Andrew Paul V, Williams Samuel F, Brown Kirsty, Chittock John, Pinnock Abigail, Poyner Anna, Cork Michael J, Danby Simon G
Sheffield Dermatology Research, Division of Clinical Medicine, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK.
Sheffield Teaching Hospitals NHS Foundation Trust, The Royal Hallamshire Hospital, Sheffield, UK.
Br J Dermatol. 2025 Sep 18;193(4):729-740. doi: 10.1093/bjd/ljaf200.
People with atopic dermatitis (AD) suffer from dry, itchy skin with reduced skin barrier function that leaves it prone to irritant and allergen penetration. Alterations in the composition and structure of the stratum corneum (SC) lipid lamellae underpin this increase in permeability. A wide range of emollients is used to ameliorate the skin of patients with AD, but the majority have unclear effects on the lipid lamellae and barrier function.
To compare the effects of a multivesicular emulsion containing physiological lipids and glycerine (MVE + GL) with a commonly prescribed oil-in-water emulsion containing glycerine without physiological lipids (O/W + G).
A double-blind intraparticipant-controlled study was undertaken in adults with a history of eczema. Participants applied MVE + GL to one forearm and lower leg and O/W + G to contralateral sites twice daily for 28 days. Skin properties were assessed before and after treatment. A detailed lipidomic profile was generated from SC samples, alongside in vivo attenuated total reflectance Fourier transform infrared spectroscopic analysis of its molecular composition.
Fifty-eight people were included in the study [mean (SD) age 46 (21) years]. At sites treated with MVE + GL skin barrier integrity improved significantly [mean (SD) transepidermal water loss after 20 skin tape strips (TEWL20) 38.02 (18.64) g m-2 h-1 pretreatment vs. 29.79 (13.47) g m-2 h-1 post-treatment; P < 0.001], whereas O/W + G had no effect [35.6 (18.39) g m-2 h-1 vs. 37.4 (16.69) g m-2 h-1]. Concordantly, skin sensitivity to sodium lauryl sulfate (SLS) was significantly reduced by MVE + GL treatment [mean (SD) post-SLS TEWL 35.58 (15.43) g m-2 h-1 pretreatment vs. 29.54 (11.64) g m-2 h-1 post-treatment (P < 0.001); erythema was also reduced]. Skin moisture increased more rapidly at sites treated with MVE + GL vs. O/W + G, leading to a more rapid reduction in visual skin dryness. Over 1600 lipid species were detected in the SC. Ceramide species NP (non-hydroxy-phytosphingosine) and AP (α-hydroxy-phytosphingosine) with 18-carbon sphingoid bases, both ingredients of the MVE + GL, increased significantly by 24% and 19%, respectively, following MVE + GL treatment. In contrast, changes of 9% for NP(18) and 6% for AP(18) were not statistically significant at sites treated with O/W + G. Increased abundance of NP(18) species relative to NdS (non-hydroxy-dihydrosphingosine) species was related to improvements in skin barrier integrity.
While the glycerine-containing emollient reduced skin dryness, it had no impact on barrier function. In contrast, MVE + GL improved the physical integrity of the barrier and reduced the sensitivity of the skin.
特应性皮炎（AD）患者的皮肤干燥、瘙痒，皮肤屏障功能降低，容易受到刺激物和过敏原的侵入。角质层（SC）脂质层的组成和结构改变是导致通透性增加的基础。多种润肤剂被用于改善AD患者的皮肤状况，但大多数对脂质层和屏障功能的影响尚不清楚。
比较含有生理性脂质和甘油的多泡乳剂（MVE + GL）与常用的不含生理性脂质的水包油乳剂（O/W + G）的效果。
对有湿疹病史的成年人进行了一项双盲自身对照研究。参与者每天两次将MVE + GL涂抹于一侧前臂和小腿，将O/W + G涂抹于对侧部位，持续28天。在治疗前后评估皮肤特性。从SC样本中生成详细的脂质组学图谱，并对其分子组成进行体内衰减全反射傅里叶变换红外光谱分析。
58人纳入研究[平均（标准差）年龄46（21）岁]。在使用MVE + GL治疗的部位，皮肤屏障完整性显著改善[20次皮肤胶带粘贴后经表皮水分流失（TEWL20），治疗前平均（标准差）为38.02（18.64）g·m-2·h-1，治疗后为29.79（13.47）g·m-2·h-1；P < 0.001]，而O/W + G没有效果[35.6（18.39）g·m-2·h-1对37.4（16.69）g·m-2·h-1]。相应地，MVE + GL治疗显著降低了皮肤对月桂醇硫酸酯钠（SLS）的敏感性[SLS后TEWL，治疗前平均（标准差）为35.58（15.43）g·m-2·h-1，治疗后为29.54（11.64）g·m-2·h-1（P < 0.001）；红斑也有所减轻]。与O/W + G相比，MVE + GL治疗部位的皮肤水分增加更快，导致视觉上的皮肤干燥减轻更快。在SC中检测到1600多种脂质。MVE + GL的两种成分、具有18个碳原子鞘氨醇碱基的神经酰胺NP（非羟基植物鞘氨醇）和AP（α-羟基植物鞘氨醇），在MVE + GL治疗后分别显著增加24%和19%。相比之下，在使用O/W + G治疗的部位，NP(18)变化9%和AP(18)变化6%无统计学意义。相对于NdS（非羟基二氢鞘氨醇）种类，NP(18)种类丰度增加与皮肤屏障完整性改善有关。
含甘油的润肤剂虽能减轻皮肤干燥，但对屏障功能无影响。相比之下，MVE + GL改善了屏障的物理完整性并降低了皮肤的敏感性。
