Background: Dry skin reflects a skin barrier defect which can lead to atopic dermatitis. Little is known about the distinct effects of emollient use in children with dry skin and atopic predisposition. Objectives: We investigated the effects of daily application of pressed ice plant juice (PIPJ)-based emollients and petrolatum-based emollients. Methods: Children aged 2-6 years with dry skin and atopic predisposition were randomized into 2 groups: group 1 received emollients containing PIPJ and natural lipids, while group 2 received petrolatum-based emollients. Skin condition and biophysical properties of the skin barrier were assessed at inclusion and weeks 4, 12 and 16. Results: Skin condition improved significantly in all children. Comparing the groups, children treated with emollients containing PIPJ showed significantly higher stratum corneum hydration values and significantly lower transepidermal water loss values at week 16 on the forearm and forehead. A significant decrease in skin pH was noted in group 2 on the forearm and forehead; group 1 showed a stable course. Conclusion: Early intervention with emollients in children with dry skin condition and atopic predisposition may improve their skin condition during daily emollient application. PIPJ-based formulations may be helpful to maintain skin barrier integrity.

Böhme M, et al: Hanifin's and Rajka's minor criteria for atopic dermatitis: which do 2-year-olds exhibit? J Am Acad Dermatol 2000;43:785-792.
Cork MJ, Danby S: Skin barrier breakdown: a renaissance in emollient therapy. Br J Nurs 2009;18:876-877.
Flohr C, et al: Filaggrin loss-of-function mutations are associated with early-onset eczema, eczema severity and transepidermal water loss at 3 months of age. Br J Dermatol 2010;163:1333-1336.
Proksch E, Lachapelle JM: The management of dry skin with topical emollients: recent perspectives. J Dtsch Dermatol Ges 2005;3:768-774.
Simpson EL, et al: A pilot study of emollient therapy for the primary prevention of atopic dermatitis. J Am Acad Dermatol 2010;63:587-593.
Seidenari S, Giusti G: Objective assessment of the skin of children affected by atopic dermatitis: a study of pH, capacitance and TEWL in eczematous and clinically uninvolved skin. Acta Derm Venereol 1995;75:429-433.
Horii I, et al: Stratum corneum hydration and amino acid content in xerotic skin. Br J Dermatol 1989;121:587-592.
Berry N, et al: A clinical, biometrological and ultrastructural study of xerotic skin. Int J Cosmet Sci 1999;21:241-252.
Moncrieff G, et al: Use of emollients in dry-skin conditions: consensus statement. Clin Exp Dermatol 2013;38:231-238.
Pons-Guiraud A: Dry skin in dermatology: a complex physiopathology. J Eur Acad Dermatol Venereol 2007;21(suppl 2):1-4.
Nikolovski J, et al: Barrier function and water-holding and transport properties of infant stratum corneum are different from adult and continue to develop through the first year of life. J Invest Dermatol 2008;128:1728-1736.
Chaumont A, et al: Interactions between domestic water hardness, infant swimming and atopy in the development of childhood eczema. Environ Res 2012;116:52-57.
Seyfarth F, et al: Dry skin, barrier function, and irritant contact dermatitis in the elderly. Clin Dermatol 2011;29:31-36.
Seidenari S, et al: Thickness and echogenicity of the skin in children as assessed by 20-MHz ultrasound. Dermatology 2000;201:218-222.
Stamatas GN, et al: Infant skin physiology and development during the first years of life: a review of recent findings based on in vivo studies. Int J Cosmet Sci 2011;33:17-24.
Garcia Bartels N, et al: Influence of bathing or washing on skin barrier function in newborns during the first four weeks of life. Skin Pharmacol Physiol 2009;22:248-257.
Garcia Bartels N, et al: Effect of standardized skin care regimens on neonatal skin barrier function in different body areas. Pediatr Dermatol 2010;27:1-8.
Fluhr JW, et al: Impact of anatomical location on barrier recovery, surface pH and stratum corneum hydration after acute barrier disruption. Br J Dermatol 2002;146:770-776.
Reuter J, Merfort I, Schempp CM: Botanicals in dermatology: an evidence-based review. Am J Clin Dermatol 2010;11:247-267.
Ring J, et al: Guidelines for treatment of atopic eczema (atopic dermatitis). Part II. J Eur Acad Dermatol Venereol 2012;26:1176-1193.
