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Aqueous cream likely to make eczema worse

Discussion in 'General Issues and Discussion Forum' started by blinda, Jul 13, 2011.

  1. blinda

    blinda MVP

    Members do not see these Ads. Sign Up.
    This is one for those who, despite NICE guidelines in 2007 suggesting that aqueous cream (inc. E45) should not be used as a leave-on emollient in children with eczema, due to increased risk of irritant reactions, it still remains the most frequently prescribed emollient cream in the UK today for patients with atopic dermatitis.

    In a nutshell, this study found that corneocyte maturity were significantly decreased in skin that had been exposed to aqueous cream compared with skin that had not, which is clearly indicative of accelerated skin turnover. Also, transepidermal water loss was higher in aqueous cream treated skin when compared with untreated areas of skin, all of which would be likely to worsen rather than improve symptoms of eczema.



    10 June 2011
    Br J Dermatol 2011: 164; 1304–1310, 1179-1180
  2. SarahR

    SarahR Active Member

    Not suprising to me! Aqueous cream is petrochemical hydrocarbons mixed with emulsifier sodium Laurylsulfate. SLS is an irritant and sensitizer. Topical application of petrochemicals (including baby oil) have been linked to higher rates of skin cancer also.
    I use organic products but these cost more and have a shorter shelf life, and pharmaceutical and cosmetic company chemical engineers scoff at the idea that rubbing ingredients that have more in common with kerosine and gasoline than our natural lipids could have a negative impact on health. One laughed at the idea; "that would be like rubbing food on your body". Um yea if I wouldn't eat it why would I practically bathe in it daily??
    I wish someone would come out with a line of natural podiatry products, anyone know of any?
  3. blinda

    blinda MVP

  4. SarahR

    SarahR Active Member

    No paraben preservatives, SLS, petrochemicals/mineral spirits etc. Not that green washed crud that has just as much bad stuff as the regular.
    I also don't like tea tree oil as it is an allergen and irritant.
  5. manmantis

    manmantis Active Member

    Thanks Belinda, the article looks interesting, although I can't access the link you gave. I need to do some more ferreting around to find the full text.

    This prompted me to revisit the NICE guideline. The statement from NICE in the 2007 guideline regarding Aqueous cream reads: "Aqueous cream is associated with stinging when used as a leave-on emollient but can be used as a wash product." Which I suggest isn't quite as strong a statement as "should not be used as a leave-on emollient...".

    I would imagine that a cheap & readily available emollient would routinely be suggested as one of a number of products to try. If it stings as a leave-on emollient, then use as a wash product only. It won't cause skin irritation for everyone.

    The effectiveness of any one emollient changes over time for any particular patient, so it still makes sense to me to keep aqueous cream in the armoury even if we know that it is likely to cause stinging in many patients. We have a responsibility to explain the risks & likelihood of reactions of any treatment to patients, and that of course includes aqueous cream (however benign it might seem to some).

    The current review of the guideline makes note of the high propensity for sensitivity to Aqueous cream, citing 2003 & 2010 studies, but the recommendation from the review thus far states "No conclusive evidence was identified that would invalidate current guideline recommendations".

    My personal experience of Aqueous cream is with my eldest son for whom it is the one product that he can return to when his current emollient or cortisone cream stops doing its job (as they all do with irritating inevitability). He mainly uses it as a wash product, but it becomes a leave-on product at these times. He doesn't find that it stings and for him it works well. We don't let him use it regularly, lest its effectiveness for him wane.

    The fact is there is no magic bullet for Eczema.
  6. Kaleidoscope

    Kaleidoscope Active Member

    Perhaps this appears TOO simplistic but I use Holland & Barrett's PURE Coconut Oil (no additives) and you can even cook with it!!

    Ive had some good results and it doesnt have chemicals causing side-effects.


  7. blinda

    blinda MVP

    No problem, considering the full text is freely available to health care professionals, I have attached a copy.

    You`re absolutely right, it is recommended as a `wash on – wash off` product, sorry if I didn’t acknowledge that. Perhaps I should have said `should not be used chronically as a leave-on emollient`, which is the main thrust of the article.


    Attached Files:

  8. blinda

    blinda MVP

    Not happy with my last post, was rushing to prepare for a dinner party...

    What I wanted to convey was that the chronic use of Aqueous cream has already been associated with skin irritation (Cork et al, 2004) and thinning of the skin (Tsang et al, 2010). The article I originally attached concurs that continued application of aqueous cream appears to disrupt the normal corneocyte maturation process, thereby affecting the thickness of the stratum corneum .

    Interestingly, this is also confirmed on `The National Eczema Society`(which also states "aqueous cream BP should not be used as a leave-on emollient");

    That said, I am not adverse to recommending aqueous cream as a soap substitute.

