Topical Isosorbide Diesters Improve Itch and Reduce Steroid Use in Pediatric Atopic Dermatitis
Adding isosorbide diesters (IDEAS) to a colloidal oatmeal cream improved clinical outcomes and reduced topical steroid use in children with mild-to-moderate atopic dermatitis (AD), according to results from a randomized, double-blind, vehicle-controlled trial. The findings suggest a potential steroid-sparing adjunct for pediatric AD management.
The study enrolled children aged 2 to 17 years with mild-to-moderate AD, who were randomized to receive either colloidal oatmeal cream alone or colloidal oatmeal cream containing IDEAS derived from coconut and sunflower seed oil. Participants applied the assigned treatment daily for 8 weeks, with hydrocortisone 2.5% permitted as needed. Disease severity, itch, sleep disturbance, steroid use, and skin microbiome composition were assessed at baseline, week 4, and week 8.
Clinical improvement favored the IDEAS group. By week 4, a higher proportion of patients receiving IDEAS achieved a clinically meaningful 4-point reduction in subjective itch compared with controls (45.5% vs 6.3%), a difference that persisted at week 8 (42.9% vs 12.5%). More patients in the IDEAS group also reached Eczema Area and Severity Index (EASI) 50 and EASI 75 thresholds at week 4, although these differences did not reach statistical significance.
Steroid-sparing effects were notable. Cumulative topical corticosteroid use over the study period was significantly lower in the IDEAS group, with a mean use of 3.4 g compared with 13.3 g in the control group. In parallel, microbiome analysis showed a reduction in the relative abundance of Staphylococcus aureus after 8 weeks among patients treated with IDEAS.
The authors concluded that “the addition of IDEAS to colloidal lotion improved AD, improved itch, reduced the use of topical steroids, and reduced the relative abundance of S. aureus in the skin microbiome.” These findings align symptomatic relief with microbiome changes that may support barrier recovery.
For dermatologists, the key takeaway is that incorporating IDEAS into an emollient regimen may offer meaningful itch reduction and steroid-sparing benefit in pediatric AD. While longer-term studies are needed, this approach may be useful for children requiring frequent topical steroid use or those with microbiome-driven disease features.
Reference
Khan ZE, Dulai AS, O'Neill A, et al. Impact of isosorbide diesters from coconut and sunflower fatty acids on pediatric atopic dermatitis and the skin microbiome: a randomized, double-blind, vehicle-controlled trial. J Clin Med. 2026;15(2):829. doi:10.3390/jcm15020829
