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 for protecting the human body against external factors that may affect or damage the skin, such as allergens, chemicals, exposure to ultraviolet (UV) radiation, infections, and stress.1,2
Internally, the skin helps sustain homeostasis and protects the body from increased loss of water.1,2 Moreover, the skin barrier is responsible for filtering 60% to 70% of UVB rays.3 Essential components of the skin barrier are ceramides, which comprise approximately 50% of the lipids found within the skin barrier.3
Ceramides, which are the major lipids in the outermost layer of the epidermis, known as the stratum corneum, contribute to the intercellular lipid bilayer, which is involved directly in regulation of transepidermal water loss.4
The 3 major functions of ceramides in the skin barrier and in skin care are improving hydration, prevention or treatment of dermatological conditions, and skin barrier homeostasis.5 Research has clearly demonstrated that alterations of stratum corneum lipid composition, barrier disruption, and low levels of skin ceramides may result in 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 conditions.
Pharmacists can assist patients seeking guidance on the selection of the various OTC skin care products on the market and provide them with pertinent clinical information about the essential roles of ceramides in dermatological health.
The results of numerous studies have shown that the using products containing ceramides improves moisture and resilience, supports the health of the skin’s natural skin barriers, and thwarts dry skin. These are all factors that may contribute to or exacerbate the manifestation of many common dermatological issues. 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 skin damaged by surfactants.9,10 Research has also shown that use of ceramide-containing skin care products diminishes the disease severity of many common skin conditions and enhances skin function.11,12
The results of a study published in the Journal of Drugs in Dermatology showed that implementing a ceramide-containing moisturizer and sunscreen skin care routine protects against UV-induced skin surface barrier changes by improving skin hydration, preserving normal superficial skin cells morphology and turnover, and thwarting erythema and hyperpigmentation.13
In addition to enhancing the appearance of lesions and minimizing skin irritation, the study results showed that delivering 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 restoration of the skin barrier, especially the role of topically applied mixtures of ceramides, cholesterol, and essential/nonessential free fatty acids strengthens the compromised skin barrier and alleviates symptoms and discomfort linked with skin barrier disorders.14
The results of another study indicated that moisturizers containing ceramides have clinically demonstrated the capacity to support the management of skin conditions, such as atopic dermatitis, by decreasing the severity of the disease and recurrence and enhancing patients’ perception of overall skin health and quality.15
Pharmacists can expand awareness about the clinical benefits associated with the use of ceramide-containing skin care cleansers, moisturizers, and sunscreen products. Ceramides commonly found in OTC products may be listed as ceramide AP, ceramide EOP, ceramide NG, ceramide NP, ceramide NS, phytosphingosine, and sphingosine. Pharmacists can educate patients about avoiding skin care products that exacerbate or irritate common skin conditions, and they also are in a pivotal position to identify patients at risk for possible hyperpigmentation, photosensitivity, and xerosis reactions because of
the use of certain pharmacological agents, such as loop diuretics, nonsteroidal anti-inflammatory drugs, phenothiazines, quinine, statins, tetracyclines, thiazides, vemurafenib, and voriconazole.16 Advise patients who use these pharmacological agents to always use a sunscreen product with a sunscreen protection factor of 30 or higher when going outdoors, especially for extended periods of time.17
Establishing a skin care regimen is critical to maintaining healthy, hydrated skin, and incorporating preventive measures can also aid in diminishing or eliminating common dermatological issues. Pharmacists can help educate and remind patients to use 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 Res. 2018;147(1):117-118. doi:10.4103/0971-5916.232013
3. New research reveals the impact of UV exposure on the skin barrier & the 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. Ceramide-and keratolytic-containing body cleanser and cream application in patients with psoriasis: outcomes from a consumer usage study. J Clin Aesthet 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 kinds of dermatitis: a review. Clin Med Res. 2017;15(3-4):75-87. doi:10.3121/cmr.2017.1363
7. Zeichner JA, Del Rosso JQ. Multivesicular emulsion ceramide-containing moisturizers: an evaluation of their role in the management of common skin disorders. J Clin Aesthet Dermatol. 2016;9(12):26-32.
8. Kahraman E, Kaykın M, Şahin Bektay H, Güngör S. Recent advances on topical application of ceramides to restore barrier function of skin. 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 skincare products into treatment regimens. J Drugs Dermatol. 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 Venereol. 2016;30(3):428- 434. doi:10.1111/jdv.13556
11. Lueangarun S, Tragulplaingam P, Sugkraroek S, Tempark T. The 24-hr, 28-day, and 7-day post-moisturizing efficacy of ceramides 1, 3, 6-II containing moisturizing cream compared with hydrophilic cream on skin dryness and barrier disruption in senile xerosis treatment. Dermatol Ther. 2019;32(6):e13090. doi:10.1111/dth.13090
12. Draelos ZD, Baalbaki NH, Raab S, Colón G. The effect of a ceramide-containing product on stratum corneum lipid levels in dry legs. J Drugs Dermatol. 2020;19(4):372-376. doi:10.36849/ JDD.2020.4796
13. Dumbuya H, Yan X, Chen Y, et al. ARTICLE: efficacy of ceramide-containing formulations on UV-induced skin surface barrier alterations. J Drugs Dermatol. 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 diverse populations. J Drugs Dermatol. 2021;20(4):s17-s22. doi:10.36849/JDD.2021.589c
15. Haftek M, Roy DC, Liao IC. ARTICLE: evolution of skin barrier science for healthy and compromised skin. J Drugs Dermatol. 2021;20(4):s3-s9. doi:10.36849/JDD.2021.589a
16. Oakley AM, Badri T, Harris BW. Photosensitivity. StatPearls; 2021.
17. CrosbyK.Preventionofsun-inducedskindisorders.In:KrinskyD,Ferreri S, et al, eds. Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care. 20th ed. American Pharmacists Association; 2020.
18. Clinical guidelines. American Academy of Dermatology Association. Accessed December 15, 2021. https://www.aad.org/member/clinical- quality/guidelines