    This is the abstract for Cork et al paper;

    An audit of adverse drug reactions to aqueous creamin children with atopic eczema
    Cork MJ, Timmins J, Holden C et al. Pharm J 2003; 271; 747-748
    Objective; To determine what proportion of children with atopic eczema develop cutaneous reactions to aqueous cream or other emollient creams and ointments.
    Background; A comprehensive emollient regime, comprising creams, ointments, bath oils and soap substitutes, is the first line treatment for atopic eczema. However, patient compliance is poor, most commonly because of a lack of understanding of how emollients should be used. Non-compliance is also often the result of adverse reactions to the prescribed emollient. The authors had noted that adverse reactions appeared to be more common with aqueous cream than with any other emollient. This study was undertaken to determine how many children develop reactions to emollients.
    Subjects; 100 children with atopic eczema aged 1-16 years attending a paediatric dermatology clinic at Sheffield Children’s Hospital.
    Methods; All reports of burning, stinging, itching or redness developing within 20 minutes of the use of emollients were noted and the relative frequencies following exposure to either aqueous cream or other emollients were compared.
    A total of 14 emollients other than aqueous cream had been used, with the result that numbers using any particular one were too small to show statistically significant differences. However, the frequencies of reactions reported were similar for all of them, so the overall frequency for all other emollients was used for comparison.
    Results; A high proportion of the children reported adverse reactions following the application of aqueous cream. Similar reactions were noted after other emollients but much less often.
    71 of the children had been exposed to aqueous cream. Of these 40 (56.3%) had developed an immediate cutaneous reaction.
    There had also been a total of 622 exposures to the other 14 emollients. Only 111 (17.8%) of these resulted in an adverse reaction. The difference was highly significant (p<0.001).

    This is the abstract for Tsang et al paper;

    Effect of Aqueous Cream BP on human stratum corneum in vivo.
    Tsang M, Guy RH. . Br J Dermatol 2010; 163:954–8.
    Background;  Aqueous Cream BP is widely prescribed to patients with eczema to relieve skin dryness. The formulation contains sodium lauryl sulphate (SLS), a chemical that is a known skin irritant and a commonly used excipient in personal care and household products. The chronic effects of Aqueous Cream BP application on skin barrier function have not been determined.
    Objectives;  To characterize and assess skin barrier function of healthy skin after application of Aqueous Cream BP and to study the physical effects of the formulation on the stratum corneum (SC).
    Methods;  The left and right volar forearms of six human volunteers were each separated into treated and control sides. The treated sides of each forearm were subjected to twice daily applications of Aqueous Cream BP for 4 weeks at the end of which concomitant tape stripping and transepidermal water loss (TEWL) measurements were made. The untreated sides of the forearms were not exposed to any products containing SLS during the study period.
    Results;  Changes in SC thickness, baseline TEWL and rate of increase in TEWL during tape stripping were observed in skin treated with Aqueous Cream BP. The mean decrease in SC thickness was 1•1 μm (12%) (P = 0•0015) and the mean increase in baseline TEWL was 2•5 g m−2 h−1 (20%) (P < 0•0001). Reduced SC thickness and an increase in baseline TEWL, as well as a faster rate of increase in TEWL during tape stripping, were observed in 16 out of 27 treated skin sites.
    Conclusions;  The application of Aqueous Cream BP, containing ∼1% SLS, reduced the SC thickness of healthy skin and increased its permeability to water loss. These observations call into question the continued use of this emollient on the already compromised barrier of eczematous skin.

  9. blinda

    blinda MVP

    ...and more;

    Aqueous cream damages skin barrier in people with atopic dermatitis

    22 July 2011
    Br J Dermatol 2011: Advance online publication

    MedWire News: Application of aqueous cream BP to the skin of people with a history of atopic dermatitis (AD) leads to significant skin barrier damage, report researchers.

    These findings add to those of another study, previously reported by MedWire News, which demonstrated that corneocyte maturity and size were significantly reduced, and desquamatory and inflammatory protease activity and transepidermal water loss (TEWL) significantly increased following the application of aqueous cream to the skin of volunteers with no history of AD.

    In this study, Simon Danby and colleagues, from the University of Sheffield in the UK recruited 13 volunteers with a previous history of AD (symptom free for 6 months) to test the cutaneous effects of aqueous cream BP application.

    The cream was applied twice daily to the underside of one forearm for 4 weeks. The other forearm of each participant was used as a control.

    The team assessed permeability barrier function and stratum corneum integrity before and after aqueous cream BP application by measuring TEWL and use of tape stripping.

    The researchers also enrolled 13 volunteers with current symptoms of AD, who did not apply aqueous cream, to act as controls. Stratum corneum integrity and skin barrier function were also measured in these individuals.

    Compared with the untreated control arm, treatment with aqueous cream BP for 4 weeks led to significant elevations in TEWL from baseline. At 4 weeks, TEWL was an average of 24% higher in the treated compared with the control arm, at 12.55 versus 10.11 g/m2/hour.

    Tape stripping was carried out to assess the stability of the stratum corneum, with a TEWL measurement of 90 g/m2/hour used as an endpoint to assess skin barrier integrity. In every case, the endpoint was reached significantly sooner on the treated compared with the untreated side.

    The researchers note that the volunteers with active AD had significantly higher TEWL measures at baseline than the participants with inactive AD. However, the increase in TEWL brought about by aqueous cream BP application in the participants with inactive AD brought their levels up close to those observed in patients with active disease.

    "The negative effects of aqueous cream BP on the skin barrier are most likely associated with the presence of sodium lauryl sulphate (1% w/w)," write Danby and team in the British Journal of Dermatology.

    "Aqueous solutions of sodium lauryl sulphate have been shown to cause cutaneous irritation and elevate TEWL at concentrations of 1% and less," they explain.

    The authors emphasize that these results and others strongly suggest that aqueous cream BP should not be used or prescribed for treatment of atopic dermatitis or similar conditions.

    Now quit with the E45, OK? ;)
    Unless you`re using it as a soap sub.....


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