CoChat
Sign Up
Cited by 32Dermatology and Skin DiseasesAdvancements in Transdermal Drug DeliveryContact Dermatitis and Allergies

Patient acceptability, efficacy, and skin biophysiology of a cream and cleanser containing lipid complex with shea butter extract versus a ceramide product for eczema

Open access
Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, Hon, KL, Tsang, YC, Pong, NH, Lee, Vivian WY, Luk, NM, Chow, CM, Leung, TF·2015·Hong Kong Medical Journal
DOI 10.12809/hkmj144472
Open this paper in CoChat — free accountOpen PDF

Abstract

OBJECTIVES: To investigate patient acceptability, efficacy, and skin biophysiological effects of a cream/cleanser combination for childhood atopic dermatitis. SETTING: Paediatric dermatology clinic at a university teaching hospital in Hong Kong. PATIENTS: Consecutive paediatric patients with atopic dermatitis who were interested in trying a new moisturiser were recruited between 1 April 2013 and 31 March 2014. Swabs and cultures from the right antecubital fossa and the worst eczematous area, disease severity (SCORing Atopic Dermatitis index), skin hydration, and transepidermal water loss were obtained prior to and following 4-week usage of a cream/cleanser containing lipid complex with shea butter extract (Ezerra cream; Hoe Pharma, Petaling Jaya, Malaysia). Global or general acceptability of treatment was documented as 'very good', 'good', 'fair', or 'poor'. RESULTS: A total of 34 patients with atopic dermatitis were recruited; 74% reported 'very good' or 'good', whereas 26% reported 'fair' or 'poor' general acceptability of treatment of the Ezerra cream; and 76% reported 'very good' or 'good', whereas 24% reported 'fair' or 'poor' general acceptability of treatment of the Ezerra cleanser. There were no intergroup differences in pre-usage clinical parameters of age, objective SCORing Atopic Dermatitis index, pruritus, sleep loss, skin hydration, transepidermal water loss, topical corticosteroid usage, oral antihistamine usage, or general acceptability of treatment of the prior emollient. Following use of the Ezerra cream, mean pruritus score decreased from 6.7 to 6.0 (P=0.036) and mean Children's Dermatology Life Quality Index improved from 10.0 to 8.0 (P=0.021) in the 'very good'/'good' group. There were no statistically significant differences in the acceptability of wash (P=0.526) and emollients (P=0.537) with pre-trial products. When compared with the data of another ceramide-precursor moisturiser in a previous study, there was no statistical difference in efficacy and acceptability between the two products. CONCLUSIONS: The trial cream was acceptable in three quarters of patients with atopic dermatitis. Patients who accepted the cream had less pruritus and improved quality of life than the non-accepting patients following its usage. The cream containing shea butter extract did not differ in acceptability or efficacy from a ceramide-precursor product. Patient acceptability is an important factor for treatment efficacy. There is a general lack of published clinical trials to document the efficacy and skin biophysiological effects of many of the proprietary moisturisers.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.12809/hkmj144472

