gamma-linolenic-acid and Dermatitis--Atopic

The etiology of diet-related disorders is closely associated with dietary factors. A special role is attributed to intake of fat and fatty acid profile, both quantitative and qualitative. For prevention and treatment of the abovementioned diseases a proper supply of unsaturated fatty acids plays a significant role, because of their particular importance to health. γ-Linolenic acid (GLA), with three double bonds in the carbon chain, also known as all-cis 6,9,12-octadecatrienoic acid, belongs to the n-6 family of fatty acids. It plays biologically important functions in the human body, such as being a substrate for eicosanoids synthesis, involvement in the transport and oxidation of cholesterol, and being one of the components of lipid membrane. Its inadequate dietary intake or impaired formation is the cause of many inflammatory and degenerative diseases. A rich source of this fatty acid is vegetable oils, until recently used mainly in folk medicine. Nowadays, studies conducted both in animal models and in humans suggest its health-promoting properties in the prevention and treatment of atopic dermatitis, cardiovascular diseases, diabetes, cancers and rheumatoid arthritis.

Topics: Animals; Antineoplastic Agents; Arthritis, Rheumatoid; Cardiovascular Diseases; Dermatitis, Atopic; Dry Eye Syndromes; gamma-Linolenic Acid; Humans; Metabolic Diseases; Neoplasms

Eczema is a chronic inflammatory skin condition, which usually develops in early childhood. Many children outgrow this disorder as they reach secondary school age, and although It may improve with age, there is no cure. Constant itch makes life uncomfortable for those with this condition, no matter what age they are, so it may have a significant effect on a person's quality of life. Its prevalence seems to be increasing as populations move from rural locations to cities. Some people, who do not see an adequate improvement or fear side-effects of conventional medical products, try complementary alternatives to conventional treatment. This is a review of evening primrose oil (EPO) and borage oil (BO) taken orally (by mouth); these have been thought to be beneficial because of their gamma-linolenic acid content.. To assess the effects of oral evening primrose oil or borage oil for treating the symptoms of atopic eczema.. We searched the following databases up to August 2012: Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library, MEDLINE (from 1946), EMBASE (from 1974), AMED (from 1985), and LILACS (from 1982). We also searched online trials registers and checked the bibliographies of included studies for further references to relevant trials. We corresponded with trial investigators and pharmaceutical companies to try to identify unpublished and ongoing trials. We performed a separate search for adverse effects of evening primrose oil and borage oil in November 2011.. All randomised controlled, parallel, or cross-over trials investigating oral intake of evening primrose oil or borage oil for eczema.. Two review authors independently applied eligibility criteria, assessed risk of bias, and extracted data. We pooled dichotomous outcomes using risk ratios (RR), and continuous outcomes using the mean difference (MD). Where possible, we pooled study results using random-effects meta-analysis and tested statistical heterogeneity using both the Chi(²) test and the I(²) statistic test. We presented results using forest plots with 95% confidence intervals (CI).. A total of 27 studies (1596 participants) met the inclusion criteria: 19 studies assessed evening primrose oil, and 8 studies assessed borage oil. For EPO, a meta-analysis of results from 7 studies showed that EPO failed to significantly increase improvement in global eczema symptoms as reported by participants on a visual analogue scale of 0 to 100 (MD -2.22, 95% CI -10.48 to 6.04, 176 participants, 7 trials) and a visual analogue scale of 0 to 100 for medical doctors (MD -3.26, 95% CI -6.96 to 0.45, 289 participants, 8 trials) compared to the placebo group.Treatment with BO also failed to significantly improve global eczema symptoms compared to placebo treatment as reported by both participants and medical doctors, although we could not conduct a meta-analysis as studies reported results in different ways. With regard to the risk of bias, the majority of studies were of low risk of bias; we judged 67% of the included studies as having low risk of bias for random sequence generation; 44%, for allocation concealment; 59%, for blinding; and 37%, for other biases.. Oral borage oil and evening primrose oil lack effect on eczema; improvement was similar to respective placebos used in trials. Oral BO and EPO are not effective treatments for eczema.In these studies, along with the placebos, EPO and BO have the same, fairly common, mild, transient adverse effects, which are mainly gastrointestinal.The short-term studies included here do not examine possible adverse effects of long-term use of EPO or BO. A case report warned that if EPO is taken for a prolonged period of time (more than one year), there is a potential risk of inflammation, thrombosis, and immunosuppression; another study found that EPO may increase bleeding for people on Coumadin® (warfarin) medication.. Noting that the confidence intervals between active and placebo treatment are narrow, to exclude the possibility of any clinically useful difference, we concluded that further studies on EPO or BO for eczema would be hard to justify.This review does not provide information about long-term use of these products.

Topics: Administration, Oral; Adult; Child; Dermatitis, Atopic; Dermatologic Agents; Eczema; gamma-Linolenic Acid; Humans; Linoleic Acids; Oenothera biennis; Plant Oils; Randomized Controlled Trials as Topic

Atopic dermatitis (AD) is a relapsing inflammatory skin disease with a considerable social and economic burden. Functional textiles may have antimicrobial and antipruritic properties and have been used as complementary treatment in AD. We aimed to assess their effectiveness and safety in this setting. We carried out a systematic review of three large biomedical databases. GRADE approach was used to rate the levels of evidence and grade of recommendation. Meta-analyses of comparable studies were carried out. Thirteen studies (eight randomized controlled trials and five observational studies) met the eligibility criteria. Interventions were limited to silk (six studies), silver-coated cotton (five studies), borage oil, and ethylene vinyl alcohol (EVOH) fiber (one study each). Silver textiles were associated with improvement in SCORAD (2 of 4), fewer symptoms, a lower need for rescue medication (1 of 2), no difference in quality of life, decreased Staphyloccosus aureus colonization (2 of 3), and improvement of trans-epidermal water loss (1 of 2), with no safety concerns. Silk textile use was associated with improvement in SCORAD and symptoms (2 of 4), with no differences in quality of life or need for rescue medication. With borage oil use only skin erythema showed improvement, and with EVOH fiber, an improvement in eczema severity was reported. Recommendation for the use of functional textiles in AD treatment is weak, supported by low quality of evidence regarding effectiveness in AD symptoms and severity, with no evidence of hazardous consequences with their use. More studies with better methodology and longer follow-up are needed.

Topics: Complementary Therapies; Cotton Fiber; Dermatitis, Atopic; Disease Progression; gamma-Linolenic Acid; Humans; Plant Oils; Polyvinyls; Quality of Life; Randomized Controlled Trials as Topic; Silk; Silver; Staphylococcal Skin Infections; Staphylococcus aureus; Textiles; Treatment Outcome

Topics: Biofeedback, Psychology; Dermatitis, Atopic; Dermatologic Agents; gamma-Linolenic Acid; Homeopathy; Humans; Hypnosis; Linoleic Acids; Oenothera biennis; Patient Education as Topic; Plant Oils; Practice Guidelines as Topic; Probiotics; Relaxation Therapy

The global incidence of atopic eczema is escalating. While new treatment options are becoming available, previous treatments with certain confirmed benefits are still worth investigating as safe and effective therapies. One such treatment, Efamol evening primrose oil (EPO), was proven efficacious in a 1989 meta-analysis of randomized, double-blind, placebo-controlled clinical trials. A decade of further testing and subsequent independent reanalysis of 26 clinical studies including 1207 patients presented here, establishes that Efamol EPO has a simultaneous, beneficial effect on itch/pruritus, crusting, oedema and redness (erythema) that becomes apparent between 4 and 8 weeks after treatment is initiated. However, the magnitude of this effect is reduced in association with increasing frequency of potent steroid use. This and other confounding variables that are now being reported in the literature may account for historically reported inconsistent patient response. Recent research has uncovered unique complexities in fatty acid metabolism and immune response in the atopic condition beyond those previously reported and may well have identified a subcategory of non-responders and has helped established those that can consistently derive significant benefit. Further research is needed to provide a better understanding of the physiology behind this complex disorder and the beneficial role that fatty acids can play in its development and management.. Efamol EPO has a simultaneous, beneficial effect on itch/pruritus, crusting, oedema and redness (erythema) that becomes apparent between 4 and 8 weeks after treatment is initiated. However, the magnitude of this effect is reduced in association with increasing frequency of potent steroid use.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Dermatitis, Atopic; Dermatologic Agents; Fatty Acids, Essential; gamma-Linolenic Acid; Linoleic Acids; Oenothera biennis; Outcome Assessment, Health Care; Placebo Effect; Plant Oils; Prevalence; Prognosis; Randomized Controlled Trials as Topic; Risk Assessment; Risk Factors; Treatment Outcome

