Reevaluation of the Importance of Barrier Dysfunction in the Nonlesional Dry Skin of Atopic Dermatitis Patients through the Use of Two Barrier Creams

Abstract

Background: Atopic dermatitis (AD) can be considered a barrier disease in which antigens and irritants that can easily penetrate clinically normal, nonlesional skin due to its defective barrier function trigger and worsen the dermatitis. Thus, replenishing the barrier function in clinically normal, nonlesional skin of patients with AD seems to be a key for preventing the refractory nature of the dermatitis. Objective: To determine whether the disrupted barrier function of AD nonlesional skin can be repaired by topical application of a synthetic ceramide known to induce barrier recovery and to subsequently evaluate the relationship between enhanced barrier function and improved dry skin conditions. Methods: We applied topically a synthetic ceramide (CER) or hirudoid (HIRU)-containing cream to the nonlesional skin of AD patients for 4 weeks and evaluated their efficacy by measuring transepidermal water loss (TEWL) and capacitance values as well as clinical scoring for scaling/dryness/itchiness. Results: Treatment for 4 weeks with the CER cream significantly reduced dryness/scaling/itchiness which was accompanied by significant decreases in TEWL and increases in capacitance values at 2 and 4 weeks. In contrast, treatment for 4 weeks with the HIRU cream elicited a similar but lesser reduction in dryness/scaling/itchiness which was accompanied by significant but lesser decreases and increases in TEWL and capacitance values, respectively, at 2 and 4 weeks. Comparison of TEWL and capacitance values during the 4 weeks of treatment with CER or HIRU creams revealed that while the two parameters of CER cream-treated skin were generally similar to healthy control skin, those of the HIRU cream-treated skin remained similar to mild or moderate AD skin. Conclusion: It is likely that the recovery of barrier function reflects the improvement in clinically evaluated dry skin conditions of the nonlesional skin to a greater extent than that in water deficiency, which suggests that the barrier-replenishing effect is a more important factor for treatment of AD nonlesional skin than is the improvement of water deficiency.

Ceramide analogue 14S24 selectively recovers perturbed human skin barrier

“…This seems to be in contrast with the previous studies, which described that ceramide and fatty acid alone, as well as their two-component mixtures, delayed barrier recovery, while complete mixtures of ceramide, fatty acid and cholesterol allowed normal barrier recovery. 15,16,39 On the contrary, other studies showed a positive effect of a ceramide or a pseudoceramide alone on the barrier recovery, 11,12,[41][42][43] thus supporting our results. The reasons for the discrepancy could be numerous, originating from a different chemical structure, study design, skin species, etc.…”

Efficacy of a moisturizer containing a pseudo‐ceramide and a eucalyptus extract for Japanese patients with mild atopic dermatitis in the summer

“…The efficacies of topically applied ceramides, pseudo‐ceramide, or precursors of ceramide, have been reported for AD patients. A synthesized pseudo‐ceramide (cetyl PG hydroxyethyl palmitamide), which compensates for natural ceramides, effectively improves the skin symptoms of patients with AD . Furthermore, we found that a topically applied eucalyptus extract increases ceramide levels in the epidermis accompanied by improvements of stratum corneum function …”

“…Hata et al reported that penetration rates of lipophilic dye was significant higher on mild atopic dermatitis group compered to healthy group, however, there were no significant difference in TEWL value between these groups, which may suggest that each value represents a different barrier function against different substances . The application of a pseudo‐ceramide reinforces the cutaneous barrier function of AD skin . Furthermore, Matsuki et al reported that similar pseudo‐ceramide congaing cream has already shown a marked improvement of both water‐holding and barrier functions in atopic patients even on nonlesional dry skin .…”

“…The application of a pseudo‐ceramide reinforces the cutaneous barrier function of AD skin . Furthermore, Matsuki et al reported that similar pseudo‐ceramide congaing cream has already shown a marked improvement of both water‐holding and barrier functions in atopic patients even on nonlesional dry skin . Thus, even there were no decrease in TEWL value, it is presumed that the application of a moisturizing gel reinforce cutaneous barrier functions, resulting in preventing the penetration of stimuli (including sweat) and improves skin erythema and itchiness.…”

Efficacy of the combined use of a mild foaming cleanser and moisturizer for the care of infant skin

“…Ceramide is a major component of intercellular lipids and crucial for cutaneous water-holding capacity and barrier function. Imokawa et al14 designed pseudo-ceramide to compensate for natural ceramide and reported the efficacy of topical application of this pseudo-ceramide against atopic dermatitis skin or sensitive skin 15. Thus, we used pseudo-ceramide in our moisturizer for infant skin care.…”