The Role of Ceramides in Eczema

Ceramides in the skin influence the strength and suppleness of the skin barrier. 

People with eczema often have insufficient long chain ceramides and poorly organized ceramide structure in their skin barrier.

Eczema is a chronic skin condition characterized by periodic flare-ups, with symptoms such as red, itchy, and inflamed skin. Three main factors influence the severity and duration of an eczema flare-up:

Skin barrier strength and the volume of triggers that are able to penetrate the skin barrier are largely controlled by the ceramide composition and organization in the skin. 

Ceramides are essential lipids making up 50% of the outermost layer of the skin and providing the “suppleness” of the skin while also providing a barrier to the outside world.(MEC 2014) This barrier plays a vital role in keeping irritants, allergens, and pathogens out, while retaining moisture within the skin. 

People with eczema often have a genetic predisposition which prevents their bodies from forming sufficient long chain ceramides and/or organizing those ceramides in their skin barrier.

In the following sections, we will explore the role of ceramides in skin health, their importance in eczema, and how ceramide-based treatments can help manage eczema symptoms.

What Are Ceramides?

Ceramides are a class of bioactive waxy-fats, or lipids, involved in various molecular mechanisms in the body. Ceramides are constructed in your skin and are also produced by the microbiome on your skin.(ZEL 2023)

Long chain ceramides help form the “glue” between skin cells, bolstering your skin barrier’s strength, suppleness, and smoothness. 

The skin barrier in healthy people tends to be made up of more long chain ceramides. 

Why are Ceramides So Important for Eczema?

Ceramides play a crucial role in the development and management of eczema due to their involvement in maintaining skin barrier function, affecting the skin's lipid content, and influencing the microbial life on the skin.(KOH 2022) 

One of the primary causes of eczema is a dysfunctional skin barrier, primarily through the lack of long chain ceramides, which allows for increased moisture loss and exposure to allergens and irritants.(COD 2003)

A weakened skin barrier in eczema patients is often associated with imbalances in ceramide composition, specifically:

  • Decreased abundance of long chain ceramides

  • Increased quantity of short chain ceramides

  • Decreased organization of the ceramides in the barrier

Even the “normal” skin of people with eczema tends to have fewer long chain ceramides than that of a person without eczema, and those ceramides are often poorly organized.(BER 2018) This makes the skin susceptible to triggers and it also makes it harder for the skin to heal during a flare. The immune reaction further disrupts the formation and organization of ceramides, often leading to the flare spreading across the skin. 

The ceramide composition and pH of the skin have a significant impact on the types of microbial life that can inhibit it. In atopic eczema, lipid composition correlates with the presence of S. aureus, among others, which have the potential to exacerbate eczema symptoms and delay healing from flares.(KIM 2018) 

As the skin is symbiotic with a healthy microbiome, when ceramides are disorganized and not enough long chain ceramides are present, the microbiome is disrupted, further challenging the skin and potentially sustaining a flare.(COD 2003)

The Role of Long Chain Ceramides In Eczema

Long chain ceramides, compared to their short-chain counterparts, are crucial in reducing eczema symptoms. Their absence can lead to various skin problems related to eczema. A reduction in the chain length of ceramides has a stronger association with the severity of eczema than the total level of ceramides or ceramide subclasses

You may have read that many eczema patients have a mutation which prevents proper production of filaggrin, a protein which plays a role in the organization of ceramides in the skin barrier. The evidence indicates that long vs short chain ceramide production has a stronger correlation with the presence of eczema and the severity of a flare.(JAN 2012)

Long chain ceramides contribute to the strength of the skin barrier through several mechanisms:

  • Trigger blocking: Ceramides, along with cholesterol and fatty acids, form a lipid matrix within the skin barrier that provides structural support and cohesion. Long chain ceramides are in a gel-state or solid-state at the body’s temperature whereas shorter chain ceramides are more liquid, making them more permeable.(COD 2023)
  • Moisture retention: Long chain ceramides help to seal in moisture within the skin by forming a hydrophobic barrier, preventing water loss through evaporation (transepidermal water loss). Adequate hydration is essential for skin to heal, as well as preventing dryness, itching, and irritation.
  • Barrier repair and regeneration: Long chain ceramides have been shown to play a role in the natural repair and regeneration processes of the skin barrier. They contribute to the regulation of skin cell growth and differentiation, ensuring that damaged or compromised barrier layers can be replaced and restored effectively.
  • Microbiome balance: A healthy skin barrier is crucial for maintaining a balanced skin microbiome, as the lipid composition, including ceramides, can influence the microbial species that inhabit the skin. Long chain ceramides help support a healthy microbiome, preventing the overgrowth of potentially harmful bacteria, such as S. aureus, which can contribute to additional inflammation.

