Effect of Skin Barrier Emulsion Cream vs a Conventional Moisturizer on Transepidermal Water Loss and Corneometry in Atopic Dermatitis: A Pilot Study
December 2014 | Volume 13 | Issue 12 | Original Article | 1482 | Copyright © 2014
Leon H. Kircik MD
Icahn School of Medicine at Mount Sinai, New York, NY; Indiana University School of Medicine, Indianapolis, IN;
Physicians Skin Care, PLLC, Louisville, KY
The repair and maintenance of the epidermal barrier is of the utmost importance in the treatment of atopic dermatitis (AD). While barrier
creams and emollients are considered to be a foundation of AD therapy, there is little comparative data between various product options.
This was a pilot study with a small sample size to investigate the use of skin barrier emulsion cream vs a commonly used moisturizing
lotion to improve the epidermal barrier in subjects with atopic dermatitis.
J Drugs Dermatol. 2014;13(12):1482-1484.
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It is now well recognized that the epidermal barrier serves not only to prevent the entry of exogenous factors such as irritants or allergens, but also to mediate disease. Although it was long known that dysfunction of the barrier may directly contribute to atopic dermatitis (AD), most of the evidence now suggests that there is a significant relationship between epidermal barrier dysfunction and cutaneous inflammation.
One of the primary functions of the stratum corneum (SC) is to maintain homeostasis by the regulation of water content with regulation of water flux, and thus the modification of transepidermal water loss (TEWL).1-3 The now outdated bricks and mortar model of the SC provided a reasonable basis for conceptualizing its components. The bricks are the corneocytes, comprised primarily of keratin macrofibrils protected externally by a cornified cell envelope cohesively held together by corneodesmosomes.4 The cornified cell envelope is composed predominantly of proteins (eg, loricin, involucrin) and a covalently bound outer lipid monolayer that is made up primarily of long chain ceramides.1,4,5,6 The mortar is a bilayered intercellular membrane comprised of 3 major classes of lipid components present in a relative ratio of approximately 3:1:1—ceramides, cholesterol, and fatty acids. These major physiological SC lipids are produced enzymatically within the SC from specific precursor lipids.1,2,4,7,8,9
We now know that the physiological properties of these lipids, in this specific composition, permit the SC to perform its primary functions.1,2,3
Each component of the intercellular lamellar lipid membrane influences proper SC function. When the epidermal barrier in normal skin is disrupted, this results in upregulation of cholesterol, ceramides, and free fatty acids.10
A specific ceramide-dominant, physiologic lipid-based barrier repair emulsion cream (EpiCeram® Skin Barrier Emulsion, Puracap Pharmaceutical, LLC, South Plainfield, New Jersey) is a Food and Drug Administration—cleared 510K prescription medical device product indicated for the treatment of dry skin conditions and to manage and relieve the burning and itching associated with various types of dermatological conditions including AD, irritant contact dermatitis, and radiation dermatitis. This formulation has a 3:1:1 molar ratio of ceramides, cholesterol, and free fatty acids that simulates the relative amount of these same 3 lipid components in the endogenous intercellular lipid membrane of the SC.
Specifically, the formulation contains ceramide (pseudo-ceramide- 104 or PC-104), conjugated linoleic acid (CLA), and cholesterol in an emollient base. The base consists of a patented controlled release system (MultiSal™ Encapsulation Technology, Salvona, Hamilton, New Jersey) that facilitates the slow release of PC-104, CLA, and cholesterol (Figure 1).
The advantages of this skin barrier emulsion are that it is steroid free, with no restriction on application site or duration, and also no age restriction.
A pilot study was undertaken to determine the effects of this barrier repair emulsion cream (EpiCeram) on skin hydration and TEWL, and to compare it with the effects of a commonly used petrolatum-based moisturizing lotion (Eucerin®, Beiersdorf AG, Hamburg, Germany).
This was a single-center, randomized, investigator-blind study. Subjects were randomized at a 1:1 ratio for the application of the study treatment to the left side and the moisturizing lotion (Eu-