Correspondence
(b)
(a)
(c)
Figure 1 (a) Before treatment, the
patient’s hair was completely white; (b,c) after treatment, darkening and curling of the hair was apparent, particularly affecting the frontal area.
on the medication because any attempt at withdrawal has caused a worsening of the rash, so we can only assume that a cessation of the medication would return his hair to baseline. In conclusion, we report a patient with darkening and thickening of hair after acitretin therapy. Acitretin seems the likeliest candidate for these hair changes, and is supported by a few reports in the literature.1–3 We therefore suggest that repigmentation and thickening of hair is occasionally a sequelae of acitretin treatment. P. D. Ward,1 H. L. Miller,1 and A. R. Shipman2 1 College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK; and 2Department of Dermatology, Worcestershire Royal Hospital, Worcester, UK. E-mail: [email protected] Conflict of interest: none declared. Accepted for publication 16 April 2012
References 1 Vesper JK, Fenske NA. Hair darkening and new growth associated with etretinate therapy. J Am Acad Dermatol 1996; 34: 860. 2 Clark JT, Price H, Clarke S, et al. Acquired kinking of the hair caused by acitretin. J Drugs Dermatol 2007; 6: 937–8. 3 Seckin D, Yildiz A. Repigmentation and curling of hair after acitretin therapy. Australas J Dermatol 2009; 50: 214–16. 4 Chappell JA, Chu MB, Martin K, Hurley Y. Acitretin-induced poliosis with concurrent alopecia. J Drugs Dermatol 2012; 11: 247–9. 5 Cline DJ. Changes in hair color. Dermatol Clin 1988; 6: 295–303.
92
Clinical and Experimental Dermatology (2014) 39, pp58–93
The aqueous cream controversy doi: 10.1111/ced.12211 I should like to comment on the recent consensus statement on the use of emollients in dry-skin conditions by Moncriefff et al.1 published in Clinical and Experimental Dermatology. I concur with most of the paper, but consider condemnatory mention of aqueous cream six times as rather excessive, although I am aware of oft-quoted papers suggesting that aqueous cream should not be used as a leave-on emollient.2,3 Aqueous cream first appeared in the 1958 British Pharmacopoeia and, relevantly, it should be noted, it is still extensively used today, both as a soap substitute and leave-on emollient. Aqueous cream products contain sodium lauryl sulfate (SLS), a known skin irritant, as a subcomponent of emulsifying wax. However, the content of 0.9% w/w is very much lower than that of liquid hand soap preparations, which generally have between 10% and 15% w/w SLS.4 Aqueous cream products also contain other ingredients, including the preservatives phenoxyethanol, and sometimes parabens or chlorocresol, likely to irritate damaged skin. Certainly, these days, there are very many emollients available that do not contain SLS, and I prescribe aqueous cream by itself uncommonly. However, I do use it quite regularly as a vehicle in dispensed topical applications without any problem. In very many years of practice, I cannot recollect my own patients having more frequent skin reactions after use of aqueous cream than more modern emollients. In fact, I see parents of first-attendance patients with atopic eczema, who have
ª 2013 British Association of Dermatologists
Correspondence
refused my suggestion to try a change of emollient from aqueous cream, prescribed by their GP or other doctor, because they were so happy with its effectiveness. Obviously, however, if any emollient in any individual gives rise to a cutaneous reaction, that preparation should be discontinued.
Acknowledgements I thank Andrea Leatherbarrow, Lead Pharmacist (Neuro/ Head and Neck), Pharmacy Department, for providing helpful information. J. Verbov Department of Dermatology, Alder Hey Children’s NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, UK E-mail: [email protected] Conflict of interest: none declared. Accepted for publication 16 April 2013
ª 2013 British Association of Dermatologists
References 1 Moncrieff G, Cork M, Lawton S et al. Use of emollients in dry-skin conditions: consensus statement. Clin Exp Dermatol 2013; 38: 231–8. 2 Cork MJ, Timmins J, Holden C et al. An audit of adverse drug reactions to aqueous cream in children with atopic eczema. Pharmaceut J 2003; 271: 746–7. 3 Danby S, Al Enezi T, Sultan A et al. The effect of aqueous cream BP on the skin barrier in volunteers with a previous history of atopic dermatitis. Br J Dermatol 2011; 165: 329–34. 4 Medicines and Healthcare products Regulatory Agency. Aqueous cream. UK Public Assessment Report, 2013. Available at: https://www.google.com/url?q=http://www. mhra.gov.uk/home/groups/s-par/documents/ websiteresources/con251957.pdf&sa=U&ei=iPGDUbmf EZOZ0AXliYGYBQ&ved=0CBAQFjAD&client=internaluds-cse&usg=AFQjCNF4FQB4tykSem05K4DwVDD 4fi0zcg.