Cites

1 of 1 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 46

  1. Leung AK, Hon KL, Robson WL. Atopic dermatitis. Adv Pediatr 2007;54:241-73.
  2. Sandilands A, Terron-Kwiatkowski A, Hull PR, et al. Comprehensive analysis of the gene encoding filaggrin uncovers prevalent and rare mutations in ichthyosis vulgaris and atopic eczema. Nat Genet 2007;39:650-4.
  3. Sandilands A, Smith FJ, Irvine AD, McLean WH. Filaggrin's fuller figure: a glimpse into the genetic architecture of atopic dermatitis. J Invest Dermatol 2007;127:1282-4.
  4. Enomoto H, Hirata K, Otsuka K, et al. Filaggrin null mutations are associated with atopic dermatitis and elevated levels of IgE in the Japanese population: a family and case-control study. J Hum Genet 2008;53:615-21.
  5. Chamlin SL, Kao J, Frieden IJ, et al. Ceramide-dominant barrier repair lipids alleviate childhood atopic dermatitis: changes in barrier function provide a sensitive indicator of disease activity. J Am Acad Dermatol 2002;47:198-208.
  6. Maintz L, Novak N. Getting more and more complex: the pathophysiology of atopic eczema. Eur J Dermatol 2007;17:267-83.
  7. Hon KL, Leung AK. Use of ceramides and related products for childhood-onset eczema. Recent Pat Inflamm Allergy Drug Discov 2013;7:12-9.
  8. Hon KL, Wang SS, Pong NH, Leung TF. The ideal moisturizer: a survey of parental expectations and practice in childhood-onset eczema. J Dermatolog Treat 2013;24:7- 12.
  9. Williams HC, Burney PG, Pembroke AC, Hay RJ. The U.K. Working Party's Diagnostic Criteria for Atopic Dermatitis. III. Independent hospital validation. Br J Dermatol 1994;131:406-16.
  10. Hon KL, Wong KY, Leung TF, Chow CM, Ng PC. Comparison of skin hydration evaluation sites and correlations among skin hydration, transepidermal water loss, SCORAD index, Nottingham Eczema Severity Score, and quality of life in patients with atopic dermatitis. Am J Clin Dermatol 2008;9:45-50.
  11. Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology 1993;186:23-31.
  12. Kunz B, Oranje AP, Labreze L, Stalder JF, Ring J, Taieb A. Clinical validation and guidelines for the SCORAD index: consensus report of the European Task Force on Atopic Dermatitis. Dermatology 1997;195:10-9.
  13. Hon KL, Wang SS, Lau Z, et al. Pseudoceramide for childhood eczema: does it work? Hong Kong Med J 2011;17:132-6.
  14. Hon KL, Pong NH, Wang SS, Lee VW, Luk NM, Leung TF. Acceptability and efficacy of an emollient containing ceramide-precursor lipids and moisturizing factors for atopic dermatitis in pediatric patients. Drugs R D 2013;13:37-42.
  15. Leung DY, Boguniewicz M, Howell MD, Nomura I, Hamid QA. New insights into atopic dermatitis. J Clin Invest 2004;113:651-7.
  16. Hon KL, Lam MC, Leung TF, et al. Clinical features associated with nasal Staphylococcus aureus colonisation in Chinese children with moderate-to-severe atopic dermatitis. Ann Acad Med Singapore 2005;34:602-5.
  17. Hon KL, Wang SS, Lee KK, Lee VW, Fan LT, Ip M. Combined antibiotic/corticosteroid cream in the empirical treatment of moderate to severe eczema: friend or foe? J Drugs Dermatol 2012;11:861-4.
  18. Hanifin JM, Rajka RG. Diagnostic features of atopic dermatitis. Acta Derm Venereol (Stockh) 1980;2:44-7.
  19. Hanifin JM. Atopic dermatitis. J Am Acad Dermatol 1982;6:1-13.
  20. Hon KL, Leung AK, Barankin B. Barrier repair therapy in atopic dermatitis: an overview. Am J Clin Dermatol 2013;14:389-99.
  21. Krakowski AC, Eichenfield LF, Dohil MA. Management of atopic dermatitis in the pediatric population. Pediatrics 2008;122:812-24.
  22. Lancaster W. Atopic eczema in infants and children. Community Pract 2009;82:36-7.
  23. Tarr A, Iheanacho I. Should we use bath emollients for atopic eczema? BMJ 2009;339:b4273.
  24. Hon KL, Leung TF, Wong Y, So HK, Li AM, Fok TF. A survey of bathing and showering practices in children with atopic eczema. Clin Exp Dermatol 2005;30:351-4.
  25. Hon KL, Ching GK, Leung TF, Choi CY, Lee KK, Ng PC. Estimating emollient usage in patients with eczema. Clin Exp Dermatol 2010;35:22-6.
  26. Hon KL, Leung TF, Ng PC, et al. Efficacy and tolerability of a Chinese herbal medicine concoction for treatment of atopic dermatitis: a randomized, double-blind, placebo- controlled study. Br J Dermatol 2007;157:357-63.
  27. Hon KL, Kam WY, Leung TF, et al. Steroid fears in children with eczema. Acta Paediatr 2006;95:1451-5.
  28. Roos TC, Geuer S, Roos S, Brost H. Recent advances in treatment strategies for atopic dermatitis. Drugs 2004;64:2639-66.
  29. Baumer JH. Atopic eczema in children, NICE. Arch Dis Child Educ Pract Ed 2008;93:93-7.
  30. Park KY, Kim DH, Jeong MS, Li K, Seo SJ. Changes of antimicrobial peptides and transepidermal water loss after topical application of tacrolimus and ceramide-dominant emollient in patients with atopic dermatitis. J Korean Med Sci 2010;25:766-71.
  31. Mohammed D, Matts PJ, Hadgraft J, Lane ME. Influence of Aqueous Cream BP on corneocyte size, maturity, skin protease activity, protein content and transepidermal water loss. Br J Dermatol 2011;164:1304-10.
  32. Tsang M, Guy RH. Effect of Aqueous Cream BP on human stratum corneum in vivo. Br J Dermatol 2010;163:954-8.
  33. Simpson E, Böhling A, Bielfeldt S, Bosc C, Kerrouche N. Improvement of skin barrier function in atopic dermatitis patients with a new moisturizer containing a ceramide precursor. J Dermatolog Treat 2013;24:122-5.
  34. Laquieze S, Czernielewski J, Baltas E. Beneficial use of Cetaphil moisturizing cream as part of a daily skin care regimen for individuals with rosacea. J Dermatolog Treat 2007;18:158-62.
  35. Simpson E, Trookman NS, Rizer RL, et al. Safety and tolerability of a body wash and moisturizer when applied to infants and toddlers with a history of atopic dermatitis: results from an open-label study. Pediatr Dermatol 2012;29:590-7.
  36. Miller MA, Borys D, Riggins M, Masneri DC, Levsky ME. Two cases of contact dermatitis resulting from use of body wash as a skin moisturizer. Am J Emerg Med 2008;26:246. e1-2.
  37. Miller DW, Koch SB, Yentzer BA, et al. An over-the- counter moisturizer is as clinically effective as, and more cost-effective than, prescription barrier creams in the treatment of children with mild-to-moderate atopic dermatitis: a randomized, controlled trial. J Drugs Dermatol 2011;10:531-7.
  38. Draelos ZD. The effect of ceramide-containing skin care products on eczema resolution duration. Cutis 2008;81:87- 91.
  39. Madaan A. Epiceram for the treatment of atopic dermatitis. Drugs Today (Barc) 2008;44:751-5.
  40. Palatty PL, Azmidah A, Rao S, et al. Topical application of sandal wood oil and turmeric based cream prevents radiodermatitis in head and neck cancer patients undergoing external beam radiotherapy: a pilot study. Br J Radiol 2014;87:20130490.
  41. Wang S, Kislalioglu MS, Breuer M. The effect of rheological properties of experimental moisturizing creams/lotions on their efficacy and perceptual attributes. Int J Cosmet Sci 1999;21:167-88.
  42. Boffa MJ, Beck MH. Allergic contact dermatitis from quaternium 15 in Oilatum cream. Contact Dermatitis 1996;35:45-6.
  43. Garfield SS. The beneficial effects of oilatum cream on hyperhydrosis. J Am Podiatry Assoc 1966;56:22-4.
  44. Yilmaz E, Borchert HH. Effect of lipid-containing, positively charged nanoemulsions on skin hydration, elasticity and erythema-an in vivo study. Int J Pharm 2006;307:232-8.
  45. Kemeny L, Koreck A, Kis K, et al. Endogenous phospholipid metabolite containing topical product inhibits ultraviolet light-induced inflammation and DNA damage in human skin. Skin Pharmacol Physiol 2007;20:155-61.
  46. Dizon MV, Galzote C, Estanislao R, Mathew N, Sarkar R. Tolerance of baby cleansers in infants: a randomized controlled trial. Indian Pediatr 2010;47:959-63.

