The role of ceramide, menthol, and polidocanol on pruritus, skin barrier function, and disease severity of mild atopic dermatitis

Authors

  • Menul Ayu Umborowati Dermatology and Venereology Department Faculty of Medicine Universitas Airlangga
  • Dewi Nurasrifah Dermatology and Venereology Department Faculty of Medicine Universitas Airlangga
  • Diah Mira Indramaya Dermatology and Venereology Department Faculty of Medicine Universitas Airlangga
  • Sylvia Anggraeni Dermatology and Venereology Department Faculty of Medicine Universitas Airlangga
  • Damayanti Damayanti Dermatology and Venereology Department Faculty of Medicine Universitas Airlangga
  • Cita Rosita Sigit Prakoeswa Dermatology and Venereology Department Faculty of Medicine Universitas Airlangga

DOI:

https://doi.org/10.66344/jpad.v30i1.1288

Keywords:

atopic dermatitis, moisturizer, pruritus, skin barrier, severity

Abstract

Background Atopic Dermatitis (AD) relates with skin barrier defect. Unbearable itch leads to intense scratching, causing skin damage, and perpetuates the disease. The aim of this study is to investigate efficacy of topical ceramide, menthol, and polidocanol to decrease itch and AD severity, also improve skin barrier function.

Methods Total 30 subjects were included in this pre-experimental, before-after observational study. The subjects were children 8-18 years old with mild atopic dermatitis. We evaluated SCORAD index and daily patient-based Patient Eczema Scoring Time (PEST) for AD severity, transepidermal water loss (TEWL) using Tewameter to represent skin barrier function, and also visual analog scale (VAS) to observe itch. The preparation was applied twice daily for 4 weeks. The progression of AD after application, along with side effects, was evaluated on 5 minutes, week 1, 2, and 4.

Results SCORAD index started to decrease after 1-week application. PEST and itch VAS decreased as immediate as 5 minutes after application. Skin barrier function also improved represented by declining of TEWL values. The differences were statistically significant (P < 0.05).

Conclusion Combination of ceramide, menthol, and polidocanol suppress itchy and disease severity, also improve skin barrier function in AD patients.

Author Biography

  • Dewi Nurasrifah, Dermatology and Venereology Department Faculty of Medicine Universitas Airlangga
    Dewi Nurasrifah, MD is board-certified dermatologist in Surabaya, Indonesia

References

1. Y Valdman-Grinshpoun, D Ben-Amitai and A Zvulunox. Barrier-restoring therapies in atopic dermatitis: current approaches and future perspective. Dermatol res Pract 2012: 1-6.

2. E Van Zuuren, Z Fedorowicz and B Arents. "Emollients and moisturizers for eczema: a bridge Cochrane systematic review including GRADE assessments," Br J Dermatol 2017; 177: 1256-71.

3. J Hong, J Buddenkotte, TG Berger and M Steinhoff. Management of Itch in Atopic Dermatitis. Seminars in Cutaneous Medicine and Surgery 2011; 30: 71-86.

4. SB Elmariah and EA Lerner. Topical Therapies for Pruritus. Seminars in Cutaneous Medicine and Surgery 2011; 30: 118-126.

5. SB Elmariah. Adjunctive management of itch in Atopic Dermatitis. Dermatol Clin 2017; 1-22.

6. A Reich, M Heisig, NQ Phan, K Taneda, K Takamori and S Takeuchi. Visual analogue scale: evaluation of the instrument for the assessment of pruritus. Acta Derm Venereol 2012; 92: 497-501.

7. D Rubel, T Thirumoorthy, RW Soebaryo, SC Weng, TM Gabriel , LL Villafuerte, CY Chu, S Dhar, D Parikh, LC Wong and KK Lo. Consensus guidelines for the management of atopic dermatitis: An Asia–Pacific perspective. J Dermatolo 2013; 40: 160-171.

8. KL Hon, JSC Kung, WGG Ng and TF Leung. Emollient treatment of atopic dermatitis: latest evidence and clinical considerations. Drugs in Context 2018; 7: 1-14.

