Ceramides may act as barrier repair emulsions
New ceramides are available as barrier repair emulsions, e.g., EpiCeram. Company-sponsored studies claim that Epiceram has a comparable effect to low-potency topical steroids. The cream has a 3:1:1 ratio of ceramide, cholesterol, and fatty acids, similar to that found in normal skin. EpiCeram was developed by dermatologists at the University of California, San Francisco.
EpiCeram is prescription only. It is classified by the FDA as Prescription Medical Device; Federal Law restricts this device to sale by or on the order of a physician.
EpiCeram has been available by prescription since 2008. It is a steroid-free, fragrance-free, non-greasy treatment for dermatoses such as atopic dermatitis, allergic or irritant contact dermatitis and radiation dermatitis.
How does EpiCeram work?
Atopic dermatitis may be associated with lipid deficiency in the skin barrier. These important lipids include ceramides (some of the building blocks of skin), cholesterol, and fatty acids. EpiCeram aims to restore the skin barrier with a lipid-based formulation, which has a 3:1:1 ratio of ceramide, cholesterol, and fatty acids, similar to that found in normal skin.
How to use it?
Apply in a thin layer to affected skin areas 2 times per day (or as needed). After application, a temporary tingling sensation may occur (10-15 minutes). EpiCeram can be used on adults and children without restrictions to the face or skin folds, according to the manufacturer.
How effective is EpiCeram?
Company-sponsored studies have shown that EpiCeram works as well as mid-potency (prescription strength) topical corticosteroids in relieving the signs and symptoms of atopic dermatitis after 28 days of treatment. Source: Sugarman, J. L., & Parish, L. C. (2009). Efficacy of a lipid-based barrier repair formulation in moderate-to-severe pediatric atopic dermatitis. Journal of Drugs in Dermatology, 8 (12), 1106-1111.
Capric Acid, Cholesterol, Citric Acid, Conjugated Linoleic Acid, Dimethicone, Disodium EDTA, E. Cerifera (Candelilla) Wax, Food Starch Modified Corn Syrup Solids, Glycerin, Glyceryl Stearate, Hydroxypropyl Bispalmitamide MEA (Ceramide), Palmitic Acid, PEG-100 Stearate, Petrolatum, Phenoxyethanol, Potassium Hydroxide, Purified Water, Sorbic Acid, Squalane, Xanthan Gum.
EpiCeram® Skin Barrier Emulsion is supplied as follows:
- NDC: 51013-800-90: 90 gram tube
- NDC: 51013-800-50: 50 gram tube
Distributed by PuraCap Pharmaceutical LLC, South Plainfield, NJ 07080
How much does it cost?
A few online patient discussions forums mention that the price of Epiceram is in the range of $50 for a 50-gram tube, if covered by health insurance. At $1 per 1 gram, Epiceram is approximately 20 times more expensive than Eucerin.
Barrier creams and emollients for atopic dermatitis
Barrier creams and emollients for atopic dermatitis include CeraVe (http://cerave.com), Mimyx, EpiCeram (http://epiceram-us.com), Eletone, Theraplex (http:/theraplex.com), Eucerin and Aquaphor.
I have the most experience with Eucerin and Aguaphor, they are relatively inexpensive, and therefore I recommend them as part of the treatment plan for atopic dermatitis illustrated below:
Atopic Dermatitis Treatment - Illustrated (click to enlarge the image).
Sugarman, J. L., & Parish, L. C. (2009). Efficacy of a lipid-based barrier repair formulation in moderate-to-severe pediatric atopic dermatitis. Journal of Drugs in Dermatology, 8 (12), 1106-1111.
Full prescribing information: http://www.epiceram-us.com/prescribing-information
Kircik, L. H., Del Rosso, J. Q., & Aversa, D. (2011). Evaluating clinical use of ceramide-dominant, physiologic lipid-based topical emulsion for atopic dermatitis. The Journal of Clinical and Aesthetic Dermatology, 4 (3), 34-40.