acne, rosacea, psoriasis, atopic dermatitis, irritant dermatitis, and sensitive skin, etc) and relief of skin symptoms.
Of these skin barrier lipids, ceramides occupy a central and essential role. Topical application of a ceramide-dominant, barrier repair emollient in children with AD has been demonstrated to be a safe, useful adjunct to the treatment of childhood AD.53 In a large multicenter, open-label study, the investigator evaluated the efficacy of ceramide-dominant lipid barrier repair emulsion in 207 AD patients after three weeks either using a ceramidedominant emulsion only or in combination with another AD treatment. The ceramide-dominant product provided clinical efficacy with patient satisfaction and improvement of pruritus and quality of life.54 AD and other impaired epidermal barrier associated dermatological conditions have provided clear rationale for the use of ceramides as topical agent in restoring epidermal barrier integrity and function.
In addition, exposure to hot water, soaps, certain chemicals, and other environmental factors can also cause a decrease in SC lipids, especially ceramides. Currently, a variety of products are available in the market containing ceramides for moisturization, protection, and restoration of skin barrier. Products that feature at least three types of essential ceramides (Ceramides 1, 3, 6) can help restore the skin barrier integrity and function, and improve the quality of life more efficiently.55,56
Of these skin barrier lipids, ceramides occupy a central and essential role. Topical application of a ceramide-dominant, barrier repair emollient in children with AD has been demonstrated to be a safe, useful adjunct to the treatment of childhood AD.53 In a large multicenter, open-label study, the investigator evaluated the efficacy of ceramide-dominant lipid barrier repair emulsion in 207 AD patients after three weeks either using a ceramidedominant emulsion only or in combination with another AD treatment. The ceramide-dominant product provided clinical efficacy with patient satisfaction and improvement of pruritus and quality of life.54 AD and other impaired epidermal barrier associated dermatological conditions have provided clear rationale for the use of ceramides as topical agent in restoring epidermal barrier integrity and function.
In addition, exposure to hot water, soaps, certain chemicals, and other environmental factors can also cause a decrease in SC lipids, especially ceramides. Currently, a variety of products are available in the market containing ceramides for moisturization, protection, and restoration of skin barrier. Products that feature at least three types of essential ceramides (Ceramides 1, 3, 6) can help restore the skin barrier integrity and function, and improve the quality of life more efficiently.55,56
CONCLUSION
It is clear that skin properties and barrier vary considerably
between healthy and compromised skin. Although much
progress has been achieved in understanding physiological
differences between these two skin states, recent developments
are allowing us to better understand them and especially in
relation to skin health, reactivity, and sensitivity. Since we
already known how to deal with compromised skin barrierrelated
conditions such as AD and sensitive skin, we can apply
these learnings in the management of emerging conditions
such as the cutaneous manifestation of COVID-19 and those
associated with PPE and hand washing dermatoses. While
ceramides have long existed in the field of dermatology, new
emerging science on how ceramides are affected by daily
activities such as sun exposure and skincare habits will lead us
to optimize their usage in daily life.
ACKNOWLEDGMENTS
We thank Dr. Kumar Pillai for critical reading and editing of the
manuscript and Dr. Dominique Bernard for critical reading of
the manuscript.
REFERENCES
1. Elias PM, Menon GK. Structural and Lipid Biochemical Correlates of the Epidermal Permeability Barrier. In: ELIAS PMBT-A in LR, ed. Skin Lipids. Vol 24. Elsevier; 1991:1-26. doi:https://doi.org/10.1016/B978-0-12-024924- 4.50005-5
2. Elias PM. Epidermal lipids, barrier function, and desquamation. J Invest Dermatol. 1983;80(1 Suppl):44s-9s. doi:10.1038/jid.1983.12
3. Tagami H, Kobayashi H, Zhen XS, Kikuchi K. Environmental effects on the functions of the stratum corneum. J Investig Dermatol Symp Proc. 2001;6(1):87-94. doi:10.1046/j.0022-202x.2001.00016.x
4. Wilson D, Berardesca E, Maibach HI. In vitro transepidermal water loss: differences between black and white human skin. Br J Dermatol. 1988;119(5):647-652. doi:10.1111/j.1365-2133.1988.tb03478.x
5. Wesley NO, Maibach HI. Racial (ethnic) differences in skin properties: the objective data. Am J Clin Dermatol. 2003;4(12):843-860. doi:10.2165/00128071-200304120-00004
6. Rawlings A V. Ethnic skin types: Are there differences in skin structure and function? Int J Cosmet Sci. 2006;28(2):79-93. doi:10.1111/j.1467- 2494.2006.00302.x
7. Kompaore F, Marty JP, Dupont C. In vivo evaluation of the stratum corneum barrier function in blacks, Caucasians and Asians with two noninvasive methods. Skin Pharmacol. 1993;6(3):200-207. doi:10.1159/000211136
8. Reed JT, Ghadially R, Elias PM. Skin type, but neither race nor gender, influence epidermal permeability barrier function. Arch Dermatol. 1995;131(10):1134-1138.
