Download advances in managing hyperkeratotic conditions

Supplement to the May 2012
®
Advances in
managing
Hyperkeratotic
Conditions
A review of a new formulation to
manage keratosis pilaris and damaged
and cracked heels.
Supported by
May 2012
•
Supplement to The Dermatologist
®
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Advances in managing
Hyperkeratotic Conditions
A review of a new formulation to manage keratosis pilaris and damaged and cracked heels.
Julia Ernst, MS, Assistant Editor
T
he new SA Renewing Lotion from CeraVe is
formulated with salicylic acid, ammonium lactate and
vitamin D3 to repair, restore and renew skin, making the
product ideal for dry, cracked heels or keratosis pilaris.
This article reviews these two conditions, the new
CeraVe SA Renewing Lotion and the ways in which
the new lotion helps patients with these conditions.
Hyperkeratosis is a condition marked by thickening
of the outer layer of the skin.1 The condition’s etiologies include eczema (chronic inflammation), X-linked
ichthyosis/ichthyosis vulgaris (genetic disorders) and
corns/calluses (normal use).1 Going barefoot and biomechanical factors (increased body weight) also play
important roles in its development. It occurs because of
hypertrophy of the stratum corneum.2
Dry, cracked heels or keratosis pilaris are two types of hyperkeratotic conditions. Dry, cracked heels occur for a number of reasons, according to Joseph Bikowski, MD, FAAD,
of Bikowski Skin Care Center in Sewickely, PA, including
the anatomic features of the heels, skin dryness and trauma,
which is often minor, or a combination of these factors.
The convex shape of the heel causes tension, which
contributes to the phenomenon of cracked heels (see
Figure 1), and is why the fingertips can also crack, Dr.
Bikowski explains. Keratosis pilaris (KP) (see Figure 2)
causes rough patches and small, acne-like bumps on the
skin — on the facial cheeks and, most commonly, on the
arms, thighs and buttocks.3 KP is a genetic disorder of
keratinization of hair follicles of the skin4 that can also
be associated with dryness and, sometimes, perifollicular
erythema, according to Dr. Bikowski.
Neither condition is associated with increased morbidity or mortality.3,4 Effective treatment options are
limited, according to Dr. Bikowski. The primary treatment option is moisturizing.
“Moisturizing is key, with the ultimate goal, in the
case of dry, cracked heels, to restore hydration and
encourage proper barrier function,” Dr. Bikowski
says. “In the case of KP, topical moisturizers help to
relieve the dry, rough feel often associated with the
condition. Application of moisturizers under occlusion can also help enhance skin hydration. Patients
apply a thick moisturizing agent to the affected areas,
then place a clean sock over top. This should be done
at bedtime.”
Figure 1. Dry, cracked heel.
Figure 2. Keratosis pilaris. Photo courtesy of Bernard Cohen, MD.
Hyperkeratotic Conditions: Dry, Cracked Heels or
Keratosis Pilaris
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Case Study
Joseph B. Bikowski, JR, MD, FAAD
A 39-year-old moderately obese Caucasian
female presented with a many-year history of
dry, painful heels. She reported that a number of over-the-counter medications had been
ineffective. A KOH preparation for dermatophytes was negative and, on examination, the
weight-bearing sides of the heels were dry,
flaking and cracked.
Figure 3a. Before
The patient was instructed to apply CeraVe SA
Renewing Lotion to the affected area twice a
day for 2 weeks. Upon her return visit after 2
weeks of twice-daily application of the lotion,
the skin of the heels was essentially normal in
appearance and feel (see Figures 3a and 3b).
Figure 3b. After two weeks
Both conditions may also benefit from the use of
keratolytics, Dr. Bikowski explains. Keratolytics are
used to soften skin and facilitate the removal of epidermal cells; some examples include salicylic acid
and urea. 5,6
Keratolytics “desquamate the thick, keratinized skin of
the heels and increase suppleness, to withstand trauma,”
Dr. Bikowski explains. “In KP, keratolytics can help to
unplug the pores and reduce the formation of bumps.”
According to Dr. Bikowski, cracked heels and feet
may be mediated by other factors, such as dermatophyte infections. In the case of infection, he explains,
inflammation and a compromised epidermal barrier
may heighten the likelihood of trauma and dryness. No
known factors for KP are within a patient’s control, Dr.
Bikowski explains.
CeraVe SA Renewing Lotion
What is the SA Renewing Lotion?
The new SA Renewing Lotion from CeraVe is used
for extremely dry, rough, bumpy skin, making it a good
moisturizer for patients with cracked heels or KP. The
product was formulated in conjunction with dermatologists and is designed to exfoliate, smooth and soften
extremely dry skin.7 In the case of dry, cracked heels or
KP, SA Renewing Lotion can serve a dual purpose, by
helping to slough off damaged skin cells and encourage
the growth of new, healthy skin.7
As with all CeraVe products, the new SA Renewing
Lotion includes ceramides, which help to restore, repair
and maintain the skin barrier.7 The new lotion is also
formulated with salicylic acid and ammonium lactate,
two key ingredients that help to loosen and exfoliate
dead skin cells.7 This process lets the moisturizing agents
penetrate the deeper layers of the skin for enhanced effectiveness.7 Also included in SA Renewing Lotion is
vitamin D, another key ingredient that helps to keep skin
looking smooth and hydrated.7
How do the key ingredients work?