Restoring proper long chain ceramide composition and structure in the skin may block new triggers from increasing the intensity or duration of a flare, will moisturize the skin, and will reduce skin bacterial colonization in patients with atopic dermatitis.(BOR 2016)

How to Prevent the Loss of Ceramides

Ceramides naturally decrease as we age and during winter months. If you are an adult eczema warrior, then you have doubtless experienced how eczema is worse in the winter and after age 40.

Although we cannot control the passage of time or the changing seasons, there are several strategies to help prevent ceramide loss and maintain healthy skin.

  • Protect against ionizing radiation: Exposure to ionizing radiation, such as ultraviolet (UV) light, can result in the loss of long-chain ceramides. To protect your skin from UV damage, wear high-quality sunscreen that does not negatively impact the microbiome.
  • Be cautious with exfoliation: While exfoliation is often promoted for its numerous skincare benefits, including the removal of dead skin cells, the process can also disrupt ceramides that hold skin cells within the barrier. Consider a gentle approach to exfoliation to minimize ceramide loss.
  • Maintain a healthy microbiome: A well-balanced skin microbiome contributes ceramides to the skin. Ensuring the health of your skin's microbiome can help prevent the breakdown of existing ceramides and reduce inflammation, which can also damage ceramides. Focus on skincare products and habits that support a healthy microbiome to protect and maintain your skin's ceramide levels.

Ceramide-based Treatments for Eczema

Ceramide-based topical treatments can help replenish the reduced levels of long chain ceramides in the skin, improving the overall skin barrier function and addressing the symptoms of eczema. These products are available in various forms, including creams, lotions, and ointments.

Important considerations when choosing ceramide-based treatments:

  • Look for long chain ceramides: Ceramides on the ingredient label are usually listed by their class (“NP”, “NS”, and “EOS”). This describes the type of ceramide, not the length of it. You will likely need to rely on the brand and description of the product to know which length of ceramide it contains. EOS or EOP are typically long chain though. 
  • Avoid microbiome harming ingredients: As part of the goal of eczema treatment is to restore a healthy microbiome (which lowers inflammation and promotes healing), it is essential to avoid ingredients in moisturizers or ceramide creams that can harm the microbiome.
  • Choose fragrance-free and hypoallergenic products: This can help minimize the risk of triggers passing the already weak skin barrier.

Prescription-strength products

A few prescription medications contain ceramides and feature patented formulas that closely mimic the ceramide composition of healthy skin. However, these products may not offer significant advantages over over-the-counter ceramide-based moisturizers - possibly due to their impact on the microbiome

Oral Supplements for Ceramide Support

Some oral supplements on the market claim to support ceramide production in the body. These supplements may include ingredients such as phytoceramides (plant-derived ceramides) or other nutrients that support skin barrier function. 

The effectiveness of oral ceramide supplements in treating eczema has not been well-established.

For many eczema sufferers, their bodies naturally lack the enzymes and processes required to build long chain ceramides. As a result, supplements providing the building blocks for ceramides may be less effective than topical ceramides.

The Rulo Difference

Rulo's products are clinically proven to produce long chain ceramides while simultaneously promoting a healthier microbiome. We feed the microbiome health food to induce it to produce long chain ceramides for you. Rulo's products offer the following advantages:

  • No harmful ingredients - for you or your microbiome

  • Added protection through a healthier microbiome

  • No disruption of the skin from foreign ceramides or chemicals

In a 15-week clinical trial, Rulo's products demonstrated the following results:

  • 93% of participants experienced relief from dry, red, itchy skin concerns

  • 95% saw a decreased appearance of skin sensitivity

  • 84% reported a reduction in the appearance of cracking, flaking, and irritation

Learn More About the Aspects of Eczema

While eczema presents numerous challenges, understanding the role of ceramides in maintaining skin health can help you better manage its symptoms. It's essential to consider various aspects of eczema when identifying and treating symptoms, and incorporating ceramides into your skincare regimen can improve your overall skin health.

Explore our range of resources and articles to learn more about how ceramides can aid in the treatment and management of eczema.

Share your experiences with us! Tell us what has and hasn’t worked for you. What did we miss in this article that you've found personally impactful? Your insights can help others better understand and manage their eczema.

About the Author(s)

Dr. Nicole Scott, PhD, MPH

Dr. Scott has published 29 peer-reviewed papers regarding human biology and the microbiome. Her work has been cited over 4300 times by other scientists.

She has battled eczema for most of her life and is the Founder of Rulo Skin.

Read her work on Google Scholar

Special Thanks

This article was prepared in collaboration with the Itchhikers Guide

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