9. E Weisshaar, JC Szepietowski, U Darsow, L Misery, J Wallengren, T Mettang, U Gieler, T Lotti, J Lambert, P Maisel and M Streit. European guideline on chronic pruritus. Acta Derm Venereol 2012; 92: 563-581.

10. S Takeuchi, F Yasukawa and M Furue. Collared mice: a model to assess the effects of scratching. J Dermatol Sci 2010; 57: 44–50.

11. S Chow, CS Seow, MV Dizon, K Godse, H Foong, C Vicheth, TH Khang, L Xiang, S Hidayat, MY Listiawan, D Triwahyudi, SP Gondokaryono, E Sutedja, I Arline and O Suwarsa. A clinician's reference guide for the management of atopic dermatitis in Asians. Asia Pac Allergy 2018; 8(4): e41.

12. J Hanifin and G Rajka. Diagnostic features of atopic eczema. Acta Derm Venereol (Stockh) 1980; 92: 44-47.

13. A Oranje, E Glazenburg, A Wolkerstorfer and F de Waard-van der Spek. Practical issues on interpretation of scoring atopic dermatitis: the SCORAD index, objective SCORAD and the three-item severity score. Br J Dermatol 2007; 157: 645-648.

14. JM Jungersted and T Agner. Eczema and ceramides: an update," Contact Dermatitis 2013; 69: 65-71.

15. M Milani. Barrier Repair Therapy in Atopic Eczema: New Evidences in Improving Skin Functions with Topical Emolliency and Hydration Strategies. J Clin Dermatol Ther 2015; 2(2): 011.

16. G Yosipovitch and AD Papoiu. What Causes Itch in Atopic Dermatitis ? Curr Allergy Asthma Rep 2008; 8(4): 306-311.

17. DW Miller, SB Koch and BA Yentzer. 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: 531-53.

18. M Kido-Nakahara, M Furue, D Ulzii and T Nakahara. Itch in Atopic Dermatitis. Immunol Allergy Clin N Am 2016: 1-10.

19. T Hawro, JW Fluhr, V Mengeaud, D Redoules, MK Church, M Maurer and M Metz. Polidocanol inhibits cowhage - but not histamine-induced itch in humans. Exp Dermatol 2014; 23: 922–941.

20. G Freitag and T Hooppner. Results of a post marketing drug monitoring survey with a polidocanol-urea preparation for dry, itching skin. Current Medical Research and Opinion 1997; 13(9): 529-537.

21. N Galeotti, M DiCesare, G Mazzanti, A Bartolini and C Ghelardini. Menthol: a natural analgesic compound. Neurosci Lett 2002; 322: 145-148.

22. M Fröhlich, A Enk, TL Diepgen and E Weisshaar. Successful Treatment of Therapy-resistant Pruritus in Lichen Amyloidosis with Menthol. Acta Dermato-Venereologica 2009; 89: 524-5269.

23. E Sundstrup, MD Jakobsen, M Brandt, K Jay, JC Colado, Y Wang and LL Andersen. Acute Effect of Topical Menthol on Chronic Pain in Slaughterhouse Workers with Carpal Tunnel Syndrome: Triple-Blind, Randomized Placebo-Controlled Trial. Rehabilitation research and practice 2014; 2014: 310913.

24. E van Zuuren, Z Fedorowicz, R Christensen, A Lavrijsen and B Arents. Emollients and moisturisers for eczema (Review). Cochrane Database Syst Rev 2017; 2, no. Art, p. No.: CD012119.

25. MJA Koh, YC Giam, HM Liew, AYW Foong, JC Ho, SMY Wong, MBY Tang, MSL Ho, LS Tan, JM Mason and MJ Cork. Comparison of the Simple Patient-Centric Atopic Dermatitis Scoring System PEST with SCORAD in Young Children Using a Ceramide Dominant Therapeutic Moisturizer. Dermatol Ther (Heidelb), 2017.

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Published

07.08.2020

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Original Articles

How to Cite

1.
The role of ceramide, menthol, and polidocanol on pruritus, skin barrier function, and disease severity of mild atopic dermatitis. J Pak Assoc Dermatol [Internet]. 2020 Aug. 7 [cited 2026 Jul. 22];30(1):98-105. Available from: https://www.jpad.com.pk/index.php/jpad/article/view/1288