Essential fatty acids are components of cell membranes and precursors of immunomodulating factors that may play a role in the inflammatory and immunological pathogenesis of atopic dermatitis. Trials of supplementation with essential fatty acids (EFA) to alleviate atopic dermatitis (AD) have given inconsistent results.. To summarize and quantify the results of placebo-controlled trials with EFA for AD.. Publications of clinical trials were searched in a systematic way and the study characteristics assessed independently by three assessors. Trials were selected for inclusion in the meta-analysis when they had included a placebo group and when the outcome measure included the severity of AD. The pooled effect sizes of improvement of the overall severity of AD were calculated by random effects meta-analysis. The dependence of the results on study characteristics was studied using meta-regression analysis.. We identified 34 publications of controlled trials in AD up to April 2002. Nineteen trials of gamma-linolenic acid (GLA) and five trials of fish oil matched our inclusion criterion of placebo-controlled trial. The effect size of GLA supplementation on the improvement of the overall severity of AD could be calculated from 11 of these trials. The pooled effect size was 0.15 [95% confidence limits (CL) - 0.02, 0.32]. The effect size of fish oil supplementation, calculated from three trials was - 0.01 (95% CL - 0.37, 0.30). For component subscales such as itch, scaling and lichenification, EFA supplementation showed no benefit. The study characteristics showed no detectable influence on the overall result.. Supplementation with EFA has no clinically relevant effect on the severity of AD.

Topics: Administration, Oral; Adult; Child; Dermatitis, Atopic; Dietary Supplements; Fatty Acids, Essential; Fish Oils; gamma-Linolenic Acid; Humans; Randomized Controlled Trials as Topic

Research from the 1930s to the 1950s established that a deficit of n-6 essential fatty acids (EFAs) leads to an inflammatory skin condition in both animals and humans. In a common inherited skin condition, atopic dermatitis (eczema), there was evidence of low blood EFA concentrations and of a therapeutic response to exceptionally high doses of linoleic acid. More recently, it has been established that there is no deficit of linoleic acid in atopic eczema. Concentrations of linoleic acid instead tend to be elevated in blood, milk, and adipose tissue of patients with atopic eczema, whereas concentrations of linoleic acid metabolites are substantially reduced. This suggests reduced conversion of linoleic acid to gamma-linolenic acid (GLA). In most but not all studies, administration of GLA has been found to improve the clinically assessed skin condition, the objectively assessed skin roughness, and the elevated blood catecholamine concentrations of patients with atopic eczema. Atopic eczema may be a minor inherited abnormality of EFA metabolism.

Topics: Adipose Tissue; Adolescent; Adult; alpha-Linolenic Acid; Anti-Inflammatory Agents, Non-Steroidal; Child; Child, Preschool; Dermatitis, Atopic; Fatty Acids, Essential; Fatty Acids, Unsaturated; Female; gamma-Linolenic Acid; Humans; Infant; Linoleic Acid; Linoleic Acids; Milk, Human; Oenothera biennis; Plant Oils

Linoleic acid is the main dietary essential fatty acid (EFA). To be fully utilized by the body, it must be metabolized to a range of other substances. The first step in this pathway is delta-6-desaturation to gamma-linolenic acid (GLA). This step is slow and rate-limiting, particularly in humans. If delta-6-desaturation is impaired for any reason, the supply of further metabolites may be inadequate for normal function. If the consumption of further metabolites is excessive, then a normal rate of delta-6-desaturation may be inadequate. In these circumstances the direct supply of GLA or further metabolites may be of value. This concept is illustrated by atopic eczema and diabetes, which may represent inherited and acquired examples of inadequate delta-6-desaturation.

Topics: Dermatitis, Atopic; Diabetes Mellitus; Diabetic Neuropathies; Fatty Acid Desaturases; Fatty Acids, Essential; gamma-Linolenic Acid; Humans; Linoleic Acid; Linoleic Acids; Linolenic Acids; Linoleoyl-CoA Desaturase

Recently a defect in the function of the enzyme delta-6-desaturase has been discussed as a major factor in the development of atopic eczema. Delta-6-desaturase is responsible for the conversion of linoleic acid to gamma linolenic acid. Several plants, including evening primrose, are known to be fairly rich in gamma linolenic acid. Hence, substitution of gamma linolenic acid in patients prone to developing atopic eczema seems like a feasible concept. During the last few years different clinical trials have been performed. Controlled trials following a parallel study design showed marked improvement in atopic eczema. Patients treated with the drug showed less inflammation, dryness, scaling and overall severity compared to controls. Although these findings have been supported by meta-analysis, there is still conflicting evidence in trials based on a crossover design alone, demonstrating a decrease in itching. At present, evening primrose oil in doses used for the treatment of atopic eczema is considered safe. However, still more trials addressing both efficacy and safety are needed to make a final decision.

Topics: Administration, Oral; Alprostadil; Dermatitis, Atopic; Dermatologic Agents; Fatty Acids, Essential; gamma-Linolenic Acid; Humans; Linoleic Acids; Linolenic Acids; Oenothera biennis; Plant Oils

Topics: Aged; Autoimmune Diseases; Cardiovascular Diseases; Child; Dermatitis, Atopic; Diabetes Mellitus; gamma-Linolenic Acid; Humans; Linolenic Acids; Nutritional Physiological Phenomena

Topics: Anti-Inflammatory Agents, Non-Steroidal; Dermatitis, Atopic; Fatty Acids, Essential; gamma-Linolenic Acid; Humans; Linoleic Acids; Meta-Analysis as Topic; Oenothera biennis; Plant Oils

Topics: Dermatitis, Atopic; Dermatologic Agents; Fatty Acids, Essential; gamma-Linolenic Acid; Humans; Linoleic Acids; Oenothera biennis; Plant Oils

The proposed concept links the alterations in cell-mediated and humoral immunity in atopy to impaired prostaglandin E (PGE)-mediated thymic maturation of T-suppressor lymphocytes and diminished activation of T-suppressor lymphocytes of the peripheral atopic immune system. The decreased sensitivity of atopic T lymphocytes to PGE, recently explained by a reduction of PGE2-receptors on atopic lymphocytes, is regarded as the common underlying defect in atopy. A second defect, the delta-6-desaturase deficiency, affects the regular supply of the PGE-precursors dihomo-gamma-linolenic acid and arachidonic acid and predisposes for atopic dermatitis. Furthermore, the composition of omega-6-fatty acids in breast milk of atopic mothers represents a delta-6-desaturase deficiency. Substitution of the delta-6-desaturase product gamma-linolenic acid to the atopic pregnant and nursing woman and her newborn infant at increased risk for atopy offers a chance for the prevention of atopic diseases.

Topics: Breast Feeding; Dermatitis, Atopic; Dietary Fats, Unsaturated; Fatty Acid Desaturases; Female; gamma-Linolenic Acid; Humans; Immunoglobulin E; Infant, Newborn; Linolenic Acids; Linoleoyl-CoA Desaturase; Pregnancy; Prostaglandins E; Receptors, Prostaglandin; Receptors, Prostaglandin E; T-Lymphocytes

Our hypothesis on the origin of atopy links alterations in omega-6-fatty acid metabolism in atopic persons (i.e., reduced formation of delta-6-desaturase products) to deficient T cell differentiation and function. We suggest that a relative deficiency in dihomo-gamma-linolenic acid-derived prostaglandin E1 is the major etiologic factor for diminished T cell maturation postpartum. Its precursors, gamma-linolenic acid and dihomo-gamma-linolenic acid, are physiologically provided in colostrum and mature breast milk of healthy mothers. Depressed cell-mediated immunity and uncontrolled B-cell response with increased IgE synthesis are explained as prostaglandin E1-dependent defects of T cell differentiation caused by insufficient supply of prostaglandin E1 precursors during early infancy. Thus, in our opinion atopy is a metabolic disorder and the associated immunologic disturbances are epiphenomena.

Topics: Adjuvants, Immunologic; Alprostadil; Breast Feeding; Cell Differentiation; Dermatitis, Atopic; Fatty Acid Desaturases; gamma-Linolenic Acid; Humans; Linolenic Acids; Linoleoyl-CoA Desaturase; T-Lymphocytes

This paper discusses recent advances in therapy of atopic dermatitis (AD), excluding those that include dietary management. Some of these therapies are anecdotal, experimental, or somewhat controversial. It is important to emphasize that physicians should not try what is new without first having given standard therapy a long and reasonable chance to succeed. This is important because AD does not last forever, and in many patients, mild disease heals spontaneously.

