title: The effect of aqueous cream BP on the skin barrier in volunteers with a previous history of atopic dermatitis.
abstract: BACKGROUND
  The emollient aqueous cream BP is frequently used for the treatment of atopic dermatitis (AD), yet it is associated with a high rate of adverse cutaneous reactions. It contains the harsh anionic surfactant sodium lauryl sulphate, a known negative environmental factor associated with the exacerbation of AD.
  
  
  OBJECTIVE
  To investigate the effect of aqueous cream BP on stratum corneum (SC) integrity and skin barrier function in volunteers with a predisposition to a defective skin barrier.
  
  
  METHODS
  Thirteen volunteers with a previous history of AD (no symptoms for 6 months) applied aqueous cream BP twice daily to the volar side of one forearm for 4 weeks. The other forearm was left untreated as a control. Permeability barrier function and SC integrity were determined before and after treatment by measuring transepidermal water loss (TEWL) in conjunction with tape-stripping. For comparison, 13 volunteers with current AD were recruited for assessment, without treatment, of SC integrity and skin barrier function at unaffected sites.
  
  
  RESULTS
  Topical application of aqueous cream BP resulted in significant elevation of baseline TEWL and a concomitant decrease in SC integrity. Measurements made after no treatment in volunteers with current AD, at unaffected sites, suggest that application of aqueous cream BP negatively affects the skin barrier towards the damaged state associated with onset of flares of the disease.
  
  
  CONCLUSIONS
  Aqueous cream BP used as a leave-on emollient caused severe damage to the skin barrier in volunteers with a previous history of AD. Aqueous cream BP should not be used as a leave-on emollient in patients with AD.
authors.affiliation: Academic Unit of Dermatology Research, Department of Infection and Immunity, Faculty of Medicine, Dentistry and Health, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX, UK. s.danby@sheffield.ac.uk
authors.forename: S G
authors.initials: SG
authors.lastname: Danby
authors.forename: T
authors.initials: T
authors.lastname: Al-Enezi
authors.forename: A
authors.initials: A
authors.lastname: Sultan
authors.forename: J
authors.initials: J
authors.lastname: Chittock
authors.forename: K
authors.initials: K
authors.lastname: Kennedy
authors.forename: M J
authors.initials: MJ
authors.lastname: Cork
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003876:Dermatitis, Atopic / Q000150:complications / Q000188:drug therapy*; D004198:Disease Susceptibility; D003875:Drug Eruptions / Q000209:etiology*; D004643:Emollients / Q000009:adverse effects*; D004817:Epidermis / Q000187:drug effects; D005260:Female; D005542:Forearm; D006801:Humans; D008297:Male; D012867:Skin / Q000187:drug effects*; D012967:Sodium Dodecyl Sulfate / Q000009:adverse effects*; D014870:Water Loss, Insensible / Q000187:drug effects*
chemical_list: D004643:Emollients; D012967:Sodium Dodecyl Sulfate