Luu Lydia A, Flowers Richard H, Kellams Ann L, Zeichner Steven, Preston DeVon C, Zlotoff Barrett J, Wisniewski Julia A
Department of Dermatology, University of Virginia, Charlottesville, Virginia.
Division of General Pediatrics, Department of Pediatrics, University of Virginia, Charlottesville, Virginia.
Pediatr Dermatol. 2019 Sep;36(5):634-639. doi: 10.1111/pde.13888. Epub 2019 Jul 22.
BACKGROUND/OBJECTIVES: Atopic dermatitis (AD) is a common chronic inflammatory skin condition associated with high transepidermal water loss, high skin pH, and Staphylococcus aureus skin colonization. The treatment of AD with bath additives remains highly debated. Recent evidence suggests that dilute apple cider vinegar (ACV) may improve skin barrier integrity in AD, but its safety and efficacy are not well studied. This pilot split-arm study analyzed the effect of dilute apple cider vinegar soaks on skin barrier integrity in patients with atopic dermatitis as measured by skin transepidermal water loss and skin pH.
A total of 22 subjects (11 AD and 11 healthy controls) were enrolled. Subjects soaked both of their forearms for 14 days, with one arm in dilute ACV (0.5% acetic acid) and the other in water 10 minutes daily. Transepidermal water loss and pH were measured pre- and post-treatment.
In both groups, transepidermal water loss increased and pH decreased at 0 minutes post-ACV treatment, but these effects were not sustained at 60 minutes. In total, 72.7% (16/22) of subjects reported mild side effects from ACV with improvement after discontinuing the soaks.
Dilute ACV soaks have no significant effect on skin barrier integrity but caused skin irritation in a majority of subjects. Study limitations include analysis of a single brand, dilution, and application of ACV. Future studies are needed to explore whether lower concentrations of ACV soaks or other applications such as a leave-on acidic ointment could improve skin barrier integrity in a safe, nonirritating way.
背景/目的：特应性皮炎（AD）是一种常见的慢性炎症性皮肤病，与经表皮水分流失增加、皮肤pH值升高和金黄色葡萄球菌皮肤定植有关。使用沐浴添加剂治疗AD仍存在很大争议。最近的证据表明，稀释的苹果醋（ACV）可能会改善AD患者的皮肤屏障完整性，但其安全性和有效性尚未得到充分研究。这项初步的双臂研究分析了稀释的苹果醋浸泡对特应性皮炎患者皮肤屏障完整性的影响，通过皮肤经表皮水分流失和皮肤pH值来衡量。
共招募了22名受试者（11名AD患者和11名健康对照）。受试者将双臂浸泡14天，一只手臂浸泡在稀释的ACV（0.5%乙酸）中，另一只手臂浸泡在水中，每天浸泡10分钟。在治疗前后测量经表皮水分流失和pH值。
在两组中，ACV治疗后0分钟时经表皮水分流失增加，pH值降低，但这些效果在60分钟时未持续。总共有72.7%（16/22）的受试者报告ACV有轻微副作用，停止浸泡后有所改善。
稀释的ACV浸泡对皮肤屏障完整性没有显著影响，但在大多数受试者中引起了皮肤刺激。研究局限性包括对单一品牌、稀释度和ACV应用的分析。未来需要进行研究，以探索较低浓度的ACV浸泡或其他应用（如留置酸性软膏）是否能以安全、无刺激的方式改善皮肤屏障完整性。
