patients that replaced standard moisturizers with ceramidedominate lipid-based emollients experienced reduced injury severity, decreased TEWL, and increased hydration.66 In cases of mild-to-moderate eczema, moisturizers and cleansers containing ceramides outperformed mild bar soap, when each was paired with a topical corticosteroid, by reducing severity scores within the first week of application.67 Similarly, twice-daily application of a ceramide-containing cleanser and moisturizer reduced dryness, itching, and other AD symptoms in both adult (>12 year old) and child (<12 year old) populations after 42 days compared to baseline.68 When used in combination with the corticosteroid mometasone furoate, ceramide-linoleic acid-containing moisturizer accelerated the reestablishment of the epidermal permeability barrier, increased capacitance, reduced TEWL, and reduced pruritus in AD patients compared to mometasone furoate alone.69 When applied to psoriasis vulgaris, a similar combination treatment reduced pruritus, accelerated the reduction in TEWL, and increased capacitance compared to mometasone furoate cream alone.70 Consumer perception following application of ceramide-containing moisturizers is also improved, as one study found that ~70% of subjects with mild-to-moderate psoriasis self-reported improved appearance and when a ceramide-containing cream was used in combination with a ceramide-containing cleanser, 85% reported relief of psoriasis, and ~90% experienced soft and smooth skin.71 While it is important to acknowledge that these studies do not suggest that the improved clinical outcomes are solely due to the inclusion of ceramides, they nonetheless highlight the positive impact of regular application of ceramide-containing moisturizers to support recovery from skin conditions associated with compromised barrier.
CONCLUSION
Formation and restoration of abolished SC barrier is a dynamic,
finely regulated process prone to the influences from intrinsic
and environmental factors. In addition to disease conditions
(eg, AD and psoriasis) and severe environmental exposures
from ultraviolet rays or pollution, events that occur in everyday
life can also negatively impact the skin barrier. The importance
of the SC in maintaining skin homeostasis, coupled with the
prevalence and severity of internal and external factors that can
alter its permeability, highlight the need for topical products to
support the skin barrier. Fortunately, continued progress in the
understanding of the epidermal permeability barrier structure,
composition, and function provides sound foundations for
knowledge-based elaboration of topical treatments aimed at
the maintenance and improvement of patients’ skin in health
and disease. This advanced understanding is evidenced by the
inclusion of essential lipids (eg, ceramides) into moisturizers
and skin protectants. Whether applied alongside a topical drug
for disease management (eg, corticosteroids for AD) or as part
of one’s daily skin care routine, ceramide-containing topical
products are an effective way to help restore and maintain the
skin barrier.
DISCLOSURE
Dr. Marek Haftek has received honoraria for consultancy from
L’Oréal Research and Innovation.
REFERENCES
1. Haftek M. ‘Memory’ of the stratum corneum: exploration of the epidermis’ past. Br J Dermatol. 2014;171:6-9.
2. Menon GK, Feingold KR, Elias PM. Lamellar body secretory response to barrier disruption. J Invest Dermatol. 1992;98(3):279-289.
3. Eckert RL, Sturniolo MT, Broome A-M, et al. Transglutaminase function in epidermis. J Invest Dermatol. 2005;124(3):481-492.
4. Elias PM. Epidermal lipids, barrier function, and desquamation. J Invest Dermatol. 1983;80(1):S44-S49.
5. Brandner JM, Haftek M, Niessen CM. Adherens junctions, desmosomes and tight junctions in epidermal barrier function. Open Dermatol J. 2010;4(1):14-20.
6. Danzberger J, Donovan M, Rankl C, et al. Glycan distribution and density in native skin’s stratum corneum. Skin Res Technol. 2018;24(3):450-458.
7. Rankl C, Zhu R, Luengo GS, et al. Detection of corneodesmosin on the surface of stratum corneum using atomic force microscopy. Exp Dermatol. 2010;19(11):1014-1019.
8. Haftek M. Epidermal barrier disorders and corneodesmosome defects. Cell Tissue Res. 2015;360(3):483-490.
9. Milani P, Chlasta J, Abdayem R, et al. Changes in nano-mechanical properties of human epidermal cornified cells depending on their proximity to the skin surface. J Mol Recognit. 2018;31(9):e2722.
10. Guo S, Domanov Y, Donovan M, et al. Anisotropic cellular forces support mechanical integrity of the stratum corneum barrier. J Mech Behav Biomed Mater. 2019;92:11-23.
