Abstract
Active rebuilding, stabilizing, and maintaining the lipid barrier of the skin is an encouraging disease management and care concept for dry skin, atopic dermatitis (eczema, neurodermatitis), and psoriasis. For decades, corticosteroids have been the mainstay of topical therapy for atopic dermatitis; however, innovations within the scope of basic therapy are rare. In (extremely) dry, irritated, or inflammatory skin, as well as in lesions, an altered (sphingo)lipid profile is present. Recovery of a balanced (sphingo)lipid profile is a promising target for topical and personalized treatment and prophylaxis. New approaches for adults and small children are still lacking. With an ingenious combination of commonly used active ingredients, it is possible to restore and reinforce the dermal lipid barrier and maintain refractivity. Lysosomes and ceramide de novo synthesis play a key role in attenuation of the dermal lipid barrier. Linoleic acid in combination with amitriptyline in topical medication offers the possibility to relieve patients affected by dry and itchy skin, mild to moderate atopic dermatitis lesions, and eczemas without the commonly occurring serious adverse effects of topical corticosteroids or systemic antibody administration.
Highlights
Atopic dermatitis (AD), atopic eczema, or neurodermatitis is a chronic or chronic relapsing, non-contagious skin disease
Lysosomes and ceramide de novo synthesis play a key role in attenuation of the dermal lipid barrier
Starting from the altered ceramide profile and the appearance of C16-ceramide in the skin of AD patients, we try to point out the underlying causes and to describe how these alterations can be eliminated by topical therapy in order to restore the original complexion
Summary
Atopic dermatitis (AD), atopic eczema, or neurodermatitis is a chronic or chronic relapsing, non-contagious skin disease. Topical calcineurin inhibitors tacrolismus and pimecrolimus cause transient warmth, tingling, or a burning sensation at the application site during the first days of application and increase the risk of bacterial or viral skin infections [3,4]. The major goal of any advanced disease management concept is to improve therapeutic effectiveness, increase patient satisfaction with treatment, and minimize adverse effects. Symptomatic therapy (inflammation: glucocorticoids; itching: H1-receptor antagonists or local anesthetics (polidocanol)) are often unable to restore skin integrity. Starting from the altered ceramide profile and the appearance of C16-ceramide in the skin of AD patients, we try to point out the underlying causes and to describe how these alterations can be eliminated by topical therapy in order to restore the original complexion. Our therapeutic approach is applicable to all age groups with just fractional adverse effects
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