Vehicles often drive treatment of difficult ailments

Louisville, Ky. - In treating difficult dermatologic conditions such as acne, atopic dermatitis (AD) and plantar warts, a leading expert says the key to successful treatment often involves picking the right vehicle.

AD represents a chronic inflammatory condition for which treatments can only control symptoms, not cure patients, he says. Although dermatologists typically treat AD with topical steroids, Dr. Kircik notes that one should use these drugs with caution in children due to concerns for side effects including systemic absorption, skin atrophy, telangiectasia formation and tachyphylaxis.

At the same time, Dr. Kircik points out that the constant irritation of AD disrupts the skin barrier in most children with the illness. Transepidermal water loss (TEWL) follows, causing further irritation as the vicious cycle of flareups continues, he adds.

However, Dr. Kircik says that if one repairs the skin barrier system, "That solves half the problem" by helping to hydrate the skin and calm irritation. In this area, he says two new products are proving helpful - MimyX (Stiefel) and Atopiclair (hydrolipid cream, Chester Valley).

"These products help to reduce TEWL and essentially seal the skin. They also have anti-inflammatory effects," thanks to natural lipids such as PEA, an ingredient in MimyX. Dr. Kircik says this fatty acid appears especially helpful for children with AD. Additionally, he says that MimyX's sealing property allows medications to penetrate more deeply if one applies it over them. Conversely, he says that while Atopiclair is similar to MimyX, it's only about half as effective in reducing TEWL, and it contains peanut ingredients, to which many patients may be allergic.

Study findings

"Studies show that if one uses MimyX as a supplement to steroids," Dr. Kircik adds, "then one will decrease the use of the steroid, which is very important." Similarly, he says, one study compared use of an emollient alone to use of an emollient plus MimyX and found Mimyx-treated patients achieved remission extensions of 48 percent over their counterparts (Lecture presented at: 64th Annual Meeting of the American Academy of Dermatology; March 3-7, 2006; San Francisco).

In the same study, Dr. Kircik says MimyX reduced all AD symptoms in 60 percent of treated children. Forty percent of treated patients, likewise, were able to discontinue or reduce the potency of topical steroids. Unlike steroids or topical immunomodulators, he adds, MimyX places no limit on treatment duration, body location or patient age.

Future predictions

Going forward, Dr. Kircik says that two steroid products designed for children show great promise. The first, Desilux (desonide foam, Connetics), should be available by year's end, he predicts.

"This new formulation will be much easier to use. It's absorbed more easily and is much more elegant" than its predecessor, Dr. Kircik says.

He predicts that SkinMedica also will introduce a desonide hydrogel later this year.

"This is an interesting product. Because the steroid will be delivered in a hydrogel, the absorption will be better. It's a very effective moisturizing base" that's free from ingredients likely to irritate skin, Dr. Kircik adds.

Topical retinoids commonly used to treat acne also are very irritating, he adds.