11. Potter A, Luengo G, Santoprete R, Querleux B. Stratum Corneum Biomechanics. In: Skin Moisturization. Informa Healthcare. 2009:259-278.
12. Luengo GS, Potter A, Ghibaudo M, et al. Stratum Corneum Biomechanics (Mechanics and Friction): Influence of Lipids and Moisturizers. In: Agache’s Measuring the Skin. Springer International Publishing. 2017:373-387.
13. Coderch L, López O, de la Maza A, Parra JL. Ceramides and skin function. Am J Clin Dermatol. 2003;4(2):107-129.
14. Janssens M, van Smeden J, Gooris GS, et al. Increase in short-chain ceramides correlates with an altered lipid organization and decreased barrier function in atopic eczema patients. J Lipid Res. 2012;53(12):2755-2766.
15. Wertz PW, Miethke MC, Long SA, Strauss JS, Downing DT. The composition of the ceramides from human stratum corneum and from comedones. J Invest Dermatol. 1985;84(5):410-412.
16. Breiden B, Sandhoff K. The role of sphingolipid metabolism in cutaneous permeabilitybarrier formation. Biochim Biophys Acta - Mol Cell Biol Lipids. 2014;1841(3):441-452.
17. van Smeden J, Janssens M, Gooris GS, Bouwstra JA. The important role of stratum corneum lipids for the cutaneous barrier function. Biochim Biophys Acta - Mol Cell Biol Lipids. 2014;1841(3):295-313.
18. Kitatani K, Idkowiak-Baldys J, Hannun YA. The sphingolipid salvage pathway in ceramide metabolism and signaling. Cell Signal. 2008;20(6):1010-1018.
19. Kligman AM. Corneobiology and corneotherapy– a final chapter. Int J Cosmet Sci. 2011;33(3):197-209.
20. Madison KC. Barrier function of the skin: “la raison d’être†of the epidermis. J Invest Dermatol. 2003;121(2):231-241.
21. Bouwstra JA, Gooris GS, Ponec M. Skin lipid organization, composition and barrier function. Int J Cosmet Sci. 2008;30(5):388-388. 22. Yu G, Zhang G, Flach CR, Mendelsohn R. Vibrational spectroscopy and microscopic imaging: novel approaches for comparing barrier physical properties in native and human skin equivalents. J Biomed Opt. 2012;18(6):061207.
23. Guy RH. Skin – 'that unfakeable young surface’. Skin Pharmacol Physiol. 2013;26(4-6):181-189.
24. Celli A, Crumrine D, Meyer JM, Mauro TM. Endoplasmic reticulum calcium regulates epidermal barrier response and desmosomal structure. J Invest Dermatol. 2016;136(9):1840-1847.
25. Haftek M, Teillon MH, Schmitt D. Stratum corneum, corneodesmosomes and ex vivo percutaneous penetration. Microsc Res Tech. 1998;43(3):242-249.
26. Elias PM, Feingold KR, eds. Skin Barrier. CRC Press; 2005. doi:10.1201/ b14173
27. Brandner J, Zorn-Kruppa M, Yoshida T, et al. Epidermal tight junctions in health and disease. Tissue Barriers. 2015;3(1-2):e974451.
28. Haftek M, Callejon S, Sandjeu Y, et al. Compartmentalization of the human stratum corneum by persistent tight junction-like structures. Exp Dermatol. 2011;20(8):617-621.
29. Bergmann S, von Buenau B, Vidal-y-Sy S, et al. Claudin-1 decrease impacts epidermal barrier function in atopic dermatitis lesions dose-dependently. Sci
2. Menon GK, Feingold KR, Elias PM. Lamellar body secretory response to barrier disruption. J Invest Dermatol. 1992;98(3):279-289.
3. Eckert RL, Sturniolo MT, Broome A-M, et al. Transglutaminase function in epidermis. J Invest Dermatol. 2005;124(3):481-492.
4. Elias PM. Epidermal lipids, barrier function, and desquamation. J Invest Dermatol. 1983;80(1):S44-S49.
5. Brandner JM, Haftek M, Niessen CM. Adherens junctions, desmosomes and tight junctions in epidermal barrier function. Open Dermatol J. 2010;4(1):14-20.
6. Danzberger J, Donovan M, Rankl C, et al. Glycan distribution and density in native skin’s stratum corneum. Skin Res Technol. 2018;24(3):450-458.
