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

adverse events were mild; however, they were significantly less in severity and quicker to resolve for participants using the ceramide-based skincare regimen. The use of adjunctive skin care to improve local tolerance is well accepted, but the direct impact of skin care to maintain and restore an intact skin barrier in successful acne treatment outcomes is less investigated.¹⁰ Skin cleanser with an acidic pH is also important in acne treatment to restore a normal profile of microbiome and to remove sebum from the skin surface without damaging the intercellular lipids previously discussed. The ceramide treatment cleanser contained Ceramides 1 (EOP), 3 (NP), and 6-II (AP) in addition to cholesterol and niacinamide. It also contained the humectants glycerin and hydrolyzed hyaluronic acid. Finally, it was sulfate-free, using milder alternative surfactants such as cocamidopropyl hydroxysultaine and sodium lauroyl sarcosinate, with a slightly acidic pH of pH 5.8 (± 0.3). The control cleanser contained sodium cocoamphoacetate and sodium laureth sulfate, which may be more aggressive surfactants. This may in part have accounted for the better investigator ratings for the ceramide treatment group in terms of dryness, erythema, and scaling.

Perhaps the most significant difference between the two groups was the addition of the ceramide-containing moisturizer to the ceramide treatment group. The ceramide moisturizer contained ceramides 1 (EOP), 3 (NP), and 6-II (AP) in a physiologically relevant form. In addition, dimethicone is present to decrease TEWL through occlusion, and glycerin and hyaluronic acid are present as humectants. Niacinamide is incorporated to decrease inflammation, while cholesterol is included as a naturally occurring lipid. All these barrier repair ingredients are presented to the skin in a multivesicular emulsion (MVE). This is a physical emulsion created during formulation due to the presence of behentrimonium methosulfate, which results in the formation of multi-lamellar spheres that release ingredients onto the skin over time. This sustained-release emulsion accounts for the longevity of the moisturizer formulation on the skin and the cumulative benefit that was seen with increased use of the product over the 12-week study period. With the application of the ceramide-containing moisturizer, it was relevant to investigate any potential dilutive effect on activity of the A/BPO treatment. The ceramide treatment group showed equivalent improvement in acne to the control group in inflammatory and non-inflammatory lesion counts, indicating no interference with acne resolution. 

Cleansers and moisturizers play an important role in acne treatment during the various phases of therapy. During the facial retinization phase, this research demonstrated a less severe rise in TEWL during the first week of treatment in the ceramide treatment group over the control group. With continued retinoid exposure, the skin becomes retinized and demonstrates less irritation. This was seen with a continued decrease in TEWL for both groups at weeks 4, 8, and 12; however, the ceramide treatment group had a statistically significant superior TEWL reduction, indicating better restoration of the skin barrier. Decreased TEWL and irritation seen with the addition of ceramide-containing skin care are expected to be associated with an increase in patients’ compliance with the treatment regimen.¹¹ Finally, once acne is resolving, skincare maintenance is necessary to preserve the skin barrier and maintain skin health. Thus, this research may have demonstrated the value of ceramide-containing adjunctive skin care in the initiation, resolution, and maintenance phases of acne therapy.¹¹