Efficacy of a Cream Containing Ceramides and Magnesium in the Treatment of Mild to Moderate Atopic Dermatitis: A Randomized, Double-blind, Emollient- and Hydrocortisone-controlled Trial

Abstract

The aim of this randomized controlled trial was to assess the efficacy of a cream containing ceramides and magnesium (Cer-Mg) in the treatment of mild to moderate atopic dermatitis and to compare it with hydrocortisone and a commonly used emollient (unguentum leniens; cold cream). A total of 100 patients, randomized into 2 groups, were treated for 6 weeks simultaneously (left vs. right side of the body) with either Cer-Mg and hydrocortisone (group I) or Cer-Mg and emollient (group II). The primary outcome was a reduction in severity of lesions as assessed by (local) SCORAD (SCORing Atopic Dermatitis). Levels of trans-epidermal water loss (TEWL), skin hydration, and natural moisturizing factors (NMF) were then measured. After 6 weeks, group I showed comparable significant improvement in SCORAD and TEWL, while in group II, the decrease in SCORAD and TEWL was significantly greater after Cer-Mg compared with emollient. Finally, Cer-Mg cream was more effective in improving skin hydration and maintenance of levels of NMF than hydrocortisone and emollient.

Effects of a ceramide‐containing water‐in‐oil ointment on skin barrier function and allergen penetration in an IL‐31 treated 3D model of the disrupted skin barrier

“…Local application of the ointment over 6 days diminished this uptake and prevented increased transepidermal penetration of this allergen. These findings are in line with studies that show clear beneficial effects of ceramide‐containing ointments in improving the clinical symptoms and skin barrier of patients with AD …”

“…The alteration in skin barrier plays a major role in the pathophysiology of this disease as it leads to increased penetration by environmental allergens and infective organisms that cause persistent inflammation . The main contributor to the skin barrier is the stratum corneum, which is based on the “brick and mortar” structure that is composed of corneocytes surrounded by lipid lamellae comprised of ceramides, cholesterol, and free fatty acids . AD lesions exhibit reduced levels of ceramides in the stratum corneum and changes in their relative composition .…”

“…Such emollients aim to prevent water loss from the skin, e.g. by the addition of ceramides . Although there is some evidence that ceramide‐containing ointments might improve barrier function in AD, their efficacy and the underlying molecular effects remain to be elucidated.…”

The Importance of Magnesium in Clinical Healthcare

“…Furthermore, Mg salts are known to enhance skin hydration, dermal permeability, and barrier repair and to facilitate epidermal proliferation and differentiation, thus reducing inflammation [123, 124]. A double-blind controlled trial using a cream containing Mg along with ceramides (a family of waxy lipid molecules found in high concentrations within the cell membrane) to treat mild-to-moderate atopic dermatitis was found to be superior to hydrocortisone creams [125]. Accordingly, there may be beneficial uses of Mg for assorted skin conditions.…”

Basic skin care in atopic dermatitis – new and established treatment options

“…In a double‐blind randomized clinical trial of patients with mild AD, it was shown (split‐side comparison) that application of a topical agent containing ceramides resulted in a significantly greater improvement in the SCORAD index than basic skin care with cold cream. The reduction in the SCORAD index was equivalent to that produced by topical treatment with hydrocortisone alone (split‐side comparison) .…”