7. Rankl C, Zhu R, Luengo GS, et al. Detection of corneodesmosin on the surface of stratum corneum using atomic force microscopy. Exp Dermatol. 2010;19(11):1014-1019.
8. Haftek M. Epidermal barrier disorders and corneodesmosome defects. Cell Tissue Res. 2015;360(3):483-490.
9. Milani P, Chlasta J, Abdayem R, et al. Changes in nano-mechanical properties of human epidermal cornified cells depending on their proximity to the skin surface. J Mol Recognit. 2018;31(9):e2722.
10. Guo S, Domanov Y, Donovan M, et al. Anisotropic cellular forces support mechanical integrity of the stratum corneum barrier. J Mech Behav Biomed Mater. 2019;92:11-23.
11. Potter A, Luengo G, Santoprete R, Querleux B. Stratum Corneum Biomechanics. In: Skin Moisturization. Informa Healthcare. 2009:259-278.
12. Luengo GS, Potter A, Ghibaudo M, et al. Stratum Corneum Biomechanics (Mechanics and Friction): Influence of Lipids and Moisturizers. In: Agache’s Measuring the Skin. Springer International Publishing. 2017:373-387.
13. Coderch L, López O, de la Maza A, Parra JL. Ceramides and skin function. Am J Clin Dermatol. 2003;4(2):107-129.
14. Janssens M, van Smeden J, Gooris GS, et al. Increase in short-chain ceramides correlates with an altered lipid organization and decreased barrier function in atopic eczema patients. J Lipid Res. 2012;53(12):2755-2766.
15. Wertz PW, Miethke MC, Long SA, Strauss JS, Downing DT. The composition of the ceramides from human stratum corneum and from comedones. J Invest Dermatol. 1985;84(5):410-412.
16. Breiden B, Sandhoff K. The role of sphingolipid metabolism in cutaneous permeabilitybarrier formation. Biochim Biophys Acta - Mol Cell Biol Lipids. 2014;1841(3):441-452.
17. van Smeden J, Janssens M, Gooris GS, Bouwstra JA. The important role of stratum corneum lipids for the cutaneous barrier function. Biochim Biophys Acta - Mol Cell Biol Lipids. 2014;1841(3):295-313.
18. Kitatani K, Idkowiak-Baldys J, Hannun YA. The sphingolipid salvage pathway in ceramide metabolism and signaling. Cell Signal. 2008;20(6):1010-1018.
19. Kligman AM. Corneobiology and corneotherapy– a final chapter. Int J Cosmet Sci. 2011;33(3):197-209.
20. Madison KC. Barrier function of the skin: “la raison d’être†of the epidermis. J Invest Dermatol. 2003;121(2):231-241.
21. Bouwstra JA, Gooris GS, Ponec M. Skin lipid organization, composition and barrier function. Int J Cosmet Sci. 2008;30(5):388-388. 22. Yu G, Zhang G, Flach CR, Mendelsohn R. Vibrational spectroscopy and microscopic imaging: novel approaches for comparing barrier physical properties in native and human skin equivalents. J Biomed Opt. 2012;18(6):061207.
23. Guy RH. Skin – 'that unfakeable young surface’. Skin Pharmacol Physiol. 2013;26(4-6):181-189.
24. Celli A, Crumrine D, Meyer JM, Mauro TM. Endoplasmic reticulum calcium regulates epidermal barrier response and desmosomal structure. J Invest Dermatol. 2016;136(9):1840-1847.
25. Haftek M, Teillon MH, Schmitt D. Stratum corneum, corneodesmosomes and ex vivo percutaneous penetration. Microsc Res Tech. 1998;43(3):242-249.
26. Elias PM, Feingold KR, eds. Skin Barrier. CRC Press; 2005. doi:10.1201/ b14173
27. Brandner J, Zorn-Kruppa M, Yoshida T, et al. Epidermal tight junctions in health and disease. Tissue Barriers. 2015;3(1-2):e974451.
28. Haftek M, Callejon S, Sandjeu Y, et al. Compartmentalization of the human stratum corneum by persistent tight junction-like structures. Exp Dermatol. 2011;20(8):617-621.
29. Bergmann S, von Buenau B, Vidal-y-Sy S, et al. Claudin-1 decrease impacts epidermal barrier function in atopic dermatitis lesions dose-dependently. Sci
