Do Patients with Atopic Dermatitis Have Increased Skin Absorption With Topical Medications?
Atopic dermatitis is known to cause abnormalities in the way skin absorbs outside elements. What is interesting is that this impaired skin barrier occurs in both lesional and nonlesional skin. This raises potential risks to chemical emollients, and may lead to an elevated risk for developing skin reactions to penetrating chemicals, and increased risk of systemic chemical exposure.
In past studies a higher risk of allergic contact dermatitis to topical corticosteroids (TCSs), preservatives, surfactants and metals has been observed in patients with AD. A recent systematic review of studies evaluated skin absorption of molecules in patients with AD and sought to increase understanding of this understudied area of dermatology. The review included 40 articles where a direct measure of skin absorption was provided and where measurements had been conducted in AD skin or animal skin that had been induced to develop AD-like skin disease. Then the authors identified the molecular weight (MW) and octanol–water partition coefficient (log Kow) of skin penetrants identified in the articles by searching the chemical databases of PubChem25 and the U.S. Environmental Protection Agency.
The review showed that indeed, skin absorption is increased through AD skin compared with control skin. Based on the limited amount of data, skin absorption in AD skin vs. control skin might be more than doubled. Therefore, exposure to chemicals found in topical products is also increased in patients with AD as part of their treatment regimen.
The authors conclude that there is a need for additional epidemiological studies that examine the possible burden of these chemicals. However, based on their review they state that clinicians should be mindful and minimize their use of products that contain potent contact allergens and endocrine-disrupting chemicals in their patients with AD.
Byline: Martha L. Sikes, MS, RPh, PA-C
Posted: August 21, 2017
Source: Wiley Online Library
Adapted from the original article.