Topics: 3',5'-Cyclic-AMP Phosphodiesterases; Adrenal Cortex Hormones; Adult; Animals; Child; Dermatitis, Atopic; Dust; Eicosapentaenoic Acid; Fatty Acids, Essential; gamma-Linolenic Acid; Humans; Immunosuppressive Agents; Linoleic Acids; Mites; Oenothera biennis; Plant Oils; Ultraviolet Therapy

Topics: Animals; Anti-Bacterial Agents; Antineoplastic Agents; Dermatitis, Atopic; Dermatologic Agents; Dust; Eicosapentaenoic Acid; Fatty Acids, Essential; gamma-Linolenic Acid; Humans; Hypersensitivity; Linoleic Acids; Mites; Oenothera biennis; Phosphodiesterase Inhibitors; Plant Oils; Staphylococcal Infections; Steroids; Ultraviolet Rays

The hypothesis proposed for the pathogenesis of atopy links the well-known alterations in cell-mediated and humoral immunity, the disturbances of mediator metabolism and the increased disposition of atopic epidermis for inflammation to a common underlying deficiency in the production of prostaglandin E1. The PGE1 deficiency is explained as the result of reduced delta-6-desaturase activity in atopic patients. The development of depressed cell-mediated immunity is regarded as a PGE1-dependent T-cell-maturation defect of the newborn's immune system post partum. Our hypothesis offers a novel approach to the prevention of atopy by administration of gamma-linolenic acid to newborns with increased risk of atopy and to nursing atopic mothers. Furthermore, it provides an explanation for the beneficial therapeutic effects of dietary supplementation of gamma-linolenic acid in patients with atopic dermatitis.

Topics: Alprostadil; Dermatitis, Atopic; gamma-Linolenic Acid; Humans; Immunity, Cellular; Linolenic Acids

Lipid-based emulsions can be useful for the management of canine atopic dermatitis (cAD). 18-beta glycyrrhetinic acid (GRA), a component of liquorice root, has anti-inflammatory and anti-pruritic effects.. To evaluate the effects of a topical lipid emulsion containing ceramides, fatty acids and GRA on clinical signs of cAD and skin barrier in a randomized, double-blinded, placebo-controlled trial.. Client owned (n = 45) dogs with nonseasonal, mild/moderate AD, received either treatment or placebo for three months. Skin lesions, pruritus, transepidermal water loss (TEWL) and global assessment (GA) were evaluated.. Fourteen dogs receiving treatment and 14 receiving the placebo completed the study. After one month ≥50% reduction in pruritus was seen in seven of 14 dogs (50%) in the Treatment group, and in two of 14 dogs (14.3%) in the Control group (P = 0.047). After two and three months, significant reduction in pruritus was not seen. For Canine Atopic Dermatitis Extent and Severity Index (CADESI), TEWL and GA, there were no significant findings over time or between groups.. The emulsion had some transient beneficial clinical effects. However, it was not effective in controlling pruritus as a monotherapy. Further studies should examine whether owner compliance was a factor in the steady decline of effect on pruritus scores. Further studies evaluating its role as an adjunctive therapy are indicated.

Topics: Administration, Cutaneous; Animals; Ceramides; Dermatitis, Atopic; Dog Diseases; Dogs; Double-Blind Method; Emulsions; Fatty Acids, Essential; Female; gamma-Linolenic Acid; Glycyrrhetinic Acid; Male; Pilot Projects; Skin

Although conjugated linoleic acid (CLA) shows inhibitory effects on histamine release, eicosanoid production and pruritus in laboratory rodents, its use in canine atopic dermatitis (AD) has not been reported. The aims of this study were to assess the efficacy of CLA, black currant seed oil (BSO) or a combination of both, compared to placebo, in dogs with AD and to evaluate any changes in fatty acid metabolism with these treatments. Twenty-four dogs with AD were randomly allocated to four groups, and were treated orally each day for two months with either 1 mL/10 kg CLA (80% purity), 1 mL/10 kg pure BSO, 1 mL/10 kg CLA+1 mL/10 kg BSO, or 1 mL/10 kg sugar syrup (placebo). Serum was obtained on days 0, 30 and 60 for analysis of CLA metabolites, linoleic acid (LA), gamma-linolenic acid (GLA), dihomo-gamma-linolenic acid (DGLA) and arachidonic acid (AA). At the same time point, the owners were asked to assess pruritus and the veterinarians evaluated any skin lesions present. Although the best clinical results occurred with BSO treatment alone, improvement of clinical signs and pruritus was not significant with any of the treatments. Serum levels of GLA and DGLA significantly increased in BSO-treated dogs, but not in the CLA+BSO group. CLA at the dosage used in this study was not efficacious in treating canine AD, whereas BSO may help some dogs with AD, although further studies are necessary before this can be recommended as a treatment.

Topics: Animals; Dermatitis, Atopic; Dog Diseases; Dogs; Female; gamma-Linolenic Acid; Linoleic Acids, Conjugated; Male; Treatment Outcome

It has been reported that gamma-linolenic acid contained in borage oil is effective against atopic dermatitis. The clinical effects of undershirts coated with borage oil rich in gamma-linolenic acid on atopic dermatitis were evaluated. Thirty-two children, aged 1-10 years, were involved in the clinical control study. Sixteen had worn undershirts coated with borage oil everyday for 2 weeks, and 16 had worn non-coated undershirts as a placebo. Their symptoms were assessed on a 4-point scale. Those children who had worn undershirts coated with borage oil for 2 weeks showed improvements in their erythema and itch, which were statistically significant. Transepidermal water loss from the back was decreased. In the placebo group, there were no statistically significant differences. The undershirts coated with borage oil were found to be statistically effective, and had no side-effects on children with mild atopic dermatitis.

Topics: Administration, Cutaneous; Antirheumatic Agents; Child; Child, Preschool; Clothing; Dermatitis, Atopic; Double-Blind Method; Female; gamma-Linolenic Acid; Humans; Infant; Male; Plant Oils

Polyunsaturated fatty acids (PUFAs) are components of cell membranes and may play an immunomodulating role in the pathogenesis of atopic dermatitis (AD). The goal was to determine the impact of PUFAs on AD by dietary supplementation of infants. Based on the parents' decision on their babies' primary feeding, mothers and newborns were randomized to the supplementation with gamma-linolenic acid (GLA) or placebo for up to 6 months. Breastfed infants received GLA by supplementing their mothers. Formula diet was commercial whey hydrolysate unsupplemented with PUFAs. Of 131 eligible infants, 24 developed AD within the first year of life. Of these, nine belonged to the exclusively breastfed group (n = 58), 14 to the combined-fed group (n = 53), and one to the never breastfed group (n = 20). We could not find an influence of GLA on the development of AD. In subjects with AD, at 1 yr of age the serum-immunoglobulin E (IgE) was the lowest in the GLA-supplemented group A-subjects. In the GLA-supplemented group, GLA-levels in breast milk were similar in atopic and non-atopic infants. In the non-supplemented group the GLA-content of breast milk was 0.07% of total fatty acids in atopic infants vs. 0.17% in non-atopic infants (p < 0.01). Dietary GLA-supplementation could not prevent AD. Interestingly, the number of infants developing AD was the lowest in never breastfed children. In infants suffering from AD, GLA-supplementation seemed to reduce total IgE in the first year of life.

Topics: Breast Feeding; Dermatitis, Atopic; Dietary Fats; Dietary Supplements; Double-Blind Method; Female; gamma-Linolenic Acid; Humans; Infant; Infant Formula; Infant, Newborn

A randomized, double blind, placebo-controlled multicentre clinical trial of 12 weeks' duration was undertaken in 60 dogs with atopic dermatitis to evaluate the steroid sparing effect of essential fatty acid supplementation. The dogs were randomly assigned to receive either a combination of borage seed oil and fish oil or a placebo, in addition to prednisolone tablets. All dogs received a standardized basal diet. Owners of the dogs recorded pruritus daily using a 10 cm visual analog scale and the dosage of prednisolone was established based on the pruritus score, according to written instructions. The dosage of prednisolone and the use of any concurrent treatment (shampoo and/or ear-cleanser) were recorded by the owner on a daily basis. The investigators graded the skin lesions at days 0, 42 and 84. The use of prednisolone during the test period was lower in the active group, but the difference was not statistically significant (P = 0.32). The test period was sequentially divided into 43-84, 50-84, 57-84, 64-84, 71-84 and 78-84 days. On day 64, the difference between the active group and the placebo group reached statistical significance (P = 0.04) with an increasing difference towards the end of the study. A statistically significant reduction in the pruritus scores and the total clinical scores from day 0 to day 84 was apparent in both groups (P < 0.0001). At the end of the study, both the pruritus score and the total clinical score were lower in the active group. Our findings indicate a steroid sparing effect of essential fatty acid supplementation in canine atopic dermatitis and, furthermore, that there is a time lag before the effect is attained.

