Ceramide-Containing Adjunctive Skin Care for Skin Barrier Restoration During Acne Vulgaris Treatment

June 2023 | Volume 22 | Issue 6 | 554 | Copyright © June 2023


Published online May 16, 2023

doi:10.36849/JDD.7142 

Zoe Diana Draelos MDa, Nada Baalbaki PhDb, Gene Colon JDb, Brigitte Dreno MD PhDc

aDermatology Consulting Services , PLLC, High Point, NC
bCeraVe, New York, NY
cNantes Université, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, Nantes, France

Abstract
Barrier damage caused by facial acne vulgaris can be magnified by topical medication, such as adapalene (0.3%) and benzoyl peroxide (2.5%)(A/BPO), which utilizes a retinoid to normalize follicular keratinization and BPO to decrease the C. acnes population. Disease-induced irritation combined with topical medication-induced irritation results in dryness and enhanced inflammation leading to lower compliance and increased skin healing time. Ceramide-based moisturizers have documented barrier repair benefits for eczema but have not been studied for acne. The objective of this double-blind study was to measure the impact of acne treatment on skin barrier function and tolerance when paired with a ceramide routine. Participants were prescribed an A/BPO gel once daily. The treatment group received a ceramide-containing foaming facial cleanser and facial lotion, and the control group received basic foaming face wash for twice-daily use. Participant and investigator tolerability and efficacy were evaluated by both ordinal and clinical measures. Acne lesion counts and Investigator’s Global Assessments (IGA) of acne were obtained along with transepidermal water loss (TEWL) measurements for barrier function. TEWL for the treatment group remained significantly lower than the control at all timepoints and significantly improved from baseline by week 12. The treatment group had statistically lower mean investigator scores for dryness at all timepoints. Inflammatory lesion counts were significantly lower for the treatment group. A/BPO damaged the skin barrier, demonstrated by elevated TEWL, contributing to dryness, redness, and scaling. Use of a ceramide-containing cleanser and moisturizer significantly reduced severity and incidence of dryness, erythema, and scaling while more quickly resolving barrier damage and restoring function.


Draelos ZD, Baalbaki N, Colon G, et al. Ceramide-containing adjunctive skin care for skin barrier restoration during acne vulgaris treatment. J Drugs Dermatol. 2023;22(6):554-558. doi:10.36849/JDD.7142 

INTRODUCTION

Acne vulgaris is a chronic inflammatory skin disease of the pilosebaceous unit, characterized by permeability barrier dysfunction and reduced ceramide levels in the stratum corneum.1,2 Unfortunately, many acne medications, such as retinoids and benzoyl peroxide (BPO), cause irritation as a side effect, which can worsen underlying disease-related barrier issues.3 This irritation can be measured as increased transepidermal water loss (TEWL) and decreased stratum corneum hydration. Functionally, this irritation can result in activation of the innate immune system with subclinical inflammation and proteomic changes, such as increased filaggrin expression and decreased free fatty acid and linoleic acid production.4 Thus, the barrier alterations inherent in acne may be magnified by irritating topical treatments, decreasing patient adherence, and hampering disease resolution.5

Carefully formulated and selected adjunctive skincare products can minimize additive barrier damage. A moisturizer effective in acne medication-induced irritation must provide occlusion to control TEWL, include humectants to attract water to the dehydrated epidermis, contain emollients to smooth the desquamating skin scale, and include physiological lipids to encourage regeneration of the lipid bilayer. This research examined the effect of a ceramide-based skincare regimen as compared to a non-ceramide-containing skincare regimen in participants with moderate facial acne who used adapalene (0.3%) and benzoyl peroxide (2.5%)(A/BPO) once daily in the evening. The goal was to determine the value of ceramides in mitigating acne medication-enhanced barrier dysfunction.

MATERIALS AND METHODS

Male and female participants aged 13 to 40 years with Fitzpatrick skin types I-VI and moderate facial acne (IGA = 3) with oily/combination skin types were enrolled in this single center double-blinded randomized study. Participants possessed a minimum of 15 inflammatory lesions and 15 non-inflammatory lesions. Participants signed an IRB-approved informed consent/assent (Allendale Institutional Review Board, Old Lyme, CT) prior to initiating any study activities and were assessed at baseline, week 1, week 4, week 8, and week 12. Participants were excluded if they had used any topical prescription or over-the-counter (OTC) acne medications in the past 2 weeks
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