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3RD EDITION
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PUBLICATION BOOKLET3RD EDITION
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6 7
Treatment with a barrier-strengthening moisturizing cream delays relapse of atopicdermatitis. A prospective and randomized controlled clinical trial. Wirn K, Nohlgrd C,Nyberg F, L Holm L, Svensson M, Johannesson A, Wallberg P, B Berne B, Edlund F, Lodn M.JEADV 2009; 23: 1267-72. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 6
Moisturizers change the mRNA expression of enzymes synthesizing skinbarrier lipids. Buraczewska I, Berne B, Lindberg M, Lodn M, Trm H. ArchDermatol Res 2009; 301: 587-94. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Changes in skin barrier function by long-term treatment with moisturizers.Buraczewska I, Berne B, Lindberg M, Trm H, Lodn M. Br J Dermatol 2007;156: 492-98.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Long-term treatment with moisturizers affects the mRNA levels of genesinvolved in keratinocyte differentiation and desquamation. Buraczewska I,
Berne B, Lindberg M, Lodn M, Trm H. Br J Dermatol 2007; 156: 492-98. . . . . . . . . . . . . . . . . 20
Treatment of surfactant-damaged skin in humans with creams of different pH.Buraczewska I, Lodn M. Pharmacology 2005; 73: 1-7. Exogen Dermatol2005; 73: 1-7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Effects of pre-treatment an emollient containing urea on nickel allergic skinreactions. Kuzmina N, Nyrn M, Lodn M, Edlund F, Emtestam L. Acta DermVenereol 2005; 85: 9-12. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2
The influence of urea treatment on skin susceptibility to surfactant-inducedirritation: A placebo-controlled and randomized study. Lodn M, Brny E,Mandahl P, Wessman C. Exog Dermatol 2004; 3 : 1-6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23
Nickel susceptibility and skin barrier function to water after treatment witha urea-containing moisturizer. Lodn M, Kuzima N, Nyrn M, Edlund F,Emtestam L . Exog De rma to l 2004; 3: 9 9-105. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 4
Differences among moisturizers in affecting skin susceptibility to hexyl nicotinate,measured as time to increase skin blood flow. Duval C, Lindberg M, Boman A,Johansson S, Edlund F, Lodn M. Skin Res Technol 2003; 9: 59-63. . . . . . . . . . . . . . . . . . . . . . . . . .25
Instrumental and dermatologist evaluation of the effect of glycerine and ureaon dry skin in atopic dermatitis. Lodn M, Andersson AC, Andersson C, Frdin T,man H, L indberg M . Sk in Res Technol 2001; 7 : 209-13. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26
Improvement in skin barrier function in patients with atopic dermatitis aftertreatment with a moisturizing cream (Canoderm). Lodn M, Andersson A-C,L indbe rg M. Br J Dermatol 19 99; 14 0: 264-7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 7
The effect of two urea-containing creams on dry, eczematous skin in atopic patients.I. Expert, patient and instrumental evaluation. Andersson A-C, Lindberg M, Lodn M.J Dermatol Treat 1999; 10:165-9. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 8
The effect of two urea-containing creams on dry, eczematous skin in atopicpatients. II. Adverse effects. Lodn M, Andersson A-C, Lindberg M. J DermatolTreat 1999; 10: 171-5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Barrier recovery and influence of irritant stimuli in skin treated with a moisturizingc ream. Lodn M . Contac t Dermat iti s 1997; 36: 256-60. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
MINIDERMA double-blind study comparing the effect of glycerine and urea on dry, eczematousskin in atopic patients. M Lodn, A-C Andersson, A Anderson, I-M Bergrant, T Frdin,H hman, M-H Sandstrm, T Srnhult, E Voog, B Stenberg, E Pawlik, A Preisler-Hggqvist, Svensson & M Lindberg. Acta Dermato-Venerologica 2002; 82: 45-47. . . . . . . . . . . . . . . . . . . . .32
The influence of a cream containing 20 % glycerine and its vehicleon skin barrier properties. Lodn M, Wessman C. Int J Cosm Sci 2001; 23: 115-19. . . . . . . . . . . 33
LIST OF SCIENTIFIC PUBLICATIONS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
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THE CLINICAL BENEFIT OF MOISTURIZERS
Lodn M.
Journal of the European Academy of Dermatology
and Venereology 2005; 19: 672-688.
Moisturizing creams marketed to consumers often contain trendy ingredients
and are accompanied by exciting names and attractive claims. Moisturizers are
also an important part of the dermatologists armamentarium to treat dry skin
conditions and maintain healthy skin. The products can be regarded as cosmetics,
but may also be regulated as medicinal products if they are marketed against
dry skin diseases, such as atopic dermatitis and ichtyosis. When moisturizers are
used on the so-called dry skin, many distinct disorders that manifest themselves
with the generally recognized symptoms of dryness are treated. Dryness is not a
single entity, but is characterized by differences in chemistry and morphology in the
epidermis depending on the internal and external stressors of the skin. Patients
and the society expect dermatologists and pharmacists to be able to recommend
treatment for various skin conditions upon evidence-based medicine. Upon
completing this paper, the reader should be aware of different types of moisturizersand their major constituents. Furthermore, s/he will know more about the relief of
dryness symptoms and the functional changes of the skin induced by moisturizers.
8 9
EMOLLIENTS IN GENERAL
PREVENTION OR PROMOTION OF DRYNESSAND ECZEMA BY MOISTURIZERS?
Lodn M.
Expert Review of Dermatology 2008; 3(6): 667-676.
The use of moisturizers is almost instinctive and is also routinely recommended to
reduce the likelihood of developing dryness and eczema. However, recent findings
demonstrate that treatment with creams may increase the risks for eczema.
Symptoms of dryness may appear in normal skin and the skin susceptibility to
outside stressors may increase. Moisturizing creams contain a great variety of
ingredients, some of which are found in the stratum corneum. However, knowledge
regarding the mechanisms of the impact of different ingredients on the skin is
still lacking and, currently, it is a matter of trial and error to find the most suitable
moisturizer for an individual. The cosmetic properties and the simplicity to use the
products are important parameters for adherence, but even more important are
the effects on the skin barrier function. A defect in skin barrier function has been
suggested as the major cause for atopic eczema. Increased rate of transepidermal
water loss (TEWL) induces signals that stimulate normalization of the skin barrierfunction, but increased TEWL can also have pathological effects, which results in
cutaneous abnormalities. Therefore, we propose TEWL to be a surrogate parameter
for the changed risks for development of eczema by moisturizer treatment.
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SUN PROTECTION
ACCUMULATION OF SUNSCREEN IN HUMAN SKIN AFTER DAILYAPPLICATIONS: A STUDY OF SUNSCREENS WITH DIFFERENTULTRAVIOLET RADIATION FILTERS
Bodekaer M, Akerstrom U, Wulf HC.
