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Summary: Background: The skin of patients with atopic dermatitis is characterized by abnormal stratum corneum lipid levels. Consequently, the lamellar matrices are disrupted and skin barrier function is diminished, increasing skin sensitivity to irritants and allergens. Objectives: To determine whether a cream containing ceramides, triglycerides and cholesterol in a multivesicular emulsion can reinforce the skin barrier and protect against skin irritation. Methods: A randomized observer‐blind intrapatient‐controlled study in 34 adults with dry, eczema‐prone skin was conducted. Each participant underwent 4 weeks of treatment with the test cream on one forearm and lower leg and a reference emollient cream on the other. Skin properties were determined before and after treatment. Lipid structure was assessed by Fourier‐transform infrared spectroscopy using a novel interface. Results: Skin barrier integrity was greater at sites treated with the test cream [effect size for area under the transepidermal water loss curve −162, 95% confidence interval (CI) −206 to −118]. Skin sensitivity to sodium lauryl sulfate was reduced (−0·5 points visual redness, 97·57% CI −1·00 to −0·25), as was transepidermal water loss (−15·3 g m−2 h−1, 95% CI −20·3 to −10·4) compared with the reference. Sites treated with the test cream displayed enhanced lipid chain ordering, which was significantly associated with skin barrier integrity (r = 0·61). Compared with the reference, treatment with the test cream increased hydration (8·61 capacitance units, 95% CI 6·61–10·6) and decreased signs of dryness. Conclusions: The test cream facilitates skin barrier restoration and protects the skin from dryness and irritation. Compared with a commonly prescribed emollient in the UK, the test cream is highly suited to the management of dry, sensitive skin. [ABSTRACT FROM AUTHOR]

Linked Article: Danby et al. Br J Dermatol 2022; 186:875–886. The type and arrangement of lipids in our skin affects the way it works as a barrier to the external environment. People with eczema (atopic dermatitis) have fewer key lipids, such as ones called ceramides, in their skin. This alters the way the lipids arrange themselves, so that they are less compact, making the skin's barrier leaky. Leaky skin is prone to dryness (loss of water), and makes it react more to irritants that can aggravate the skin, making it itchy. Alterations in our skin lipids are also seen when we get older, and contribute to skin dryness. In a study in the UK, we wanted to find out if a treatment containing a special mix of lipids could improve the arrangement of lipids, and see if this protected the skin better. This involved asking 34 adults with dry, eczema‐prone, skin to apply the lipid cream to a small area of skin for 4 weeks. For a comparison we also asked them to apply a regular emollient (moisturizing) cream (without skin lipids) to a different area of skin in the same way. The arrangement of lipids was more compact after using the lipid cream than the regular emollient cream. The skins barrier was also stronger. Those with the strongest barrier had the most compact lipids in the skin. The lipid cream also reduced skin dryness and protected the skin from irritation. This study shows that the lipid cream we tested can improve skin health for people with skin conditions such as eczema. It provides greater protection from irritation and dryness compared with commonly prescribed emollient creams. Linked Article: Danby et al. Br J Dermatol 2022; 186:875–886. [ABSTRACT FROM AUTHOR]