Inflammatory skin diseases (ISD) cover a broad group of conditions where inflammation is a major contributing factor to its pathogenesis. This group of presentations include but are not limited to, psoriasis, atopic dermatitis, rosacea, and acne. The ISDs pathogenesis involves a variety of immune cells and is mediated by cytokines. For example, psoriasis is an inflammatory T cell-mediated disease involving among other cytokines Tumor Necrosis factor and IL17 [1] . Cytokines that cause an increased immune response are termed Pro Inflammatory Cytokines. Elevated levels of pro-inflammatory cytokines, including TNF-alpha, are found in psoriatic lesions. TNF-alpha has many effects in producing an inflammatory response such as stimulating production of the so called pro-inflammatory cytokines and the release of adhesion molecules. Song A, et al., [2] in the paper Immunopathology and Immunotherapy of Inflammatory Skin Diseases recognize many proinflammatory cytokines responsible for skin disorders but increasingly recognize the role of IL-17.

Cytokines were first recognized in the mid 1960’s as triggers released by T cells to affect the stimulations of B cells [3] . Over the following years many new cytokines were discovered and essentially fitted into one of two camps, the pro-inflammatory, or initiators of inflammation, and the anti-inflammatory cytokines that turn off the inflammation. Cytokines typically will cascade down a biological pathway triggering more and more cytokines along the way. The cascades of cytokines in these two groups act as regulatory mechanisms that turn on and off an inflammatory response to injury or infection, stress, toxins, and trauma. However, for a variety of reasons in certain circumstances the pro-inflammatory cytokines continue unabated causing some of the clinical manifestations of inflammatory skin disorders. This pro-inflammatory response originates with the ubiquitous cytokine tumor necrosis factor and its partner interleukin one, which trigger other cytokines especially interleukin six and seventeen to bring about an inflammatory response at specific tissues.

Whilst the role of these cytokines has been conclusively shown to have a considerable role in the pathogenesis of skin disorders, there has been an increasing recognition of the importance of certain transcription factors at the cell level that trigger the production of the cytokines in the first place [4] . Transcription factor control is seen as an important potential therapeutic tool. One of the most important nuclear transcription factors is Nuclear Factor kappa B (NF-kappa B). Obviously modifying the production of cytokines at the source, by dampening down the production from NF-kappa B, would be advantageous in the management of skin disorders [5] . Like all situations where a therapeutic agent is used as an immune modulator it is paramount not to turn off the immune system but dampen it down, as this could lead to further equally important conditions associated with immune suppression. The current use of monoclonal antibodies against TNF and other cytokines has been shown to be not only expensive but has been associated with immune compromisation [6] . There is a definite role for an inexpensive agent that just dampens down the action of PIC enough to have a clinical benefit, but not too much to cause a compromised immune system.

The components in Koena have been shown individually to influence the reduction in the level of cytokines through a variety of routes (Table 1). Certain of the components have also been shown to modify the production of cytokines by the inhibition of certain transcription factors including NF-kappa B [7] . The combination of the components leads to the synergistic action of Koena with direct effect on dampening down the production of cytokines. This makes Koena a powerful tool in the treatment of inflammatory mediated conditions. Components in Koena also have been shown to exhibit an impact on anti-inflammatory cytokine such as IL10 [8] [9] [10] .

Koena has been commercially available in Australia for several years. During that time the website has been a repository of information around the use of the product purchased and their satisfaction with the purchase. The portal for reviews is open to all who purchase and there is no inducement for positive reviews. Over the years of operation certain trends have become apparent. Interrogating the data through EXCEL files we were able to ascertain 10 most common reasons for purchasing Koena (Figure 1) and we were also able to extrapolate the satisfaction rating for each group (Figure 2).

People have reported a wide range of uses for Koena, such as sunburn and solar damaged skin, nappy rash, rosacea and eczema and psoriasis. Figure 1 and Figure 2 illustrate the findings.

For some purchasers, apart from doing a review on the website, they wanted to give a more detailed account of their results with Koena. This often-included photographs to illustrate the point. Below are several individual reports, which are anonymous. The wording has not been changed and it is how the person wrote their report.

We have seen an increase in incidence of inflammatory skin disorders during the COVID-19 epidemic. This was mainly associated with increased hand washing and the wearing of personal protective equipment. In attempting to manage this increase, people have turned to new approaches, and this includes multitherapy anti-inflammatory creams, such as Koena. There are many cytokines involved in the development of inflammatory skin disorders, including TNF, IL-1, IL-6, IL-10, and IL-17. Koena was found to reduce the impact of these cytokines directly improving certain skin disorders. Koena also was found to modify the transcription factor, NF Kappa B which leads to a reduction in cytokine production. The reviews summarized in this paper illustrate the breadth of use of the Koena suite of products and similar small molecule anti-inflammatory topical treatments.

Notes:

• In accordance with the declaration of Helsinki, this report ensured that participants who gave their review data did so with anonymity and the assessment for the responses reflected dignity, integrity, right to self-determination, privacy, and confidentiality of personal information.

• There were no inducements, implied or otherwise, given to the participants.

• There was no interest in the development of the document other than academic exercise.

• This paper received no financial support from any source.

• Limitations of study. There was no incentive to provide a review via the website, consequently there could be a bias associated with only positive people bothering to do the review. However, it is often seen that people who have a bad experience will take the time to review a product. It is considered that the positive and negative reviews, therefore, balance out.

The author declares no conflicts of interest regarding the publication of this paper.

Turner, P. (2023) Koena, a Novel Compound That Dampens Inflammation in the Skin. Journal of Cosmetics, Dermatological Sciences and Applications, 13, 45-52. https://doi.org/10.4236/jcdsa.2023.131005