Photodermatology, Photoimmunology & Photomedicine 2012; 28: 127-32.
Sunscreen applied to the skin provides a considerable sun protection factor
(SPF) even after 8 h. Sunscreen use for consecutive days may therefore result
in an accumulation of the product. This study investigated the consequences of
accumulation for SPF.
Two sunscreens, one containing organic and one containing particle ultraviolet
radiation (UVR) filters (SPF 30) (2 mg/cm2), were used. Areas on the back of
22 volunteers were applied with sunscreen on 5 consecutive days, once daily
(12 volunteers) and three times daily (10 volunteers), and phototested. The SPF
was determined on Days 1, 3 and 5. One daily application of sunscreen did not
result in an accumulation in the skin that significantly affected the SPF. However,
three daily applications provided a significantly higher SPF for both the organic(mean SPF 1.56) and particle (mean SPF 2.45) sunscreen at Day 5 compared to
Day 1 (p = 0,023 for both sunscreens). Sunscreens accumulate in the skin when
applied in the recommended amounts three times daily. In conjunction with other
sun protection strategies, sunscreen application on consecutive days prior to UVR
exposure can result in a basic skin protection, which may help to prevent severe
sunburns on sun holidays.
SUNSCREEN USE: CONTROVERSIES, CHALLENGESAND REGULATORY ASPECTS
Lodn M, Beitner H, Gonzalez H, Edstrm DW, Akerstrm U, Austad J,
Buraczewska-Norin I, Matsson M, Wulf HC.
British Journal of Dermatology 2011; 165(2): 255-62.
Mismatches between skin pigmentation and modern lifestyle continue to challenge
our naked skin. One of our responses to these challenges is the development and
use of sunscreens. The management of sunscreens has to balance their protective
effect against erythema, photocarcinogenesis and photoageing owing to the
potential toxicity of the ultraviolet (UV) filters for humans and the environment.
The protection against UV radiation offered by sunscreens was recently
standardized in the European Union (EU) based on international harmonization
of measurement techniques. Four different categories of sun protection have
been implemented along with recommendations on how to use sunscreen
products in order to obtain the labelled protection. The UV filters in sunscreens
have long been authorized for use by the EU authority on the basis of data from
studies on acute toxicity, subchronic and chronic toxicity, reproductive toxicity,genotoxicity, photogenotoxicity, carcinogenicity, irritation, sensitization, phototoxicity
and photosensitization as well as on environmental aspects. New challenges
with respect to the safety of UV filters have arisen from the banning of animal
experiments for the development of cosmetics. Future debates on sunscreens are
likely to focus on nanoparticles and environmental issues, along with motivation
campaigns to persuade consumers to protect their skin. However, more efficient
sunscreen use will also continue to raise questions on the benefit in preventing
vitamin D synthesis in the skin induced by sunlight.
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QUALITY OF LIFE
INCREASING QUALITY OF LIFE BY IMPROVING THE QUALITYOF SKIN IN PATIENTS WITH ATOPIC DERMATITIS
Halvarsson K, Lodn M.
International Journal of Cosmetic Science 2007; 29: 69-83.
Atopic dermatitis is a chronic relapsing inflammatory skin disease which usually
starts during the first years of life. In patients with the disease, the quality of
skin is severely affected, and this is closely linked to a reduced quality of life. An
increasing prevalence of the disease has also been observed during recent years,
which has been attributed to potential provocation factors in the environment.
The environmental influence of the disease is complex, but the role of stratum
corneum as a biosensor regulating the response to a variety of insults has been
suggested as one crucial factor. Therefore, our daily hygiene and treatment of
dryness are necessary measures to improve the quality of life and possibly reduce
the frequency of the disease. Soaps as well as moisturizers show important
differences in their impact on barrier function.
CANODERM
THE EFFECT OF A CORTICOSTEROID CREAM AND A BARRIER-STRENGTHENING MOISTURIZER IN HAND ECZEMA. A DOUBLE-BLIND,RANDOMIZED, PROSPECTIVE, PARALLEL GROUP CLINICAL TRIAL
Lodn M, Wirn K, Smerud KT, Meland N, Hnns H, Mrk G,
Ltzow-Holm C, Funk J, Meding B.
Journal of the European Dermatology and Venerology 2012; 26(5): 597-601
Hand eczema is a common and persistent disease with a relapsing course. Clinical
data suggest that once daily treatment with corticosteroids is just as effective as
twice daily treatment. The aim of this study was to compare once and twice daily
applications of a strong corticosteroid cream in addition to maintenance therapy
with a moisturizer in patients with a recent relapse of hand eczema. The study
was a parallel, double-blind, randomized, clinical trial on 44 patients. Twice daily
application of a strong corticosteroid cream (betamethasone valerate 0.1 %) was
compared with once daily application, where a urea-containing moisturizer was
substituted for the corticosteroid cream in the morning. The investigator scored
the presence of eczema and the patients judged the health-related quality of life
(HRQoL) using the Dermatology Life Quality Index (DLQI), which measures howmuch the patients skin problem has affected his/her life over the past week.
The patients also judged the severity of their eczema daily on a visual analogue
scale. Both groups improved in terms of eczema and DLQI. However, the clinical
scoring demonstrated that once daily application of corticosteroid was superior to
twice daily application in diminishing eczema, especially in the group of patients
with lower eczema scores at inclusion. Twice daily use of corticosteroids was
not superior to once daily use in treating eczema. On the contrary, the clinical
assessment showed a larger benefit from once daily treatment compared with
twice daily, especially in the group of patients with a moderate eczema at inclusion.
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CANODERM
TREATMENT WITH A BARRIER-STRENGTHENING MOISTURIZERPREVENTS RELAPSE OF HAND-ECZEMA. AN OPEN, RANDOMIZE D,PROSPECTIVE, PARALLEL GROUP STUDY
Lodn M, Wirn K, Smerud K, Meland N, Hnns H, Mrk G,
Ltzow-Holm C, Funk J, Meding B.
Acta Dermatology and Venerology 2010; 90(6): 602-6.
Hand eczema influences the quality of life. Management strategies include the
use of moisturizers. In the present study the time to relapse of eczema during
treatment with a barrier-strengthening moisturizer (5 % urea) was compared
with no treatment (no medical or non-medicated preparations) in 53 randomized
patients with successfully treated hand eczema. The median time to relapse
was 20 days in the moisturizer group compared with 2 days in the no treatment
group (p = 0.04). Eczema relapsed in 90 % of the patients within 26 weeks. No
difference in severity was noted between the groups at relapse. Dermatology
Life Quality Index (DLQI) increased significantly in both groups; from 4.7 to 7.1 in
the moisturizer group and from 4.1 to 7.8 in the no treatment group (p < 0.01) at
the time of relapse. Hence, the application of moisturizers seems to prolong thedisease-free interval in patients with controlled hand eczema. Whether the data is
applicable to moisturizers without barrier-strengthening properties remains to be
elucidated.
