EMOLIENTES: BENEFICIOS, ELEMENTOS CLAVES Y APLICACIÓN CLÍNICA

Gloria Gil-Castaño, Ricardo Cardona-Villa

Resumen


La piel es el órgano más extenso del cuerpo humano que contiene entre otros componentes las células epidérmicas. Estas células son células epiteliales modificadas, que descansan sobre una membrana basal separadas de la dermis; la epidermis al presentar modificaciones en su composición estructural y la distribución de sus elementos pierde grandes cantidades de agua que perpetúan estas variaciones y llevan a deshidratación permanente.

 

Los emolientes constituyen la primera línea de manejo para las patologías que afectan la hidratación de la piel entre ellas una de las más importantes la dermatitis atópica; en esta descripción trataremos de hacer un abordaje teórico y práctico que nos permita tomar una decisión adecuada a la hora de formular un emoliente. Inicialmente haremos una descripción aproximada de la barrera epidérmica con sus principales componentes y funciones de los mismos. Posteriormente describiremos las características de una barrera cutánea alterada, los mecanismos para su reparación; continuaremos con la definición de emoliente, mecanismos de hidratación para la recuperación de la barrera, tipos de emolientes, situaciones que debemos tener en cuenta la hora de indicar el uso de los emolientes al igual que la evidencia actual en relación con sus ventajas o no, finalmente indicaremos los puntos clave a la hora en realizar su formulación.


Palabras clave


emolientes; barrera cutanea; hidratación; piel

Referencias


Murata T, Honda T, Egawa G, et al. Transient elevation of cytoplasmic calcium ion concentration at a single cell level precedes morphological changes of epidermal keratinocytes during cornification. Sci Rep. 2018;8(1). doi:10.1038/s41598-018-24899-7

Jonca N, Leclerc EA, Caubet C, Simon M, Guerrin M, Serre G. Corneodesmosomes and corneodesmosin: From the stratum corneum cohesion to the pathophysiology of genodermatoses. Eur J Dermatology. 2011;21(2 SUPPL):35-42. doi:10.1684/ejd.2011.1264

Ishida‐Yamamoto A, Igawa S, Kishibe M. Molecular basis of the skin barrier structures revealed by electron microscopy. Exp Dermatol. 2018;27(8):841-846. doi:10.1111/exd.13674

Ishida-Yamamoto A, Simon M, Kishibe M, et al. Epidermal lamellar granules transport different cargoes as distinct aggregates. J Invest Dermatol. 2004;122(5):1137-1144. doi:10.1111/j.0022-202X.2004.22515.x

de Jager M, Groenink W, van der Spek J, et al. Preparation and characterization of a stratum corneum substitute for in vitro percutaneous penetration studies. Biochim Biophys Acta - Biomembr. 2006;1758(5):636-644. doi:10.1016/j.bbamem.2006.04.001

Feingold KR, Elias PM. Role of lipids in the formation and maintenance of the cutaneous permeability barrier. Biochim Biophys Acta - Mol Cell Biol Lipids. 2014;1841(3):280-294. doi:10.1016/j.bbalip.2013.11.007

Elias PM, Gruber R, Crumrine D, et al. Formation and functions of the corneocyte lipid envelope (CLE). Biochim Biophys Acta - Mol Cell Biol Lipids. 2014;1841(3):314-318. doi:10.1016/j.bbalip.2013.09.011

Meguro S, Arai Y, Masukawa Y, Uie K, Tokimitsu I. Relationship between covalently bound ceramides and transepidermal water loss (TEWL). Arch Dermatol Res. 2000;292(9):463-468. doi:10.1007/s004030000160

Behne M, Uchida Y, Seki T, Ortiz De Montellano P, Elias PM, Holleran WM. Omega-hydroxyceramides are required for corneocyte lipid envelope (CLE) formation and normal epidermal permeability barrier function. J Invest Dermatol. 2000;114(1):185-192. doi:10.1046/j.1523-1747.2000.00846.x

Hon KL, Kung JSC, Ng WGG, Leung TF. Emollient treatment of atopic dermatitis: latest evidence and clinical considerations. Drugs Context. 2018;7. doi:10.7573/dic.212530

