'Active' moisturizers key to happier skin

"Typical moisturizers allow the skin to retain the moisture that it has. With eczema, for example, the skin barrier is abnormally poor, and so patients lose a lot of fluid to the environment. By putting a regular moisturizer on, the skin's moisture is retained and that helps," he explains. "These activated moisturizers containing ceramide proteins take it to the next step."

The missing link

"Now there is a whole new class of activated moisturizers that have the ceramides in them. Not only do they function as a moisturizer but they are also repairing what is wrong with the skin to begin with," Dr. Kress tells Dermatology Times.

These moisturizers can be added to the normal regimen of treatment for atopic dermatitis. Several over-the-counter (OTC) nonprescription ceramide-based products, such as CeraVe (Coria Labs) and Triceram (Osmotics Cosmeceuticals) and Elizabeth Arden's line of ceramide products, are available.

These products are no more expensive than the similar standard moisturizers without ceramide, such as Eucerin and Cetaphil (Galderma), Dr. Kress notes.

"In cases where I use steroids and anti-inflammatory medicines and CeraVe or another ceramide-based moisturizer, once the eczema is better it is longer until the next flare requiring steroids. The skin stays clear longer," he explains.

Epiceram (Ceragenix Pharmaceuticals), a prescription ceramide product, received 510 K clearance and the company anticipates its launch in the fall of 2007. Two other prescription therapies, MimyX (Stiefel Laboratories) and Atopiclair (GraceWay), currently are available.

"Research has shown that these two products restore the skin barrier. They are not approved as medicines. Instead they are approved as medical devices. They mechanically repair the skin, similarly to the other group," he says.

MimyX and Atopiclair also have a low level of anti-inflammatory effect, similar to 1 percent hydrocortisone cream, he adds.

The ingredients found within MimyX Cream mimic natural components of the stratum corneum, thus helping to repair and restore skin barrier function. The product is designed to restore barrier function while relieving the signs and symptoms of atopic dermatitis without adversely affecting the patient's immune system.

Atopiclair prescription non-steroidal cream contains ingredients with anti-inflammatory properties that help calm the itch and redness associated with irritated skin. It also restores the skin's natural oils and hydrates the outer layer's protective barrier helping to prevent future flare-ups.

Using the buddy system

To be most effective, MimyX or Atopiclair can be coupled with other therapies.

"In my view, neither of these agents is really a treatment in and of itself. They are more these adjunctive therapies that you would use in a way to allow patients to use less steroids or use steroids less frequently," Dr. Kress says.

A recent Atopiclair clinical trial showed that treatment by itself controlled flare in 50 days with three-times-a-day use.

"It is not that they don't work by themselves, but that is not really how we should use them when we can get kids better with steroids in a couple of days or in a week or two. Then by using these other therapies, it really allows us to not use so much steroids," he explains.

In a MimyX study, half of the patient's body was treated with topical steroid and a regular moisturizer while the other half was treated with the same topical steroids plus MimyX. The children in the study were treated until they were clear.