title: Effects of pimecrolimus compared with triamcinolone acetonide cream on skin barrier structure in atopic dermatitis: a randomized, double-blind, right-left arm trial.
abstract: Patients with atopic dermatitis (AD) have an epidermal barrier dysfunction, which allows invasion of allergens to occur. Stratum corneum skin barrier is formed by corneocytes and extracellular lipids extruded from the epidermal lamellar bodies. In a controlled, randomized, double-blinded, right-left comparison study we investigated the effect of pimecrolimus (PIM) cream compared with triamcinolone acetonide cream (TA) on the skin barrier in 15 patients with symmetrical elbow lesions of AD. In punch biopsies, before and after treatment, skin lipid bilayer and lamellar body structure were examined by transmission electron microscopy (TEM). Partial Eczema Area and Severity Index (pEASi), stratum corneum hydration, and transepidermal water loss (TEWL) were monitored on days 1, 8 and 22. The pEASi was significantly more improved with TA compared with PIM, whereas stratum corneum hydration was slightly more improved after treatment with PIM. The TEM revealed a strong reduction in lamellar bodies in lesional skin of AD; only 32% of the lamellar bodies were normal. A significantly higher number of normal lamellar bodies was found after 3 weeks of treatment with PIM (58%; p < 0.005). An increase in lamellar bodies also occurred with TA treatment (46%; p < 0.05); however, significantly less than with PIM (p < 0.05). Clinical score and TEWL were more improved after treatment with TA, whereas the lamellar bodies were more normal after treatment with PIM.
authors.affiliation: Department of Dermatology, University Hospitals of Schleswig-Holstein, University of Kiel, Schittenhelmstrasse 7, Kiel, Germany. mjensen@dermatology.uni-kiel.de.
authors.forename: Jens-Michael
authors.initials: JM
authors.lastname: Jensen
authors.forename: Merle
authors.initials: M
authors.lastname: Weppner
authors.forename: Stephan
authors.initials: S
authors.lastname: Dähnhardt-Pfeiffer
authors.forename: Claudia
authors.initials: C
authors.lastname: Neumann
authors.forename: Matthias
authors.initials: M
authors.lastname: Bräutigam
authors.forename: Thomas
authors.initials: T
authors.lastname: Schwarz
authors.forename: Regina
authors.initials: R
authors.lastname: Fölster-Holst
authors.forename: Ehrhardt
authors.initials: E
authors.lastname: Proksch
mesh_terms: D000279:Administration, Cutaneous; D000328:Adult; D001706:Biopsy; D003876:Dermatitis, Atopic / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism; D003879:Dermatologic Agents / Q000008:administration & dosage*; D004311:Double-Blind Method; D004817:Epidermis / Q000187:drug effects* / Q000378:metabolism / Q000648:ultrastructure; D005260:Female; D005858:Germany; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D046529:Microscopy, Electron, Transmission; D008875:Middle Aged; D012720:Severity of Illness Index; D063465:Skin Cream; D016559:Tacrolimus / Q000008:administration & dosage / Q000031:analogs & derivatives*; D013997:Time Factors; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*; D014870:Water Loss, Insensible / Q000187:drug effects; D055815:Young Adult
chemical_list: D003879:Dermatologic Agents; D005938:Glucocorticoids; C117268:pimecrolimus; D014222:Triamcinolone Acetonide; D016559:Tacrolimus