Topics: Animals; Area Under Curve; Denmark; Dermatitis, Atopic; Dietary Supplements; Dog Diseases; Dogs; Double-Blind Method; Drug Administration Schedule; Fatty Acids, Essential; Female; Finland; Fish Oils; gamma-Linolenic Acid; Glucocorticoids; Male; Norway; Plant Oils; Prednisolone; Sweden; Treatment Outcome

Studies suggest that low concentrations of n-6 long-chain polyenes in early life are correlated to atopic disease in later life.. The purpose of the study was to investigate the possible preventive effect of gamma-linolenic acid (GLA) supplementation on the development of atopic dermatitis in infants at risk.. In a double-blind, randomized, placebo-controlled trial, formula-fed infants (n = 118) with a maternal history of atopic disease received borage oil supplement (containing 100 mg GLA) or sunflower oil supplement as a placebo daily for the first 6 mo of life. Main outcome measures were the incidence of atopic dermatitis in the first year of life (by UK Working Party criteria), the severity of atopic dermatitis (SCORing Atopic Dermatitis; SCORAD), and the total serum immunoglobulin E (IgE) concentration at the age of 1 y.. The intention-to-treat analysis showed a favorable trend for severity of atopic dermatitis associated with GLA supplementation ( x+/- SD SCORAD: 6.32 +/- 5.32) in the GLA-supplemented group as compared with 8.28 +/- 6.54 in the placebo group (P = 0.09; P = 0.06 after adjustment for total serum IgE at baseline, age 1 wk), but no significant effects on the other atopic outcomes. The increase in GLA concentrations in plasma phospholipids between baseline and 3 mo was negatively associated with the severity of atopic dermatitis at 1 y (Spearman's correlation coefficient = -0.233, P = 0.013). There was no significant effect on total serum IgE concentration.. Early supplementation with GLA in children at high familial risk does not prevent the expression of atopy as reflected by total serum IgE, but it tends to alleviate the severity of atopic dermatitis in later infancy in these children.

Topics: Dermatitis, Atopic; Dietary Supplements; Double-Blind Method; gamma-Linolenic Acid; Gestational Age; Humans; Immunoglobulin E; Infant; Infant, Newborn; Mothers; Patient Compliance; Placebos; Risk Factors; Treatment Outcome

To study the efficacy and tolerability of borage oil, which contains a high concentration of gamma linolenic acid, in children and adults with atopic eczema.. Single centre, randomised, double blind, placebo controlled, parallel group trial.. Acute district general hospital in Nuneaton, England.. 151 patients, of whom 11 failed to return for assessment, leaving an evaluable population of 140 (including 69 children).. Adults received four capsules of borage oil twice daily (920 mg gamma linolenic acid), and children received two capsules twice daily, for 12 weeks.. Change in total sign score at 12 weeks measured with the six area, six sign, atopic dermatitis (SASSAD) score (primary endpoint); symptom scores, assessed on visual analogue scales; topical corticosteroid requirement, assessed on a five point scale; global assessment of response by participants; adverse events and tolerability.. The mean SASSAD score fell from 30 to 27 in the borage oil group and from 28 to 23 in the placebo group. The difference between the mean improvements in the two groups was 1.4 (95% confidence interval -2.2 to 5.0) points in favour of placebo (P = 0.45). No significant differences occurred between treatment groups in the other assessments. Subset analysis of adults and children did not indicate any difference in response. The treatments were well tolerated.. Gamma linolenic acid is not beneficial in atopic dermatitis.

Topics: Adult; Capsules; Child; Dermatitis, Atopic; Dermatologic Agents; Double-Blind Method; gamma-Linolenic Acid; Humans; Plant Oils; Prospective Studies; Treatment Outcome

Although gamma-linolenic acid (GLA) has been shown to correct deficiencies in skin lipids associated with reduced delta-6-desaturase activity which should result in improvement of dysregulation of inflammation and immunity in atopic eczema, clinical studies with evening primrose oil containing 10% GLA have yielded contradictory results. We have therefore examined the effect of a higher percentage (at least 23%) GLA-containing borage oil in adults with stable atopic eczema of moderate severity in a double-blind, multicentre study. One hundred and sixty patients were randomized to take daily either 500 mg of borage oil-containing capsules or the bland lipid miglyol as a placebo over a 24-week period. Use of topical diflucortolone-21-valerate cream was allowed as rescue medication, with the amount used until response being defined as primary, and clinical improvement as secondary efficacy criteria. Although several clinical symptoms improved compared with placebo, the overall response to borage oil did not reach statistical significance. Significant differences in favour of borage oil were, however, observed in a subgroup excluding patients who failed to show increased erythrocyte dihomo-gamma-linolenic acid levels and in whom adherence to inclusion criteria and the study protocol were questionable. GLA metabolites increased in borage oil-treated patients only, and serum IgE showed a trend to decrease on overall and subgroup analysis. No substance-related adverse effects were observed. This study shows no overall efficacy of GLA-containing borage oil in atopic eczema, with steroid use being the primary response parameter, although it suggests that a subgroup of patients may benefit from this well-tolerated treatment.

Topics: 8,11,14-Eicosatrienoic Acid; Adolescent; Adult; Aged; Analysis of Variance; Biomarkers; Dermatitis, Atopic; Double-Blind Method; Female; gamma-Linolenic Acid; Humans; Male; Middle Aged; Plant Oils; Triglycerides

The aim of this study was to establish the effect on barrier function in atopic dermatitis of topical evening primrose oil in an amphiphilic and a stable water-in-oil emulsion. The studies were vehicle-controlled in two populations of 20 atopic subjects. Barrier function was assessed in terms of transepidermal water loss and stratum corneum hydration after a 4-week treatment period and a 1-week treatment-free period. A barrier function test with sodium lauryl sulphate (SLS) and nicotinic acid ester was also carried out. Evening primrose oil proved to have a stabilising effect on the stratum corneum barrier, but this was apparent only with the water-in-oil emulsion, not the amphiphilic emulsion. The choice of vehicle is therefore an extremely important factor in the efficacy of topically applied evening primrose oil.

Topics: Administration, Topical; Adolescent; Adult; Dermatitis, Atopic; Dermatologic Agents; Double-Blind Method; Emulsions; Fatty Acids, Essential; Female; gamma-Linolenic Acid; Humans; Linoleic Acids; Male; Nicotinic Acids; Oenothera biennis; Pharmaceutical Vehicles; Plant Oils; Skin; Skin Absorption; Sodium Dodecyl Sulfate; Water Loss, Insensible

Essential fatty acids are claimed to have positive effects in atopic diseases. In a double blind, placebo controlled, parallel group study 58 out of 60 children, with atopic dermatitis and the need for regular treatment with topical skin steroids, completed a 16 weeks' treatment period with either Epogam evening primrose oil or placebo capsules. Twenty two of these subjects also had asthma. The parents used diaries to record symptom scores and concomitant medication. Peak expiratory flow was measured and disease activity was monitored by the clinician every four weeks. The plasma concentrations of essential fatty acids increased significantly in the group treated with Epogam capsules. The study demonstrated significant improvements of the eczema symptoms but no significant difference was found between the placebo and the Epogam groups. No therapeutic effect was shown on asthma symptoms or fidget.

Topics: Administration, Topical; Adolescent; Anti-Inflammatory Agents; Asthma; Child; Child, Preschool; Dermatitis, Atopic; Dermatologic Agents; Double-Blind Method; Drug Administration Schedule; Fatty Acids, Essential; gamma-Linolenic Acid; Glucocorticoids; Humans; Infant; Linoleic Acids; Oenothera biennis; Plant Oils; Severity of Illness Index

Topics: Animals; Cross-Over Studies; Dermatitis, Atopic; Dermatologic Agents; Dog Diseases; Dogs; Double-Blind Method; Drug Therapy, Combination; Fatty Acids, Essential; Fish Oils; gamma-Linolenic Acid; Linoleic Acids; Oenothera biennis; Olive Oil; Plant Oils; Treatment Outcome

A double blind placebo-controlled study of two doses of gamma-linolenic acid, provided by evening primrose oil (EPO, Epogam, Searle, U.K.), in children with atopic dermatitis was performed: 1) to examine the effect of gamma-linolenic acid administration on the clinical status of children with atopic dermatitis and abnormalities of IgE-mediated immune responses compared to those without such IgE abnormalities; 2) to investigate the effect of gamma-linolenic acid on red cell fatty acid composition and 3) to assess whether treatment with gamma-linolenic acid induced changes in red cell membrane microviscosity. A significant improvement in the overall severity of the clinical condition was seen in children treated with gamma-linolenic acid, independent of whether the children had manifestations of IgE-mediated allergy. Furthermore, gamma-linolenic acid treatment increased the percentage content of n-6 fatty acids in erythrocyte cell membrane; this increase was more marked in the membranes of children treated with high doses of EPO. In the high dose group a significant increase in dihomogamma-linolenic acid (DGLA) occurred. This may be of particular relevance because of the potential importance of DGLA as a precursor of antiinflammatory prostanoids. Red cell membrane microviscosity did not change in any group after treatment with EPO, even in high doses, despite a significant increase in the proportion of long chain polyunsaturated fatty acids.