Cited by

Sorted by citations

Authors
Prince of Wales Hospital, T. C. U. O. H. K., Hon, K., Tsang, Y., Pong, N., Lee, V. W., Luk, N., Chow, C., & Leung, T.
Affiliations
Chinese University of Hong Kong (HK)
Venue
Hong Kong Medical Journal
Publisher
Hong Kong Academy of Medicine Press
Published
2015-08-28
Volume
21
Issue
5
Pages
417-25
ISSN
1024-2708 (ISSN-L)
DOI
10.12809/hkmj144472
OpenAlex
W2398734429
Cited by
32
References
1
Citations by year
2026: 1 · 2025: 1 · 2024: 4 · 2023: 1 · 2022: 3 · 2021: 6 · 2020: 8 · 2019: 1 · 2018: 4 · 2017: 2 · 2016: 1
FWCI
2.61
Type
journal article
Language
en
Open access
Licence
Locations
  • Hong Kong Medical Journal (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Dermatology › Dermatology and Skin Diseases
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmaceutical Science › Advancements in Transdermal Drug Delivery
  • Health Sciences › Medicine › Dermatology › Contact Dermatitis and Allergies
Keywords
atopic dermatitis, pediatric atopic dermatitis, lipid complex, ceramide, emollients, cleansers, patient acceptability, pruritus, skin hydration, transepidermal water loss, Children's Dermatology Life Quality Index, treatment efficacy, pediatric dermatology
MeSH terms
Adolescent, Ceramides, Child, Dermatitis, Atopic, Detergents, Eczema, Emollients, Female, Humans, Lipids, Male, Phytotherapy, Patient Acceptance of Health Care, Plant Extracts, Pruritus, Quality of Life, Severity of Illness Index, Water Loss, Insensible, Sapotaceae, Young Adult, Skin Cream

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review