[en] BACKGROUND: There is ample evidence that the skin barrier function is altered in atopic dermatitis. Little information is available about the effect of topical corticosteroids and calcineurin inhibitors on this function. PURPOSE: To assess the water content and its rate of accumulation in the stratum corneum of atopic patients using an indirect electrometric method while on tacrolimus or betamethasone valerate treatment. METHOD: Twenty-one patients with moderate atopic dermatitis affecting both forearms completed this double-blind randomized study. One forearm was treated twice daily for 3 weeks with 0.1% tacrolimus ointment. The other forearm was similarly treated with 0.12% betamethasone valerate ointment. Electrometric measurements were made under continuous occlusion secured by a Nova Dermal Phase Meter sensor probe. Assessments were performed at inclusion, after the 3-week treatment and after a further 3-week follow-up out of treatment. RESULTS: During treatment, both compounds yielded a similar improvement in skin barrier function. Indeed, under probe occlusion, the rate of water accumulation was significantly decreased. This improvement was sustained after stopping the tacrolimus treatment. By contrast, the benefit was in part lost at the site that had been treated by betamethasone valerate. CONCLUSION: The difference in the effect of the 2 compounds may be due to the negative influence of betamethasone valerate on the epidermal metabolism leading to progressive atrophy of the tissue. The better preservation of the skin barrier function after stopping tacrolimus treatment may help retarding relapses of atopic dermatitis.
Disciplines :
Dermatology
Author, co-author :
Xhauflaire, Emmanuelle ; Centre Hospitalier Universitaire de Liège - CHU > Dermatopathologie
Thirion, L.; Centre Hospitalier Universitaire de Liège - CHU > Dermatologie
Pierard, Claudine ; Centre Hospitalier Universitaire de Liège - CHU > Dermatopathologie
Pierard, Gérald ; Centre Hospitalier Universitaire de Liège - CHU > Dermatopathologie
Language :
English
Title :
Comparative effect of tacrolimus and betamethasone valerate on the passive sustainable hydration of the stratum corneum in atopic dermatitis.
Cheer SM, Plosker GL: Tacrolimus ointment: a review of its therapeutic potential as a topical therapy in atopic dermatitis. Am J Clin Dermatol 2001;2:389-406.
Piérard GE, Piérard-Franchimont C: Skin immune downregulators: from bench to bedside. Curr Top Pharmacol 2003;7:109-116.
Huai Q, Kim HY, Liu Y, Zhao Y, Mondragon A, Liu JO, Ke H: Crystal structure of calcineurin-cyclophilin-cyclosporine shows common but distinct recognition of immunophilin-drug complexes. Proc Natl Acad Sci USA 2002;99:12037-12042.
Taïeb A: Tacrolimus and the pigmentary system. Dermatology 2005;210:177-178.
Smit N, Sellar K, Romijn F, Van Pelt J, Pavel S: A study of calcineurin function in epidermal and melanoma cell cultures. Pigment Cell Res 2004;17:575.
Hanifin JM, Ling MR, Langley R, Breneman D, Rafal E: Tacrolimus ointment for the treatment of atopic dermatitis in adult patients. I. Efficacy. J Am Acad Dermatol 2001;44:S28-S38.
Reitamo S, Remitz A, Kyllonen H, Saarikko J: Topical noncorticosteroid immunomodulation in the treatment of atopic dermatitis. Am J Clin Dermatol 2002;3:381-388.
Reitamo S, Rustin M, Ruzicka T, Cambazard F, Kalimo K, Friedmann PS, Schoepf E, Lahfa M, et al: Efficacity and safety of tacrolimus ointment compared with that of hydrocortisone butyrate ointment in adult patients with atopic dermatitis. J Allergy Clin Immunol 2002;109:547-555.
Tomi SN, Luger TA: The treatment of atopic dermatitis with topical immunomodulators. Clin Dermatol 2003;21:221-224.
Alomar A, Berth-Jones J, Bos JD, Giannetti A, Reitamo S, Ruzicka T, Stalder JF, Thestrup-Pedersen K: The role of topical calcineurin inhibitors in atopic dermatitis. Br J Dermatol 2004;151:S3-S27.
Iskedjian M, Piwko C, Shear H, Langley RG, Einarson TR: Topical calcineurin inhibitors in the treatment of atopic dermatitis: a meta-analysis of current evidence. Am J Clin Dermatol 2004;5:267-279.
Beck LA: The efficacy and safety of tacrolimus ointment: a clinical review. J Am Acad Dermatol 2005;53:S165-S170.
Bieber T, Cork M, Ellis C, Girolomoni G, Groves R, Langley R, Luger T, Meurer M, Murrell D, Orlow S, Paller A, de Prost Y, Puig L, Ring J, Saurat JH, Scharz T, Shear N, Stingl G, Taieb A, Thestrup-Pedersen K; Pediatric Advisory Committee of the Food and Drug Administration: Consensus statement on the safety profile of topical calcineurin inhibitors. Dermatology 2005;211:77-78.
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.
Chapman MS, Schachner LA, Breneman D, Boguniewicz M, Gold MH, Shull T, Linowski GJ, Jaracz E: Tacrolimus ointment 0.03% shows efficacy and safety in pediatric and adult patients with mild to moderate atopic dermatitis. J Am Acad Dermatol 2005;53:S177-S185.