COST-EFFECTIVENESS OF A BARRIER-STRENGTHENINGMOISTURIZING CREAM AS MAINTENANCE THERAPY VS. NOTREATMENT AFTER AN INITIAL STEROID COURSE IN PATIENTS WITHATOPIC DERMATITIS IN SWEDEN WITH MODEL APPLICATIONS FORDENMARK, NORWAY AND FINLAND
Hjalte F, Asseburg C, Tennvall GR.
Journal of the European Dermatology and Venerology 2010; 24(4): 474-80.
Atopic dermatitis (AD) affects health and quality of life and it has great impact on both
health-care costs and costs to the society. The objective of this study was to develop
a model to analyse the cost-effectiveness of a barrier-strengthening moisturizing
cream as maintenance therapy compared with no treatment after initial treatment with
betamethasone valerate in adult patients with AD in Sweden. A further aim was to
apply a similar health-economic analysis for Denmark, Norway and Finland. A Markov
simulation model was developed including data from three sources: (i) efficacy data from
a randomized controlled trial including patients with moderate AD treated with either a
moisturizing cream or no treatment, (ii) resource utilization and quality of life data, and
(iii) unit prices from official price lists. A societal perspective was used and the analysiswas performed according to treatment practice in Sweden. The model simulation was
also applied for Denmark, Norway and Finland with inclusion of country-specific unit
costs. Sensitivity analyses were performed to test the robustness of the results. The
results from the present analyses of treatment for patients with moderate AD indicate
that maintenance treatment with a moisturizing cream during eczema-free periods could
be cost-effective in a societal perspective. Similar results were obtained for Sweden,
Denmark, Norway and Finland. According to the analysis, treatment with a moisturizing
cream was found to be a cost-effective option compared with no treatment in eczema-
free periods in adult patients with AD in the four Nordic countries.
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CANODERM
TREATMENT WITH A BARRIER-STRENGTHENING MOISTURIZINGCREAM DELAYS RELAPSE OF ATOPIC DERMATITIS: A PROSPECTIVEAND RANDOMIZED CONTROLLED CLINICAL TRIAL
Wirn K, Nohlgrd C, Nyberg F, Holm L, Svensson M, Johannesson A,
Wallberg P, Berne B, Edlund F, Lodn M.
Journal of the European Academy of Dermatology and
Venereology 2009; 23(11): 12671272.
Standard treatment of atopic dermatitis (AD) is based on topical
glucocorticosteroids or calcineurin inhibitors to treat flares combined with
moisturizer treatment to alleviate dry skin symptoms. Patients with AD have an
abnormal skin barrier function, and strategies for reducing the risks for eczema
would be to repair the barrier or prevent barrier dysfunction. The objective of this
study was to explore the time to relapse of eczema during a 26-week maintenance
treatment with a urea containing moisturizer compared to no treatment (neither
medical nor non-medicated preparations) after successful clearing of atopic lesions.
The moisturizer has previously been shown to improve skin barrier function. Patients
applied betamethasone valerate (0.1%) on eczematous lesions during a 3-week
period. Those with cleared eczema entered a 26-week maintenance phase, applying
the moisturizer or left the previously affected area untreated. Upon eczema relapse,
patients were instructed to contact the clinic and to have the relapse confirmedby the investigator. Fifty-five patients entered the study and 44 patients were
included in the maintenance phase (22 using moisturizer twice daily and 22 using
no treatment). Median time to relapse for patients treated with moisturizer was
> 180 days (duration of the study) compared with 30 days for the no-treatment
group. Sixty-eight per cent of the patients treated with the moisturizer and 32% of
the untreated patients remained free from eczema during the observation period.
Maintenance treatment with a barrier-improving urea moisturizer on previous
eczematous areas reduced the risk of relapse to approximately one third of that of
no treatment.
17
MOISTURIZERS CHANGE THE mRNA EXPRESSIONOF ENZYMES SYNTHESIZING SKIN BARRIER LIPIDS
Buraczewska I, Berne B, Lindberg M, Lodn M, Trm H.
Archives of Dermatological Research 2009; 301(8): 587-594.
In a previous study, 7-week treatment of normal human skin with two test
moisturizers, Complex cream and Hydrocarbon cream, was shown to affect mRNA
expression of certain genes involved in keratinocyte differentiation. Moreover, the
treatment altered transepidermal water loss (TEWL) in opposite directions. In the
present study, the mRNA expression of genes important for formation of barrier
lipids, i.e., cholesterol, free fatty acids and ceramides, was examined. Treatment with
Hydrocarbon cream, which increased TEWL, also elevated the gene expression
of GBA, SPTLC2, SMPD1, ALOX12B, ALOXE3, and HMGCS1. In addition, the
expression of PPARG was decreased. On the other hand, Complex cream, which
decreased TEWL, induced only the expression of PPARG, although not confirmed
at the protein level. Furthermore, in the untreated skin, a correlation between the
mRNA expression of PPARG and ACACB, and TEWL was found, suggesting that
these genes are important for the skin barrier homeostasis. The observed changes
further demonstrate that long-term treatment with certain moisturizers may induce
dysfunctional skin barrier, and as a consequence several signaling pathways are
altered.
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CANODERM
CHANGES IN SKIN BARRIER FUNCTION FOLLOWINGLONG-TERM TREATMENT WITH MOISTURIZERS,A RANDOMIZED CONTROLLED TRIAL
Buraczewska I, Berne B, Lindberg M, Trm H, Lodn M.
British Journal of Dermatology 2007; 156: 492-498.
Moisturizers are commonly used by patients with dry skin conditions as well as
people with healthy skin. Previous studies on short-term treatment have shown
that moisturizers can weaken or strengthen skin barrier function and also influence
skin barrier recovery. However, knowledge of the effects on skin barrier function
of long-term treatment with moisturizers are still scarce. The aim of this study was
to investigate the impact of long-term treatment with moisturizers on the barrier
function of normal skin, as measured by transepidermal water loss (TEWL) and
susceptibility to an irritant, and to relate those effects to the composition of the
designed experimental moisturizers. Volunteers (n=78) were randomized into
five groups. Each group treated one volar forearm for 7 weeks with one of the
following preparations: (i) one of three simplified creams, containing only a fewingredients in order to minimize the complexity of the system; (ii) a lipid-free gel;
(iii) one ordinary cream , containing 5% urea, which has previously been shown to
decrease TEWL. The lipids in the simplified creams were either hydrocarbons or
vegetable triglyceride oil, and one of them also contained 5% urea.