9. Muizzuddin N, Hellemans L, Van Overloop L, Corstjens H, Declercq L, Maes D. Structural and functional differences in barrier properties of African American, Caucasian and East Asian skin. J Dermatol Sci. 2010;59(2):123- 128. doi:10.1016/j.jdermsci.2010.06.003
10. Weigand DA, Haygood C, Gaylor JR. Cell layers and density of Negro and Caucasian stratum corneum. J Invest Dermatol. 1974;62(6):563-568. doi:10.1111/1523-1747.ep12679412
11. Elias PM, Menon G, Wetzel BK, Williams JW. Barrier requirements as the evolutionary “driver” of epidermal pigmentation in humans. Am J Hum Biol. 2010;22(4):526-537. doi:10.1002/ajhb.21043
12. Sugino K, Imokawa G, Maibach HI. Ethnic difference of varied stratum corneum function in relation to stratum corneum lipids. J Dermatol Sci. 1993;6(1):108. doi:10.1016/0923-1811(93)91343-s
13. Hellemans L, Muizzuddin N, Declercq L, Maes D. Characterization of stratum corneum properties in human subjects from a different ethnic background. J Invest Dermatol. 2005;124.
14. Augustin M, Wilsmann-Theis D, Körber A, et al. Diagnosis and treatment of xerosis cutis – a position paper. J Ger Soc Dermatology. 2019;17(S7):3-33. doi:10.1111/ddg.13906
15. Eberting C. Repairing a compromised skin barrier in dermatitis: leveraging the skin’s ability to heal itself. J Allergy Ther. 2014;05(05). doi:10.4172/2155- 6121.1000187
16. Rosso J Del, Zeichner J, Alexis A, Cohen D, Berson D. Understanding the epidermal barrier in healthy and compromised skin: clinically relevant information for the dermatology practitioner: proceedings of an expert panel roundtable meeting. J Clin Aesthet Dermatol. 2016;9(4 Suppl 1):S2-S8. http:// www.ncbi.nlm.nih.gov/pubmed/28936279%0Ahttp://www.pubmedcentral. nih.gov/articlerender.fcgi?artid=PMC5608132
17. Noda S, Suárez-Fariñas M, Ungar B, et al. The Asian atopic dermatitis phenotype combines features of atopic dermatitis and psoriasis with increased TH17 polarization. J Allergy Clin Immunol. 2015;136(5):1254-1264. doi:10.1016/j.jaci.2015.08.015
18. Kaufman BP, Guttman-Yassky E, Alexis AF. Atopic dermatitis in diverse racial and ethnic groups—Variations in epidemiology, genetics, clinical presentation and treatment. Exp Dermatol. 2018;27(4):340-357. doi:10.1111/ exd.13514
19. Odhiambo JA, Williams HC, Clayton TO, Robertson CF, Asher MI. Global variations in prevalence of eczema symptoms in children from ISAAC Phase Three. J Allergy Clin Immunol. 2009;124(6):1251-8.e23. doi:10.1016/j. jaci.2009.10.009
20. Paternoster L, Standl M, Waage J, et al. Multi-ancestry genome-wide association study of 21,000 cases and 95,000 controls identifies new risk loci for atopic dermatitis. Nat Genet. 2015;47(12):1449-1456. doi:10.1038/ ng.3424
21. Geng YJ, Wei ZY, Qian HY, Huang J, Lodato R, Castriotta RJ. Pathophysiological characteristics and therapeutic approaches for pulmonary injury and cardiovascular complications of coronavirus disease 2019. Cardiovasc Pathol. 2020;47(January). doi:10.1016/j.carpath.2020.107228
22. Jiang L, Tang K, Levin M, et al. COVID-19 and multisystem inflammatory syndrome in children and adolescents. Lancet Infect Dis. 2020;20(11):e276- 88. doi:10.1016/S1473-3099(20)30651-4
23. Trepanowski N, Larson AR, Evers-Meltzer R. Occupational dermatoses among frontline healthcare workers during the COVID-19 pandemic: a crosssectional survey. J Am Acad Dermatol. Published online 2020. doi:10.1016/j. jaad.2020.08.126
24. Beiu C, Mihai M, Popa L, Cima L, Popescu MN. Frequent hand washing for
2. Elias PM. Epidermal lipids, barrier function, and desquamation. J Invest Dermatol. 1983;80(1 Suppl):44s-9s. doi:10.1038/jid.1983.12
3. Tagami H, Kobayashi H, Zhen XS, Kikuchi K. Environmental effects on the functions of the stratum corneum. J Investig Dermatol Symp Proc. 2001;6(1):87-94. doi:10.1046/j.0022-202x.2001.00016.x
4. Wilson D, Berardesca E, Maibach HI. In vitro transepidermal water loss: differences between black and white human skin. Br J Dermatol. 1988;119(5):647-652. doi:10.1111/j.1365-2133.1988.tb03478.x
5. Wesley NO, Maibach HI. Racial (ethnic) differences in skin properties: the objective data. Am J Clin Dermatol. 2003;4(12):843-860. doi:10.2165/00128071-200304120-00004
6. Rawlings A V. Ethnic skin types: Are there differences in skin structure and function? Int J Cosmet Sci. 2006;28(2):79-93. doi:10.1111/j.1467- 2494.2006.00302.x
7. Kompaore F, Marty JP, Dupont C. In vivo evaluation of the stratum corneum barrier function in blacks, Caucasians and Asians with two noninvasive methods. Skin Pharmacol. 1993;6(3):200-207. doi:10.1159/000211136
8. Reed JT, Ghadially R, Elias PM. Skin type, but neither race nor gender, influence epidermal permeability barrier function. Arch Dermatol. 1995;131(10):1134-1138.