Hanifin JM, Paller AS, Eichenfield L, Clark RA, Korman N, Weinstein G, Caro I, Jaracz E, Rico M: Efficacy and safety of tacrolimus ointment treatment for up to 4 years in patients with atopic dermatitis. J Am Acad Dermatol 2005;53:S186-S194.
Koo JYM, Fleischer AB, Abramovits W, Pariser DM, McCall CO, Horn TD, Gottlieb AB, Jaracz E, Rico MJ: Tacrolimus ointment is safe and effective in the treatment of atopic dermatitis: results in 8000 patients. J Am Acad Dermatol 2005;53:S195-S205.
Hultsch T, Kapp A, Spergel J: Immunomodulation and safety of topical calcineurin inhibitors for the treatment of atopic dermatitis. Dermatology 2005;211:174-187.
Beyerler M, Schmid-Grendelmeier P, Hafner J: Significantly elevated systemic levels after occlusive application of topical tacrolimus in atopic dermatitis. Dermatology 2006;212:260-261.
Pournaras CC, Lübbe J, Saurat JH: Staphylococcal colonization in atopic dermatitis treatment with topical tacrolimus (FK506). J Invest Dermatol 2001;116:480-481.
Remitz A, Kyllönen H, Granlund H, Reitamo S: Tacrolimus ointment reduces the staphylococcal colonization of atopic dermatitis lesions. J Allergy Clin Immunol 2001;107:196-197.
Candi E, Schmidt R, Melino G: The cornified envelope: a model of cell death in the skin. Nat Rev Mol Cell Biol 2005;6:328-340.
Elias PM: Stratum corneum defensive functions: an integrated view. J Invest Dermatol 2005;125:183-200.
Berardesca E, Fideli D, Borroni G, Rabbiosi G, Maibach H: In vivo hydration and water-retention capacity of stratum corneum in clinically uninvolved skin in atopic and psoriatic patients. Acta Derm Venereol 1990;70:400-404.
Tupker RA, Pinnagoda J, Coenraads PJ, Nater JP: Susceptibility to irritants: role of barrier function, skin dryness and history of atopic dermatitis. Br J Dermatol 1990;123:199-205.
Taieb A: Hypothesis: from epidermal barrier dysfunction to atopic disorders. Contact Dermatitis 1999;41:177-180.
Nicander I, Ollmar S: Clinically normal atopic skin vs. non-atopic skin as seen through electrical impedance. Skin Res Technol 2004;10:178-183.
Pastore S, Mascia F, Girolomoni G: The contribution of keratinocytes to the pathogenesis of atopic dermatitis. Eur J Dermatol 2006;16:125-131.
Okah FA, Wickett R, Pickens WL, Hoath SB: Surface electrical capacitance as a noninvasive bedside measure of epidermal barrier maturation in the newborn infant. Pediatrics 1995;96:688-692.
Treffel P, Gabard B: Stratum corneum dynamic function measurements after moisturizer or irritant application. Arch Dermatol Res 1995;287:474-479.
Berardesca E; The European Group for Efficacy Measurements on Cosmetics and other Topical Products (EEMCO): EEMCO guidance for the assessment of stratum corneum hydration: electrical methods. Skin Res Technol 1997;3:126-132.
Paquet F, Piérard-Franchimont C, Fumal I, Goffin V, Paye M, Piérard GE: Sensitive skin at menopause, dew point and electrometric properties of the stratum corneum. Maturitas 1998;28:221-227.
Goffin V, Piérard-Franchimont C, Piérard GE: Passive sustainable hydration of the stratum corneum following surfactant challenge. Clin Exp Dermatol 1999;24:308-331.
Van Cromphaut I, Fumal I, Jacquemin D, Fissette J, Piérard GE: Skin barrier repair after contact burns: electrometric evaluation using the passive sustainable hydration test. J Environ Med 1999;1:47-50.
Letawe C, Piérard-Franchimont C, Piérard GE: Squamometry in rating the efficacy of topical corticosteroids in atopic dermatitis. Eur J Clin Pharmacol 1996;51:253-258.
Hanifin JM, Cooper KD, Ho VC, Kang S, Krafchik BR, Margolis DJ, Schachner LA, Sidbury R, Whitmore SE: Guidelines of care for atopic dermatitis developed in accordance with the American Academy of dermatology (AAD)/American Academy of Dermatology Association 'Administrative Regulations for Evidence-Based Clinical Practice Guidelines'. J Am Acad Dermatol 2004;50:391-404.
Kikuchi K, Tagami H: Comparison of the effects of daily applications between topical corticosteroid and tacrolimus ointments on normal skin: evaluation with noninvasive methods. Dermatology 2002;205:378-382.
Basketter DA, Miettinen J, Lahti A: Acute irritant reactivity to sodium lauryl sulfate in atopics and non-atopics. Contact Dermatitis 1998;38:253-257.
Di Nardo A, Wertz P, Giannetti A, Seidenari S: Ceramide and cholesterol composition of the skin of patients with atopic dermatitis. Acta Derm Venereol 1998;78:27-30.
Werfel T, Kapp A: Environmental and other major provocation factors in atopic dermatitis. Allergy 1998;53:731-739.
Pellanda C, Weber M, Bircher A, Surber C: Low-dose triamcinolone acetonide in the phytocosmetic Lichtena® reduces inflammation in mild to moderate atopic dermatitis. Dermatology 2005;211:338-340.