Topics: Child; Child, Preschool; Dermatitis, Atopic; Double-Blind Method; Erythrocyte Membrane; Erythrocytes; Fatty Acids; Female; gamma-Linolenic Acid; Humans; Male; Viscosity

Treatment of atopic dermatitis with essential fatty acids remains controversial. A double-blind, placebo-controlled, parallel-group study was done to investigate the response of patients with atopic dermatitis to essential fatty acid supplements. Patients with atopic dermatitis were randomised to receive evening primrose oil, evening primrose oil and fish oil, or placebo for 16 weeks. Disease activity was monitored by clinical severity scores recorded by the investigator, topical steroid requirement, and symptom scores recorded by subjects. Of 123 subjects recruited, 102 completed the treatment period. No improvement with active treatment was demonstrated. Our study, which avoided the methodological and analytical problems of previous studies, found no effect of essential fatty acid supplementation in atopic dermatitis.

Topics: Adult; Anti-Inflammatory Agents, Non-Steroidal; Dermatitis, Atopic; Double-Blind Method; Drug Therapy, Combination; Fatty Acids, Essential; Female; Fish Oils; gamma-Linolenic Acid; Humans; Linoleic Acids; Male; Oenothera biennis; Plant Oils

We investigated the effect of oral supplementation with evening primrose oil, containing 72% linoleic acid (18:2n-6) and 10% gamma-linolenic acid (18:3n-6), on the epidermal and neutrophil phospholipid fatty acid composition in 15 patients with atopic dermatitis (AD). Three different dose levels, 4, 8 and 12 capsules per day containing 0.5 g oil, were given to three groups of patients. The only n-6 fatty acid showing a significant (p less than 0.05) dose-related increase was dihomo-gamma-linolenic acid (20:3n-6) in neutrophil phospholipids. The highest dose increased dihomo-gamma-linolenic acid by 45% in neutrophil phospholipids, by 46% in lesion-free epidermal phosphatidylcholine, and by 15% in lesion-free epidermal phosphatidylethanolamine. In both lesional and lesion-free epidermis, supplementation resulted in a rise in the ratio between n-6 and monounsaturated fatty acids, reaching significance (p less than 0.05) in lesional epidermis. This study shows that moderate and favorable fatty acid changes can be obtained in the epidermis of AD patients, when given 6 g per day of oil rich in n-6 fatty acids. The abnormal lipid and fatty acid pattern of the atopic epidermis may be involved in the pathogenesis of the disease, and should therefore be the target for future therapeutic approaches with fatty acid supplements.

Topics: Adult; Dermatitis, Atopic; Dermatologic Agents; Fatty Acids; Fatty Acids, Essential; Female; gamma-Linolenic Acid; Humans; Linoleic Acids; Male; Middle Aged; Neutrophils; Oenothera biennis; Phospholipids; Plant Oils; Skin

Topics: Adult; Anti-Inflammatory Agents, Non-Steroidal; Child; Clinical Trials as Topic; Dermatitis, Atopic; Fatty Acids, Essential; gamma-Linolenic Acid; Humans; Linoleic Acids; Oenothera biennis; Plant Oils; Product Surveillance, Postmarketing

Topics: Anti-Inflammatory Agents, Non-Steroidal; Child; Clinical Trials as Topic; Dermatitis, Atopic; Drug Evaluation; Fatty Acids, Essential; gamma-Linolenic Acid; Humans; Linoleic Acids; Oenothera biennis; Plant Oils; Severity of Illness Index

Gamma-linolenic acid in the form of a particular variety of evening primrose oil (Epogam) has been reported of value in the treatment of atopic eczema. Nine controlled trials of evening primrose oil were performed in eight centres. Four of the trials were parallel and five cross-over. Doctors and patients assessed the severity of eczema by scoring measures of inflammation, dryness, scaliness, pruritus and overall skin involvement. Individual symptom scores were combined to give a single global score at each assessment point. In the analysis of the parallel studies, both patient and doctor scores showed a highly significant improvement over baseline (P less than 0.0001) due to Epogam: for both scores the effect of Epogam was significantly better than placebo. Similar results were obtained on analysis of the cross-over trials, but in this case the difference between Epogam and placebo in the doctors' global score, although in favour of Epogam, failed to reach significance. The effects on itch were particularly striking. There was no placebo response to this symptom, whereas there was a substantial and highly significant response to Epogam (P less than 0.0001). When the improvements, or otherwise, in clinical condition were related to changes in plasma levels of dihomogammalinolenic and arachidoni acids, it was found that there was a positive correlation between an improvement in clinical score and a rise in the fatty acid levels.

Topics: Adolescent; Adult; Child; Child, Preschool; Clinical Trials as Topic; Dermatitis, Atopic; Dermatologic Agents; Fatty Acids, Essential; Female; gamma-Linolenic Acid; Humans; Infant; Linoleic Acids; Male; Meta-Analysis as Topic; Middle Aged; Oenothera biennis; Placebos; Plant Oils

It has been reported that essential fatty acid levels may be low and that there may be reduced levels of delta-6-desaturase metabolites of linoleic acid in patients with atopic eczema. Good therapeutic results have been reported on the use of evening primrose oil (Efamol) in adults but not in children. Efamol contains gamma-linolenic acid, the delta-6-desaturase metabolite of linoleic acid. The authors have studied 24 children with atopic eczema: 12 of them were treated with a higher dose of evening primrose oil than in previous studies and 12 with placebo olive oil. The clinical status and plasma, neutrophil and lymphocyte fatty acid composition in these children have been evaluated. After 4 weeks the eczema of essential fatty acid-treated children significantly improved in comparison with that of placebo-treated children (p less than 0.01). There were significant changes in plasma fatty acid composition between the basal values and the end of active treatment, and between the placebo and actively treated children. Neutrophil and lymphocyte fatty acid composition did not seem to be related to disease activity.

Topics: Child, Preschool; Clinical Trials as Topic; Dermatitis, Atopic; Fatty Acids, Essential; Female; Follow-Up Studies; gamma-Linolenic Acid; Humans; Linoleic Acids; Male; Oenothera biennis; Plant Oils

The effect of essential fatty acids on atopic eczema is controversial. Some workers have reported that patients with atopic eczema improved following oral treatment with evening primrose oil (an oil with a high concentration of gamma-linolenic acid), but others have disputed this. This study was designed to look at the effect of evening primrose oil as a long-term oral supplementation for children with atopic eczema. Treated children dramatically improved their clinical condition after 4 weeks of therapy, and this improvement was maintained during the whole period of treatment (20 weeks). At the same time, modifications in plasma, neutrophil and lymphocyte fatty acid composition were detected.

Topics: Child, Preschool; Clinical Trials as Topic; Dermatitis, Atopic; Fatty Acids, Essential; Female; Follow-Up Studies; gamma-Linolenic Acid; Humans; Linoleic Acids; Male; Oenothera biennis; Plant Oils

The effects of unsaturated fatty acids were examined in a double-blind study on 34 patients suffering from atopic dermatitis. In comparison to the placebo group a clinical improvement (24%) was seen after a three month period during which patients had received linoleic acid and gamma-linolenic acid.

Topics: alpha-Linolenic Acid; Clinical Trials as Topic; Dermatitis, Atopic; Dietary Fats, Unsaturated; gamma-Linolenic Acid; Humans; Linolenic Acids; Random Allocation

In a double-blind trial patients with atopic eczema received either oral evening primrose oil (EPO) (n = 14) or placebo (n = 11) for 12 weeks. In the EPO group a statistically significant improvement was observed in the overall severity and grade of inflammation and in the percentage of the body surface involved by eczema as well as in dryness and itch. Patients in the placebo group showed a significant reduction in inflammation. The patients receiving EPO showed a significantly greater reduction in inflammation than those receiving placebo. Evening primrose oil caused a significant rise in the amount of dihomogammalinolenic acid in the plasma phospholipid fatty acids. Plasma levels of TXB2, 6-keto-PGF1 alpha and PGE1, and the amount of TXB2 released into serum during clotting were not altered by evening primrose oil.

