Topical supplementation with physiological lipids rebalances the stratum corneum ceramide profile and strengthens skin barrier function in adults predisposed to atopic dermatitis
- PMID: 40408261
- DOI: 10.1093/bjd/ljaf200
Topical supplementation with physiological lipids rebalances the stratum corneum ceramide profile and strengthens skin barrier function in adults predisposed to atopic dermatitis
Abstract
Background: People with atopic dermatitis (AD) suffer from dry, itchy skin with reduced skin barrier function that leaves it prone to irritant and allergen penetration. Alterations in the composition and structure of the stratum corneum (SC) lipid lamellae underpin this increase in permeability. A wide range of emollients is used to ameliorate the skin of patients with AD, but the majority have unclear effects on the lipid lamellae and barrier function.
Objectives: To compare the effects of a multivesicular emulsion containing physiological lipids and glycerine (MVE + GL) with a commonly prescribed oil-in-water emulsion containing glycerine without physiological lipids (O/W + G).
Methods: A double-blind intraparticipant-controlled study was undertaken in adults with a history of eczema. Participants applied MVE + GL to one forearm and lower leg and O/W + G to contralateral sites twice daily for 28 days. Skin properties were assessed before and after treatment. A detailed lipidomic profile was generated from SC samples, alongside in vivo attenuated total reflectance Fourier transform infrared spectroscopic analysis of its molecular composition.
Results: Fifty-eight people were included in the study [mean (SD) age 46 (21) years]. At sites treated with MVE + GL skin barrier integrity improved significantly [mean (SD) transepidermal water loss after 20 skin tape strips (TEWL20) 38.02 (18.64) g m-2 h-1 pretreatment vs. 29.79 (13.47) g m-2 h-1 post-treatment; P < 0.001], whereas O/W + G had no effect [35.6 (18.39) g m-2 h-1 vs. 37.4 (16.69) g m-2 h-1]. Concordantly, skin sensitivity to sodium lauryl sulfate (SLS) was significantly reduced by MVE + GL treatment [mean (SD) post-SLS TEWL 35.58 (15.43) g m-2 h-1 pretreatment vs. 29.54 (11.64) g m-2 h-1 post-treatment (P < 0.001); erythema was also reduced]. Skin moisture increased more rapidly at sites treated with MVE + GL vs. O/W + G, leading to a more rapid reduction in visual skin dryness. Over 1600 lipid species were detected in the SC. Ceramide species NP (non-hydroxy-phytosphingosine) and AP (α-hydroxy-phytosphingosine) with 18-carbon sphingoid bases, both ingredients of the MVE + GL, increased significantly by 24% and 19%, respectively, following MVE + GL treatment. In contrast, changes of 9% for NP(18) and 6% for AP(18) were not statistically significant at sites treated with O/W + G. Increased abundance of NP(18) species relative to NdS (non-hydroxy-dihydrosphingosine) species was related to improvements in skin barrier integrity.
Conclusions: While the glycerine-containing emollient reduced skin dryness, it had no impact on barrier function. In contrast, MVE + GL improved the physical integrity of the barrier and reduced the sensitivity of the skin.
Plain language summary
Eczema is the most common chronic skin condition. It affects 1% to 10% of adults in Europe. The upper layers of our skin form a barrier that keeps water in our bodies and stops irritants from getting in. This skin barrier is made of cells called ‘corneocytes’. These are surrounded by a tough protein envelope and embedded in a network of ‘fatty’ molecules (called ‘lipids’). The composition of these fatty molecules is altered in the skin of people with eczema. The skin does not function effectively as a barrier as more water is lost, and irritants can more easily penetrate the deeper skin layers. Moisturizing creams are an effective treatment for eczema, but it is unclear which are most appropriate to use. This study was carried out in the UK. We aimed to find out if a cream containing lipids found in skin could improve the skin’s ability to act as a barrier. We compared this cream to one without these lipids. We asked 58 people with eczema to apply these creams separately on their forearms for a month and measured how the skin responded. We found that skin treated with the cream containing skin-identical lipids lost less water. It was also more resistant to physical damage and was less sensitive to irritation than before treatment. In contrast, the cream without lipids did not improve the skin barrier. Both creams improved dryness, but quicker results were found for the cream containing the lipids found in skin. Our findings suggest that the addition of skin-identical lipids to moisturizing creams is a promising way of improving skin barrier function.
© The Author(s) 2025. Published by Oxford University Press on behalf of British Association of Dermatologists.
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