Berkers T, van Dijk L, Absalah S, van Smeden J, Bouwstra JA. Topically applied fatty acids are elongated before incorporation in the stratum corneum lipid matrix in compromised skin. Exp Dermatol. 2017;26(1):36-43. doi:10.1111/exd.13116

De Jager M, Groenink W, Bielsa I Guivernau R, et al. A novel in vitro percutaneous penetration model: Evaluation of barrier properties with P-aminobenzoic acid and two of its derivatives. Pharm Res. 2006;23(5):951-960. doi:10.1007/s11095-006-9909-1

van Smeden J, Bouwstra JA. Stratum Corneum Lipids: Their Role for the Skin Barrier Function in Healthy Subjects and Atopic Dermatitis Patients. In: ; :8-26. doi:10.1159/000441540

Ananthapadmanabhan KP, Mukherjee S, Chandar P. Stratum corneum fatty acids: their critical role in preserving barrier integrity during cleansing. Int J Cosmet Sci. 2013;35(4):337-345. doi:10.1111/ics.12042

Wertz PW, Van Den Bergh B. The physical, chemical and functional properties of lipids in the skin and other biological barriers. Chem Phys Lipids. 1998;91(2):85-96. doi:10.1016/S0009-3084(97)00108-4

Rawlings A V., Harding CR. Moisturization and skin barrier function. Dermatol Ther. 2004;17(s1):43-48. doi:10.1111/j.1396-0296.2004.04s1005.x

Verdier-Sévrain S, Bonté F. Skin hydration: a review on its molecular mechanisms. J Cosmet Dermatol. 2007;6(2):75-82. doi:10.1111/j.1473-2165.2007.00300.x

Feuillie C, Vitry P, McAleer MA, et al. Adhesion of Staphylococcus aureus to corneocytes from atopic dermatitis patients is controlled by natural moisturizing factor levels. MBio. 2018;9(4). doi:10.1128/mBio.01184-18

Celleno L. Topical urea in skincare: A review. Dermatol Ther. 2018;31(6):e12690. doi:10.1111/dth.12690

Draelos ZD. The science behind skin care: Moisturizers. J Cosmet Dermatol. 2018;17(2):138-144. doi:10.1111/jocd.12490

Seweryn A. Interactions between surfactants and the skin – Theory and practice. Adv Colloid Interface Sci. 2018;256:242-255. doi:10.1016/j.cis.2018.04.002

Moore DJ, Rawlings A V. The chemistry, function and (patho)physiology of stratum corneum barrier ceramides. Int J Cosmet Sci. 2017;39(4):366-372. doi:10.1111/ics.12399

van Smeden J, Janssens M, Kaye ECJ, et al. The importance of free fatty acid chain length for the skin barrier function in atopic eczema patients. Exp Dermatol. 2014;23(1):45-52. doi:10.1111/exd.12293

Janssens M, van Smeden J, Puppels GJ, Lavrijsen APM, Caspers PJ, Bouwstra JA. Lipid to protein ratio plays an important role in the skin barrier function in patients with atopic eczema. Br J Dermatol. 2014;170(6):1248-1255. doi:10.1111/bjd.12908

Augustin M, Wilsmann‐Theis D, Körber A, et al. Diagnosis and treatment of xerosis cutis – a position paper. JDDG J der Dtsch Dermatologischen Gesellschaft. 2019;17(S7):3-33. doi:10.1111/ddg.13906

Vyumvuhore R, Michael-Jubeli R, Verzeaux L, et al. Lipid organization in xerosis: the key of the problem? Int J Cosmet Sci. 2018;40(6):549-554. doi:10.1111/ics.12496

Blaess M, Deigner HP. Derailed ceramide metabolism in atopic dermatitis (AD): A causal starting point for a personalized (basic) therapy. Int J Mol Sci. 2019;20(16). doi:10.3390/ijms20163967

Ishikawa J, Narita H, Kondo N, et al. Changes in the ceramide profile of atopic dermatitis patients. J Invest Dermatol. 2010;130(10):2511-2514. doi:10.1038/jid.2010.161

Huppertz B, Frank HG, Kaufmann P. The apoptosis cascade - Morphological and immunohistochemical methods for its visualization. Anat Embryol (Berl). 1999;200(1):1-18. doi:10.1007/s004290050254

