Not happy with my last post, was rushing to prepare for a dinner party...
What I wanted to convey was that the chronic use of Aqueous cream has already been associated with skin irritation (Cork et al, 2004) and thinning of the skin (Tsang et al, 2010). The article I originally attached concurs that continued application of aqueous cream appears to disrupt the normal corneocyte maturation process, thereby affecting the thickness of the stratum corneum .
Interestingly, this is also confirmed on `The National Eczema Society`(which also states "aqueous cream BP should not be used as a leave-on emollien
That said, I am not adverse to recommending aqueous cream as a soap substitute.
This is the abstract for Cork et al paper;
An audit of adverse drug reactions to aqueous creamin children with atopic eczema
Cork MJ, Timmins J, Holden C et al. Pharm J 2003; 271; 747-748
Objective; To determine what proportion of children with atopic eczema develop cutaneous reactions to aqueous cream or other emollient creams and ointments.
Background; A comprehensive emollient regime, comprising creams, ointments, bath oils and soap substitutes, is the first line treatment for atopic eczema. However, patient compliance is poor, most commonly because of a lack of understanding of how emollients should be used. Non-compliance is also often the result of adverse reactions to the prescribed emollient. The authors had noted that adverse reactions appeared to be more common with aqueous cream than with any other emollient. This study was undertaken to determine how many children develop reactions to emollients.
Subjects; 100 children with atopic eczema aged 1-16 years attending a paediatric dermatology clinic at Sheffield Children’s Hospital.
Methods; All reports of burning, stinging, itching or redness developing within 20 minutes of the use of emollients were noted and the relative frequencies following exposure to either aqueous cream or other emollients were compared.
A total of 14 emollients other than aqueous cream had been used, with the result that numbers using any particular one were too small to show statistically significant differences. However, the frequencies of reactions reported were similar for all of them, so the overall frequency for all other emollients was used for comparison.
Results; A high proportion of the children reported adverse reactions following the application of aqueous cream. Similar reactions were noted after other emollients but much less often.
71 of the children had been exposed to aqueous cream. Of these 40 (56.3%) had developed an immediate cutaneous reaction.
There had also been a total of 622 exposures to the other 14 emollients. Only 111 (17.8%) of these resulted in an adverse reaction. The difference was highly significant (p<0.001).
This is the abstract for Tsang et al paper;
Effect of Aqueous Cream BP on human stratum corneum in vivo
Tsang M, Guy RH. . Br J Dermatol 2010; 163:954–8.
Background; Aqueous Cream BP is widely prescribed to patients with eczema to relieve skin dryness. The formulation contains sodium lauryl sulphate (SLS), a chemical that is a known skin irritant and a commonly used excipient in personal care and household products. The chronic effects of Aqueous Cream BP application on skin barrier function have not been determined.
Objectives; To characterize and assess skin barrier function of healthy skin after application of Aqueous Cream BP and to study the physical effects of the formulation on the stratum corneum (SC).
Methods; The left and right volar forearms of six human volunteers were each separated into treated and control sides. The treated sides of each forearm were subjected to twice daily applications of Aqueous Cream BP for 4 weeks at the end of which concomitant tape stripping and transepidermal water loss (TEWL) measurements were made. The untreated sides of the forearms were not exposed to any products containing SLS during the study period.
Results; Changes in SC thickness, baseline TEWL and rate of increase in TEWL during tape stripping were observed in skin treated with Aqueous Cream BP. The mean decrease in SC thickness was 1•1 μm (12%) (P = 0•0015) and the mean increase in baseline TEWL was 2•5 g m−2 h−1 (20%) (P < 0•0001). Reduced SC thickness and an increase in baseline TEWL, as well as a faster rate of increase in TEWL during tape stripping, were observed in 16 out of 27 treated skin sites.
Conclusions; The application of Aqueous Cream BP, containing ∼1% SLS, reduced the SC thickness of healthy skin and increased its permeability to water loss. These observations call into question the continued use of this emollient on the already compromised barrier of eczematous skin.