TNF-α and Th2 Cytokines Induce Atopic Dermatitis–Like Features on Epidermal Differentiation Proteins and Stratum Corneum Lipids in Human Skin Equivalents

Barrier Function, Epidermal Differentiation, and Human β-Defensin 2 Expression in Tinea Corporis

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TH2 cytokines increase kallikrein 7 expression and function in patients with atopic dermatitis

Altered expression of epidermal lipid bio-synthesis enzymes in atopic dermatitis skin is accompanied by changes in stratum corneum lipid composition

Targeting the skin in atopic dermatitis

Ceramide is an important constituent of stratum corneum lipids, which act as both physical barriers and signal modulators. We synthesized several ceramide derivatives and investigated their effects on keratinocyte differentiation. RT-PCR and Western blotting showed that the novel synthetic ceramide derivatives K6PC-4 [N-(2,3-dihydroxypropyl)-2-hexyl-3-oxo-decanamide], K6PC-5, [N-(1,3-dihydroxypropyl-2-hexyl-3-oxo-decanamide] and K6PC-9 (N-ethanol-2-hexyl-3-oxo-decanamide) [corrected] These ceramide derivatives elicited a rapid transient increase in intracellular calcium levels, which were measured using laser scanning confocal microscopy. In addition, K6PC-4, K6PC-5, and K6PC-9 stimulated the phosphorylation of p42/44 extracellular signal-regulated kinase and c-Jun N-terminal kinase. In a reconstituted epidermis model, K6PC-4, K6PC-5, and K6PC-9 significantly increased keratin 1 expression in the suprabasal layer. These results indicate that these novel synthetic ceramide derivatives have the potential to promote keratinocyte differentiation, suggesting that the lipid molecules are applicable for treating skin diseases involving abnormal keratinocyte differentiation.

Atopic dermatitis: Therapeutic concepts evolving from new pathophysiologic insights

Diagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Report

Our in-house human skin equivalents contain all stratum corneum (SC) barrier lipid classes, but have a reduced level of free fatty acids (FAs), of which a part is mono-unsaturated. These differences lead to an altered SC lipid organization and thereby a reduced barrier function compared to human skin. In this study, we aimed to improve the SC FA composition and, consequently, the SC lipid organization of the Leiden epidermal model (LEM) by specific medium supplements. The standard FA mixture (consisting of palmitic, linoleic and arachidonic acids) supplemented to the medium was modified, by replacing protonated palmitic acid with deuterated palmitic acid or by the addition of deuterated arachidic acid to the mixture, to determine whether FAs are taken up from the medium and are incorporated into SC of LEM. Furthermore, supplementation of the total FA mixture or that of palmitic acid alone was increased four times to examine whether this improves the SC FA composition and lipid organization of LEM. The results demonstrate that the deuterated FAs are taken up into LEMs and are subsequently elongated and incorporated in their SC. However, a fourfold increase in palmitic acid supplementation does not change the SC FA composition or lipid organization of LEM. Increasing the concentration of the total FA mixture in the medium resulted in a decreased level of very long chain FAs and an increased level of mono-unsaturated FAs, which lead to deteriorated SC lipid properties. These results indicate that SC lipid properties can be modulated by specific medium supplements.

An important feature of atopic eczema (AE) is a decreased skin barrier function. The stratum corneum (SC) lipids - comprised of ceramides (CERs), free fatty acids (FFAs) and cholesterol - fulfil a predominant role in the skin barrier function. In this clinical study, the carbon chain length distribution of SC lipids (FFAs and CERs) and their importance for the lipid organization and skin barrier function were examined in AE patients and compared with control subjects. A reduction in FFA chain length and an increase in unsaturated FFAs are observed in non-lesional and lesional SC of AE patients. The reduction in FFA chain length associates with a reduced CER chain length, suggesting a common synthetic pathway. The lipid chain length reduction correlates with a less dense lipid organization and a decreased skin barrier function. All changes are more pronounced in lesional SC compared with non-lesional skin. No association was observed between lipid properties and filaggrin mutations, an important predisposing factor for developing AE. The results of this study demonstrate an altered SC lipid composition and signify the importance of these changes (specifically regarding the CER and FFA chain lengths) for the impaired skin barrier function in AE. This provides insights into epidermal lipid metabolism as well as new opportunities for skin barrier repair.

Possible Involvement of Antigen-Presenting Cells Expressing the Macrophage Galactose-Type C-Type Lectin in Inflammatory Skin Diseases

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. 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. 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. 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.

Ceramides (CERs) in the upper layer of the skin, the stratum corneum (SC), play a key role in the skin barrier function. In human SC, the literature currently reports 11 CER subclasses that have been identified. In this paper, a novel quick and robust LC/MS method is presented that allows the separation and analysis of all known human SC CER subclasses using only limited sample preparation. Besides all 11 known and identified subclasses, a 3D multi-mass chromatogram shows the presence of other lipid subclasses. Using LC/MS/MS with an ion trap (IT) system, a Fourier transform-ion cyclotron resonance system, and a triple quadrupole system, we were able to identify one of these lipid subclasses as a new CER subclass: the ester-linked ω-hydroxy fatty acid with a dihydrosphingosine base (CER [EOdS]). Besides the identification of a new CER subclass, this paper also describes the applicability and robustness of the developed LC/MS method by analyzing three (biological) SC samples: SC from human dermatomed skin, human SC obtained by tape stripping, and SC from full-thickness skin explants. All three biological samples showed all known CER subclasses and slight differences were observed in CER profile.

Lamellar lipid layers in the stratum corneum (SC), the outermost layer of the skin, act as a primary permeability barrier to protect the body. The roles of SC lipid composition and membrane structure in skin barrier function have been extensively investigated using ex-vivo SC samples and reconstructed SC lipids in the form of multi-lamellar lipids or liposomes. The primary lipids, especially ceramide, have been found to be highly important. Atopic dermatitis (AD) is a well-known chronic inflammatory skin disease with immunologic and epidermal abnormalities of the permeability barrier; therefore, a comparison of SC lipids in AD skin with those in normal skin is a promising method to explore the mechanisms of skin barrier function. Here, we focused on the effect of sphingoids (ceramide metabolites and a minor component of the SC lipids) and their content/species on skin barrier function. A significant difference in the leakage ratio was observed between model SC lipid liposomes with a different sphingolipid ratio (sphingosine/sphinganine), with a value of 5.43 for normal skin vs. 14.3 for AD skin. This result shows a good concordance with AD mouse experiments. Therefore, an alteration in the composition of minor SC lipids resulting from a ceramide metabolic abnormality can affect the membrane integrity (i.e., skin barrier function). Small angle X-ray scattering (SAXS) measurements revealed no distinct differences in the SAXS pattern between the 3 models, with all models forming a rigid membrane (i.e., a nearly hydrated solid). According to increasing the temperature, the peaks indicated that the lamellar structures decreased in all models and that the lateral packing of lipids decreased, which suggested annealing or melting of the gel to a liquid crystal, although no distinct phase transition was observed through fluorescence anisotropy measurements. Hence, we assume that the altered sphingoid composition triggers local membrane structural changes (i.e., formation of domains or clusters).

Modulation of Filaggrin by Th2 Cytokines in the Skin of Atopic Dermatitis (AD)