Topical antihistamines are not recommended on the DA because it can cause skin sensitization.

Wet compress

Hydrate skin with wet compresses can increase transepidermal penetration of drugs - topical medications. Compress ekskoriasi can accelerate wound healing. The use of excessive compression will cause maceration and can lead to secondary infections.Wet compress and soak it can cause dryness and fissures of the skin if not given a moisturizer. So can compress to control the DA but should be under the supervision of a physician.

Systemic glucocorticoids

Short-term systemic glucocorticoids can be given to the DA who experience acute exacerbations. Although clinical recovery of DA that were treated with systemic glucocorticoids is very fast but often a rebound effect if treatment is stopped. If systemic glucocorticoids are given, it is very important to reduce the dose and provided skin care with topical glucocorticoids followed by use of a moisturizer to prevent a rebound effect on DA.

Ultraviolet Rays

Ultraviolet A (UV-A), UV-B or a combination of both, psoralen + UV-A (PUVA), UV-B 1 (narrow band UV-B) can be used. Short-wave UVB can be used for additional therapy at the recalcitrant DA. Phototherapy with PUVA can be given to people with extensive and severe DA who failed with topical glucocorticoids and topical glucocorticoids avoid side effects if given in large lesions. Side effects which occur widely in Ultraviolet light therapy is usually in the form of erythema, itching or pigmentation, whereas long-term effects of premature aging skin dar, skin malignancy. The recommended maintenance dose 1-2 times per month.

Several other drugs such as azathioprine, cyclosporine, tacrolimus, Chinese herbal medicine and immunomodulator such as interferon and thympetin been reported effective in the treatment of DA but still needs further study. Hepatotoxic effects have been reported on the provision so that patients with Chinese herbal medicine Chinese herbal liver function tests should be done regularly.

IN MOISTURIZING Dermatitis

Moisturizer (moisturizer) is a complex material made with the aim to maintain the water content in the corneum layer between 10-30%. Research on the moisturizer developed in about 1950, when it balnk showed that dry skin is caused by low water content. If there is damage to the skin barrier layer corneum's water content will also be reduced, and water content can be returned in normal condition only when the evaporation of water through the corneum layer is reduced. The purpose of the use of moisturizers is to maintain the water levels in the corneum layer temporarily until the damaged skin barrier system is restored.

There are some terms that often are associated with a moisturizer, namely: emollient and moisturizer. Each - each term is often equated by dermatologists, although in fact each - each term has a special meaning. Emollient is a material used to cover the surface of the corneum layer that can hold water in the corneum layer tersebut.sedangkan moisturizer (moisturizer) is a material that can increase the water content of the skin or to bind water in the corneum layer. The term emollient and moisturizer often equated because amolien also have the ability to increase the water content in the corneum layer.

Use a moisturizer should be combined with a soak (Bathing) because soak therapy can increase the effects of moisturizers or corticosteroid penetration, some combination therapy and the use of soak anatar pelembaba have records as follows:

• Treatment soak in the DA will clean the skin that can reduce the number of bacteria.

• Pemeberian soak therapy in combination with the use of moisturizers can add moisture to strengthen corneum layer.

• Provision of therapy can increase the absorption of corticosteroids used in the treatment of DA.

Moisturizers usually an emulation of oil in water (oil in water) such as lotions or water in oil emulsion (water in oil) like cream. Main types of moisturizers are good standing of both types.

Occlusive Material

Moisturizers this group serves to occlusive or form a layer that has kamampuan to replace natural hydrophilic layer thus reducing TEWL, usually group is also known by the term emollient because this material also has the ability as an emollient in addition to reducing TEWL.

Occlusive materials available at this time were mostly petrolatum and mineral oil. Which includes this golonga material other than petrolatum and mineral oil are:

• Paraffin

• Squalene

• Dimethcone

• Propytlene glycol

• Lanolin

DA treatment using the emollient can increase the water content at corneum layer thus put in to prevent dry skin (xeroxis) which is the cause of itching in atopic dermatitis.Emollient will form an oily layer on the surface of the corneum layer that will prevent water evaporation (TEWL). The water will evaporate will be hampered by the emollient so that water will fill the gap - a blank gap between corneocytes addition emollient will also seep into the corneum layer upon layer so as to resemble the function of intercellular fat which in DA levels berkuran. In addition to functioning as retaining water, emollient has indirect effects as an anti-inflammatory that is useful to overcome the DA.

Should be given after a bath emollient, because at this moment corneum layer of water content on high-up to when given the membrane greasy emollient emollient may prevent the evaporation of water whose levels are increased setealah bath. Emollient given at least 2 times a day, when administered to the entire body is usually in children - a child needs approximately 250-500 grams of emollient a week.

That many types of emollient use is petrolatum which is a mixture of several hydrocarbons, this substance is in use since 1872. petrolatum emollient dinaggap as standard preparations. The advantage of petrolatum is not cause allergic reactions which usually exacerbates kondisa DA. Disadvantage is its use of petrolatum, giving rise to an adult berimnyak oelh uncomfortable because it is often combined with other substances that can reduce the oily taste. The other type of emollient is lanolin that sheep sebaceous gland secretion berasaldari, lanolin it contains cholesterol, which is interselluler komponene from fat. Laonolin often cause allergies, so in general right now does not contain lanolin emollient.

