Supplement Individual Article: The Importance of a Healthy Skin Barrier From the Cradle to the Grave Using Ceramide-Containing Cleansers and Moisturizers: A Review and Consensus

February 2023 | Volume 22 | Issue 2 | SF344607s3 | Copyright © February 2023


Published online January 31, 2023

Lawrence A. Schachner MD FAAD FAAPa, Andrew F. Alexis MD MPH FAADb, Anneke Andriessen PhDc, Hilary Baldwin MDd, Michael J. Cork MB PhD FRCPe, Robert S. Kirsner PhD FAADa, Heather Woolery-Lloyd MD FAADa

aDr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, FL
bDepartment of Dermatology, Weill Cornell Medicine, New York, NY
cRadboud UMC Nijmegen, Andriessen Consultants, Malden, The Netherlands
dAcne Treatment & Research Center, Brooklyn, NY
eSheffield Dermatology research. Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK

Abstract
Introduction: Inflammatory skin disorders compromise skin barrier health. Early and daily skincare use aims to maintain a life-long healthy skin barrier. Racial/ethnic and age variations in skin barrier properties, cultural differences, and clinical presentation of the inflammatory skin disorder influence the choice of treatment and skin care. Ceramide-containing skin care may play a role in restoring and maintaining a healthy skin barrier.
Methods: A panel of 6 dermatologists met to develop consensus statements based on their 8 previous publications on promoting skin barrier health throughout life using ceramide-containing skin care. The publications covered skin barrier integrity in the newborn and infant, and the role of the skin barrier in mitigating atopic dermatitis (AD); racial/ethnic variations in the skin barrier and implications for skin care; the role of the skin barrier in inflammatory skin conditions including acne, AD and psoriasis in skin of color (SOC) populations; skin barrier integrity in patients with rosacea; and xerosis in patients with diabetes mellitus. The panel synthesized the 8 publications, selected information from a literature review, and their expert opinions and experiences to create the statements. The consensus was reached through a modified Delphi method where the panel met face-to-face and followed up virtually.
Results: The panel adopted 6 consensus statements highlighting the importance of skin care in restoring/maintaining a healthy skin barrier in the populations mentioned above. Skin care suited to this role is gentle, has near-physiologic pH, is pleasant to use, and contains ceramides. This type of skin care can promote a healthy skin barrier and attenuate or delay inflammatory skin conditions.
Conclusions: Adjunctive daily skin care throughout life promotes a healthy skin barrier and is beneficial in managing various inflammatory skin disorders in all populations. However, when choosing optimal treatment and skin care, physicians should consider variations in age, skin properties, presentation of the condition, and cultural differences.

J Drugs Dermatol. 2023;22:2(Suppl 1):s3-14.

INTRODUCTION

The skin is the largest organ of the human body, accounting for approximately 16% of total body weight, and has numerous critical functions. It retains water in the body, thermoregulates, blocks external pathogens and foreign substances, and transmits sensations.1

The skin's protective and regulatory barrier function is primarily achieved within the top layer of the epidermis, the stratum corneum (SC).2 The SC is the outermost layer of the skin and consists of 10 to 15 layers of corneocytes (enucleated protein-rich cells) and highly organized intercellular lipids. The corneocytes are the building blocks, and the water-resistant lipid lamellae are the matrix, forming a "brick-and-mortar"-like structure that prevents excess water loss and protects against external toxins and microorganisms.1,3

Skin lipids play a significant role in SC barrier function. Close to 20% of the volume of the SC is made up of lipids. These lipids consist of 40% to 50% ceramides, 25% cholesterol, and 10% to 15% free fatty acids.3,4 Maintaining physiologic SC composition is important to preserving SC hydration and healthy skin from the cradle to the grave.

Harsh chemicals, surfactants, exfoliants, aggressive cleansers, trauma, and inflammatory skin diseases can damage the SC.3,5 Ceramide abnormalities change the SC's physiologic properties
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