19
After 7 weeks, treated and control forearms were exposed for 24 h to sodium
lauryl sulphate (SLS) using a patch test. TEWL, blood flow and skin capacitance
of both SLS-exposed and undamaged skin were evaluated for 24 h after removal
of patches. Additionally, a 24-h irritancy patch test of all test preparations was
performed on 11 volunteers in order to check their possible acute irritancy
potential. Changes were found in the barrier function of normal skin after 7 weeks
of treatment with the test preparations. The simplified creams and the lipid-free
gel increased TEWL and skin response to SLS, while the ordinary cream had the
opposite effect. One of the simplified creams also decreased skin capacitance. All
test preparations were shown to be non-irritant, both by short-term irritancy patch
test and by measurement of blood flow after long-term treatment. Moisturizersinfluence the skin barrier function of normal skin, as measured by TEWL and
susceptibility to SLS. Moreover, the effect on skin barrier function is determined by
the composition of the moisturizer. The ingredients which influence the skin barrier
function need to be identified, and the mechanism clarified at the molecular level.
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CANODERM
LONG-TERM TREATMENT WITH MOISTURIZERS AFFECTSTHE mRNA LEVELS OF GENES INVOLVED IN KERATINOCYTEDIFFERENTIATION AND DESQUAMATION
Buraczewska I, Berne B, Lindberg M, Lodn M, Trm H.
Archives of Dermatological Research 2009; 301: 175-181.
In a recent study, we showed that long-term treatment with two different
moisturizers affected TEWL in opposite directions. Therefore, we decided to
examine the effect of these moisturizers on the cellular and molecular level. In a
randomized controlled study on 20 volunteers, epidermal mRNA expression of
genes essential for keratinocyte differentiation and desquamation after a 7-week
treatment with two moisturizers was analyzed. Treatment with one test moisturizer
increased gene expression of involucrin, transglutaminase 1, kallikrein 5, and
kallikrein 7, while the other moisturizer affected only expression of cyclin-dependent
kinase inhibitor 1A. Thus, moisturizers are able to modify the skin barrier function
and change the mRNA expression of certain epidermal genes. Since the type of
influence depends on the composition of the moisturizer, these should be tailored
in accordance with the requirement of the barrier of each individual patient, whichmerits further investigations.
TREATMENT OF SURFACTANT-DAMAGED SKIN IN HUMANSWITH CREAMS OF DIFFERENT PH
Buraczewska I, Lodn M.
Pharmacology 2005; 73(1): 1-7.
Skin surface has an acidic pH, whereas the bodys internal environment maintains
a near-neutral pH. The physiological role of the acidic mantle and the function
of the pH gradient throughout the stratum corneum remain unexplained. The pH
gradient has been suggested to activate enzymes responsible for the maintenance
of the skin barrier function and to facilitate the desquamation process in the
stratum corneum. The aim of the study was to investigate the influence of pH
of a moisturizing cream on barrier recovery in surfactant-damaged human skin.
Volunteers had their skin damaged with sodium lauryl sulphate and treated those
areas with the cream, adjusted to either pH 4.0 or 7.5. The study did not prove
the superiority of a cream of pH 4.0 to a cream of pH 7.5 regarding promotion
of skin barrier recovery, since no significant differences (p > 0.05) were found in
transepidermal water loss, blood flow and skin capacitance between the treated
areas.
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CANODERM
EFFECTS OF PRETREATMENT WITH A UREA-CONTAININGEMOLLIENT ON NICKEL ALLERGIC SKIN REACTIONS
Kuzmina N, Nyrn M, Lodn M, Edlund F, Emtestam L.
Acta Dermato-Venereologica 2005; 85: 9-12.
The aim of this study was to evaluate the effect of a moisturizer containing
urea on nickel-sensitized volunteers patients and five controls (non-sensitized
volunteers) applied such a moisturizer on the volar side of one forearm twice daily
for 20 days, while the other forearm served as the control. After treatment with
the moisturizer, patch tests with 0%, 0,5% and 2% NiSO 4in petrolatum were
applied in a randomized manner on each arm. After 72 h, the skin reactions were
blindly evaluated by clinical scoring and by measuring transepidermal water loss
and electrical impedance. After treatment, the baseline transepidermal water loss
values were lower and the baseline magnitude impedance index values were
higher on the pretreated forearm. According to clinical scoring and measurements
with the two physical measurement techniques, the degree of the patch test
reactions was equal. All control subjects had negative nickel tests. We concluded
that the skin reactivity to nickel in nickel-sensitized patients is not significantlyaffected by use of the urea-containing moisturizer.
THE INFLUENCE OF UREA TREATMENT ON SKIN SUSCEPTIBILITY TOSURFACTANT-INDUCED IRRITATION: A PLACEBO-CONTROLLED ANDRANDOMIZED STUDY
Lodn M, Brny E, Mandahl P, Wessman C.
Exogenous Dermatology 2004; 3: 16.
Certain ingredients in moisturizing creams may influence the skin susceptibility
to irritants. One agent of particular interest is the well-known humectant urea.
The present placebo-controlled study on 28 subjects was designed to evaluate
the effects of urea treatment on three types of sodium lauryl sulphate (SLS)
exposures: (1) repeated exposure to SLS for 15 days with concurrent cream
treatment, (2) the skin susceptibility to SLS following prophylactic treatment with
urea and (3) SLS exposure after recovery of the surfactant-damaged skin by
urea treatment. Parameters measured were transepidermal water loss (TEWL)
and skin blood flow. Repeated exposure to SLS induced a slight but significant
barrier damage, measured as TEWL, and the difference between the treatments
was almost significant (p = 0.06). Treatment of normal skin reduced TEWL in the
urea-treated area, and the irritant reaction to SLS was significantly decreased.Treatment of surfactant-damaged skin promoted barrier recovery, and the second
exposure to SLS induced a less pronounced reaction in the urea-treated area
compared to the placebo-treated site. In conclusion, urea promotes barrier
recovery in SLS-damaged skin and makes both normal and irritated skin less
susceptible to irritation. The findings may be of clinical relevance in attempts to
reduce contact dermatitis due to irritant stimuli.
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CANODERM
NICKEL SUSCEPTIBILITY AND SKIN BARRIER FUNCTION TO WATERAFTER TREATMENT WITH A UREA-CONTAINING MOISTURIZER
Lodn M, Kuzmina N, Nyrn M, Edlund F, Emtestam L.
Exogenous Dermatology 2004; 3: 99105.
