Journal Club: Colloidal Oat for Prevention and Treatment

Dr. Lisa Swanson:
Well, hello and welcome everybody to another Practical Dermatology virtual Journal Club. This is going to be really exciting because of my guest today. He's one of my mentors. He's one of my friends. He's somebody I really look up to and I can't wait to hear about this article from him. This is Dr. Larry Eichenfield. Hello, Dr. Eichenfield. 

Dr. Lawrence Eichenfield:
Hello, Lisa. Pleasure to be part of this. 

Dr. Lisa Swanson:
Yes, it's going to be so fun because we're going to be talking about a really cool article that was published in the Journal of Dermatological Treatment, entitled “Is Colloidal Oat An Effective Emollient Ingredient for the Prevention and Treatment of Atopic Dermatitis in Infants?” And so when I read through this article, A, I found it really, really interesting, really exciting to know more about oat. You see it advertised in certain over-the-counter moisturizers, and it was nice to do a deep dive about the ingredient itself. I felt like the article was divided into three sections, three main discussion points. And so I thought it would help to organize our discussion that way, too. 

So the first question the article posed was, is oat an effective emollient ingredient in moisturizers? And I learned more about oat than ever before by reading this article. And apparently, it seems it is a very effective ingredient in moisturizers. 

Dr. Lawrence Eichenfield:
Yeah, there's a long, long history of oat being used. It goes back. It's really historical with centuries of use, but let's talk... Basically, this article was about putting together the information on the modern data set on the use of oat, and people should understand that there are... We generally talk in terms of general senses of moisturizer and humectants, but one of the really takeaways from this article is that the composition of the materials that are used for moisturizers can make a big difference, especially in atopic dermatitis care. So whole oat grain, Avena sativa is the basis for colloidal oat. And with grinding and processing of this whole oat grain, there's this set of rich biochemical compounds that, when utilized in moisturizer, brings these very positive effects to the skin, with an impact on the skin barrier and promoting healing and moisturizing effects that can have a big impact on our atopic dermatitis patients. 

Dr. Lisa Swanson:
A couple of things I really honed in on is they have data showing that it helps preserve a more acidic environment to the skin, promoting that acid mantle, and helps decrease staph aureus species, increase staph epi species, and just keeping the flora more diverse, which we know is very important. 

Dr. Lawrence Eichenfield:
So you got some major points in the article there, which really is fascinating to put together this information. Products can exist as humectants, which is a component of natural moisturizing factor that brings our ability to hydrate the skin and hold onto water. But I do think the effect on staph species, both promoting microbial diversity and increasing staph epi as compared to staph aureus, I think that's something that's really useful in its use in clinical practice. 

Dr. Lisa Swanson:
Yeah, I think the article really makes a strong point that this is a very effective ingredient to include in a moisturizer. And so that begs the question, could this ingredient be enough that it could be effective to treat atopic dermatitis? If you're seeing a mild to moderate patient in the clinic, would you say, "Let's do some topical emollient with oat in it?" Would you take that approach or would you reach for your prescription pad? 

Dr. Lawrence Eichenfield:
No, it's a perfectly reasonable approach to take. So there's a broad set of studies. The thing about this article is we put together this broad set of data, and some of that data is on general moisturizing as an emollient, but other data or these studies that are done in patients with atopic dermatitis, showing improvements in skin barrier and improvements in our objective measures of inflammatory eczema, such as EASI score measures, as well as a set of work that reviews the whole literature on potential prevention. But before we go to prevention, we should just state that in active atopic dermatitis, especially milder atopic dermatitis, it's always been known that evidence is very strong that moisturizers can minimize the need for prescription or even over-the-counter hydrocortisone or prescription anti-inflammatory agents, either steroids or non-steroids. And that's partially because that moisturizers themselves can help skin barrier repair. 

And I think what the data shows is that moisturizers utilizing this colloidal oat material brings really, a set of the complex carbohydrates, the anti-inflammatory effects, as well as the improvements in skin barrier that can really assist with AD, and sometimes without the need for prescription anti-inflammatory agents. 

Dr. Lisa Swanson:
Yeah, I think the strongest point in the article to me was the data showing reduction in the use of topical corticosteroids in patients who are using an oat-based emollient. I think that if we can tell our patients, "Hey, I think you're going to need these steroids less if we use this as your moisturizer," I think that's really powerful stuff. 

Dr. Lawrence Eichenfield:
Yeah, agreed. 

Dr. Lisa Swanson:
And then the last section of the article, this is a topic that's very exciting for me. Could we be recommending appropriate emollients and moisturizers and potentially prevent eczema? If started early, if started the first few days or weeks of life, could we actually minimize the risk? And this article, your article did a wonderful job summarizing all the studies to date that have looked at this. And there were actually more than I thought. I thought there had been four, and I think there's been something like eight. And it was exciting to see that in patients who were not at risk for atopic dermatitis, early emollients didn't do anything, but patients who were at risk for atopic dermatitis, meaning family history of AD, in almost all of the studies, all but two, emollients did appear to reduce the risk of atopic dermatitis. I find that incredibly meaningful. 

Dr. Lawrence Eichenfield:
And then also, the specific study that was done with this colloidal oat preparation, also had fatty acids and glycerin-containing emollients, that was done by Alan Irvine's group and the group at Cork, was this incredible study. It was called the STOP-AD Study. This is in high-risk infants with very early intervention with moisturizers. And it was a single center at Cork, but two-armed investigator-blinded controlled study of over 300 children. And they started within four days of birth with the moisturizer and the data set done with a very rich analysis subset of patients, who has filigree mutations, who doesn't. But it really showed an incredibly positive impact in decreasing the rate of development of atopic dermatitis. Even though the moisturizer use was for a very short period of time, the cumulative incidence of atopic dermatitis over a year was significantly lower in the colloidal oat emollient group compared to a control group who used topicals as needed in that time period. So it was really an incredibly interesting article. 

Dr. Lisa Swanson:
And this is such an easy recommendation to give. If you're seeing one little kiddo for atopic dermatitis and mom's expecting another, this is an easy recommendation to say, "Hey, go ahead and moisturize your baby as soon as they're born within four days, and chances are it'll decrease the risk of eczema in your other kiddos." I think parents would love to hear that. 

Dr. Lawrence Eichenfield:
And this is one of the cases where I'm often non-denominational in terms of not leading families to one particular moisturizer, but that's one of the points of this article. That's probably an oversimplification of a takeaway given the data sets, but also when it comes to this sort of prevention and that higher risk situation, I think the data's incredibly strong based upon that STOP-AD paper with the colloidal oat fatty acid, glycerin emollient. 

Dr. Lisa Swanson:
Got you. So exciting. This article was wonderful. My one critique is that I wish you had contacted me for ideas for a title before you went to publication, because I thought of a couple of great ones. I'm going to run them by you. 

Dr. Lawrence Eichenfield:
Okay. Let's do it. 

Dr. Lisa Swanson:
Are you ready? Yeah. So number one, We're Going to Need a Bigger Oat, in honor of Jaws. And number two, Oat Is the GOAT. 

Dr. Lawrence Eichenfield:
Well done, Dr. Swanson. 

Dr. Lisa Swanson:
So if there's a sequel to this article, please take those notes. Thank you for being here. Thank you to you guys for tuning in. We hope you learned something. Have a wonderful day. 

Dr. Lawrence Eichenfield:
Take care. Thanks so much.