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Skin Conditions
Atopic Dermatitis and/or Seborrheic Dermatitis

Read on for detailed information about how various oils may help alleviate some skin conditions.

Evening Primrose Oil
Individuals with atopic dermatitis (AD) are thought to have a defect in the activity of the enzyme delta-6 desaturase (1, 2, 3, 4, 5), which converts linoleic acid (LA) into gamma-linolenic acid (GLA); this would therefore cause a reduction in the amount of GLA and its metabolites, dihomo-gamma-linolenic acid (DGLA) and arachidonic acid (AA), present in the body. In fact, decreased levels of these metabolites have been repeatedly observed in AD patients (1, 4, 6) as well as in the breast-milk of nursing mothers whose children have a family history predisposing them to AD (7).

Reduced levels of GLA and its metabolites are thought to contribute to AD through a variety of mechanisms including 1) reduced levels of DGLA-derived prostanglandin-1 (PGE1) and altered fatty acid composition of cell membranes may lead to defective immune system function (1, 4, 7, 8, 9, 10, 11) and 2) reduced GLA and DGLA may lead to altered skin permeability as well as dryness, symptoms that are seen in essential fatty acid (EFA) deficiency (1, 2, 8, 10, 12). Researchers have hypothesized that a direct way of circumventing the delta-6 desaturase defect may be to give dietary supplementation of GLA, which is concentrated in evening primrose oil (EPO).

Clinical trials have shown that treatment of AD patients with GLA in the form of EPO helps correct the EFA imbalances described above. Increases in plasma or cellular DGLA and AA have been reported in children (1, 7, , 12) and adults (3, 5) after EPO supplementation. In general, these effects were observed at doses of at least 3g/day EPO in children, and at doses of 4-6g/day EPO in adults. Changes in immune parameters have not been consistent following EPO treatment.

A variety of studies have found significant improvements in general clinical status (1, 7, 9, 13, 14) and in itching (8, 9) as well as a reduced need for steroids (13) and oral antihistamines (8) among AD patients following EPO supplementation. Alternatively, a few studies have shown no significant changes in clinical parameters (11, 15, 16) although the methodology of one of these trials (16) has been questioned (17). A 1989 meta-analysis (an analysis where research studies are evaluated cumulatively) of clinical trials (17) of EPO concluded that EPO treatment at doses of 2-6g/day in adults and children, over treatment periods of 4-12 weeks, resulted in improvements in patient and physician assessment of overall disease severity, as well as improvements in itching. This analysis also noted that there was a significant time-progressive effect, whereby results tended to improve with greater treatment duration; they also noted that the results were dose-dependent, meaning that level of improvement was correlated with dosage.

Borage Oil
Individuals with atopic dermatitis (AD) are thought to have a defect in the activity of the enzyme delta-6 desaturase (1, 2, 3, 4, 5), which converts linoleic acid (LA) into gamma-linolenic acid (GLA); this would therefore cause a reduction in the amount of GLA and its metabolites dihomo-gamma-linolenic acid (DGLA) and arachidonic acid (AA) present in the body. In fact, decreased levels of these metabolites have been repeatedly observed in AD patients (1, 4, 6) as well as in the breast-milk of nursing mothers whose children have a family history predisposing them to AD (7).

Reduced levels of GLA and its metabolites are thought to contribute to AD through several mechanisms including 1) reduced levels of DGLA-derived prostaglandin-1 (PGE1) and altered fatty acid composition of cell membranes may lead to defective immune system function [(1, 4, 7, 8, 9, 10, 11) and 2) reduced GLA and DGLA may lead to altered skin permeability as well as dryness, symptoms that are seen in essential fatty acid (EFA) deficiency (1, 2, 8, 10, 12). Researchers have hypothesized that a direct way of circumventing the delta-6-desaturase defect may be to give dietary supplementation of GLA, which is concentrated in borage oil (13, 14).

Several studies have investigated the effect of borage oil supplementation on the symptoms and biochemistry associated with AD. One study conducted over 12 weeks gave adult AD patients borage oil supplying 548mg/day GLA (the actual borage oil dose was not reported, but was probably about 2.4g/day, based on the normal GLA content of borage oil), and reported significant and progressive improvement in itching, blistering, redness and oozing, with no change in dryness or scaling (15). The study also reported large, significant reductions in the need for antihistamines, steroid medications, and antibiotics for infections of skin lesions.