Patients with eczema and other dry skin conditions use moisturizers also when
the skin appears healthy. However, moisturizers have been found to change skin
barrier function, and it appears that certain combinations of ingredients increase
the skin susceptibility to external agents. In the present randomized and single-
blind study, the influence of a urea-containing cream on nickel susceptibility in
35 patients with known allergy to nickel was evaluated. Treatment of the volar
forearm twice daily for 20 days with the urea cream reduced transepidermal water
loss (TEWL). However, the susceptibility to nickel sulfate was not changed by the
cream treatment. Clinical scoring of the skin reaction did not show any difference
between the untreated and the cream-treated area. Furthermore, the increase
in TEWL did not differ between the areas. The absence in correlation between
TEWL and skin susceptibility to nickel suggests different penetration pathways
through the skin of water and nickel. Measurement of the skin permeability toother substances than water is pertinent to the understanding of the influence of
moisturizers on the skin permeability and, ultimately, to their therapeutic efficacy
in the prevention of contact eczema due to exposure to harmful exogenous
substances.
DIFFERENCES AMONG MOISTURIZERS IN AFFECTING SKINSUSCEPTIBILITY TO HEXYL NICOTINATE, MEASURED AS TIMETO INCREASE SKIN BLOOD FLOW
Duval C, Lindberg M, Boman A, Johnsson S, Edlund F, Lodn M.
Skin Research and Technology 2003; 9: 59-63.
A wide range of branded and generic moisturizers is frequently used for the prevention
and treatment of dry skin. The influence of the moisturizers on the skin permeability is
pertinent to the understanding of their therapeutic efficacy. The aim of the present study
was to compare the effect of two moisturizers on the skin permeability barrier, assessed
as skin reactivity to a vasodilating substance. The study was parallel, randomized
and double blind on 53healthy volunteers. One of the creams contained 5%
urea, whereas the other contained no humectant but had a high lipid content.
The participants were instructed to apply the cream twice daily for three weeks
on the volar aspect of one of their forearms. The skin was then exposed to hexyl
nicotinate, which induces vasodilatation. The time-course and magnitude of the
microvascular changes in the two skin areas were monitored with a non-invasive
optical technique (laser Doppler flowmetry) with two measuring probes. Thelag-time between application and initial response was significantly longer for
the urea-treated site compared with the other cream. Furthermore, the time for
maximum response was shorter for the lipid-rich cream than for its placebo. The
study shows differences in action between moisturizers, which may influence the
skin susceptibility to other irritants and allergens in the environment.
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CANODERM
INSTRUMENTAL AND DERMATOLOGIST EVALUATION OF THE EFFECTOF GLYCERINE AND UREA ON DRY SKIN IN ATOPIC DERMATITIS.
Lodn M, Andersson AC, Andersson C, Frdin T, Oman H, Lindberg M.
Skin Research and Technology 2001; 7(4): 209-13.
Moisturising creams are useful treatment adjuncts in inflammatory dermatoses
and have beneficial effects in the treatment of dry, scaly skin. The effects on
dryness and skin permeability of a new moisturising cream with 20 % glycerine
was compared with its placebo and with a medicinally authorised cream with 4 %
urea (combined with 4 % sodium chloride) in the treatmentof dry skin. Patients
(n=109) with atopic dermatitis were treated for 30 days with a moisturiser in a
randomised, parallel and double-blind fashion. Transepidermal water loss (TEWL)
and skin capacitance were assessed instrumentally, and changes in the dryness of
the skin were assessed by the dermatologist. No difference in TEWL was found
between glycerine treatment and its placebo, whereas a lower value was found
in the urea-treated area compared to the glycerine-treated area. No difference in
skin capacitance was found. The clinical assessment of dryness showed urea to
be superior to glycerine in treating the condition.
Moisturising creams are different, not only with respect to composition but also
with respect to their influence on skin as a barrier to water in patients with atopic
dermatitis.
IMPROVEMENT IN SKIN BARRIER FUNCTION IN PATIENTSWITH ATOPIC DE RMATITIS AFTER TREATMENT WITHA MOISTURIZING CREAM (CANODERM)
Lodn M, Andersson A-C, Lindberg M.
British Journal of Dermatology 1999; 140: 264-267.
Patients with atopic skin show a defective barrier function both in rough and in
clinically normal skin, with an increasing risk of developing contact dermatitis.
Moisturizing creams are often used in the treatment of dry skin. The purpose of
this study was to investigate the influence of treatment with a urea-containing
moisturizer on the barrier properties of atopic skin. Fifteen patients with atopic
dermatitis treated one of their forearms twice daily for 20 days with a moisturizing
cream. Skin capacitance and transepidermal water loss (TEWL) were measured at
the start of the study and after 10 and 20 days. On day 21 the skin was exposed
to sodium lauryl sulphate (SLS) and on day 22 the irritant reaction was measured
non-invasively. Skin capacitance was significantly increased by the treatment,
indicating increased skin hydration. The water barrier function, as reflected by
TEWL values, tended to improve (P=0.07). And the skin susceptibility to SLSwas significantly reduced, as measured by TEWL and superficial skin blood flow
(P
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CANODERM
THE EFFECT OF TWO UREA-CONTAINING CREAMS ON DRY,ECZEMATOUS SKIN IN ATOPIC PATIENTS. I. EXPERT, PATIENT ANDINSTRUMENTAL EVALUATION
Andersson A-C, Lindberg M, Lodn M.
Journal of Dermatological Treatment 1999; 10: 165-169.
The management of atopic dermatitis includes moisturizing creams, although
scientific studies of their influence on the skin are scarce. In the present
randomized, double-blind study, the effects of a new moisturizing cream were
compared with those of an already registered medicinal cream in the treatment
of dry eczematous skin in atopic patients, using multiple methods. The new cream
contained 5% urea as active substance and the established licensed cream
contained 4% urea and 4% sodium chloride as active ingredients. The new cream
was studied in 25 patients and the established cream was tested in 23patients.
The patients were asked to apply the cream to dry, eczematous areas at least once
daily for 20 days. At inclusion in the study and after 15 and 30days of treatment
the severity of the skin was evaluated by a dermatologist, assessed by the patients
and measured in terms of transepidermal water loss (TEWL) and skin capacitance.Both groups improved during the study, but no statistically significant differences
between them were found. This multiparametric approach covers different aspects
of skin dryness and provides the possibility of evaluating treatment effects in a
cost-effective way.
8 29
THE EFFECT OF TWO UREA-CONTAINING CREAMS ON DRY,ECZEMATOUS SKIN IN ATOPIC PATIENTS. II. ADVERSE EFFECTS
Lodn M, Andersson A-C, Lindberg M.
Journal of Dermatological Treatment 1999; 10: 171-5.