Topics: 6-Ketoprostaglandin F1 alpha; Adult; Alprostadil; Anti-Inflammatory Agents, Non-Steroidal; Clinical Trials as Topic; Dermatitis, Atopic; Dermatologic Agents; Double-Blind Method; Fatty Acids; Fatty Acids, Essential; Female; gamma-Linolenic Acid; Humans; Linoleic Acids; Male; Oenothera biennis; Phospholipids; Plant Oils; Random Allocation; Skin; Thromboxane B2

Topics: Adolescent; Child; Child, Preschool; Dermatitis, Atopic; Fatty Acids, Essential; gamma-Linolenic Acid; Humans; Hyperkinesis; Linoleic Acids; Oenothera biennis; Plant Oils

The effects of dietary supplementation with evening primrose oil (Efamol) in 99 patients with atopic dermatitis were investigated in a double blind, controlled crossover study. Simultaneously, plasma phospholipid essential fatty acid status was determined in 50 of these patients before and after treatment. In a separate study, lymphocyte subsets and mitogen responses were investigated in 15 atopic patients before and after treatment. The conclusion is that evening primrose oil improves atopic dermatitis; an abnormality of the enzyme delta-6-desaturase is proposed to explain the biochemical findings. Finally, it is concluded that the therapeutic effect of evening primrose oil is unlikely to be mediated through a primarily immunological mechanism.

Topics: Adult; Child; Clinical Trials as Topic; Dermatitis, Atopic; Double-Blind Method; Fatty Acids, Essential; Fatty Acids, Unsaturated; gamma-Linolenic Acid; Humans; Hypolipidemic Agents; Linoleic Acids; Oenothera biennis; Plant Oils; T-Lymphocytes

This study was designed to look at the effect of evening primrose oil (linoleic and gamma-linolenic acids) as an oral supplement for patients with atopic eczema. We used a double-blind, blocked crossover design with random assignment of patients to treatment groups. We used Wilcoxon's signed-ranks method of comparing changes during the trial. We observed no significant effect on erythema, scale, excoriation, lichenification, or overall severity in 123 patients with atopic eczema of average severity while they took oral doses of evening primrose oil (2 or 4 gm in children, 6 or 8 gm in adults).

Topics: Administration, Oral; Adolescent; Adult; Aged; Child; Child, Preschool; Clinical Trials as Topic; Dermatitis, Atopic; Dermatologic Agents; Double-Blind Method; Fatty Acids, Essential; Fatty Acids, Unsaturated; gamma-Linolenic Acid; Humans; Linoleic Acids; Middle Aged; Oenothera biennis; Plant Oils; Random Allocation

We have measured all the essential fatty acids (EFA) in plasma phospholipids in forty-one adults with atopic eczema and fifty normal controls. The major dietary n-6 EFA, linoleic acid, was significantly elevated, but all its metabolites, 18:3n-6, 20:3n-6, 20:4n-6, 22:4n-6, and 22:5n-6 were significantly reduced. The major dietary n-3 EFA, alpha-linolenic acid, was also elevated, though not significantly, while all its metabolites were also significantly reduced. These observations suggest that atopic eczema is associated not with any defect of EFA intake, but with abnormal metabolism, possibly involving the enzyme delta-6-desaturase. Treatment with oral evening primrose oil produced partial correction of the n-6 EFA abnormality, but had no effect on the n-3 EFAs.

Topics: Adult; alpha-Linolenic Acid; Dermatitis, Atopic; Dermatologic Agents; Fatty Acids, Essential; Fatty Acids, Unsaturated; Female; gamma-Linolenic Acid; Humans; Hypolipidemic Agents; Linoleic Acid; Linoleic Acids; Linolenic Acids; Male; Oenothera biennis; Phospholipids; Plant Oils

Topics: Administration, Oral; Adolescent; Adult; Child; Child, Preschool; Clinical Trials as Topic; Dermatitis, Atopic; Dermatologic Agents; Double-Blind Method; Fatty Acids, Essential; Fatty Acids, Unsaturated; gamma-Linolenic Acid; Humans; Infant; Linoleic Acids; Middle Aged; Oenothera biennis; Plant Oils

Atopic dermatitis (AD) is a chronic eczematous disease characterized by T helper 2 (Th2) -shifted allergic immunity, skin barrier impairment, and pruritus. Oral intake of certain nutrients might help regulate AD. Serum 25-hydroxyvitamin D levels are often low in patients with AD, and oral vitamin D supplementation improves AD. Vitamin D increases regulatory T (Treg) cells, which promote tolerance to allergens and prevent allergic inflammation by inducing expression of filaggrin and cathelicidin in keratinocytes. Vitamin A strengthens Treg cells by inducing expression of forkhead box P3 and inhibits mediator release from mast cells and eosinophils. Serum levels of γ-linolenic acid and its metabolite, dihomo-γ-linolenic acid, are low in patients with AD, and oral γ-linolenic acid improves AD through anti-inflammatory prostaglandin D

Topics: Bifidobacteriales Infections; Bifidobacterium; Dermatitis, Atopic; Filaggrin Proteins; gamma-Linolenic Acid; Humans; Inflammation; Lactobacillus; Nutritional Status; Probiotics; T-Lymphocytes, Regulatory; Treatment Outcome; Vitamin D; Zinc

Atopic dermatitis (AD) has been related to a deficiency of delta-6-desaturase, an enzyme responsible for the conversion of linoleic acid to gamma-linolenic acid (GLA). Evening primrose oil (EPO) contains high amounts of GLA. Therefore, this study investigated whether EPO supplementation results in an increase in plasma GLA and its metabolite dihomo-gamma-linolenic acid (DGLA) correlating with clinical improvement of AD, assessed by the SCORing Atopic Dermatitis (SCORAD) index.. The open study included 21 patients with AD. EPO (4-6 g) was administered daily for 12 weeks. Before treatment, and 4 and 12 weeks after initiation of EPO supplementation, objective SCORAD was assessed and plasma concentrations of GLA and DGLA were determined by gas chromatography.. A significant increase in plasma GLA and DGLA levels and a decrease in the objective SCORAD were observed 4 and 12 weeks after initiation of EPO treatment. In the per-protocol population (n = 14), a significant inverse correlation between the changes in plasma GLA levels and SCORAD was found (P = 0.008).. The clinical disease activity under EPO treatment correlates with the individual increase in plasma GLA levels. Thus, the results of this pilot study indicate that an increase in plasma GLA might be used as predictive parameter for responsiveness of AD to EPO therapy.

Topics: 8,11,14-Eicosatrienoic Acid; Adolescent; Adult; Child; Child, Preschool; Cohort Studies; Dermatitis, Atopic; Dermatologic Agents; Female; gamma-Linolenic Acid; Humans; Linoleic Acids; Male; Middle Aged; Oenothera biennis; Plant Oils; Prospective Studies; Treatment Outcome; Young Adult

Disruption of the skin barrier function caused by epidermal hyper-proliferation, results in the skin becoming dry and showing high transepidermal water loss (TEWL). Gamma linolenic acid (GLA) is reportedly efficacious for treating TEWL and epidermal hyper-proliferation. In this study, to elucidate the effect of GLA-rich oil on skin function, GLA-containing food was given to adults with dry skin or mild atopic dermatitis and skin parameters were evaluated. In the results, we recognized beneficial effects on the TEWL index. The efficacy of GLA was also demonstrated to be statistically significant especially in subjects with pro-inflammatory features. The results suggest that the mechanism of improvement of skin barrier has been associated with possible generation of anti-inflammatory metabolites from GLA. The clinical physician also confirmed that none of the subjects showed any noteworthy side effects. GLA-enriched food appears to be safe and to improve skin barrier function in subjects with dry skin conditions and mild atopic dermatitis.

