Creating a barrier: Novel therapy replenishes deficient lipids

February 1, 2009

Novel approach to atopic dermatitis therapy aims to repair the skin barrier by replenishing deficient lipids in individuals with atopic dermatitis and restoring the skin barrier to the physiologic status quo.

Key Points

Epiceram Skin Barrier Emulsion (Promius Pharma) not only repairs the skin barrier and returns the skin to its normal physiologic state, but it also seems to be comparatively effective as a mid-strength topical corticosteroid.

The skin's stratum corneum is primarily composed of three major lipids: ceramides, free fatty acids and cholesterol.

Clinical study

A multicenter, investigator-blind study was conducted in 113 patients with AD to evaluate the efficacy of Epiceram compared to Cutivate (GlaxoSmithKline, fluticasone), a mid-potent topical corticosteroid.

Results showed that the patients using Epiceram fared equally well as those using Cutivate cream, although the Cutivate cream cleared the skin symptoms faster.

At the two-week follow-up, patients on Cutivate were doing better than the patients on Epiceram; however, at the four-week follow-up, there was no statistically significant difference between the two therapies.

There were no serious adverse events in either group in the study.

Main advantage

"The advantage of a barrier repair cream is that it does not contain topical corticosteroids, and we do not have to worry about the numerous adverse events, including striae, thinning of the stratum corneum, perioral dermatitis and adrenal axis suppression, which all can be seen with topical steroid use," says Jeffrey L. Sugarman, M.D., Ph.D., department of dermatology, University of California, San Francisco.

"Even in the short-term use of a corticosteroid cream, there is adrenal axis suppression in a small number of people, as demonstrated in numerous studies," Dr. Sugarman tells Dermatology Times.

Ultimately, and very importantly, because AD is a chronic condition, Epiceram will most likely be most useful in reducing long-term topical steroid use.

"I am hopeful that barrier repair creams like Epiceram will reduce the amount of topical steroid you are going to need and how frequently you will need to use it," Dr. Sugarman says.

Replacing other therapies

Other effective topical nonsteroid therapies include the calcineurin inhibitors tacrolimus and pimecrolimus; however, the safety profile of Epiceram appears to be much better.

Furthermore, these calcineurin medications are not indicated for children under the age of 2, and because most children with eczema are under the age of 2, Epiceram can serve as an excellent therapeutic option for them.

Epiceram emulsion could also be used very successfully for the adult population. According to Dr. Sugarman, it is not unlikely that Epiceram will also reduce the need for calcineurin inhibitors such as tacrolimus and pimecrolimus in adolescents and adults just as it will reduce the need for topical steroids.

"Atopic dermatitis is a challenging disease to treat, because multimodal therapy is often required. We as clinicians can optimally manage AD by utilizing a combination of therapies," Dr. Sugarman says.

Disclosure: Dr. Sugarman is on the speakers list for Promius Pharma.