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

(Figure 2b). Finally, scaling was significantly reduced in the ceramide treatment group at week 1 and completely resolved by week 12 (Figure 2c). Thus, the ceramide treatment group outperformed the control group in all investigator-assessed parameters by the completion of the week 12 study.

The investigator assessments were mirrored by the participant assessments (Figure 3). The participants rated the ceramide treatment regimen as superior to the control regimen beginning at week 1 and continuing through week 12 in terms of skin dryness, tightness, and comfort. Most participants (97.8%) were satisfied with the ceramide treatment regimen.

The study also addressed whether the ceramide-based skincare regimen interfered with acne resolution. Inflammatory and noninflammatory acne lesion counts were obtained at each visit. Both regimens contained the prescription acne medication so both regimens resulted in a decrease in inflammatory and non-inflammatory lesion counts (Figure 4). Thus, the ceramide treatment regimen did not interfere with the prescription acne medication.

Skin with acne is associated with alterations of the skin barrier function, proliferation, and composition, induced by increased sebum rich in unsaturated free fatty acids.⁶ The skin barrier is increasingly important in acne as medications are prescribed that can further impair barrier function. This research examined the role of ceramides in restoring the skin barrier as applied in a cleanser and moisturizer to skin treated with A/BPO. BPO is an antiinflammatory substance, producing concentration-dependent irritation, while topical retinoids such as second-generation adapalene is comedolytic, disrupting the stratum corneum and inducing acanthosis, epidermal dysadhesion, and desmosomal shedding.⁷ This results in irritation that decreases patient compliance and slows down acne resolution. Therefore, there is a need for a regimen that is effective but will not induce side effects that contribute to low adherence.¹¹

TEWL, which is a measure of permeability barrier disruption, is minimized by hydrophobic intercellular lipids. Irritants can increase TEWL by denaturing epidermal proteins, damaging the natural moisturizing factor (NMF), and removing intercellular lipids.⁸ The intercellular lipids are derived from lipid precursors secreted by NMF in the granular layer. The composition of the intercellular lipids is 50% ceramides, 25% cholesterol, and 10% to 20% non-essential free fatty acids.⁹ Endogenous ceramides play a role in intercellular lipid lamellar organization, skin water retention, cell cycle control, and apoptosis. When applied exogenously, they are thought to integrate into the intercellular lipids, contribute to the skin barrier function, and increase NMF contents in the stratum corneum. This research functionally demonstrated that the ceramide-based skincare treatment regimen significantly reduced TEWL over the control regimen after 4, 8, and 12 weeks of twice-daily application when used with a topical prescription A/BPO acne medication. Paralleling the restoration of skin barrier function, adjunctive application of the ceramide-containing skincare routine with tretinoin A/ BPO significantly improved tolerance, alleviating dryness, scaling, and erythema. For all participants, these cutaneous