Ceramides (Cers) are major constituents of the stratum corneum intercellular lipids, which are involved in the barrier function of the skin. Here, we examined the ratio of molecular species of Cers and their correlation with disease severity in patients with atopic dermatitis (AD). The levels of unsaturated fatty acids (USFAs) in both covalently bound and free Cers were higher in the lesional skin of patients with AD than in the non-lesional skin of patients with AD and normal skin of healthy controls. The proportion of USFAs (C30:1, C32:1, and C34:1) was considerably higher than that of other Cer molecular species in both covalently bound and free Cers in patients with AD. The proportion of USFAs in covalently bound Cers positively correlated with the levels of transepidermal water loss (TEWL) (r = 0.542) in the lesional skin of patients with AD. Additionally, the proportion of USFAs in covalently bound Cers positively correlated with thymus and activation-regulated chemokine (TARC), which is an index of disease severity, in the non-lesional (r = 0.676) and lesional (r = 0.503) skin of patients with AD. The proportion of USFA (C32:1), which was the highest in covalently bound Cers, also positively correlated with the TARC level in non-lesional (r = 0.733) and lesional (r = 0.515) skin of patients with AD. Our study is the first to show that there is an increase in USFA in not only lesional but also non-lesional skin of patients with AD. Moreover, this increase in USFA was associated with dryness and impaired barrier function and correlated with the TARC levels, a marker for the degree of type 2 inflammation. We speculate that exacerbation of type 2 inflammation may lead to abnormal epidermal lipid metabolism in the skin of patients with AD.
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