Franco J, Ferreira C, Paschoal Sobreira TJ, Sundberg JP, HogenEsch H. Profiling of epidermal lipids in a mouse model of dermatitis: Identification of potential biomarkers. PLoS One. 2018;13(4). doi:10.1371/journal.pone.0196595

Kanoh H, Ishitsuka A, Fujine E, et al. IFN-γ reduces epidermal barrier function by affecting fatty acid composition of ceramide in a mouse atopic dermatitis model. J Immunol Res. 2019;2019. doi:10.1155/2019/3030268

Lee SE, Lee SH. Skin barrier and calcium. Ann Dermatol. 2018;30(3):265-275. doi:10.5021/ad.2018.30.3.265

Diana Draelos Z. Therapeutic moisturizers. Dermatol Clin. 2000;18(4):597-607. doi:10.1016/s0733-8635(05)70210-2

van Smeden J, Janssens M, Gooris GS, Bouwstra JA. The important role of stratum corneum lipids for the cutaneous barrier function. Biochim Biophys Acta - Mol Cell Biol Lipids. 2014;1841(3):295-313. doi:10.1016/j.bbalip.2013.11.006

Katoh N, Ohya Y, Ikeda M, et al. Clinical practice guidelines for the management of atopic dermatitis 2018. J Dermatol. 2019;46(12):1053-1101. doi:10.1111/1346-8138.15090

Moncrieff G, Cork M, Lawton S, Kokiet S, Daly C, Clark C. Use of emollients in dry-skin conditions: consensus statement. Clin Exp Dermatol. 2013;38(3):231-238. doi:10.1111/ced.12104

Bath emollients for atopic eczema: Why use them? Drug Ther Bull. 2007;45(10):73-75. doi:10.1136/dtb.2007.09.0015

Topical therapy for scalp psoriasis in adults. Drug Ther Bull. 2012;50(3):33-36. doi:10.1136/dtb.2012.02.0093

Kusari A, Han AM, Virgen CA, et al. Evidence‐based skin care in preterm infants. Pediatr Dermatol. December 2018:pde.13725. doi:10.1111/pde.13725

Lodén M. Role of Topical Emollients and Moisturizers in the Treatment of Dry Skin Barrier Disorders. Am J Clin Dermatol. 2003;4(11):771-788. doi:10.2165/00128071-200304110-00005

Yang EJ, Hendricks AJ, Beck KM, Shi VY. Bioactive: A new era of bioactive ingredients in topical formulations for inflammatory dermatoses. Dermatol Ther. 2019;32(6). doi:10.1111/dth.13101

Li Q, Fang H, Dang E, Wang G. The role of ceramides in skin homeostasis and inflammatory skin diseases. J Dermatol Sci. 2019. doi:10.1016/j.jdermsci.2019.12.002

Proksch E, Berardesca E, Misery L, Engblom J, Bouwstra J. Dry skin management: practical approach in light of latest research on skin structure and function. J Dermatolog Treat. June 2019:1-7. doi:10.1080/09546634.2019.1607024

Stettler H, Kurka P, Wagner C, et al. A new topical panthenol-containing emollient: skin-moisturizing effect following single and prolonged usage in healthy adults, and tolerability in healthy infants. J Dermatolog Treat. 2017;28(3):251-257. doi:10.1080/09546634.2016.1218417

Giam YC, Hebert AA, Dizon MV, et al. A review on the role of moisturizers for atopic dermatitis. Asia Pac Allergy. 2016;6(2):120. doi:10.5415/apallergy.2016.6.2.120

Hon KL, Leung AKC, Barankin B. Barrier repair therapy in atopic dermatitis: An overview. Am J Clin Dermatol. 2013;14(5):389-399. doi:10.1007/s40257-013-0033-9

Lachapelle JM, Gimenez-Arnau A, Metz M, Peters J, Proksch E. Best practices, new perspectives and the perfect emollient: optimizing the management of contact dermatitis. J Dermatolog Treat. 2018;29(3):241-251. doi:10.1080/09546634.2017.1370074

Czarnowicki T, Malajian D, Khattri S, et al. Petrolatum: Barrier repair and antimicrobial responses underlying this “inert” moisturizer. J Allergy Clin Immunol. 2016;137(4):1091-1102.e7. doi:10.1016/j.jaci.2015.08.013

