Introduction: The natural cyclic tetrahydropyrimidine, ectoine, is a low-molecular, water-binding, organic osmolyte. Previously, topical application of ectoine to healthy human skin was shown to improve skin hydration as well as skin barrier function. Objectives: We therefore speculated that topical application of ectoine would be beneficial for patients with atopic dermatitis (AD), in which a genetically defined defect in skin barrier function is of major pathogenetic relevance. We assessed the efficacy of an ectoine-containing cream (EHK02-01) in the management of 65 patients with mild to moderate AD in a randomized, intra-individual, double-blind, multi-center trial, in which the efficacy of ectoine was compared to a nonsteroidal anti-inflammatory cream previously found to primarily act on skin barrier function and therefore with a comparable mode of action. Methods: Sixty-five patients with mild to moderate AD aged 18-65 years were enrolled. The patients applied EHK02-01 and the control cream on two symmetrical lesions twice daily for 28 days. At the beginning, after 7 and after 28 days, treated skin areas were assessed by modified, objective local SCORAD (Scoring Atopic Dermatitis) and IGA (Investigator's Global Assessment) as well as the patients' judgment of efficacy and their assessment of pruritus. Results: EHK02-01 was found to be very well tolerated. Even more important, efficacy of EHK02-01 treatment was equivalent to that achieved with the reference product. Conclusion: These results indicate that topical treatment with EHK02-01 may represent a novel option for the treatment of patients with AD.

1.
Akdis CA, Akdis M, Bieber T, Bindslev-Jensen C, Boguniewicz M, Eigenmann P, Hamid Q, Kapp A, Leung DY, Lipozencic J, Luger TA, Muraro A, Novak N, Platts-Mills TA, Rosenwasser L, Scheynius A, Simons FE, Spergel J, Turjanmaa K, Wahn U, Weidinger S, Werfel T, Zuberbier T: Diagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Report. J Allergy Clin Immunol 2006;118:152-169.
2.
Williams HC: Clinical practice. Atopic dermatitis. N Engl J Med 2005;352:2314-2324.
3.
Breuer K, Werfel T, Kapp A: Safety and efficacy of topical calcineurin inhibitors in the treatment of childhood atopic dermatitis. Am J Clin Dermatol 2005;6:65-77.
4.
Chen SL, Yan J, Wang FS: Two topical calcineurin inhibitors for the treatment of atopic dermatitis in pediatric patients: a meta-analysis of randomized clinical trials. J Dermatolog Treat 2010;21:144-156.
5.
Frankel HC, Qureshi AA: Comparative effectiveness of topical calcineurin inhibitors in adult patients with atopic dermatitis. Am J Clin Dermatol 2012;13:113-123.
6.
Shams K, Grindlay DJ, Williams HC: What's new in atopic eczema? An analysis of systematic reviews published in 2009-2010. Clin Exp Dermatol 2011;36:573-577.
7.
Galinski EA, Pfeffer HP, Trüpper HG: 1,4,5,6-Tetrahydro-2-methyl-4-pyrimidinecarboxylic acid. A novel cyclic amino acid from halophilic phototropic bacteria of the genus Ectothiorhodospira. Eur J Biochem 1995;149:135-139.
8.
Lentzen G, Schwarz T: Extremolytes: natural compounds from extremophiles for versatile applications. Appl Microbiol Biotechnol 2006;72:623-634.
9.
Yancey PH: Organic osmolytes as compatible, metabolic and counteracting cytoprotectants in high osmolarity and other stresses. J Exp Biol 2005;208:2819-2830.
10.
Graf R, Anzali S, Buenger J, Pfluecker F, Driller H: The multifunctional role of ectoine as a natural cell protectant. Clin Dermatol 2008;26:326-333.
11.
Lentzen G, Schwarz T: Extremolytes: natural compounds from extremophiles for versatile applications. Appl Microbiol Biotechnol 2006;72:623-634.
12.
Dirschka T: Doppelblinde, randomisierte monozentrische Untersuchung zur Wirksamkeit und Verträglichkeit einer ectoinhaltigen Crème bei chronischer Plaque-Psoriasis; a study report, Wuppertal, 2008.
