2 Methods Patients with AD were recruited from the pediatric dermatology clinic at a teaching hospital. AD was diagnosed according to the UK Working Party’s criteria [9]. Skin hydration, TEWL on the right forearm (2 cm below the antecubital flexure), and disease severity [according to the SCORing Atopic Dermatitis (SCORAD) Index] were measured.

We have SCH 900776 supplier previously described our method of standardizing measurements of skin hydration and TEWL [10]. After acclimatization in the consulting room with the patient sitting comfortably in a chair for 20 to 30 minutes, skin hydration [in arbitrary units (a.u.)] and TEWL (in g/m2/h) were measured with a Mobile Skin Center® MSC 100 equipped with a Corneometer® CM 825 and a Tewameter® TM 210 probe (Courage & Khazaka Electronic GmbH, Cologne, Germany), according to the manufacturer’s instructions. We documented that GSK126 mouse a site 2 cm distal to the right antecubital flexure was optimal for standardization. Oozing and infected areas were avoided by moving the probe slightly sideways [10]. The clinical severity of AD was assessed with the SCORAD Index [11, 12]. Patients were given a liberal supply of the LMF moisturizer (Cetaphil® RESTORADERM™ Lotion; Galderma Canada Inc., Thornhill, ON, Canada) and moisturizing wash (Cetaphil® RESTORADERM™ Wash; Galderma Canada Inc.). The moisturizer claims to contain purified water,

glycerin, caprylic/capric triglyceride, Helianthus annuus (sunflower) seed oil, pentylene glycol, Butyrospermum parkii (shea butter), sorbitol, cyclopentasiloxane, cetearyl alcohol, behenyl alcohol, glyceryl stearate, tocopheryl acetate, hydroxypalmitoyl sphinganine (0.01 % w/w), cetyl alcohol, arginine (0.50 % w/w), disodium ethylene dicocamide polyethylene glycol (PEG)-15 disulfate, glyceryl stearate citrate, niacinamide, sodium pyrrolidone carboxylate (PCA) [0.50 % Dimethyl sulfoxide w/w], ceteareth-20, sodium polyacrylate, caprylyl glycol, allantoin, citric acid, panthenol, dimethiconol, disodium ethylenediaminetetraacetic acid (EDTA), and sodium hyaluronate. Hydroxypalmitoyl sphinganine is a ceramide

precursor. Arginine and sodium PCA are natural moisturizing factors. Arginine acts as a substrate not only for arginase but also for nitric oxide synthase. The moisturizing wash contains purified water, B. parkii, sodium trideceth sulfate, glycerin, H. annuus seed oil, sodium chloride, sodium lauramphoacetate, cocamide monoethanolamine (MEA), citric acid, niacinamide, sodium PCA (0.50 % w/w), tocopheryl acetate, 1,2-hexanediol and caprylyl glycol, disodium EDTA, guar hydroxypropyltrimonium chloride, allantoin, potassium sorbate, arginine (0.10 % w/w), and methylisothiazolinone. The patients were instructed not to use any other topical treatment except for their usual corticosteroid on an as-necessary basis. They were encouraged to use the LMF moisturizer at least twice daily on the flexures and areas with eczema.