Educate and remind patients to use appropriate OTC products to help protect, restore and maintain the natural skin barrier.
The skin is considered the first line of defense to protect the human body from external factors that can affect or damage the skin, such as allergens, chemicals, ultraviolet (UV) exposure, infections and stress.1.2
Internally, the skin helps support homeostasis and protects the body from increased water loss.1.2 Furthermore, the skin barrier is responsible for filtering 60% to 70% of UVB rays.3 The essential components of the skin barrier are ceramides, which make up about 50% of the lipids present within the skin barrier.3
Ceramides, which are the main lipids in the outermost layer of the epidermis, known as the stratum corneum, contribute to the intercellular lipid bilayer, which is directly involved in the regulation of transepidermal water loss.4
The 3 main functions of ceramides in the skin barrier and skin care are the improvement of hydration, the prevention or treatment of dermatological conditions and the homeostasis of the skin barrier.5 Research has clearly shown that alterations in the lipid composition of the stratum corneum, disruption of the barrier and low levels of cutaneous ceramides can cause the manifestation of skin disorders associated with barrier defects, including acne, atopic dermatitis, photosensitivity, rosacea, UV damage. and xeroderma.4-8
Establishing a skin care regimen is essential for promoting and maintaining dermatological health and in the prevention and treatment of common skin diseases.
Pharmacists can assist patients seeking guidance on selecting the various OTC skin care products on the market and provide them with relevant clinical information on the essential roles of ceramides in dermatological health.
The results of numerous studies have shown that the use of products containing ceramides improves hydration and resilience, supports the health of the skin’s natural skin barriers and counteracts skin dryness. These are all factors that can contribute to or exacerbate the onset of many common skin problems. Various publications have indicated that ceramide levels are reduced or are structurally abnormal in skin conditions, such as acne, atopic dermatitis, ichthyosis, psoriasis, rosacea, and surfactant-damaged skin.9.10 Research has also shown that the use of skin care products containing ceramide decreases the disease severity of many common skin conditions and improves skin function.11.12
The results of a study published in the Journal of Drugs in Dermatology showed that the implementation of a moisturizer and sunscreen containing ceramide protects against UV-induced changes in the skin barrier by improving skin hydration, preserving normal morphology and turnover. of superficial skin cells and contrasting erythema and hyperpigmentation.13
In addition to improving the appearance of lesions and minimizing skin irritation, the study results showed that providing skin-identical stratum corneum lipids could add benefits to patients’ daily routines by strengthening the barrier and improving skin health. against chronic sun exposure.13
In another study published in the Journal of Drugs in Dermatology, the authors indicated that restoring the skin barrier, particularly the role of locally applied mixtures of ceramides, cholesterol, and essential / non-essential free fatty acids strengthens the compromised skin barrier and relieves symptoms and discomfort related to skin barrier disorders.14
The results of another study indicated that moisturizers containing ceramides have clinically demonstrated the ability to support the management of skin diseases, such as atopic dermatitis, by decreasing disease severity and relapses and improving patients’ perception of overall skin health and quality.15
Pharmacists can broaden awareness of the clinical benefits associated with the use of skin care cleansers, moisturizers, and sunscreen products containing ceramide. Ceramides commonly found in OTC products can be listed as ceramide AP, ceramide EOP, ceramide NG, ceramide NP, ceramide NS, phytosphingosine and sphingosine. Pharmacists can educate patients to avoid skin care products that exacerbate or irritate common skin conditions and are also in a key position to identify patients at risk for possible hyperpigmentation, photosensitivity and xerosis reactions due to
the use of some pharmacological agents, such as loop diuretics, non-steroidal anti-inflammatory drugs, phenothiazines, quinine, statins, tetracyclines, thiazides, vemurafenib and voriconazole.16 Advise patients using these pharmacological agents to always use a sunscreen product with a sun protection factor of 30 or greater when going outdoors, especially for long periods of time.17
Establishing a skincare regimen is key to maintaining healthy and hydrated skin, and taking preventative measures can also help reduce or eliminate common skin problems. Pharmacists can help educate and remind patients about the use of OTC skin care products that contain ceramides, which can maintain, protect and restore the natural skin barrier and overall dermatological health. Pharmacists should also be familiar with guidelines for the management and treatment of common dermatological conditions as outlined by the American Academy of Dermatology Association.18
