title: Comparing the Effect of a Twice-weekly Tacrolimus and Betamethasone Valerate Dose on the Subclinical Epidermal Barrier Defect in Atopic Dermatitis.
abstract: The proactive use of topical anti-inflammatory (TAI) therapy to address subclinical inflammation is an effective, contemporary clinical strategy for the management of atopic dermatitis (AD). The interaction of a proactive TAI dose with the subclinical epidermal barrier defect in AD is yet to be determined. A randomised, observer-blind, functional mechanistic study in 17 subjects with quiescent AD was performed to compare the effect of a twice-weekly dose of betamethasone valerate (0.1%) cream (BMVc), against tacrolimus (0.1%) ointment (TACo) on the biophysical and biological properties of the epidermal barrier. Application of BMVc preserved epidermal barrier function and stratum corneum (SC) integrity, but significantly elevated skin-surface pH with concomitant loss of SC cohesion. By contrast, TACo improved SC integrity, exerted an overall hydrating action, and significantly reduced caseinolytic and trypsin-like protease activity. The differential effects reported support the proactive use of TACo to promote reparation of the subclinical barrier defect in AD.
authors.affiliation: The Academic Unit of Dermatology Research, Department of Infection and Immunity, Faculty of Medicine, Dentistry and Health, The University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX, United Kingdom. j.chittock@sheffield.ac.uk.
authors.forename: John
authors.initials: J
authors.lastname: Chittock
authors.forename: Kirsty
authors.initials: K
authors.lastname: Brown
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Cork
authors.forename: Simon G
authors.initials: SG
authors.lastname: Danby
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001624:Betamethasone Valerate / Q000008:administration & dosage*; D065095:Calcineurin Inhibitors / Q000008:administration & dosage*; D003720:Densitometry; D003876:Dermatitis, Atopic / Q000188:drug therapy / Q000201:enzymology / Q000503:physiopathology*; D025802:Electric Capacitance; D004817:Epidermis / Q000737:chemistry / Q000187:drug effects / Q000503:physiopathology; D006801:Humans; D006863:Hydrogen-Ion Concentration / Q000187:drug effects; D009824:Ointments / Q000008:administration & dosage; D010447:Peptide Hydrolases / Q000378:metabolism; D016037:Single-Blind Method; D063465:Skin Cream / Q000008:administration & dosage; D012879:Skin Physiological Phenomena / Q000187:drug effects*; D016559:Tacrolimus / Q000008:administration & dosage*; D014870:Water Loss, Insensible / Q000187:drug effects
chemical_list: D000893:Anti-Inflammatory Agents; D065095:Calcineurin Inhibitors; D009824:Ointments; D001624:Betamethasone Valerate; D010447:Peptide Hydrolases; D016559:Tacrolimus