Salicylic acid is a member of the beta hydroxy acid
family. This lipid-soluble agent is used for epidermal exfoliation. Salicylic acid breaks up keratin in hyperkeratotic conditions, enhances the shedding of thick skin and
softens newly growing skin.8 SA Renewing Lotion contains 3% salicylic acid.
“Salicylic acid is one of the most commonly prescribed agents used to treat KP,” Dr. Bikowski explains.
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Figure 4. MVE absorption rate into the skin.
“Its incorporation into a moisturizing, barrier-supporting topical lotion is a benefit for patients.”
Ammonium lactate is a combination of alpha hydroxy acid (AHA) and lactic acid that is neutralized
with ammonium hydroxide.8 This component relieves
dry skin by increasing the moisture content of the stratum corneum, the skin’s outermost layer.8 AHA acts as
a humectant and has a normalizing effect on the skin.
Lactic acid has also been shown to reduce the thickened stratum corneum that results from hyperkeratotic
conditions.8 SA Renewing Lotion contains 3.5% ammonium lactate.8
“Ammonium lactate also helps restore moisture
while reducing skin thickness and roughness,” explains
Dr. Bikowski.
Vitamin D3 helps to maintain healthy skin that is
firm and supple.8 Analogs of vitamin D3 such as calcipotriene and becocalcidiol have been shown to be effective in psoriasis; it was particularly effective for resistant
plaques and lesions on the face.9 Vitamin D3 has also
been effective for the treatment of vitiligo, scleroderma
and actinic keratosis.10 It’s said to have antipruritic, antiinflammatory and healing properties in psoriasis treatment.11 All these factors may play a role in the use of
vitamin D3 for skin conditions.9–11
The role of multivesicular emulsion technology
CeraVe skincare products feature multivesicular emulsion (MVE) technology (see Figure 4), a patented process that delivers CeraVe products into the skin over a
period of time, rather than all at once.12 This delivery
method also “locks in” moisture.12
“The MVE technology facilitates slow release of ceramides over time, which means continuous skin moisturization,” Dr. Bikowski explains. “This is a practical
benefit for both cracked heels or KP, as patients are
unlikely to remove their shoes or clothing to re-apply
moisturizer multiple times throughout the day.”
Additional benefits for patients with cracked heels or KP
The ingredients in CeraVe SA Renewing Lotion
work together to exfoliate and remove dead skin cells
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and help soften the new skin that is regenerated.7,8,12 The
MVE technology allows for a continuous dispensation
of products, which is crucial for patients with hyperkeratotic skin conditions. SA Renewing lotion is also
non-comedogenic and non-irritating.7
“The unique combination of these exfoliating keratolytic agents and humectants within a formulation
containing barrier-supporting ceramides is expected
to optimize patient response and enhance healing,” Dr.
Bikowski says. n
Disclosure: Dr. Bikowski is a consultant for Valeant.
References
1. National Cancer Institute. Dictionary of cancer terms: hyperkeratosis. Available at www.cancer.gov/dictionary?cdrid:413928. Accessed
April 6, 2012.
2. Merriam Webster’s Collegiate Dictionary. 11th ed. Springfield, MA:
Merriam-Webster Inc; 2003.
3. Mayo Clinic. Keratosis pilaris. Available at http://www.mayoclinic.
com/health/keratosis-pilaris/DS00769/METHOD=print. Accessibility verified April 9, 2012.
4. Medscape Reference: Drugs, Diseases and Procedures. Keratosis
pilaris. Available at http://emedicine.medscape.com/article/1070651overview. Accessed April 9, 2012.
5. Merck Manual Professional. Principles of topical dermatologic
therapy. Available at http://www.merckmanuals.com/professional/
dermatologic_disorders/principles_of_topical_dermatologic_therapy/principles_of_topical_dermatologic_therapy.html. Accessed
April 9, 2012.
6. Skin & Aging. Management of seborrheic dermatitis. Available
at http://www.the-dermatologist.com/article/9049. Accessed
April 9, 2012.
7. When your skin hits a bumpy patch, change direction with new
CeraVe SA Renewing Lotion! [press release]. New York, NY: The
Lane Communications Group; February 6, 2012.
8. New CeraVe SA Renewing Lotion Key Ingredients [press release].
New York, NY: The Lane Communications Group; February 6, 2012.
9. Mayo Clinic.Vitamin D. Available at http://www.mayoclinic.com/
health/vitamin-d/NS_patient-vitamind. Accessed April 9, 2012.
10. Medline Plus.Vitamin D. Available at http://www.nlm.nih.gov/
medlineplus/druginfo/natural/929.html. Accessed April 9, 2012.
11. Kuravi A. Effect of parenteral vitamin D3 in skin diseases. Indian J
Dermatol Venereol Leprol 1998;64:251-252.
12. CeraVe. The role of MVE technology. Available at http://cerave.
com/cerave-resources/the-role-of-mve-technology/. Accessed April
5, 2012.