Topics: Adult; Body Water; Dermatitis, Atopic; Dermis; Dietary Supplements; Double-Blind Method; Fatty Acids; Food, Fortified; gamma-Linolenic Acid; Humans; Inflammation Mediators; Male; Middle Aged; Water Loss, Insensible

Topics: 8,11,14-Eicosatrienoic Acid; Animals; Dermatitis, Atopic; Dog Diseases; Dogs; gamma-Linolenic Acid; Linoleic Acids, Conjugated; Linolenic Acids; Plant Oils

It has been suggested that atopic dermatitis (AD) is associated with impaired delta-6 desaturase activity and the subsequent altered composition of n-6 essential fatty acids (EFAs).. To investigate whether n-6 EFA deficiency accounts for AD by affecting transepidermal water loss or the immune response.. Serum levels of n-6 EFAs were measured using gas chromatography-mass spectrometry in a well-defined group of 35 children with AD (IgE level >150 U/mL); 35 age-matched children with allergic rhinitis, asthma, or both (IgE level >150 U/mL); and 31 nonatopic controls (IgE level <100 U/mL). Skin barrier function was evaluated by measuring transepidermal water loss and severity of AD by computing the Scoring Atopic Dermatitis (SCORAD) index.. Atopic children had higher levels of linoleic acid (LA) and lower levels of its metabolites. Furthermore, gamma-linolenic acid to LA and dihommo-gamma-linolenic acid to LA ratios were significantly reduced in atopic patients. Transepidermal water loss and the SCORAD index were negatively correlated with serum levels of LA metabolites. There was no correlation between the SCORAD index and IgE level (P = .51) or between n-6 EFA concentrations and IgE level (P > .10).. Deficits in n-6 EFAs were correlated with the severity of AD by affecting skin barrier function and cutaneous inflammation. The link between impaired n-6 EFA metabolism and IgE level could not be defined.

Topics: 8,11,14-Eicosatrienoic Acid; Adolescent; Arachidonic Acid; Asthma; Child; Child, Preschool; Dermatitis, Atopic; Epidermis; Fatty Acids, Omega-6; Fatty Acids, Unsaturated; Female; gamma-Linolenic Acid; Humans; Immunoglobulin E; Linoleic Acid; Lipids; Male; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Water; Water Loss, Insensible

We compared the dietary effects of dihomo-gamma-linolenic acid (DGLA) contained in the DGLA oil produced by a fungus with gamma-linolenic acid (GLA) on the fatty acid composition. Wistar rats were fed with three kinds of oil for two weeks as follows: (i) control group: corn oil; (ii) GLA group: borage oil; (iii) DGLA group: DGLA oil/safflower oil = 55:45. The DGLA concentrations in the liver, serum, and brain of the DGLA group were higher than those of the GLA oil group. We also examined the dose effect of DGLA. The DGLA levels in the liver, serum, and brain significantly increased with increasing dosage of DGLA in the diet. DGLA administration significantly increased the ratio of PGE1/PGE2 in the rat plasma. The mechanism for GLA administration to improve atopic eczema is thought to involve an increase in the concentration of DGLA metabolized from GLA, so these results suggest that the dietary effect of DGLA would be more dominant than GLA.

Topics: 8,11,14-Eicosatrienoic Acid; Administration, Oral; Alprostadil; Animals; Brain; Delta-5 Fatty Acid Desaturase; Dermatitis, Atopic; Dinoprostone; Fatty Acid Desaturases; gamma-Linolenic Acid; Linoleoyl-CoA Desaturase; Liver; Male; PPAR alpha; Rats; Rats, Wistar; Reverse Transcriptase Polymerase Chain Reaction; RNA, Messenger; Sterol Regulatory Element Binding Proteins

Cutaneous mast cells are considered as key immune effectors in the pathogenesis of canine atopic dermatitis (CAD). These cells release immediate-phase and late-phase mediators of inflammation. Dietary fatty acids are incorporated in cellular membranes and seem to influence mediator production and release. A dietary intervention with n6- and n3-fatty acids is thought to alleviate clinical symptoms in atopic dogs. The purpose of this study was to examine the effects of n6- and n3-fatty acids on the fatty acid composition of canine mastocytoma cells (C2) as a possible model for CAD. The C2 was cultured in a basic medium called Dulbecco's modified Eagle's medium (DEH) or with additional 14 mum linoleate (C18:2n6, DEH-LA), gamma-linolenate (C18:3n6, DEH-GLA), arachidonate (C20:4n6, DEH-AA), alpha-linolenate (C18:3n3, DEH-LnA), eicosapentaenoate (C20:5n3, DEH-EPA) or docosahexaenoate (C22:6n3, DEH-DHA). Cell growth was examined for 11 days in all media. Cell growth increased from days 1 to 8 and decreased thereafter in all media conditions. The fatty acids supplied did not influence cell growth. The cells were harvested after 8 days for fatty acid analysis. The fatty acid composition was determined by gas chromatography after extraction and trans-esterification of the lipids. The added fatty acids increased the concentration of these fatty acids in C2 differently (LA 4.9-fold, GLA 6.9-fold, AA 6-fold, LNA 9.3-fold, EPA 6.5-fold and DHA 8.4-fold). Furthermore, elongated and Delta6-desaturated products of the corresponding fatty acids were significantly elevated. However, Delta5-desaturated products were not measurable. These results let us assume that C2 has no measurable activity of the Delta5-desaturase. In case the low activity of Delta5-desaturase is one of the mechanisms underlying the pathogenesis of CAD, C2 seems to be an adequate model for investigations in CAD.

Topics: Animals; Cell Line, Tumor; Dermatitis, Atopic; Disease Models, Animal; Docosahexaenoic Acids; Dog Diseases; Dogs; Fatty Acids, Unsaturated; gamma-Linolenic Acid; Inflammation Mediators; Mast Cells; Mastocytoma

In 1989 we demonstrated that 71% of children referred to our paediatric dermatology clinic with atopic dermatitis (AD) had been subject to dietary manipulation by their parents in order to manage their disease. We have re-examined our clinic population to determine whether the documented rise in the use of complementary therapy in children with skin disease has been accompanied by a rise in dietary manipulation.. To qualify and quantify the usage of dietary manipulation in children with AD in secondary care.. A face-to-face structured questionnaire study of 100 children with AD.. The mean age of the children interviewed was 7.3 years (median 5.9, range 0.6-17.1) and ethnic origin was 59% white, 35% Indo-Asian, 3% Afro-Caribbean and 3% mixed race. Seventy-five per cent of patients (75 of 100) had tried some form of dietary exclusion; the most common foods omitted were dairy products in 48% (36 of 75), eggs in 27% (20 of 75) and cow's milk in 25% (19 of 75). Forty-one per cent of patients (41 of 100) had tried some form of dietary supplementation. The most common dietary supplement was evening primrose oil in 59% (24 of 41), of whom 13% (three of 24) felt this had helped their skin. Only 51% (38 of 75) had consulted a doctor or dietician before commencing any dietary change, but 39% (29 of 75) felt that their skin had improved as a result of this dietary manipulation.. In comparison with our previous study, the proportion of patients excluding foods from their diet had increased from 71% to 75%. The proportion of these dietary changes that are unsupervised has remained the same, as have the food types avoided. The proportion of patients who report that unsupervised dietary manipulation is beneficial has increased from 10% to 39%.

Topics: Adolescent; Animals; Child; Child, Preschool; Dairy Products; Dermatitis, Atopic; Diet; Dietary Supplements; Eggs; Fatty Acids, Essential; Female; Food Hypersensitivity; gamma-Linolenic Acid; Humans; Infant; Linoleic Acids; Male; Milk; Oenothera biennis; Parents; Plant Oils; Self Care

The purpose of our investigations was to evaluate the supposed beneficial effects of gamma-linolenic (GLA) and docosahexaenoic acid (DHA) in a canine mastocytoma cell line (C2) as a model for canine atopic dermatitis. Cells were cultured in a basic medium (DEH) and in DEH supplemented with 14.3 microM GLA (DEH-GLA) or 14.3 microM DHA (DEH-DHA) for 8 days. Chymase and tryptase activity, as well as histamine and prostaglandin (PG)E(2) release were measured. To stimulate histamine and PGE(2) release, cells were incubated with the wasp venom peptide mastoparan (50 microM) for 30 min. GLA increased tryptase activity and decreased histamine release after C2 stimulation. DHA diminished PGE(2) production in activated C2. These results support the prescription of GLA- and DHA-enriched diets to reduce inflammatory signs in canine atopic dermatitis.

