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38 HEALTH SKIN CONDITIONS FROM PAGE 36 it. What you want is the smallest number of treatment steps to get the biggest bang for your buck. “There’s evidence for the effectiveness of cleansing, and while a lot of teenagers don’t like doing it, you do want to exfoliate, because of the build-up of skin cells. “The problem is that if you do that in a pro-inflammatory way by using either a scrub, microbeads or even just a strong scrub with a face washer, it’s pro-inflammatory, which actually causes more skin damage. “So, it’s important to remove the excess cells with a soap-free cleanser, using something like hydroxy acid. That’s step number one. “Step number two is for when they ask what they can use during the day after cleansing. For this, I strongly suggest a sunscreen that’s broad spectrum, meaning it’s effective against both UVA and UVB. I also strongly suggest that it’s non comedogenic (oil free), which means that it doesn’t create more pimples by blocking pores. “Certain moisturising ingredients have been known to sit in pores and block them. They’re the ones you really want to avoid, particularly for people with acne. “I’m also a big fan of physical rather than chemical sunscreens, because chemical ones have got some clouds over their safety and can cause inflammation. “I believe zinc is the best, followed by titanium dioxide. After all, we put zinc on babies’ bums, so we know it’s very soothing. It’s also very anti-inflammatory and it has a really low comedogenic rating so doesn’t tend to cause pimples.” Change the atopic Consultant dermatologist specialist and Mohs micrographic surgeon Dr Eleni Yiasemides tells Retail Pharmacy the most important aspect of managing atopic eczema is to respect and repair the barrier function of the skin. “We know that people who have eczema have damaged barrier function of the skin and have low levels of ceramides, which are types of lipids (fats) found in the skin,” she said. “They act as the ‘glue’ between the ‘bricks’ of our skin cells and play an essential role in the barrier function of the skin. “It’s extremely important to use a gentle, soap-free cleanser on the face and body if you suffer from atopic eczema. Avoid soaps and detergents on the skin and instead look for products that contain ceramides, as these help to replenish the levels that we know are low in eczema affected skin. “Those with eczema should use lukewarm water when washing face and body, and avoid really hot showers as these dehydrate the skin and exacerbate the drying effects of the eczema. Also, avoid scrubs, harsh cleansers or physical exfoliation, and instead use a cotton washcloth or a soft sponge. Anything harsher than this will cause physical exfoliation and further damage the impaired barrier of the skin, leading to more sensitivity and irritability with redness, scale, burning and itchy skin.” When patients present with atopic eczema, Dr Yiasemides suggests pharmacists recommend a generous amount of a thick, rich moisturiser, as this will help to soothe the skin, repair the dryness, and protect the barrier. “Apply products that contain ceramides, hyaluronic acid and glycerin, as these are great for dry, eczema prone skin,” she said. “Apply the moisturiser after shower or bath, as the heat and moisture of bathing aids the absorption of the moisturiser on the skin. “Also, try and avoid dry conditions, such as air-conditioning, and if possible, use a humidifier to add moisture to the air and help keep the skin hydrated.” Rachel McAdam, L’Oréal’s Medical Communications Manager, also advocates skin care formulations containing hyaluronic acid and amino acids, telling Retail Pharmacy both can play an important role in protecting and treating eczema prone skin. “Hyaluronic acid is a powerful humectant, able to draw and hold moisture in the form of water molecules,” she said. “In eczema prone skin, this is useful because the skin will tend to lose its moisture and become dehydrated, which may in turn trigger flare-ups. “Amino acids play an important role in skin health on many levels, including hydration and protection, and they also can be really useful when formulating a cleanser that’s able to effectively cleanse impurities, such as makeup, while still remaining very gentle.” Fully human monoclonal antibody now PBS listed for severe atopic dermatitis Experts have welcomed the PBS listing, for eligible patients, of a first- in-class therapy that blocks proteins responsible for type 2 inflammation in atopic dermatitis. Dupixent (dupilumab) is the first biologic to target underlying immune dysregulation to be listed on the PBS for adults and adolescents (12 years and above) for the treatment of patients with severe atopic dermatitis who have failed to respond to optimally prescribed topical treatments. “The PBS listing of Dupixent is exciting news for many patients with severe atopic dermatitis,” said Associate Professor Peter Foley, a dermatologist and Director of Research at the Skin Health Institute. “It will provide specialists with a welcome alternative to long- term use of topical medication and immunosuppressant therapy. Biologic therapy represents a new treatment paradigm for severely impacted atopic dermatitis patients.” Dupixent is a fully human monoclonal antibody that inhibits the signalling of the interleukin-4 (IL-4) and interleukin-13 (IL-13) proteins, and isn’t an immunosuppressant. Data from Dupixent clinical trials have shown that IL-4 and IL-13 are key drivers of the type 2 inflammation that plays a major role in atopic dermatitis. Type 2 inflammation is the common denominator behind a range of lifelong diseases, including atopic dermatitis, asthma and other allergic or atopic disorders, which appear to be disparate conditions but occur when the immune system overreacts to an allergen or pathogen. RETAIL PHARMACY • JUN 2021