13.
Heffernan M, Houshmand E: Treatment options for atopic dermatitis. US Spec Popul Pediatr Rev 2006:57-58.
14.
Patrizi A, Raone B, Neri I: Atopiclair. Expert Opin Pharmacother 2009;10:1223-1230.
15.
Veraldi S, De Micheli P, Schianchi R, Lunardon L: Treatment of pruritus in mild-to-moderate atopic dermatitis with a topical non-steroidal agent. J Drugs Dermatol 2009;8:537-539.
16.
Boguniewicz M, Zeichner JA, Eichenfield LF, Hebert AA, Jarratt M, Lucky AW, Paller A: MAS063DP (Atopiclair™) is in infants and children: a multicenter, randomized, vehicle-controlled study. J Pediatr 2008;152:854-859.
17.
Abramovits W, Boguniewicz M, Adult Atopiclair Study Group: A multicenter, randomized, vehicle-controlled clinical study to examine the efficacy and safety of MAS063DP (Atopiclair) in the management of mild to moderate atopic dermatitis in adults. J Drugs Dermatol 2006;5:236-244.
18.
Patrizi A, Capitanio B, Neri I, Giacomini F, Sinagra JL, Raone B, Berardesca E: A double-blind, randomized, vehicle-controlled clinical study to evaluate the efficacy and safety of MAS063DP (ATOPICLAIR) in the management of atopic dermatitis in paediatric patients. Pediatr Allergy Immunol 2008;19:619-625.
19.
European Task Force on Atopic Dermatitis: Severity scoring of atopic dermatitis: the SCORAD Index. Dermatology 1993;186:23-31.
20.
Charman C, Chambers C, Williams H: Measuring atopic dermatitis severity in randomized controlled clinical trials: what exactly are we measuring? J Invest Dermatol 2003;120:932-941.
21.
Wellek S: Statistische Methoden zum Nachweis von Äquivalenz. Stuttgart, Fischer, 1994.
22.
Heinrich U, Garbe B, Tronnie H: In vivo assessment of ectoin: a randomized, vehicle-controlled clinical trial. Skin Pharmacol Physiol 2007;20:211-218.
23.
Bünger J, Degwert J, Driller H: The protective function of compatible solute ectoin on the skin, skin cells and its biomolecules with respect to UV radiation, immunosuppression and membrane damage. IFSCC Mag 2001;4:127-131.
24.
Beyer N, Driller H, Bünger J: Ectoin - an innovative, multi-functional active substance for the cosmetic industry. SÖFW J 2000;126:27-29.
25.
Bünger J, Driller H: Ectoin: An effective natural substance to prevent UVA-induced premature photoaging. Skin Pharmacol Physiol 2004;17:232-237.
26.
Bünger J: Ectoine added protection and care for the skin. Eurocosmetics 1999;7:22-24.
27.
Grether-Beck S, Timmer A, Felsner I, Brenden H, Brammertz D, Krutmann J: Ultraviolet A-induced signaling involves a ceramide-mediated autocrine loop leading to ceramide de novo synthesis. J Invest Dermatol 2005;125:545-553.
28.
Vejlsgaard GL, Ralfkiaer E, Avnstorp C, Czajkowski M, Marlin SD, Rothlein R: Kinetics and characterization of intercellular adhesion molecule-1 (ICAM-1) expression on keratinocytes in various inflammatory skin lesions and malignant cutaneous lymphomas. J Am Acad Dermatol 1989;20:782-790.
29.
Sydlik U, Gallitz I, Albrecht C, Abel J, Krutmann J, Unfried K: The compatible solute ectoine protects against nanoparticle-induced neutrophilic lung inflammation. Am J Respir Crit Care Med 2009;180:29-35.
30.
Sydlik U, Peuschel H, Paunel-Görgülü A, Keymel S, Krämer U, Weissenberg A, Kroker M, Seghrouchni S, Heiss C, Windolf J, Bilstein A, Kelm M, Krutmann J, Unfried K: Recovery of neutrophil apoptosis by ectoine: a new strategy against lung inflammation. Eur Respir J 2013;41:1-11.
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