The roles of ceramides and multivesicular emulsion (MVE) technology in atopic dermatitis: a narrative review

Atopic dermatitis (AD) is a highly prevalent chronic inflammatory skin condition. In Malaysia, a prevalence of 13.4% was reported for children between one and six years of age, one of the highest prevalence rates of AD in Asia. Many guidelines recommended moisturisers as the mainstay of treatment strategy for AD. Selecting an effective and suitable moisturiser for people with AD plays a crucial role in avoiding acute exacerbation of AD and achieving remission. Given that an array of active ingredients and topical vehicles for moisturisers are available in the market, this review summarised the roles of ceramides and multivesicular emulsion (MVE) technology in managing AD to help guide treatment decisions. Ceramides are essential in maintaining the skin permeability barrier and hydration, modulating skin immunity through anti-inflammatory and antimicrobial defence system, and regulating cellular functions. Low levels and altered structures and composition of ceramides, compromised skin permeability barrier and increased transepidermal water loss were commonly observed in AD patients. Most clinical studies have shown that ceramidedominant moisturisers are safe and effective in adults and children with AD. MVE technology offers an attractive delivery system to replenish ceramides in the SC, repairing the compromised skin permeability barrier and potentially improving patient compliance. Recommending clinically proven therapeutic moisturisers with the right ingredients (level, ratio, structure and composition), alongside an effective sustained release delivery system, to AD patients is one key strategy to successful disease control and flare prevention, subsequently reducing the disease burden to patients, families and societies.