Stratum Corneum Lipids as Bioactive Materials for Atopic Dermatitis

There are two paradigms to explain the atopic dermatitis. The first is outside-inside paradigm and the second is inside-outside paradigm. According to the outside-inside paradigm the best way to treat the atopic dermatitis is recovery of skin barrier function. The barrier function is maintained by the specific structure of stratum corneum, which is constructed from corneocytes and intercellular lipids. In terms of lipid structures of SC in atopic dermatitis and lamellar ichthyosis, they contain more fluid hexagonal gel structures in SC and show deficiencies in free fatty acids, especially long chains and certain ceramides. With this reason, moisturizer which has the lamellar structure and restoring function of intrinsic intercellualr long periodicity phase can maintain and restore the lamellar structure of intercellular lipids in SC. The moisturizers containing ceramide or pseudoceramide also seem to be reasonable therapy for atopic dermatitis and several skin diseases, which interrelated with impaired skin harrier. By the way, according to the inside-outside paradigm, immune response including helper T cells, IgE, eosinophils is related. It is effective treatment of atopic dermititis to restore imbalance between Th1 and Th2 cells. Even though several kinds of immune-suppressor were introduced, these can affect the intrinsic immune function. SPC and S1P, metabolites of ceramide, would be interesting because they have the function of wound healing and immune modulating properties.