Another study involving children and adults given 3g/day borage oil reported no change in total disease assessment score compared with placebo, although improvements were reported in several symptoms, including blistering, redness, skin peeling and insomnia (2). A subpopulation of this study – patients with stable disease – showed a significant reduction in the need for steroids. Another study of adults and children administering 2g/day borage oil in children and 4g/day borage oil in adults reported modest improvements in symptomatology, but no significant differences between treated and placebo subjects (16) A randomized trial of borage oil (446mg/day borage oil) in newborn infants measured incidence and severity of AD as outcomes after 6 months of treatment and one year of follow-up (16). Although no improvements in symptoms or medication use were noted, researchers suggested that the dosages used in the study may have been inadequate beyond 3 months of age because of increasing body mass/weight.

A few studies have examined borage oil as a topically-applied treatment for other dermatologic conditions. Two studies used a topical application of borage oil (0.5ml twice daily) in children with infantile seborrheic dermatitis and saw a rapid (10 days – 4 weeks) disappearance of symptoms, even in skin areas not directly treated with borage oil (17, 18). The discontinuation of treatment led to return of symptoms, but a maintenance treatment 2-3 times per week was sufficient to keep symptoms at bay (17). A study of detergent-induced skin irritation reported no effect on symptoms of irritation after borage oil application (19).

The information presented here is for educational purposes only and is not intended as curative or prescriptive advice.

Bibliography - Evening Primrose Oil
1. Bordoni A, Biagi PL, Masi M, Ricci G, Fanelli C, Patrizi A et al. Evening primrose oil (Efamol) in the treatment of children with atopic eczema. Drugs Exp Clin Res 1988;14(4):291-7.
2. Kerscher MJ, Korting HC. Treatment of atopic eczema with evening primrose oil: rationale and clinical results. Clin Investig 1992;70(2):167-71.
3. Manku MS, Horrobin DF, Morse N, Kyte V, Jenkins K, Wright S et al. Reduced levels of prostaglandin precursors in the blood of atopic patients: defective delta-6-desaturase function as a biochemical basis for atopy. Prostaglandins Leukot Med 1982;9(6):615-28.
4. Schafer L, Kragballe K. Supplementation with evening primrose oil in atopic dermatitis: effect on fatty acids in neutrophils and epidermis. Lipids 1991;26(7):557-60.
5. Manku MS, Horrobin DF, Morse NL, Wright S, and Burton JL. Essential fatty acids in the plasma phospholipids of patients with atopic eczema. Br J Dermatol 1984;110(6):643-8.
6. Horrobin DF. Essential fatty acid metabolism and its modification in atopic eczema. Am J Clin Nutr 2000;71(1 Suppl):367S-72S.
7. Biagi PL, Bordoni A, Masi M, Ricci G, Fanelli C, Patrizi A et al. A long-term study on the use of evening primrose oil (Efamol) in atopic children. Drugs Exp Clin Res 1988;14(4):285-90.
8. Fiocchi A, Sala M, Signoroni P, Banderali G, Agostoni C, and Riva E. The efficacy and safety of gamma-linolenic acid in the treatment of infantile atopic dermatitis. J Int Med Res 1994;22(1):24-32
9. Wright S, Burton JL. Oral evening-primrose-seed oil improves atopic eczema. Lancet 1982;2(8308):1120-2.
10. Gehring W, Bopp R, Rippke F, and Gloor M. Effect of topically applied evening primrose oil on epidermal barrier function in atopic dermatitis as a function of vehicle. Arzneimittelforschung 1999;49(7):635-42.
11. Hederos CA, Berg A. Epogam evening primrose oil treatment in atopic dermatitis and asthma. Arch Dis Child 1996;75(6):494-7.
12. Shimasaki H. PUFA content and effect of dietary intake of g-linolenic acid-rich oil on profiles of n-6, n-3 metabolites in plasma of children with atopic eczema. J Clin Biochem Nutr 1995;19:183-92.
13. Schalin-Karrila M, Mattila L, Jansen CT, Uotila P. Evening primrose oil in the treatment of atopic eczema: effect on clinical status, plasma phospholipid fatty acids and circulating blood prostaglandins. Br J Dermatol 1987;117(1):11-9
14. Biagi PL, Bordoni A, Hrelia S, Celadon M, Ricci GP, Cannella V et al. The effect of gamma-linolenic acid on clinical status, red cell fatty acid composition and membrane microviscosity in infants with atopic dermatitis. Drugs Exp Clin Res 1994;20(2):77-84.
15. Skogh M. Atopic eczema unresponsive to evening primrose oil (linoleic and gamma-linolenic acids). J Am Acad Dermatol 1986;15(1):114-5.
16. Bamford JT, Gibson RW, Renier CM. Atopic eczema unresponsive to evening primrose oil (linoleic and gamma-linolenic acids). J Am Acad Dermatol 1985;13(6):959-65.
17. Morse PF, Horrobin DF, Manku MS, Stewart JC, Allen R, Littlewood S et al. Meta-analysis of placebocontrolled studies of the efficacy of Epogam in the treatment of atopic eczema. Relationship between plasma essential fatty acid changes and clinical response. Br J Dermatol 1989;121(1):75-90.

