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Ceramides are essential for healthy skin, but the real solution to restoring barrier function lies in the right combination of essential lipids.

The skin is our largest organ and the skin barrier bears the heavy responsibility of being the first line of defence against moisture loss, irritants and bacteria. When examined closely, it’s a marvel of construction with multiple layers creating a complex matrix.

Out of the three essential lipids in the skin barrier, ceramides are the dominant lipid, together with cholesterol and free fatty acids in a ratio of 50%, 25% and 15% respectively.^R1

Eczema-prone skin contains reduced levels of this essential component, by as much as 30-50% compared to normal skin, leading to impaired barrier function.^R2 As a result, a vicious cycle ensues:

• The skin loses moisture more easily in a process known as transepidermal water loss (TEWL)
• Skin becomes unable to repel irritants and is easily aggravated; this is a common feature in skin conditions like eczema.
• Skin becomes dry, uncomfortable and itchy
• Scratching leads to further damage of the skin barrier.^R3

The solution to breaking this cycle lies in maintaining the right balance of ceramides. In the case of eczema-prone skin, it becomes necessary to correct the balance of lipids topically.^R4

There are nine types or subclasses of ceramides in the topmost level of the skin, known as the stratum corneum.^R4 Any or all of these may be found in topical applications, with ceramides 1, 3, and 6-II commonly used to help dry, irritated skin conditions.^R5 They are further distinguished as free human skin ceramides or protein bound ceramides based on their chemical structure, of which there are 18 types such as ceramide NS, ceramide AdS, ceramide EOH and so forth.^R6

With such a wide variety and many options on pharmacy shelves, it’s hard to know what works. Furthermore, it’s tempting to think that more is better – after all, the goal is to replenish low ceramide levels.

However, research shows that, firstly, ceramides are specialists hence all ceramides are not considered equal when it comes to restoring barrier function. Secondly, in addition to using the right type of ceramide, it’s also important to use it in the right balance.

Ceramide PC-104, also known as Hydroxylpropyl Bispalmitamide MEA,^R7 when used in ceramide-dominant formulations in a 3:1:1 ratio of ceramide:cholesterol:free fatty acids, is clinically proven to repair the skin’s protective barrier.^R8

Significantly, repeated research has shown that application of only one or two out of these three lipids, or a combination of all three that does not comply with this ratio, does not produce the same barrier-strengthening results; this further reinforces the importance of using the right balance of essential lipids.^R9

This balance lies at the core of Ceradan^®, a specialised range of ceramide-dominant skincare employing the optimal 3:1:1 ratio of essential lipids to repair the skin barrier and restore its natural function in order to provide relief to those who suffer eczema-prone skin.

In a study involving 58 children with mild-to-moderate eczema:

• The use of Ceradan^® Moisturising Wash and Ceradan^® Skin Barrier Repair Cream applied twice daily for 12 weeks prevented recurrence or dry, irritated skin in 45.5% of the children.
• This improvement was supported in both patient-centric reporting known as PEST (Patient eczema severity time) as well as through clinical observation using the widely-used SCORAD (SCORing of Atopic Dermatitis) method.
• With ongoing use, the children’s skin barrier function continued to improve
• Almost 90% of the participants stated that they would like to continue with the regimen^R10

These results, indicating clear and measurable improvements in skin barrier function, further support the existing body of research that a ceramide-dominant formulation with the correct balance of essential lipids, together with the use of topical anti-inflammatory or steroid creams where necessary, are an effective strategy for long-term management of eczema-prone skin. As eczema is common among young children, this regimen may also help with reducing dependence on steroid-based treatments.

For more information about managing eczema and solutions for strengthening the skin barrier, speak to your doctor for advice.

Results may vary.

References:

1. Vávrová K., Kováčik A., Opálka L. Ceramides in the Skin Barrier, Eur. Pharm. J. 2017, 64 (2): 28-35.
2. Data on file
3. Jonathan I. Silverberg, Diane B. Nelson & Gil Yosipovitch (2016) Addressing treatment challenges in atopic dermatitis with novel topical therapies, Journal of Dermatological Treatment, 27:6, 568-576, DOI: 10.1080/09546634.2016.1174765
4. Myeong Jun Choi and Howard I. Maibach, Role of Ceramides in Barrier Function of Healthy and Diseased Skin, Am J Clin Dermatol 2005; 6 (4): 215-223
5. Everything You Should Know About Using Ceramides, Healthline. https://www.healthline.com/health/beauty-skin-care/ceramide
6. Vávrová K., Kováčik A., Opálka L. Ceramides in the Skin Barrier, Eur. Pharm. J. 2017, 64 (2): 28-35.
7. Hydroxypropyl bispalmitamide monoethanolamide, https://pubchem.ncbi.nlm.nih.gov/compound/Hydroxypropyl-bispalmitamide-monoethanolamide
8. Mao-Qiang et al (1993a). Optimization of Physiological Lipid Mixtures for Barrier Repair. The Society for Investigative Dermatology, Inc. Vol. 106, No. 5 May 1996
9. Myeong Jun Choi and Howard I. Maibach, Role of Ceramides in Barrier Function of Healthy and Diseased Skin, Am J Clin Dermatol 2005; 6 (4): 215-223
10. Koh MJ et al. Comparison of the Simple Patient-Centric Atopic Dermatitis Scoring System PEST with SCORAD in Young Children Using a Ceramide Dominant Therapeutic Moisturizer. Dermatol Ther (Heidelb) (2017) 7:383–393, DOI 10.1007/s13555-017-0186-1