Vaillant L, Georgescou G, Rivollier C, Delarue A. Combined effects of glycerol and petrolatum in an emollient cream: A randomized, double‐blind, crossover study in healthy volunteers with dry skin. J Cosmet Dermatol. September 2019:jocd.13163. doi:10.1111/jocd.13163

Benedetto A V. What’s New in Cosmetic Dermatology. Dermatol Clin. 2019;37(1):117-128. doi:10.1016/j.det.2018.08.002

Eichenfield LF, Tom WL, Berger TG, et al. Guidelines of care for the management of atopic dermatitis: Section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014;71(1):116-132. doi:10.1016/j.jaad.2014.03.023

Tessema EN, Gebre-Mariam T, Neubert RHH, Wohlrab J. Potential Applications of Phyto-Derived Ceramides in Improving Epidermal Barrier Function. Skin Pharmacol Physiol. 2017;30(3):115-138. doi:10.1159/000464337

Spada F, Barnes TM, Greive KA. Clinical, Cosmetic and Investigational Dermatology Dovepress Skin hydration is significantly increased by a cream formulated to mimic the skin’s own natural moisturizing systems. Clin Cosmet Investig Dermatol. 2018:11-491. doi:10.2147/CCID.S177697

Danby SG, Brown K, Higgs-Bayliss T, Chittock J, Albenali L, Cork MJ. The effect of an emollient containing urea, Ceramide NP, and lactate on skin barrier structure and function in older people with dry skin. Skin Pharmacol Physiol. 2016;29(3):135-147. doi:10.1159/000445955

Mojumdar EH, Pham QD, Topgaard D, Sparr E. Skin hydration: Interplay between molecular dynamics, structure and water uptake in the stratum corneum. Sci Rep. 2017;7(1). doi:10.1038/s41598-017-15921-5

Tang SC, Yang JH. Dual effects of alpha-hydroxy acids on the skin. Molecules. 2018;23(4). doi:10.3390/molecules23040863

Ridd MJ, Roberts A, Grindlay D, Williams HC. Which emollients are effective and acceptable for eczema in children? BMJ. 2019;367:l5882. doi:10.1136/bmj.l5882

Grimalt R, Mengeaud V, Cambazard F. The Steroid-Sparing Effect of an Emollient Therapy in Infants with Atopic Dermatitis: A Randomized Controlled Study. Dermatology. 2007;214(1):61-67. doi:10.1159/000096915

Gelmetti C, Wollenberg A. Atopic dermatitis - all you can do from the outside. Br J Dermatol. 2014;170:19-24. doi:10.1111/bjd.12957

Chiang C, Eichenfield LF. Quantitative assessment of combination bathing and moisturizing regimens on skin hydration in atopic dermatitis. Pediatr Dermatol. 2009;26(3):273-278. doi:10.1111/j.1525-1470.2009.00911.x

Wollenberg A, Barbarot S, Bieber T, et al. Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I. J Eur Acad Dermatology Venereol. 2018;32(5):657-682. doi:10.1111/jdv.14891

Wollenberg A, Schnopp C. Evolution of conventional therapy in atopic dermatitis. Immunol Allergy Clin North Am. 2010;30(3):351-368. doi:10.1016/j.iac.2010.06.005

Wollenberg A, Oranje A, Deleuran M, et al. ETFAD/EADV Eczema task force 2015 position paper on diagnosis and treatment of atopic dermatitis in adult and paediatric patients. J Eur Acad Dermatology Venereol. 2016;30(5):729-747. doi:10.1111/jdv.13599

Lodén M, Andersson A-C, Anderson C, et al. A Double-Blind Study Comparing the Effect of Glycerin and Urea on Dry, Eczematous Skin in Atopic Patients. Acta Derm Venereol. 2002;82(1):45-47. doi:10.1080/000155502753600885

Lack G, Fox D, Northstone K, Golding J. Factors Associated with the Development of Peanut Allergy in Childhood. N Engl J Med. 2003;348(11):977-985. doi:10.1056/NEJMoa013536