The management of atopic dermatitis includes moisturizing creams to reduce
the dryness. The adverse skin reactions during topical treatment with two
medicinal moisturizers were monitored in a double-blind randomized study on two
parallel groups of patients with dry, eczematous skin. One cream contained 4 %
urea and 4 % sodium chloride as active ingredients (23 patients), and the other
5 % urea (25 patients). The patients were asked to apply the cream at least once
daily for 30 days. The cream containing urea and salt induced skin sensations
in about 60 % of the patients. Significantly fewer patients experienced sensations
with the 5 % urea cream. Interestingly, no correlation was found between the
severity of the dry skin condition and the degree of smarting. The degree of
smarting did not change from day 15 to day 31. The face was reported by the
patients to be most sensitive area and five patients (four in one group and one in
the other) discontinued or reduced treatment of that area.
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CANODERM
BARRIER RECOVERY AND INFLUENCE OF IRRITANT STIMULIIN SKIN TREATED WITH A MOISTURIZING CREAM
Lodn M.
Contact Dermatitis 1997; 36: 256-260.
Moisturizers are used daily by many people to alleviate symptoms of clinically
and subjectively dry skin. Recent studies suggest that certain ingredients in
creams may accelerate the recovery of a disrupted barrier and decrease the skin
susceptibility to irritant stimuli. In the present single-blind study, a moisturizing
cream was tested for its influence both on barrier recovery in surfactant-damaged
skin and on the susceptibility of normal skin to exposure to the irritant sodium
lauryl sulphate (SLS). Parameters measured were transepidermal water loss
(TEWL) and skin corneometer values, indicating degree of hydration. Treatment
of surfactant-damaged skin with the test cream for 14days promoted barrier
recovery, as observed as a decrease in TEWL. Skin corneometer values also
normalized more rapidly during the treatment. In normal skin, use of the test cream
significantly reduced TEWL after 14days of treatment, and irritant reactions to
SLS were significantly decreased. Skin corneometer values increased after only1 application and remained elevated after 14days. In conclusion, the accelerated
rate of recovery of surfactant-damaged skin and the lower degree of SLS-induced
irritation in normal skin treated with the test cream may be of clinical relevance in
attempts to reduce contact dermatitis due to irritant stimuli.
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MINIDERM
A DOUBLE-BLIND STUDY COMPARING THE EFFECT OF GLYCERINEAND UREA ON DRY, ECZEMATOUS SKIN IN ATOPIC PATIENTS
Lodn M, Andersson A-C, Anderson A, Bergrant I-M, Frdin T,
hman H, Sandstrm M-H, Srnhult T, Voog E, Stenberg B, Pawlik E,
Preisler-Hggqvist A, Svensson , Lindberg M.
Acta Dermato-Venerologica 2002; 82: 45-47.
Moisturizing creams have beneficial effects in the treatment of dry, scaly skin,
but they may induce adverse skin reactions. In a randomized double-blind study,
197 patients with atopic dermatitis were treated with one of the following: a new
moisturizing cream with 20 % glycerine, its cream base without glycerine as
placebo, or a cream with 4 % urea and 4 % sodium chloride. The patients were
asked to apply the cream at least once daily for 30 days. Adverse skin reactions
and changes in skin dryness were assessed by the patient and a dermatologist.
Adverse skin reactions such as smarting (a sharp local superficial sensation) were
felt significantly less among patients using the 20 % glycerine cream compared
with the urea-saline cream, because 10 % of the patients judged the smarting
as severe or moderate when using glycerine cream, whereas 24 % did so usingurea-saline cream (p < 0.0006).
No differences were found regarding skin reactions such as stinging, itching
and dryness/irritation. The study showed equal effects on dry skin as judged by
the patients and the dermatologist. In conclusion, a glycerine containing cream
appears to be a suitable alternative to urea/sodium chloride in the treatment of
atopic dry skin.
THE INFLUENCE OF A CREAM CONTAINING 20 % GLYCERINEAND ITS VEHICLE ON SKIN BARRIER PROPERTIES
Lodn M, Wessman C.
International Journal of Cosmetic Science 2001; 23: 115-119.
Glycerine is widely used in cosmetics as well as in pharmaceutical formulations,
mainly as humectant. In vitro studies have shown glycerine to prevent
crystallization of stratum corneum model lipid mixture at low room humidity.
Whether this may affect the skin barrier function during repeated application of
glycerine in a cream base to normal skin is not known. Therefore, the influence
of a cream containing 20 % glycerine was compared with its placebo cream in a
bilateral, double-blind study on 17 healthy volunteers. The effect was evaluated
as influence on hydration with a corneometer and on skin barrier function. Skin
barrier function was assessed as permeability to water with an evaporimeter
(transepidermal water loss; TEWL) and as sensitivity to an irritating surfactant
by measuring the biological response (measured as TEWL and skin blood flow).
Ten days treatment of normal skin with 20 % glycerine significantly increased
skin corneometer values, indicating an increased hydration. However, our studyfailed to show an influence of glycerine on human skin, in terms of TEWL and skin
sensitivity to SLS-induced irritation.
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LIST OF SCIENTIFIC PUBLICATIONS
ORIGINAL SCIENTIFIC PUBLICATIONS1. Lodn M, Wirn K, Smerud K, Meland N, Hnns H, Mrk G, Ltzow-Holm C, Funk J, Meding M.
The effect of a corticosteroid cream and a barrier-strengthening moisturizer in hand eczema.A double-blind, randomized, prospective, parallel group clinical trial. JEADV 2012; 26(5): 597-601.
2. Lodn M, Wirn K, Smerud K, Meland N, Hnns H, Mrk G, Ltzow-Holm C, Funk J, MedingM. Treatment with a Barrier-strengthening Moisturizer Prevents Relapse of Hand-eczema.An open, randomized, prospective, parallel group study. Acta Derm Venerol 2010; 90: 602-6.
3. Hjalte F, Asseburg C, Tennvall GR. Cost-effectiveness of a barrier-strengthening moisturizing creamas maintenance therapy vs. no treatment after an initial steroid course in patients with atopicdermatitis in Sweden with model applications for Denmark, Norway and Finland.
JEADV 2010; 24(4): 474-80.
4. Buraczewska I, Berne B, Lindberg M, Lodn M, Trm H. Moisturizers change the mRNA expressionof enzymes synthesizing skin barrier lipids. Arch Dermatol Res 2009; 301(8): 587-94.
5. Buraczewska I, Berne B, Lindberg M, Lodn M, Trm H. Long-term treatment with moisturizersaffects the mRNA levels of gene involved in keratinocyte differentiation and desquamation.Arch Dermatol Res 2009; 301: 175-81.
6. Wirn K, Nohlgrd C, Nyberg F, Holm L, Svensson M, Johanness on A, Wallberg P, Berne B, Edlund F,Lodn M. Treatment with a barrier-strengthening moisturizing cream delays relapse of atopicdermatitis: a prospective and randomized controlled clinical trial. J EADV 2009; 23(11): 1267-72.
7. Buraczewska I, Berne B, Lindberg M, Trm H, Lodn M. Changes in skin barrier function bylong term treatment with moisturizers. Br J Dermatol 2007; 156: 492-98.
