Ceramide Moisturizer Relieves Atopic Dermatitis Symptoms

Laurie Barclay, MD

August 12, 2002

Aug. 12, 2002 -- As an adjunct to anti-inflammatory medications, a moisturizer containing ceramide dramatically improved atopic dermatitis symptoms and reversed underlying damage, according to a report in the August issue of the Journal of the American Academy of Dermatology.

"Topical glucocorticoids and other immunosuppressive agents are mainstays of therapy, but the risk of toxicity from these agents is not insignificant, particularly in children," write Sarah L. Chamlin, MD, and colleagues from the University of California, San Francisco. "Because stratum corneum permeability barrier function is also abnormal in atopic dermatitis, it has been hypothesized that the barrier abnormality could drive disease activity. Yet commonly used emollients and moisturizers do not correct the stratum corneum ceramide deficiency, the putative cause of the barrier abnormality."

The investigators substituted a newly developed, ceramide-dominant, physiologic lipid-based emollient for currently used moisturizers in 24 children who were also receiving standard therapy for stubborn-to-recalcitrant atopic dermatitis. Except for the moisturizer, all subjects continued prior therapy such as topical tacrolimus or corticosteroids. After 12 weeks of twice-daily treatment, patients were able to reduce the moisturizer dose to once per day.

Severity scoring of atopic dermatitis (SCORAD) values improved significantly in 22 of 24 patients by three weeks, with additional progressive improvement in all patients between six and 21 weeks. Transepidermal water loss levels were elevated at study entry, decreased in parallel with SCORAD scores, and continued to decline even after SCORAD scores plateaued.

Integrity and hydration in the stratum corneum also improved slowly but significantly during treatment, and electron microscopy revealed new appearance of extracellular lamellar membranes.

"These studies suggest that a ceramide-dominant, barrier repair emollient represents a safe, useful adjunct to the treatment of childhood atopic dermatitis, and that transepidermal water loss level is at least as sensitive an indicator of fluctuations in atopic dermatitis disease activity as are SCORAD values," the authors write. "It is currently fashionable to consider atopic dermatitis, like other inflammatory dermatoses, as immunologic in pathogenesis ("inside-outside" hypothesis).... These studies support the outside-inside hypothesis as a component of pathogenesis in atopic dermatitis and other inflammatory dermatoses that are accompanied by a barrier abnormality."

The senior author on this study is a consultant for Osmotics Corporation.

J Am Acad Derm. 2002;47(2):198-208

Reviewed by Gary D. Vogin, MD

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