9. Muizzuddin N, Hellemans L, Van Overloop L, Corstjens H, Declercq L, Maes D. Structural and functional differences in barrier properties of African American, Caucasian and East Asian skin. J Dermatol Sci. 2010;59(2):123- 128. doi:10.1016/j.jdermsci.2010.06.003
10. Weigand DA, Haygood C, Gaylor JR. Cell layers and density of Negro and Caucasian stratum corneum. J Invest Dermatol. 1974;62(6):563-568. doi:10.1111/1523-1747.ep12679412
11. Elias PM, Menon G, Wetzel BK, Williams JW. Barrier requirements as the evolutionary “driver” of epidermal pigmentation in humans. Am J Hum Biol. 2010;22(4):526-537. doi:10.1002/ajhb.21043
12. Sugino K, Imokawa G, Maibach HI. Ethnic difference of varied stratum corneum function in relation to stratum corneum lipids. J Dermatol Sci. 1993;6(1):108. doi:10.1016/0923-1811(93)91343-s
13. Hellemans L, Muizzuddin N, Declercq L, Maes D. Characterization of stratum corneum properties in human subjects from a different ethnic background. J Invest Dermatol. 2005;124.
14. Augustin M, Wilsmann-Theis D, Körber A, et al. Diagnosis and treatment of xerosis cutis – a position paper. J Ger Soc Dermatology. 2019;17(S7):3-33. doi:10.1111/ddg.13906
15. Eberting C. Repairing a compromised skin barrier in dermatitis: leveraging the skin’s ability to heal itself. J Allergy Ther. 2014;05(05). doi:10.4172/2155- 6121.1000187
16. Rosso J Del, Zeichner J, Alexis A, Cohen D, Berson D. Understanding the epidermal barrier in healthy and compromised skin: clinically relevant information for the dermatology practitioner: proceedings of an expert panel roundtable meeting. J Clin Aesthet Dermatol. 2016;9(4 Suppl 1):S2-S8. http:// www.ncbi.nlm.nih.gov/pubmed/28936279%0Ahttp://www.pubmedcentral. nih.gov/articlerender.fcgi?artid=PMC5608132
17. Noda S, Suárez-Fariñas M, Ungar B, et al. The Asian atopic dermatitis phenotype combines features of atopic dermatitis and psoriasis with increased TH17 polarization. J Allergy Clin Immunol. 2015;136(5):1254-1264. doi:10.1016/j.jaci.2015.08.015
18. Kaufman BP, Guttman-Yassky E, Alexis AF. Atopic dermatitis in diverse racial and ethnic groups—Variations in epidemiology, genetics, clinical presentation and treatment. Exp Dermatol. 2018;27(4):340-357. doi:10.1111/ exd.13514
19. Odhiambo JA, Williams HC, Clayton TO, Robertson CF, Asher MI. Global variations in prevalence of eczema symptoms in children from ISAAC Phase Three. J Allergy Clin Immunol. 2009;124(6):1251-8.e23. doi:10.1016/j. jaci.2009.10.009
20. Paternoster L, Standl M, Waage J, et al. Multi-ancestry genome-wide association study of 21,000 cases and 95,000 controls identifies new risk loci for atopic dermatitis. Nat Genet. 2015;47(12):1449-1456. doi:10.1038/ ng.3424
21. Geng YJ, Wei ZY, Qian HY, Huang J, Lodato R, Castriotta RJ. Pathophysiological characteristics and therapeutic approaches for pulmonary injury and cardiovascular complications of coronavirus disease 2019. Cardiovasc Pathol. 2020;47(January). doi:10.1016/j.carpath.2020.107228
22. Jiang L, Tang K, Levin M, et al. COVID-19 and multisystem inflammatory syndrome in children and adolescents. Lancet Infect Dis. 2020;20(11):e276- 88. doi:10.1016/S1473-3099(20)30651-4
23. Trepanowski N, Larson AR, Evers-Meltzer R. Occupational dermatoses among frontline healthcare workers during the COVID-19 pandemic: a crosssectional survey. J Am Acad Dermatol. Published online 2020. doi:10.1016/j. jaad.2020.08.126
24. Beiu C, Mihai M, Popa L, Cima L, Popescu MN. Frequent hand washing for