8. Buraczewska I, Lodn M. Treatment of surfactant-damaged skin in humans with creams of differentpH. Pharmacology 2005; 73: 1-7.
9. Lodn M, Brny E, Mandahl P, Wessman C. The influence of urea treatment on skin susceptibility tosurfactant-induced irritation: A placebo-controlled and randomized study. Exogen Dermatol2004; 3: 1-6.
10. Lodn M, Kuzima N, Nyrn M, Edlund F, Emtestam L. Nickel susceptibility and skin barrier functionto water after treatment with aurea-containing moisturizer. Exog Dermatol 2004; 3: 99-105.
11. Kuzmina N, Nyrn M, Lodn M, Edlund F, Emtestam L. Effects of pre-treatment an emollient containingurea on nickel allergic skin reactions Acta Derm Venereol 2004; 84: 1-4.
12. Duval C, Lindberg M, Boman A, Johansson S, Edlund F, Lodn M. Differences among moisturizers inaffecting skin susceptibility to hexyl nicotinate, measured as time to increase skin blood flow. Skin Res& Technol 2003; 9: 59-63.
13. Lodn M, Andersson A-C, Andersson C, Bergbrant I-M, Frdin T, man H, Sandstrm MH,Srnhult T, Voog E, Stenberg B, Pawlik E, Preisler-Hggqvist A, Svensson , Lindberg M. A double-
blind study of the effect of glycerine and urea on dry, eczematous skin in atopic patients. Acta DermVenereol 2002; 82: 45-47.
14. Lodn M, Andersson AC, Andersson C, Frdin T, man H, Lindberg M. Instrumental anddermatologist evaluation of the effect of glycerine and urea on dry skin in atopic dermatitis.Skin Res & Technol 2001; 7: 209-13.
15. Lodn M, Wessman C. The influence of a cream containing 20 % glycerine and its vehicle on skinbarrier properties. Int J Cosm Sc 2001; 23: 115-20.
16. Lodn M, Andersson A-C, Lindberg M. Improvement in skin barrier function in patients with atopicdermatitis after treatment with a moisturizing cream (Canoderm). Br J Dermatol 1999; 140: 264-67.
17. Ander sson A-C, Lindberg M, Lodn M. The effect of two urea-containing creams on dry, eczematous
skin in atopic patients. I. Expert, patient and instrumental evaluation. J Dermatol Treat 1999; 10:165-69.
18. Lodn M, Andersson A-C, Lindberg M. The effect of two urea-containing creams on dry, eczematousskin in atopic patients. II. Adverse effects. J Dermatol Treat 1999; 10: 171-75.
SCIENTIFIC BACKGROUND
19. Lodn M. Barrier recovery and influence of irritant stimuli in skin treated with a moisturizing cream.Cont Derm 1997; 36: 256-60.
20. Buraczewska I, Brostrm U, Lodn M. Artificial reduction in transepidermal water loss improves skinbarrier function. Br J Dermatol 2007; 157: 82-6.
21. Brny E, Lindberg M, Lodn M. Unexpected skin barrier influence from nonionic emulsifiers.Int J Pharm 2000; 195: 189-95.
22. Lodn M, Brny E. Skin identical lipids versus petrolatum in the treatment of tape-stripped anddetergent pertubed human skin. Acta Derm Venerol 2000; 80: 412-15.
23. Lodn M. Urea containing moisturizers influence barrier properties of human skin. Arch Dermatol Res1996; 288: 103-7.
24. Lodn M, Andersson AC. Effect of topically applied lipids on surfactant-irritated skin. Br J Dermatol 1996; 134: 215-20.
25. Lodn M, Hagforsen E, Lindberg M. The presence of body hair influences the measurement of skinhydration with the corneometer. Acta Dermatol Venereol (Stockh) 1995; 75: 449-50.
26. Lodn M, Olsson H, Axll T, Linde YW. Friction, capacitance and transepidermal water loss (TEWL)in dry atopic and normal skin. Br J Dermatol 1992; 126: 137-41.
27. Lodn M, Olsson H, Skare L, Axll T. Instrumental and sensory evaluat ion of the frictiona l response ofthe skin following a single application of five moisturizing creams. J Soc Cosmet Chem 1992; 43:13-20.
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28. Lodn M. The increase in skin hydration after application of emollients with different amounts of lipids.Acta Derm Venereol (Stockh) 1992; 72: 327-30.
29. Lodn M, Lindberg M. The influence of a single application of different moisturizers on the skincapacitance. Acta Derm Venereol (Stockh) 1991; 71: 79-92.
30. Lodn M. The simultaneous penetration of water and sodium lauryl sulfate through isolated humanskin. J Soc Cosmet Chem1990; 41: 227-33.
31. Lodn M, Bengtsson A. Mechanical removal of the superficial portion of the stratum. Corneum bya scrub cream: Methods for the objective assessment of the effects. J Soc Cosmet Chem 1990;41: 111-21.
QUALITY OF LIFE
32. Halvarsson K, Lodn M. Increasing quality of life by improving the quality of skin in patients with atopicdermatitis. Int J Cosmet Sci 2007; 29(2): 69-83.
SUN PROTECTION
33. Bodekaer M, Akerstrom U, Wulf HC. Accumulation of sunscreen in human skin after dailyapplications: a study of sunscreens with different ultraviolet radiation filters. PhotodermatolPhotoimmunol Photomed 2012; 28: 127-32.
34. Lodn M, Beitner H, Gonzalez H, Edstrm DW, Akerstrm U, Austad J, Buraczewska-Norin I,Matsson M, Wulf HC. Sunscreen use: controversies, challenges and regulatory aspects. Br JDermatol 2011; 165(2): 255-62.
35. Meijer J, Lodn M. Stability analysis of three UV-filters using HPLC. J Liq Chromatogr 1995;18: 1821-32.
REVIEW ARTICLES AND BOOK CHAPTERS
36. Izabela Buraczewska-Norin, Skin Barrier responses to Moisturizers: Functional and Biochemical
Changes, p525-544, In: Treatment of Dry Skin Syndrome: The Art and Science of Moisturizers,edited by Marie Lodn and Howard I. Maibach, Springer, 2012.
37. Loden M, Hydrating substances . Pp 107-119, In Handbook of Cosmetic Science and Technology,3rd edition, edited by Andr O. Barel, Marc Paye, Howard I. Maibach. Informa Healthcare, 2009.
38. Lodn M. Urea as a moisturizing and barrier-enhancing ingredient. Pp 335-46. In: Skin Moisturization,2nd edition, Ed. Rawlings AV, JJ, 2009.
39. Buraczewska I. Skin barrier responses to moisturizers, Acta Universitatis Upsaliensis, ComprehensiveSummaries of Uppsala Dissertations from the Faculty of Medicine 381, 66 pp. Uppsala, 2008.