Clinical and Experimental Dermatology (2014) 39, pp58–93
93
(b)
(a)
(c)
Figure 1 (a) Before treatment, the
patient’s hair was completely white; (b,c) after treatment, darkening and curling of the hair was apparent, particularly affecting the frontal area.
on the medication because any attempt at withdrawal has caused a worsening of the rash, so we can only assume that a cessation of the medication would return his hair to baseline. In conclusion, we report a patient with darkening and thickening of hair after acitretin therapy. Acitretin seems the likeliest candidate for these hair changes, and is supported by a few reports in the literature.1–3 We therefore suggest that repigmentation and thickening of hair is occasionally a sequelae of acitretin treatment. P. D. Ward,1 H. L. Miller,1 and A. R. Shipman2 1 College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK; and 2Department of Dermatology, Worcestershire Royal Hospital, Worcester, UK. E-mail: [email protected] Conflict of interest: none declared. Accepted for publication 16 April 2012
References 1 Vesper JK, Fenske NA. Hair darkening and new growth associated with etretinate therapy. J Am Acad Dermatol 1996; 34: 860. 2 Clark JT, Price H, Clarke S, et al. Acquired kinking of the hair caused by acitretin. J Drugs Dermatol 2007; 6: 937–8. 3 Seckin D, Yildiz A. Repigmentation and curling of hair after acitretin therapy. Australas J Dermatol 2009; 50: 214–16. 4 Chappell JA, Chu MB, Martin K, Hurley Y. Acitretin-induced poliosis with concurrent alopecia. J Drugs Dermatol 2012; 11: 247–9. 5 Cline DJ. Changes in hair color. Dermatol Clin 1988; 6: 295–303.
92
Clinical and Experimental Dermatology (2014) 39, pp58–93
The aqueous cream controversy doi: 10.1111/ced.12211 I should like to comment on the recent consensus statement on the use of emollients in dry-skin conditions by Moncriefff et al.1 published in Clinical and Experimental Dermatology. I concur with most of the paper, but consider condemnatory mention of aqueous cream six times as rather excessive, although I am aware of oft-quoted papers suggesting that aqueous cream should not be used as a leave-on emollient.2,3 Aqueous cream first appeared in the 1958 British Pharmacopoeia and, relevantly, it should be noted, it is still extensively used today, both as a soap substitute and leave-on emollient. Aqueous cream products contain sodium lauryl sulfate (SLS), a known skin irritant, as a subcomponent of emulsifying wax. However, the content of 0.9% w/w is very much lower than that of liquid hand soap preparations, which generally have between 10% and 15% w/w SLS.4 Aqueous cream products also contain other ingredients, including the preservatives phenoxyethanol, and sometimes parabens or chlorocresol, likely to irritate damaged skin. Certainly, these days, there are very many emollients available that do not contain SLS, and I prescribe aqueous cream by itself uncommonly. However, I do use it quite regularly as a vehicle in dispensed topical applications without any problem. In very many years of practice, I cannot recollect my own patients having more frequent skin reactions after use of aqueous cream than more modern emollients. In fact, I see parents of first-attendance patients with atopic eczema, who have
ª 2013 British Association of Dermatologists
Correspondence
refused my suggestion to try a change of emollient from aqueous cream, prescribed by their GP or other doctor, because they were so happy with its effectiveness. Obviously, however, if any emollient in any individual gives rise to a cutaneous reaction, that preparation should be discontinued.
Acknowledgements I thank Andrea Leatherbarrow, Lead Pharmacist (Neuro/ Head and Neck), Pharmacy Department, for providing helpful information. J. Verbov Department of Dermatology, Alder Hey Children’s NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, UK E-mail: [email protected] Conflict of interest: none declared. Accepted for publication 16 April 2013
ª 2013 British Association of Dermatologists
References 1 Moncrieff G, Cork M, Lawton S et al. Use of emollients in dry-skin conditions: consensus statement. Clin Exp Dermatol 2013; 38: 231–8. 2 Cork MJ, Timmins J, Holden C et al. An audit of adverse drug reactions to aqueous cream in children with atopic eczema. Pharmaceut J 2003; 271: 746–7. 3 Danby S, Al Enezi T, Sultan A et al. The effect of aqueous cream BP on the skin barrier in volunteers with a previous history of atopic dermatitis. Br J Dermatol 2011; 165: 329–34. 4 Medicines and Healthcare products Regulatory Agency. Aqueous cream. UK Public Assessment Report, 2013. Available at: https://www.google.com/url?q=http://www. mhra.gov.uk/home/groups/s-par/documents/ websiteresources/con251957.pdf&sa=U&ei=iPGDUbmf EZOZ0AXliYGYBQ&ved=0CBAQFjAD&client=internaluds-cse&usg=AFQjCNF4FQB4tykSem05K4DwVDD 4fi0zcg.
Clinical and Experimental Dermatology (2014) 39, pp58–93
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