Emerging Insights On The Efficacy Of A New Antipruritic Gel

You will never find me waiting in line for the latest tech gadget. I am always terribly behind in that department but you will find me hunting through the literature and the exhibit halls at dermatology meetings for the latest topicals for various skin conditions. Throughout my training, I got encouragement to “think outside the box” when it came to prescribing and treating skin conditions, and that has certainly helped me establish treatment plans for my patients when all other regimens have failed. 

I truly enjoy both treating and embracing the challenges of treating inflammatory skin conditions of the lower extremity. That said, there are times when patients do not want a topical steroid. Some patients may have tried many topical steroids that failed to have an impact and they are frustrated. Alternately, I may not feel that a topical steroid is appropriate (as in the case of my pediatric patients). Beyond the non-steroidal topicals you might be familiar with such as pimecrolimus (Elidel, Valeant Dermatology) and tacrolimus (Protopic, Astellas), there are numerous other topicals that one can prescribe to assist with conditions like psoriasis and atopic eczema. I am going to focus on one for this blog: Alevicyn^™ antipruritic gel and dermal spray (IntraDerm Pharmaceuticals). 

Perhaps you have used Microcyn^® (Oculus Innovative Sciences) spray or gel in the wound care center where you work. Have you ever considered what Microcyn spray is? It is hypochlorous acid (HOCl) in a liquid or gel base. What does this product do? Well, besides acting as a skin prep prior to the debridement of wounds, it has other properties as well. Microcyn is a non-steroidal anti-itch reliever, a debriding agent, a biofilm disruptor, a broad-spectrum antimicrobial, and it enhances wound healing. 

BioScience Laboratories examined Microcyn versus Hibiclens (Molnlycke Health Care) and a placebo in 50 organisms.¹ Microcyn demonstrated rapid antimicrobial activity versus a broad spectrum of challenge microorganisms. In its research, the company found that in microbial populations of 47 of the 50 Gram-positive, Gram-negative and yeast species, there was a reduction of more than 5.0 Log10 within 30 seconds of exposure to the Microcyn product.

Huang and colleagues examined the use of Microcyn technology to decrease Staph aureus in atopic skin lesions, an issue we are seeing in increasing numbers.² The study yielded a favorable clinical outcome in the management of atopic skin lesions for both Staph aureus reduction and as an anti-inflammatory. 

So, what is Alevicyn antipruritic gel? The antipruritic gel incorporates the Microcyn technology (i.e. HOCl) in a non-oily, pH neutral vehicle. An open-label study showed that 82 percent of study participants with atopic dermatitis responded to treatment (i.e. itch decrease) by day three and continued to respond for the 14-day study.³ 

Alevicyn dermal spray has pure stabilized HOCl. One can not only use this instead of bleach bath therapy for those with atopic dermatitis but the treatment can also be a non-cytotoxic cleanser, irrigator, and debriding agent for acute and chronic wounds, including pressure ulcers, burns, diabetic foot ulcers and graft donor sites. 

How do I use these products in my practice? I have used them both with steroids and in a steroid-free regimen. As Microcyn and Alevicyn are non-irritating, I have had patients use these on a prn basis in between their topical steroid regimen in order to reduce bioburden, pruritus and inflammation. In a steroid-free regimen, I have combined this product with a solid prescription or over-the-counter moisturizer and a low molecular weight hyaluronic acid topical to soothe the skin, reduce inflammation and create a non-cytotoxic environment. With these two products, I am not concerned about the patient using the products multiple times daily as needed to contain the itch.  

References

1. BioScience Laboratories, data on file.

2. Huang JT, Abrams M, Tlougan B, et al. Treatment of Staph aureus colonization in atopic dermatitis decreases disease severity. Pediatrics. 2009; 123(5):808-814.

3. Draelos Z. RD047-26 antipruritic hydrogel for the treatment of atopic dermatitis: an open label pilot study. Cutis. 2012; 90(2):97-102.