ACO Booklet Extern

8/10/2019 ACO Booklet Extern

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PUBLICATION BOOKLET

3RD EDITION


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PUBLICATION BOOKLET3RD EDITION


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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.

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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.

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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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6 27

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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