Topics: Animals; Cells, Cultured; Chymases; Dermatitis, Atopic; Dietary Supplements; Dinoprostone; Docosahexaenoic Acids; Dog Diseases; Dogs; gamma-Linolenic Acid; Histamine; Inflammation Mediators; Mast Cells; Serine Endopeptidases; Tryptases

Topics: Dermatitis, Atopic; Dermatologic Agents; Fatty Acids, Essential; gamma-Linolenic Acid; Humans; Linoleic Acids; Oenothera biennis; Plant Oils; Treatment Outcome

Topics: Dermatitis, Atopic; gamma-Linolenic Acid; Humans; Plant Oils; Research Design; Treatment Outcome

Atopic eczema is a chronic, recurrent, multifactorial skin disease, and, accordingly, there are numerous therapeutic options for its symptomatic treatment. Conventional medications are however often unsatisfactory for many patients because of adverse effects on long-term use. For this reason, patients often readily welcome unconventional therapeutic approaches. We present here a selected number of such treatment modalities, namely gamma-linolenic acid, Chinese herbal tea, diets eliminating allergens, pseudoallergens, metal salts and sodium, and bioresonance. When stringent scientific criteria are applied in the evaluation of such study results, none of the reviewed alternative treatments provides unequivocal, convincing evidence of its efficacy, even when double-blind, placebo-controlled studies are available. With Chinese herbal tea, potentially serious adverse effects should be considered as well. Any new type of unconventional therapy should thus be thoroughly evaluated and shown to be equal or superior to conventional treatments with regard to both efficacy and tolerability before it is recommended for use in clinical practice.

Topics: Dermatitis, Atopic; Diet; Drugs, Chinese Herbal; gamma-Linolenic Acid; Humans; Phytotherapy; Tea

For the past decades, the prevalence of atopic dermatitis is on the rise. Three phases of the disease are recognized according to the age of the patient, either in the newborn age, in infancy or after puberty. A partial enzymatic defect in delta-6 desaturase has been reported. Such metabolic anomaly would be responsible for the alterations in both the skin barrier function and in the Th2 inflammatory reactions in part mediated through IgE. Some microorganisms colonizing the skin play an important causal role in the clinical exacerbations. The influence of food allergy on atopic dermatitis remains obscure and often unconvincing. By contrast, irritant and allergic challenges from the environment exhibit an undisputable worsening effect. The prevention relies on the eviction of predisposing factors and is favourably influenced by emollients specifically designed for atopic dermatitis. A food supplementation in alpha-linoleic acid and some specific chinese herbal remedies might well be useful. The treatment relies primarily on topical applications of corticoids. Puva-therapy, UVB phototherapy and immunomodulation by cyclosporine are indicated for difficult cases.

Topics: Administration, Topical; Adolescent; Adult; Age Factors; Allergens; Anti-Inflammatory Agents; Child; Child, Preschool; Cyclosporine; Dermatitis, Atopic; Dermatologic Agents; Drugs, Chinese Herbal; Emollients; Fatty Acid Desaturases; Food Hypersensitivity; gamma-Linolenic Acid; Glucocorticoids; Humans; Immunoglobulin E; Immunosuppressive Agents; Infant; Infant, Newborn; Irritants; Linoleoyl-CoA Desaturase; Metabolism, Inborn Errors; Prevalence; PUVA Therapy; Skin; Th2 Cells; Ultraviolet Therapy

Topics: Administration, Oral; Anti-Inflammatory Agents, Non-Steroidal; Dermatitis, Atopic; Dermatologic Agents; Fatty Acids, Essential; gamma-Linolenic Acid; Humans; Linoleic Acids; Oenothera biennis; Plant Oils

Topics: Dermatitis, Atopic; Dermatologic Agents; Fatty Acids, Essential; gamma-Linolenic Acid; Humans; Linoleic Acids; Oenothera biennis; Plant Oils

Topics: Clinical Trials as Topic; Dermatitis, Atopic; Dermatologic Agents; Fatty Acids, Essential; gamma-Linolenic Acid; Humans; Linoleic Acids; Oenothera biennis; Plant Oils

Topics: Arthritis, Rheumatoid; Clinical Trials as Topic; Cross-Over Studies; Dermatitis, Atopic; Dermatologic Agents; Fatty Acids, Essential; Female; gamma-Linolenic Acid; Humans; Hypolipidemic Agents; Linoleic Acids; Oenothera biennis; Plant Oils; Premenstrual Syndrome

Topics: Anti-Inflammatory Agents, Non-Steroidal; Clinical Trials as Topic; Dermatitis, Atopic; Fatty Acids, Essential; gamma-Linolenic Acid; Humans; Linoleic Acids; Oenothera biennis; Plant Oils; Research Design

Topics: Administration, Topical; Dermatitis, Atopic; gamma-Linolenic Acid; Humans; Lipid Peroxidation

Thirty-five dogs with non-seasonal atopic dermatitis were used in a double-blind, placebo-controlled crossover study of the effects of evening primrose (Oenothera biennis) oil. There was a significant treatment effect (P less than 0.05) on erythema. An analysis of the changes in plasma phospholipid levels of essential fatty acids revealed a significant (P less than 0.05) rise in linoleic acid concentration above that in the placebo group. Arachidonic acid levels in the treated group increased significantly (P less than 0.005) in the first phase and also in the second phase (P less than 0.05). In the second phase the levels of arachidonic acid in the active and placebo groups differed significantly (P less than 0.05) and there was a significant treatment effect (P less than 0.05).

Topics: Animals; Arachidonic Acid; Dermatitis, Atopic; Dermatologic Agents; Dog Diseases; Dogs; Double-Blind Method; Fatty Acids, Essential; gamma-Linolenic Acid; Linoleic Acid; Linoleic Acids; Oenothera biennis; Phospholipids; Plant Oils

Topics: Anti-Inflammatory Agents, Non-Steroidal; Dermatitis, Atopic; Fatty Acids, Essential; gamma-Linolenic Acid; Humans; Linolenic Acids; Prostaglandins E

Topics: Dermatitis, Atopic; Dermatologic Agents; Fatty Acids, Essential; gamma-Linolenic Acid; Humans; Linoleic Acids; Oenothera biennis; Plant Oils

Topics: Dermatitis, Atopic; Dermatologic Agents; Fatty Acids, Essential; gamma-Linolenic Acid; Humans; Linoleic Acids; Neurodermatitis; Oenothera biennis; Plant Oils

Topics: Dermatitis, Atopic; Drug Evaluation; Fatty Acids, Essential; gamma-Linolenic Acid; Humans; Linoleic Acids; Oenothera biennis; Plant Oils

The total lipid fatty acid composition of mature breast milk has been analysed in a group of twenty-five mothers of children with atopic eczema, and compared with breast milk from twenty-two controls. Total lipids were extracted into chloroform-methanol (2:1, v/v) and the methyl esters prepared by alkalicatalysed trans-esterification were separated by gas-liquid chromatography and identified by comparison with standard fatty acid methyl esters. Results show that mothers of children with atopic eczema have a significantly greater proportion of linoleic acid, and a smaller proportion of dihomo-gamma-linolenic acid in their total breast milk lipid than the controls. Proportions of total derived fatty acids were similar between groups and there were no differences in the principal saturated and monounsaturated fats. It was concluded that mothers of children with atopic eczema have an abnormal breast-milk fatty acid composition. This supports previous evidence of a defect of conversion of linoleic acid into its long-chain polyunsaturated metabolites in the condition.

Topics: Adult; Arachidonic Acids; Dermatitis, Atopic; Fatty Acids; Female; gamma-Linolenic Acid; Humans; Infant; Linoleic Acids; Linolenic Acids; Milk, Human

Topics: Anti-Inflammatory Agents, Non-Steroidal; Dermatitis, Atopic; Fatty Acids, Essential; gamma-Linolenic Acid; Humans; Linoleic Acids; Oenothera biennis; Plant Oils

The metabolism of essential unsaturated fatty acids seems to show changes in patients with atopic dermatitis (AD). A defect or a deficiency of a Delta-6-Desaturase, which transforms cis-linoleic acid into gamma-linolenic-acid will be discussed. We examined the influence of a treatment with unsaturated fatty acids on clinical phenotype and the surface antigens of lymphocytes in peripheral blood. Prolonged recurrence free intervals as well as a faster ability to control relapse were established. Dysbalance in the lymphocytic system was able to be positively influenced. We found an increase of Leu 2 a-antigen carrying T-suppressor-lymphocytes and of the Leu 3+8+- antigen carrying subpopulation of T-helper-lymphocytes, which are responsible for activation of precursor T-suppressor cells into.

Topics: Adolescent; Adult; Dermatitis, Atopic; Dietary Fats, Unsaturated; Female; gamma-Linolenic Acid; Humans; Immunity, Cellular; Immunocompetence; Linoleic Acid; Linoleic Acids; Linolenic Acids; Male; T-Lymphocytes

Topics: Adolescent; Adult; Dermatitis, Atopic; Female; gamma-Linolenic Acid; Humans; Linoleic Acid; Linoleic Acids; Linolenic Acids; Male

Topics: Dermatitis, Atopic; Fatty Acids, Essential; Fatty Acids, Unsaturated; Food Hypersensitivity; gamma-Linolenic Acid; Humans; Hypolipidemic Agents; Linoleic Acids; Oenothera biennis; Plant Oils