Natural Moisturizing Factor-Enriched Formulations Compared to a Ceramide-Based Cream

While the focus on barrier repair with topical moisturization has often centered on the inclusion of ceramides in formulations, the utilization of additional ingredients, including NMFs, has not received adequate attention to their potential importance in moisturizer formulations. In this study, we demonstrate the statistical superiority of both a ceramide plus NMF cream and a ceramide plus NMF lotion compared to a ceramide cream based on recognized objective methods of testing hydration after 10 days of daily application. While all 3 formulations improved skin hydration, as indicated by the significant increase in corneometer units from baseline, the ceramide plus NMF cream and ceramide plus NMF lotion demonstrated a significantly higher increase in skin hydration as compared to baseline and as compared to the ceramide cream.

Ceramides and NMFs are major SC components that contribute to maintaining skin hydration.¹⁵ NMFs originate from the breakdown of filaggrin and include hydrophilic amino acids, and their derivatives such as PCA, UCA, lactic acid, sugars, organic acids, peptides, and urea, which collectively are associated with the establishment of a physiologic water gradient in the SC.^16-18 

The increased role of NMFs in skin barrier function continues to be elucidated, with recent studies demonstrating the importance of NMFs in skin barrier function in atopic dermatitis (AD).¹⁹ Decreases in NMF are attributed to both intrinsic and extrinsic factors, which are associated with xerotic skin, increased surface pH, and increased risk for worsening of AD.¹⁹ The addition of NMFs in well-formulated topical moisturizers has previously been shown to augment skin hydration by supporting the maintenance of water content in dehydrated conditions, thus retaining the optimal fluidity and function in SC lipid and protein components.²⁰ Exposure of the skin to commonly encountered external daily conditions that can impair epidermal barrier function, including washing, showering, and bathing, or the use of occlusive sanitary products such as diapers, which can deplete important hydrophilic compounds of the SC, including NMFs. This depletion markedly affects the ability of the SC to attract and maintain water, leading to a cascade of events that can steadily progress to severe xerosis and eczematous dermatitis, both associated with pruritus and increased potential for microbial colonization.^21,22 These data and the results of our study suggest that the utilization of a moisturizer (cream or lotion) that contains both ceramides and NMFs may be a more optimal formulation, compared to a ceramide cream alone, for maintaining skin hydration, improving barrier function, and decreasing the clinical sequela associated with dry skin.