Barrier Repair Therapy in Atopic Eczema: Effects of Isoleucine, Rhamnosoft, Ceramides and Niacinamide Facial and Body Creams on Clinical, Itch and Staphylococcus aureus Skin Colonization: A Prospective Assessor-Blinded Study

Background: Atopic eczema (AE) is a very common chronic skin inflammatory disease of pediatric age. Skin xerosis and itch are the hallmark of the disease pointing out that skin barrier alteration is the background condition of AE. Skin barrier alteration could favour S. aureus colonization which in turn could be a process involved in AE flares. Due to their positive effects on skin barrier functions emollient and moisturizing compounds are considered a mainstay therapy of AE. New emollient and moisturizing facial and a body creams containing L-isoleucine, ceramides, niacinamide and rhamnosoft have been recently developed (Pro-AMP body and facial creams). The composition of these creams could act on different aspects of skin barrier defects improving skin barrier functions in AE. In particular L-isoleucine and its analogues are highly specific anti-microbial peptides (AMP) inducers in epithelial cells. Study aim: We evaluated in a prospective assessor-blinded clinical evaluation study, the effects of pro-AMP facial and body creams on clinical evolution, itch and S. aurues colonization in children with mild-to-moderate AE. Subjects and methods: A total of 45 children (24 girls and 21 boys; mean age 5 years) were enrolled after their parents’ written informed consent. Treatments were applied twice daily for a 2-month period on the affected area (face, neck, upper limbs, body and lower limbs). Eczema Area Severity Index (EASI) score (face/neck and body) scoring redness, thickness scratching and lichenification was assessed using a 4-point grading severity score (from 0: absent, to 3: severe) and evaluated at baseline, month 1, and month 2. Itching was evaluated using an AnalogueVisual scale (VAS) from 0 (no itch to 10 very severe itch). Skin swabs for detection of S. aureus were obtained from lesional skin at baseline and at month 2. Results: At baseline, EASI facial and body scores mean (SD), were 1.6 (0.8) and 1.9 (0.9) respectively. Itch VAS score at baseline was 6.4 (2.8). Nine (20%) subjects were positive for S. aureus at baseline. EASI scores significant decreased by 50% (facial) and by 52% (body) at month 1. At month 2, EASI facial, and body scores decreased by 75%, and 79%, respectively. Itch VAS score was reduced by 42% at week 4 and by 66% at week 8. All but one subjects with S. aureus at baseline had negative skin swabs at month 2. Conclusion: These new Pro-AMP facial and body creams containing isoleucine, ceramides, niacinamide and rhamnosoft have shown to be effective in reducing signs and symptoms in mild-to-moderate chronic lesions of AE of the body. Treatment was also associated with an improvement on lesion skin dysbiosis.