Some studies suggest a complete emollient treatment consisting of emollient ointment / cream, emlien bath oil, and use of emollient soap. The effectiveness of the use of emollient can be improved by using the wet wrapping. Cork menunjukkna improvement in skin condition atopic dermatitis after the use of emlien regularly after 28 days. The applicability of emolie n regularly can reduce the symptoms of itching and to reduce the use of topical corticosteroids. Evaluation of the use of emollient can be made of them by observation / complaint civilization of the skin and decrease itching. Lucky and his friends - friends show that can act as an emollient cream seteroid - sparring in the treatment of atopic dermatitis children, emollient which dberikan with hydrocortisone cream 2.5%, respectively - each once a day turned out to have the same effectiveness with the provision of 2.5% hydrocortisone twice a day.

Humketan

Humektan is a material that is soluble in water and has a high kemempuan absorb water. Hmektan can absorb water from around and beneath the epidermis layer of the corneum. Humektan ability to absorb water from the surroundings can only be done if the surrounding environment kelebaban mncapai 80%. We recommend the use of emollient humektan combined premises so as to achieve maximum effect. Therefore humektan have the ability to absorb water then a layer of corneum become a bit "swollen", this change will give the sensation of smooth skin is not wrinkled. Some examples are benyak humektan used are:

• Glycerin

• Sorbitol

• Sodium hyaluronate

• Urea

• Propylene glycol

• Hydroxy acid

Glycerin is a strong humektan and has the ability to absorb water hampr same as natural moisturizing factor (NMF) which is a natural water-binding in the corneocytes.What type of moisturizing glycerin membandngkan others on 394 patients with dry skin manunjukkan better results in patients who used glycerin moisturizer mamakai compared with the other. Glycerin is normal to dry skin back like Nirmal and able to maintain normal conditions is much longer than other moisturizers.

Humektan other types are urea which is a component of the NMF. Urea is widely used as a hand cream since the 1940s. Apart from being humektan urea also has kemampuan.sebagai antipruritus, it is advantageous to use on DA. TEWL can be lowered with the use of 10% urea cream. Penetration of urea can be increased when combined with hydrocortisone. Use a moisturizer that contains urea is recommended only used when the skin is moist (after a bath) to avoid irritation. In AD patients there is a lack of skin in urea up to 85% so that the use of urea in atopic dermatitis diaharapkan can improve these factors. Pigatto and friends - friends using urea cream 10% with vehikulum vaseline, paraffin, and glycol propelin in his research. After giving two meals a day for 15 days in patients with atopic dermatitis, ceramide levels increase by 30% and clinical improvement occurred in the form of reduced xerosis, pruritus and erythema.

Humektan which is a lot of other used-hydrocy acids (AHAs), which is a class of organic acids and can also serve as the substance ekfoliatif. Several substances including AHAs group are: glycolic acid (glicilic acid), lactic acid (lactic acid) and malic acid (malic acid). Humektan class propylene glycol is an odorless liquid that can function as well humektan occlusive material.

Materials that are important for treatment humketana DA is lactic acid. As is known in patients with decreased levels of ceramide DA which is a component of intercellular fat so that an increase in TEWL, whereas from studies in vitro and in vivo is known that administration of lactic acid can increase the production of ceramide which improves the conditions in pnederita DA.penelitian corneum layer made by Rogers and friends - friends getting results that lotio lactic acid 5% given twice daily for two weeks can reduce the severity of xerosis, although better results obtained by using ammonium lactate 12%.

SUMMARY

Atopic dermatitis is a skin disease characterized by itching and dry skin (xerosis) usually found in infants and children. Some factors that have a close connection with atopic sermatitis include immunological factors and genetic factors. In atopic dermatitis there is a change in skin khususya the corneum layer which is the skin barrier system.Normally corneum layer is composed of corneocytes and intercellular fat consisting of: ceramide, fatty acids and cholesterol. The main function is to prevent the corneum layer waters trasnipedermal loss (TEW) so the skin moisture content can be maintained under normal circumstances. What happens in atopic dermatitis adala changes in the structure of corneocytes and intercellular fat so that an increase in TEWL leading to atopic skin becomes dry.

One modality of treatment of atopic dermatitis is by giving a moisturizer that aims to mengmbalikan water levels become normal again. Moisturizers are used to form occlusive ingredients that make up the veil on the skin surface to reduce TEWL or humketan binding water. Treatment of atopic dermatitis by using a moisturizer is often combined with the use of corticosteroids to achieve optimal results.

Use moisturizer on the DA can improve skin barrier, reducing TEWL and can relieve itching and to reduce the provision of topical steroids.

Literature

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2. Atopic Dermatitis, Eczema, and noninfectious Imonudeficiency Disorders. In: Odom RB, James WD, Berger TG, editors. Disease of the skin. 9 Ed. Philadelphia: WB Saunders Company; 2000.p. 69-94.

3. Rebecca J. Atopic dermatitis. Primary Care: Clinics in Office Practice 2000; 27: 1-11.

4. Rajka G. Emollient therapy in atopic dermatitis. J Dermatol Treat 1997; 8: S19-S21.

Correale CE, Walker C, Murphy L, Graig TJ. Atopic Dermatitis: A Review of Diagnosis and Treatment og. Am Fam Physician 1999; 60: 1191-210.

Edting By: EnongXp