Mandeau A, Aries MF, Boé JF, et al. Rhealba® oat plantlet extract: Evidence of protein-free content and assessment of regulatory activity on immune inflammatory mediators. Planta Med. 2011;77(9):900-906. doi:10.1055/s-0030-1250649

Gueniche A, Knaudt B, Schuck E, et al. Effects of nonpathogenic gram-negative bacterium Vitreoscilla filiformis lysate on atopic dermatitis: a prospective, randomized, double-blind, placebo-controlled clinical study. Br J Dermatol. 2008;159(6):1357-1363. doi:10.1111/j.1365-2133.2008.08836.x

Bianchi P, Theunis J, Casas C, et al. Effects of a New Emollient-Based Treatment on Skin Microflora Balance and Barrier Function in Children with Mild Atopic Dermatitis. Pediatr Dermatol. 2016;33(2):165-171. doi:10.1111/pde.12786

Aries MF, Hernandez-Pigeon H, Vaissière C, et al. Anti-inflammatory and immunomodulatory effects of Aquaphilus dolomiae extract on in vitro models. Clin Cosmet Investig Dermatol. 2016;9:421-434. doi:10.2147/CCID.S113180

Fostini AC, Georgescu V, Decoster CJ, Girolomoni G. A cream based on aquaphilus dolomiae extracts alleviates non-histaminergic pruritus in humans. Eur J Dermatology. 2017;27(3):317-318. doi:10.1684/ejd.2017.2994

Boralevi F, Saint Aroman M, Delarue A, et al. Long-term emollient therapy improves xerosis in children with atopic dermatitis. J Eur Acad Dermatology Venereol. 2014;28(11):1456-1462. doi:10.1111/jdv.12314

Angelova-Fischer I, Neufang G, Jung K, Fischer TW, Zillikens D. A randomized, investigator-blinded efficacy assessment study of stand-alone emollient use in mild to moderately severe atopic dermatitis flares. J Eur Acad Dermatology Venereol. 2014;28:9-15. doi:10.1111/jdv.12479

Simpson EL, Chalmers JR, Hanifin JM, et al. Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention. J Allergy Clin Immunol. 2014;134(4):818-823. doi:10.1016/j.jaci.2014.08.005

Horimukai K, Morita K, Narita M, et al. Application of moisturizer to neonates prevents development of atopic dermatitis. J Allergy Clin Immunol. 2014;134(4):824-830.e6. doi:10.1016/j.jaci.2014.07.060

Spada F, Barnes TM, Greive KA.

Emollient formulations containing antiseptics reduce effectively the level of Staphylococcus aureus on skin

. Clin Cosmet Investig Dermatol. 2019;Volume 12:639-645. doi:10.2147/ccid.s215023

Draelos ZD. An evaluation of prescription device moisturizers. J Cosmet Dermatol. 2009;8(1):40-43. doi:10.1111/j.1473-2165.2009.00422.x

van Zuuren EJ, Fedorowicz Z, Christensen R, Lavrijsen A, Arents BWM. Emollients and moisturisers for eczema. Cochrane Database Syst Rev. 2017;2017(2). doi:10.1002/14651858.CD012119.pub2

Santer M, Ridd MJ, Francis NA, et al. Emollient bath additives for the treatment of childhood eczema (BATHE): Multicentre pragmatic parallel group randomised controlled trial of clinical and cost effectiveness. BMJ. 2018;361. doi:10.1136/bmj.k1332

Ridd MJ, Gaunt DM, Guy RH, et al. Comparison of patient (POEM), observer (EASI, SASSAD, TIS) and corneometry measures of emollient effectiveness in children with eczema: findings from the COMET feasibility trial. Br J Dermatol. June 2018. doi:10.1111/bjd.16475

Lowe A, Su J, Tang M, et al. PEBBLES study protocol: A randomised controlled trial to prevent atopic dermatitis, food allergy and sensitisation in infants with a family history of allergic disease using a skin barrier improvement strategy. BMJ Open. 2019;9(3). doi:10.1136/bmjopen-2018-024594




DOI: http://dx.doi.org/10.29262/ram.v67i1.730

Enlaces refback

  • No hay ningún enlace refback.


Licencia de Creative Commons
Este obra está bajo una licencia de Creative Commons Reconocimiento-NoComercial 4.0 Internacional.