ABSTRACT
Background/Objective
Growing evidence highlights the role of physiological lipids, namely ceramides, cholesterol, and free fatty acids, in maintaining skin barrier function and preventing atopic dermatitis (AD). Current evidence on the efficacy, safety, and clinical relevance of stratum corneum (SC) lipid-based therapies to prevent AD and increase skin barrier integrity in high-risk infants was reviewed and synthesized.
Methods
Searches with key words lipid-based therapy, atopic dermatitis, infant, and prevention were conducted to identify papers using PubMed, Embase, Cochrane Library, and Scopus databases from January 2000 to June 2024.
Results
SC lipid-based therapies were reported to replenish deficient SC lipids, thereby improving skin barrier function, a critical aspect of AD management.
These therapies reduced SCORAD scores, enhanced hydration, and improved epidermal cohesion, with some studies reporting comparable efficacy to topical corticosteroids when used as adjunct treatments. However, evidence supporting their effectiveness in preventing AD onset in infants remains limited, with only trends toward reduced AD incidence and food sensitization reported, without statistical significance. Importantly, SC lipid therapies are well tolerated, with no significant adverse effects noted, supporting their safety in infants and children.Conclusion
This review ascertained knowledge gaps that can direct research and resolve controversies regarding emollients. Mechanistic studies in high-risk and non-atopic infants, starting at birth, are warranted using within-subject comparisons and frequent evaluations, including SC sampling for proteomics and lipidomics outcomes for mechanistic insight. Studies should begin with relatively simple formulations, for example, containing only ceramides, cholesterol, and fatty acids matched to varying infant SC lipid profiles at birth and over time.
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