40. Lodn M. Prevention or promotion of dryness and eczema by mois turizers? Exp Rev 2008; 3: 667-676.
41. Lodn M, Ungerth L, Serup J. Changes in European Legislation Make it Timely to Introduce aTransparent Market Surveillance System for Cosmetics. Acta Derm Venereol 2007; 87: 485-92.
42. Halvarsson K, Lodn M. Increasing quality of life by improving the quality of skin in patients with atopicdermatitis. Int J Cosm Sci 2007; 29: 69-83.
43. Lodn M. Atopic dermatitis and other skin diseases. Pp 333-343. In: Bioengineering of the Skin: SkinImaging and Analysis. Ed. Wilhelm KP, Elsner P, Berardesca E, Maibach HI. CRC Press Taylor &Francis Group, Boca Raton. 2006.
44. Lodn M. Clinical evidence for the use of urea. Pp 211-225. In: Dry Skin and Moisturizers: Chemistryand function. 2nd ed. Ed: Lodn M. Maibach HI. CRC Press Taylor & Francis Group, Boca Raton, 2006.
45. Lodn M. Hydrating substances. Pp 265-280. In: Handbook of cosmetic science and technology.2nd ed. Paye M, Barel AO, Maibach H I. CRC Press Taylor & Francis Group, Boca Raton. 2006.
46. Lodn M, Lindberg M. Moisturizers and irritant contact dermatitis. Pp 445-453. In: Irritant Dermatitis.Chew A-L, Maibach H I (eds). Springer-Verlag, Berlin. 2006.
47. Lodn M. The clinical benefit with moisturisers . JEADV 2005; 19: 672-88.
48. Loden M. Do moisturisers work? J Cosm Derm 2004; 2: 141-49.
49. Lodn M. Moisturizers. Pp 219-246. In: Cosmeceuticals and Active Cosmetics. 2nd ed. Elsner P, Maibach HI (eds).
50. Lodn M. Transepidermal water loss and dry skin. Pp 171-185, In: Bioengineering and the Skin.Water and stratum corneum. Fluhr J, Elsner P, Berardesca E, Maibach HI. (eds) CRC Press BocaRaton, USA. 2005.
51. Lodn M. Hydration and Moisturizers. Pp 295-306. In Bioengineering and the Skin. Water andstratum corneum. Fluhr J, Elsner P, Berardesca E, Maibach HI. (eds) CRC Press Boca Raton,USA. 2005.
52. Lodn M, Lindberg M. Testing of Moisturizers. Pp 387-406. In Bioengineering and the Skin. Waterand stratum corneum. Fluhr J, Elsner P, Berardesca E, Maibach HI. (eds) CRC Press Boca Raton,USA.
53. Lodn M. Role of topical emollients and moisturizers in the treatment of skin barrier disorders. Am JClin Derm 2003; 4: 771-788.
54. Lodn M. The skin barrier and use of moisturizers in atopic dermatitis. Clinics in Dermatology2002; 21: 145-157.
55. Lodn M, Edlund F, Jansson T. Strategies to reduce contact allergy to fragrances. Cosmet & Toiletr2002; 117: 39-45.
56. Lodn M. Skin barrier function: Effects of moisturizers, Cosmet & Toiletr 2001; 116: 31-40.
57. Lodn M: Hydrating substances. Pp 347-360. In: Handbook of cosmetic science and technology.2nd ed, Ed:, Barel AO, Paye M, Maibach HI. Marcel Dekker, New York, 2001.
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58. Lodn M. Efficacy testing of cosmetics and other topical products. IFSCC Magazine 2000; 3: 47-53.59. Lodn M. Hydrating substances. Pp. 347-360. In: Handbook of cosmetic science and technology.
Ed: Barel AO, Maibach HI, Paye M. Marcel Dekker, 2001.
60. Lodn M. Urea. pp 243-250. In: Dry skin and moisturizers. Chemistry and function. Eds Lodn M,Maibach HI. CRC Press, Boca Raton, 2000.
61. Lodn M. Moisturizers. Pp 73-96. In: Drugs versus Cosmetics: Cosmeceuticals, Eds Elsner P,Maibach HI. Marcel Dekker, New York, Basel, 2000.
62. Lodn M. Keratolytics. Pp 255-280. In: Dermatopharmacology of topical preparations, Eds Gabard B,Elsner P, Surber C, Treffel P. Springer-Verlag, 1999.
63. Rogiers V, Balls M, Basketter D, Berardesca E, Edwards C, Elsner P, Ennen, Leveque JL, Lodn M,Masson P, Parra J, Paye M, Pierard G, Rodrigues L, Schaefer H, Salter D, Zuang V. Non-invasivemethods and their potential use in safety assessment of cosmetics. ECVAM-EEMCO WorkshopReport 36 ATLA 1999; 27: 515-537.
64. Lodn M, Linde YW. Atopic dermatitis and other skin diseases. Pp 251-260. In Bioengineering ofthe skin: Skin surface imaging and analysis. Eds. Wilhelm KP, Elsner P, Berardesca E, Maibach HI.CRC Press, Boca Raton, 1997.
65. Lodn M. Biophysical properties of dry atopic and normal skin with special reference to effects of skincare products. Acta Derm Venerol 1995; suppl 192: 1-48.
66. Lodn M. 1995. Biophysical properties of dry atopic and normal skin with special reference toeffects of skin care products. Acta Universitatis Upsaliensies, Comprehensive Summaries of UppsalaDissertations from the Faculty of Medicine 521, 60 pp. Uppsala.
67. Lodn M. Biophysical methods of providing objective documentation of the effects of moisturizingcreams. Skin Res Technol 1995; 1:101-8.
68. Lodn M, Lindberg M. Product testing. Testing of moisturizers. pp 275-279. In: Handbooks of SkinBioengineering, vol. 1. Water and the Stratum corneum, Eds. Elsner P, Berardesca E, Maibach HI.CRC Press, Boca Raton, 1994.
69. Lodn M. Detection methods. Pp 127-145. In: Methods for skin absorption, eds. Kemppainen BW,Reifenrath WG. CRC Press, Boca Raton, 1990.
BOOKS
Lodn M. Ren, mjuk och vacker Kemi och funktion hos kosmetika. 2nd ed, Apotekarsocieteten, 2008.
Lodn M, Maibach HI. Dry Skin and Moisturizers: Chemistry and function. CRC Press, Boca Raton, 2000.
Lodn M, Maibach HI. Dry Skin and Moisturizers: Chemistry and function. 2nd ed. CRC Press Taylor &Francis Group, Boca Raton, 2006.
Lodn M. Ren, Mjuk och Vacker. Kemi och Funktion hos Kosmetika. Apotekarsocieteten, 2002.
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