Skin barrier function, as indicated by TEWL, also showed significant improvements with both products from baseline to week 4 (P<0.05), however, differences between the two products were not statistically significant.
According to the tape stripping results, both products significantly increased ceramide levels for the arm and leg at week 4 compared to baseline (Figure 3). There was no significant difference in ceramide synthesis between the two products at week 4.
As shown in Figure 4, ESM application resulted in an overall skin improvement in a diverse panel (White, Asian, and African American). Eczema and eczema-prone skin present differently in patients with skin of color. Currently, its variations are not well represented visually. Healthcare professionals need to be able to recognize the differences in order to properly manage a patient's eczema. As can be appreciated in the photos, eczema skin can have a different hue in darker skin types and can also sometimes manifest as an ashen gray appearance.
The participant-perception questionnaire showed that 98.1% of ESM-treated participants and 94.2% of IRML-treated participants felt their skin was softer, with 94.2% of participants in both groups reporting their skin was soothed at week 1. At week 4, participants reported their skin was healthiest (93.3% ESM, 90.0% IRML), their eczema-prone skin had significantly improved (93.3% ESM, 88.3% IRML), and was completely soothed (93.3% ESM, 91.7% IRML). In addition, when asked about their preferences, 50% of participants preferred ESM, 33.3% preferred IRML, and 16.7% had no prefer-ence. Further, 46.7% reported ESM provided better soothing ben-efits compared to 40.0% for IRML.
Safety
Two adverse events occurred during the study and were resolved; however, neither was considered related to the study products.
DISCUSSION
Both ESM and IRML significantly improved skin hydration and barrier function by corneometer and assessment of TEWL after 4 weeks of twice-daily application. ESM had a statistically significantly better effect in hydrating the skin when compared to IRML at week 4. Both products increased skin ceramide content, with no significant differences between them. Participants reported favorable perceptions of both products, but there was a numerical trend in favor of ESM. As shown via clinical photography, ESM was effective and suitable for a range of skin types, which is important in the representation, diagnosis, and treatment of those with eczema and eczema-prone skin across diverse populations.
Supplementation of ceramides through topical products is an important way to support a healthy skin barrier with OTC treatments, and both products tested in this study increased skin ceramide levels. However, moisturizers should not rely on ceramide supplementation alone.9 ESM has additional beneficial ingredients compared to IRML, such as colloidal oatmeal, a well-established soothing ingredient, and the filaggrin technology including the breakdown products, arginine, and sodium PCA. In eczema, filaggrin abnormalities encourage invasion of foreign substances including antigens and microbes, which in turn trigger allergic reactions.4,10 Thus, the inclusion of filaggrin technology helps to support skin barrier