Serup J: EEMCO guidance for the assessment of dry skin (xerosis) and ichthyosis: clinical scoring systems. Skin Res Technol 1995;1:109-114.
Diepgen TL, Fartasch M, Hornstein OP: Criteria of atopic skin diathesis. Derm Beruf Umwelt 1991;39:79-83.
Diepgen TL, Sauerbrei W, Fartasch M: Development and validation of diagnostic scores for atopic dermatitis incorporating criteria of data quality and practical usefulness. J Clin Epidemiol 1996;49:1031-1038.
Hanifin JM, Rajka G: Diagnostic features of atopic dermatitis. Acta Derm Venereol 1980;92(suppl):44-47.
Turner L, et al: Consolidated Standards of Reporting Trials (CONSORT) and the completeness of reporting of randomised controlled trials (RCTs) published in medical journals. Cochrane Database Syst Rev 2012;11:MR000030.
Kunz B, et al: Clinical validation and guidelines for the SCORAD index: consensus report of the European Task Force on Atopic Dermatitis. Dermatology 1997;195:10-19.
Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology 1993;186:23-31.
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.
Schmitt J, et al: What are the best outcome measurements for atopic eczema? A systematic review. J Allergy Clin Immunol 2007;120:1389-1398.
Oranje AP, et al: 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.
Schram ME, et al: EASI, (objective) SCORAD and POEM for atopic eczema: responsiveness and minimal clinically important difference. Allergy 2012;67:99-106.
Schmitt J, et al: Assessment of clinical signs of atopic dermatitis: a systematic review and recommendation. J Allergy Clin Immunol 2013;132:1337-1347.
Zeger SL, Liang KY, Albert PS: Models for longitudinal data: a generalized estimating equation approach. Biometrics 1988;44:1049-1060.
Lodén M: Role of topical emollients and moisturizers in the treatment of dry skin barrier disorders. Am J Clin Dermatol 2003;4:771-788.
Proksch E: The role of emollients in the management of diseases with chronic dry skin. Skin Pharmacol Physiol 2008;21:75-80.
Fluhr JW, et al: Infant epidermal skin physiology: adaptation after birth. Br J Dermatol 2012;166:483-490.
Guenther L, et al: Pathway to dry skin prevention and treatment. J Cutan Med Surg 2012;16:23-31.
Garcia Bartels N, et al: Effect of baby swimming and baby lotion on the skin barrier of infants aged 3-6 months (in English, German). J Dtsch Dermatol Ges 2011;9:1018-1025.
Fischer TW, Wigger-Alberti W, Elsner P: Assessment of ‘dry skin': current bioengineering methods and test designs. Skin Pharmacol Appl Skin Physiol 2001;14:183-195.
Yosipovitch G, et al: Skin barrier properties in different body areas in neonates. Pediatrics 2000;106:105-108.
Garcia Bartels N, et al: Standardized diaper care regimen: a prospective, randomized pilot study on skin barrier function and epidermal IL-1α in newborns. Pediatr Dermatol 2012;29:270-276.
Leung DY, Bieber T: Atopic dermatitis. Lancet 2003;361:151-160.
Abramovits W: Atopic dermatitis. J Am Acad Dermatol 2005;53(suppl 1):S86-S93.
Fluhr JW, Pfisterer S, Gloor M: Direct comparison of skin physiology in children and adults with bioengineering methods. Pediatr Dermatol 2000;17:436-439.
Szczepanowska J, Reich A, Szepietowski JC: Emollients improve treatment results with topical corticosteroids in childhood atopic dermatitis: a randomized comparative study. Pediatr Allergy Immunol 2008;19:614-618.
Hon KL, et al: The ideal moisturizer: a survey of parental expectations and practice in childhood-onset eczema. J Dermatol Treat 2013;24:7-12.
Fluhr JW, Darlenski R, Surber C: Glycerol and the skin: holistic approach to its origin and functions. Br J Dermatol 2008;159:23-34.
Harding CR, et al: Dry skin, moisturization and corneodesmolysis. Int J Cosmet Sci 2000;22:21-52.
Crowther JM, et al: Measuring the effects of topical moisturizers on changes in stratum corneum thickness, water gradients and hydration in vivo. Br J Dermatol 2008;159:567-577.
Scott IR, Harding CR: Filaggrin breakdown to water binding compounds during development of the rat stratum corneum is controlled by the water activity of the environment. Dev Biol 1986;115:84-92.
