Prebiotic Skin Care’s Effectiveness in AD for SOC Patients

La Roche-Posay’s Lipikar AP+ Gentle Foaming Cleansing Oil and Lipikar AP+M Moisturizing Cream

Study Key Takeaways

Our study design consisted of 140 patients, of whom 50% had skin of color, presenting with mild atopic dermatitis (AD) or severe xerosis, aged 3 to 80 years old and from different racial/ethnic backgrounds. All patients were instructed to use La Roche-Posay’s Lipikar AP+ Gentle Foaming Cleansing Oil alone for 2 weeks followed by Lipikar AP+M Moisturizing Cream in conjunction for an additional 8 weeks.¹

There were 3 key takeaways from our new study:

1. Our prebiotic cleanser and moisturizer regimen offered strong benefits in reducing both severe xerosis and mild AD severity, by decreasing skin roughness, improving appearance, strengthening skin barrier properties on both normal and lesional skin, and by promoting better quality of life by significantly reducing itch sensation as early as 2 weeks.
2. Performing subanalysis, separating patients of color vs White counterparts, we observed that patients of color with AD experienced greater itching sensation than White counterparts, while White patients with xerosis perceived worse quality of life vs patients with skin of color counterparts at baseline.
3. By implementing SkinCam, we successfully captured quality clinical images of xerosis and AD (clinically diagnosed with same severity levels) in patients with multiple skin tones and monitored improvement over time with our prebiotic skin care regimen.

Introduction

We know that AD is a chronic relapsing inflammatory skin disease associated with a significant burden on patient quality of life.² AD has a very complex pathophysiology that consists of an imbalance in skin microbiome, impaired skin barrier, and inflammation.³

Thanks to research advances, we now understand that it is in fact the decrease in skin microbial diversity, particularly an overabundance of Staphylococcus aureus colonization observed on AD lesional skin, that is associated with disease severity and compromised skin barrier.^3,4 Prebiotic emollients, containing several ingredients, are shown to decrease AD-related symptoms and normalize skin microbiota by reducing S aureus abundance in patients.^5-7

Racial/ethnic variations in AD prevalence and severity, plus clinical phenotypes and endophenotypes, including S aureus colonization, have been reported.⁸ Despite higher AD prevalence and persistence, particularly in children, skin of color (SOC) populations are underrepresented in AD clinical trials.⁹

This lack of inclusive recruitment (and retention) leads to AD being understudied in patients of color, plus very likely misdiagnosed or undercounted due to different clinical presentations of the disease vs in White counterparts.^10-12 Additionally, there is a very limited number of studies showing the benefits of emollients in the management of AD in diverse patients, including those with skin of color.⁹

New Research Study Objectives

We saw the opportunity to build a new inclusive research program, in partnership with Zoe Diana Draelos, MD. Draelos is a consulting professor of dermatology at Duke University School of Medicine in Durham, North Carolina, and Dermatology Times’ editor in chief emeritus. The research program’s overall objective was to evaluate the benefits of La Roche Posay’s Lipikar prebiotic cleanser and moisturizer regimen on managing AD and xerosis and determine any nuances in skin conditions’ impact on quality of life in ethnically diverse patients. In addition, to address the lack of representation of dark skin images of common dermatologic conditions, we partnered with Newtone Technologies to implement its new imaging device (SkinCam)¹³ into study to obtain qualitative and standardized imaging of both AD and xerosis in patients with lightly and darkly pigmented skin.

Closing Remarks

Rising evidence demonstrates an imbalance in skin microbiome plays an essential role in AD pathogenesis.^3,4 Depending on the patient’s age, skin tone, and disease severity, lesion distribution and appearance can greatly vary.^1,8

What is exciting is that using clinical expert grading, instrumentation, self-assessment questionnaires, and standardized imaging, collectively, our results first demonstrate that a prebiotic skin care routine can effectively manage AD- and xerosis-related symptoms over time in ethnically diverse patients.¹ The nuances observed in our study between patients of color and White counterparts will hopefully help support clinicians in disease management strategies to consider for better treatment outcomes for all patients, particularly for patients of color.

Hawasatu Dumbuya, PhD, is the director of clinical research and medical affairs for La Roche-Posay at L’Oréal USA.

References

1. Dumbuya H, Podimatis K, Kerob D, Draelos ZD. Efficacy of a prebiotic skincare regimen on improving mild atopic dermatitis and severe xerosis in diverse ethnically patients. J Drugs Dermatol. 2024;23:3(suppl 2):s12-s22. doi:10.36849/jdd.SF395747
2. Silverberg JI. Comorbidities and the impact of atopic dermatitis. Ann Allergy Asthma Immunol. 2019;123(2):144-151. doi:10.1016/j.anai.2019.04.020
3. Alenius H, Sinklo H, Moitinho-Silva, et al. The power and potential of BIOMAP to elucidate host-microbiome interplay in skin inflammatory diseases. Exp Dermatol. 2021;30(10):1517-1531. doi:10.1111/exd.14446
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7. Magnolo N, Jaenicke T, Tsianakas A, et al. Comparison of different skin care regimens in patients with moderate to severe atopic dermatitis receiving systemic treatment: a randomized controlled trial. J Eur Acad Dermatol Venereol. 2023:37(suppl 5):18-26. doi:10.1111/jdv.18949
8. Kaufman BP, Guttman-Yassky E, Alexis AF. Atopic dermatitis in diverse racial and ethnic groups—variations in epidemiology, genetics, clinical presentation and treatment. Exp Dermatol. 2018;27(4):340-357. doi:10.1111/exd.13514
9. Mineroff J, Nguyen JK, Jagdeo J. Racial and ethnic underrepresentation in dermatology clinical trials. J Am Acad Dermatol. 2023;89(2):293-300. doi:10.1016/j.jaad.2023.04.011
10. Chansky PB, Mittal L, Werth VP. Dermatological evaluation in patients with skin of colour: the effect of erythema on outcome measures in atopic dermatitis. Br J Dermatol. 2017;176(4):853-854. doi:10.1111/bjd.15433
11. Wilson BN, Alexis A, Murase JE. Art of prevention: atopic dermatitis in women and families of color-prevalence, recognition, and prevention. Int J Womens Dermatol. 2022;8(1):e014. doi:10.1097/JW9.0000000000000014
12. Zhao CY, Hao EY, Oh DD, et al. A comparison study of clinician-rated atopic dermatitis outcome measures for intermediate- to dark-skinned patients. Br J Dermatol. 2017;176(4):985-992. doi:10.1111/bjd.15271
13. Maudet A, Le Bec J, Flament F, et al. Analysis of images supplied by SkinCam can record the changes of some scar features that occur over time: comparisons with the assessments of dermatologist and patients’ perception. J Cosmet Dermatol. 2023;22(4):1334-1343. doi:10.1111/jocd.15575