1. Yousef H, Alhajj M, Sharma S. Anatomy, skin (integument), epidermis. StatPearls; 2021.
2. Kanwar AJ. Skin barrier function. Indian J Med Ris. 2018; 147 (1): 117-118. doi: 10.4103 / 0971-5916.232013
3. New research reveals the impact of UV exposure on the skin barrier and benefits of ceramides. CeraVe. July 8, 2021. Accessed November 30, 2021. https://www.prnewswire.com/news-releases/ new-research-reveals-the-impact-of-uv-exposure-on-the-skin-barrier-the -benefits-of-ceramides-301327759.html
4. Del Rosso JQ. Body cleanser containing ceramide and keratolytic and cream application in patients with psoriasis: results of a study on use by consumers. J Clin Estet Dermatol. 2019; 12 (7): 18-21.
5. Li Q, Fang H, Dang E, Wang G. The role of ceramides in skin homeostasis and inflammatory skin diseases. J Dermatol Sci. 2020; 97 (1): 2-8. doi: 10.1016 / j.jdermsci.2019.12.002
6. Purnamawati S, Indrastuti N, Danarti R, Saefudin T. The role of moisturizers in addressing various types of dermatitis: a review. Clin Med Ris. 2017; 15 (3-4): 75-87. doi: 10.3121 / cmr.2017.1363
7. Zeichner JA, Del Rosso JQ. Multivesicular emulsion moisturizers containing ceramide: an assessment of their role in the management of common skin disorders. J Clin Estet Dermatol. 2016; 9 (12): 26-32.
8. Kahraman E, Kaykın M, Şahin Bektay H, Güngör S. Recent advances in topical application of ceramides to restore skin barrier function. Cosmetics. 2019; 6 (3): 52. doi: 10.3390 / cosmetics6030052
9. Baldwin H, Alexis AF, Andriessen A, et al. Evidence of barrier deficiency in rosacea and the importance of integrating OTC skin care products into treatment regimens. Dermatol J Drugs. 2021; 20 (4): 384-392. doi: 10.36849 / JDD.2021.5861
10. Tan J, Schöfer H, Araviiskaia E, et al. The RISE study group. Prevalence of rosacea in the general population of Germany and Russia: the RISE study. J Eur Acad Dermatol Venereolo. 2016; 30 (3): 428- 434.doi: 10.1111 / jdv.13556
11. Lueangarun S, Tragulplaingam P, Sugkraroek S, Tempark T. The 24-hour, 28-day and 7-day post-moisturizing efficacy of moisturizer containing ceramides 1, 3, 6-II versus hydrophilic cream on dry skin and breakage of the barrier in the treatment of senile xerosis. Dermatol Ter. 2019; 32 (6): e13090. doi: 10.1111 / dth.13090
12. Draelos ZD, Baalbaki NH, Raab S, Colón G. The effect of a product containing ceramide on the lipid levels of the stratum corneum in dry legs. Dermatol J Drugs. 2020; 19 (4): 372-376. doi: 10.36849 / JDD.2020.4796
13. Dumbuya H, Yan X, Chen Y, et al. ARTICLE: efficacy of formulations containing ceramide on the alterations of the skin barrier induced by UV rays. Dermatol J Drugs. 2021; 20 (4): s29-s35. doi: 10.36849 / JDD.2021.589E
14. Wu Y, Wangari-Olivero J, Zhen Y. ARTICLE: Compromised skin barrier and sensitive skin in different populations. Dermatol J Drugs. 2021; 20 (4): s17-s22. doi: 10.36849 / JDD.2021.589c
15. Haftek M, Roy DC, Liao IC. ARTICLE: Evolution of the science of the skin barrier for healthy and compromised skin. Dermatol J Drugs. 2021; 20 (4): s3-s9. doi: 10.36849 / JDD.2021.589a
16. Oakley AM, Badri T, Harris BW. Photosensitivity. StatPearls; 2021.
17. CrosbyK.Preventionofsun-indotteskindisorders.In:KrinskyD, Ferreri S, et al, eds. Non-Prescription Drug Handbook: An Interactive Approach to Self-Care. 20th ed. Association of American Pharmacists; 2020.
18. Clinical guidelines. Association of the American Academy of Dermatology. Accessed December 15, 2021. https://www.aad.org/member/clinical-quality/guidelines