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The efficacy of topical lipid replacement therapy for the treatment of dry, irritated skin found support in study data published in the British Journal of Dermatology. In a trial of patients with eczema-prone skin, the application of a novel emulsion with ceramides, triglycerides, and cholesterol was associated with significantly improved skin barrier integrity and reduced levels of dryness and irritation.
Topical supplementation with lipids is theorized to support healthy skin, although its potential therapeutic effects in dry, eczema-prone skin are unexplored. To inform this gap, investigators conducted a randomized controlled trial of a novel moisturizer containing skin lipids and humectants (“test cream”) vs a reference emollient cream without these additives.
Adult patients with dry skin and a predisposition to eczema were recruited from dermatology clinics in the United Kingdom from June 2018 to March 2019. Each participant underwent 4 weeks of treatment with the test cream on 1 forearm and lower leg and the reference emollient on the other forearm and lower leg. Patients were instructed to apply 2 fingertip units of study emollients twice per day during the study period. The primary outcomes were changes in skin sensitivity and integrity metrics after 4 weeks of treatment, including transepidermal water loss (TEWL), skin sensitivity to sodium lauryl sulfate (SLS), and visual redness. Skin barrier integrity was measured as area under the TEWL curve obtained during skin tape stripping. Skin hydration and visual dryness score were also assessed.
A total of 34 patients completed the study, among whom61.8% were women and 91.2% were White. Mean age at enrollment was 43 ± 18 years. At baseline, 56% of patients had current active eczema with visible skin patches; 26% had current active eczema but no visible skin patches; and 18% had a history of eczema but no current activity.
At week 4, skin barrier integrity was improved at sites treated with the test cream compared with the reference condition. Specifically, it was noted, TEWL was 1.21 g/m2/h lower on sites treated with test cream (95% confidence interval [CI], 0.34-2.1 g/m2/h). The area under the TEWL curve was also significantly different between treatment conditions, with an effect size of -161.9 with the test cream (95% CI, -205.5 to -118.3). Skin reaction to SLS was reduced in areas treated with test cream, with lower visible redness and TEWL Per measures of capacitance, the skin of the legs was significantly more hydrated after 4 weeks of treatment with test cream compared with reference.
Results from this study demonstrate the efficacy of the test cream for treating and preventing skin dryness and irritation, the investigators posit. Study limitations include the small study cohort, short follow-up period, and limited number of enrollees with dark skin types. Further study in a broader patient group is necessary to determine the utility of the test cream formulation in clinical practice, they suggest.
“[These] results have significant implication for clinical practice given the very common use of simple emollient creams, like the reference used here, for the management of xerotic skin conditions,” investigators wrote. “Given that irritants like SLS are important triggers for [atopic dermatitis] lesions, the effects of the Test cream on the [skin barrier] could potentially help maintain healthy skin and reduce the burden of managing this condition.”
Disclosure: This research was supported by a grant from L’Oréal. Please see the original reference for a full list of disclosures.
Reference
Danby SG, Andrew PV, Kay LJ, et al. Enhancement of stratum corneum lipid structure improves skin barrier function and protects against irritation in adults with dry, eczema-prone, skin. Br J Dermatol. Published online December 18, 2021. doi:10.1111/bjd.20955