Rawlings AV, Matts PJ: Stratum corneum moisturization at the molecular level: an update in relation to the dry skin cycle. J Invest Dermatol 2005;124:1099-1110.
Sator PG, Schmidt JB, Hönigsmann H: Comparison of epidermal hydration and skin surface lipids in healthy individuals and in patients with atopic dermatitis. J Am Acad Dermatol 2003;48:352-358.
Patzelt A, et al: In vivo investigations on the penetration of various oils and their influence on the skin barrier. Skin Res Technol 2012;18:364-369.
Boralevi F, et al: Long-term emollient therapy improves xerosis in children with atopic dermatitis. J Eur Acad Dermatol Venereol 2013, Epub ahead of print.
Evangelista MT, Abad-Casintahan F, Lopez-Villafuerte L: The effect of topical virgin coconut oil on SCORAD index, transepidermal water loss, and skin capacitance in mild to moderate pediatric atopic dermatitis: a randomized, double-blind, clinical trial. Int J Dermatol 2014;53:100-108.
Lodén M: Effect of moisturizers on epidermal barrier function. Clin Dermatol 2012;30:286-296.
Rippke F, et al: Stratum corneum pH in atopic dermatitis: impact on skin barrier function and colonization with Staphylococcus aureus. Am J Clin Dermatol 2004;5:217-223.
Rippke F, Schreiner V, Schwanitz HJ: The acidic milieu of the horny layer: new findings on the physiology and pathophysiology of skin pH. Am J Clin Dermatol 2002;3:261-272.
Harder J, Schröder JM, Gläser R: The skin surface as antimicrobial barrier: present concepts and future outlooks. Exp Dermatol 2013;22:1-5.
Hachem JP, et al: Acute acidification of stratum corneum membrane domains using polyhydroxyl acids improves lipid processing and inhibits degradation of corneodesmosomes. J Invest Dermatol 2010;130:500-510.
Rawlings AV, et al: Effect of lactic acid isomers on keratinocyte ceramide synthesis, stratum corneum lipid levels and stratum corneum barrier function. Arch Dermatol Res 1996;288:383-390.
Hatano Y, et al: Maintenance of an acidic stratum corneum prevents emergence of murine atopic dermatitis. J Invest Dermatol 2009;129:1824-1835.
Chamlin SL, et al: Ceramide-dominant, barrier-repair lipids improve childhood atopic dermatitis. Arch Dermatol 2001;137:1110-1112.
Morren MA, et al: Atopic dermatitis: triggering factors. J Am Acad Dermatol 1994;31:467-473.
Reuter J, et al: Which plant for which skin disease? Part 1. Atopic dermatitis, psoriasis, acne, condyloma and herpes simplex. J Dtsch Dermatol Ges 2010;8:788-796.
Casetti F, et al: Dermocosmetics for dry skin: a new role for botanical extracts. Skin Pharmacol Physiol 2011;24:289-293.
Romojaro A, et al: Nutritional and antioxidant properties of wild edible plants and their use as potential ingredients in the modern diet. Int J Food Sci Nutr 2013;64:944-952.
Ibtissem B: Antioxidant and antibacterial properties of Mesembryanthemum crystallinum and Carpobrotus edulis extracts. Adv Chem Eng Sci 2012;2:359-365.
Lee BH, Lee CC, Wu SC: Ice plant (Mesembryanthemum crystallinum) improves hyperglycemia and memory impairments in STZ-induced diabetic Wistar rats. J Sci Food Agric 2013, Epub ahead of print.
Bouftira I, Abdelly C, Sfar S: Characterization of cosmetic cream with Mesembryanthemum crystallinum plant extract: influence of formulation composition on physical stability and anti-oxidant activity. Int J Cosmet Sci 2008;30:443-452.
Hanen F, et al: Interspecific variability of antioxidant activities and phenolic composition in Mesembryanthemum genus. Food Chem Toxicol 2009;47:2308-2313.
Deters AM, Meyer U, Stintzing FC: Time-dependent bioactivity of preparations from cactus pear (Opuntia ficus indica) and ice plant (Mesembryanthemum crystallinum) on human skin fibroblasts and keratinocytes. J Ethnopharmacol 2012;142:438-444.
Wende K, et al: Dank Trockenstress zum Hautpflegemittel. Pharmazeutische Zeitung 2006;151:322-324.
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