Bibliography - Borage Oil
1. Bordoni A, Biagi PL, Masi M, Ricci G, Fanelli C, Patrizi A et al. Evening primrose oil (Efamol) in the treatment of children with atopic eczema. Drugs Exp Clin Res 1988;14(4):291-7.
2. Henz BM, Jablonska S, van de Kerkhof PC, Stingl G, Blaszczyk M, Vandervalk PG et al. Double-blind, multicentre analysis of the efficacy of borage oil in patients with atopic eczema. Br J Dermatol 1999;140(4): 685-8.
3. Kerscher MJ, Korting HC. Treatment of atopic eczema with evening primrose oil: rationale and clinical results. Clin Investig 1992;70(2):167-71.
4. Manku MS, Horrobin DF, Morse N, Kyte V, Jenkins K, Wright S et al. Reduced levels of prostaglandin precursors in the blood of atopic patients: defective delta-6-desaturase function as a biochemical basis for atopy. Prostaglandins Leukot Med 1982;9(6):615-28.
5. Schafer L, Kragballe K. Supplementation with evening primrose oil in atopic dermatitis: effect on fatty acids in neutrophils and epidermis. Lipids 1991;26(7):557-60.
6. Manku MS, Horrobin DF, Morse NL, Wright S, and Burton JL. Essential fatty acids in the plasma phospholipids of patients with atopic eczema. Br J Dermatol 1984;110(6):643-8.
www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8509576&dopt=Abstract:Businco L, Ioppi M, Morse NL, Nisini R, Wright S. Breast milk from mothers of children with newly developed atopic eczema has low levels of long chain polyunsaturated fatty acids. J Allergy Clin Immunol 1993;91(6):1134-9.
8. Horrobin DF. Essential fatty acid metabolism and its modification in atopic eczema. Am J Clin Nutr 2000;71(1 Suppl):367S-72S.
9. Fiocchi A, Sala M, Signoroni P, Banderali G, Agostoni C, and Riva E. The efficacy and safety of gamma-linolenic acid in the treatment of infantile atopic dermatitis. J Int Med Res 1994;22(1):24-32.
10. Biagi PL, Bordoni A, Masi M, Ricci G, Fanelli C, Patrizi A et al. A long-term study on the use of evening primrose oil (Efamol) in atopic children. Drugs Exp Clin Res 1988;14(4):285-90.
11. Wright S, Burton JL. Oral evening-primrose-seed oil improves atopic eczema. Lancet 1982;2(8308):1120-2.
12. Gehring W, Bopp R, Rippke F, and Gloor M. Effect of topically applied evening primrose oil on epidermal barrier function in atopic dermatitis as a function of vehicle. Arzneimittelforschung 1999;49(7):635-42.
13. Barre DE, Holub BJ. The effect of borage oil consumption on the composition of individual phospholipids in human platelets. Lipids 1992;27(5):315-20.
14. Takwale A, Tan E, Agarwal S, Barclay G, Ahmed I, Hotchkiss K et al. Efficacy and tolerability of borage oil in adults and children with atopic eczema: randomised, double blind, placebo controlled, parallel group trial. BMJ 2003;327(7428):1385.
15. Andreassi M., Forleo P, Di Lorio A, Masci S, Abate G, Amerio P. Efficacy of gamma-linolenic acid in the treatment of patients with atopic dermatitis. J Int Med Res 1997;25(5):266-74.
16. van Gool CJ, Thijs C, Henquet CJ, van Houwelingen AC, Dagnelie PC, Schrander J et al. Gamma-linolenic acid supplementation for prophylaxis of atopic dermatitis--a randomized controlled trial in infants at high familial risk. Am J Clin Nutr 2003;77(4):943-51.
17. Tollesson A, Frithz A. Borage oil, an effective new treatment for infantile seborrhoeic dermatitis. Br J Dermatol 1993;129(1):95.
18. Tollesson A., Frithz A. Transepidermal water loss and water content in the stratum corneum in infantile seborrhoeic dermatitis. Acta Derm Venereol 1993;73(1):18-20.
19. Loden M, Andersson AC. Effect of topically applied lipids on surfactant-irritated skin. Br J Dermatol 1996;134(2):215-20.

 
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