Aberrant Lipid Organization in Stratum Corneum of Patients with Atopic Dermatitis and Lamellar Ichthyosis

Center for Electron Microscopy, Leiden University Medical Center, Leiden, the Netherlands.
Journal of Investigative Dermatology (Impact Factor: 6.37). 08/2001; 117(3):710-717. DOI: 10.1046/j.0022-202x.2001.01455.x

ABSTRACT There are several skin diseases in which the lipid composition in the intercellular matrix of the stratum corneum is different from that of healthy human skin. It has been shown that patients suffering from atopic dermatitis have a reduced ceramide content in the stratum corneum, whereas in the stratum corneum of lamellar ichthyosis patients, the amount of free fatty acids is decreased and the ceramide profile is altered. Both patient groups also show elevated levels of transepidermal water loss indicative of an impaired barrier function. As ceramides and free fatty acids are essential for a proper barrier function, we hypothesized that changes in the composition of these lipids would be reflected in the lipid organization in stratum corneum of atopic dermatitis and lamellar ichthyosis patients. We investigated the lateral lipid packing using electron diffraction and the lamellar organization using freeze fracture electron microscopy. In atopic dermatitis stratum corneum, we found that, in comparison with healthy stratum corneum, the presence of the hexagonal lattice (gel phase) is increased with respect to the orthorhombic packing (crystalline phase). In lamellar ichthyosis stratum corneum, the hexagonal packing was predominantly present, whereas the orthorhombic packing was observed only occasionally. This is in good agreement with studies on stratum corneum lipid models that show that the presence of long-chain free fatty acids is involved in the formation of the orthorhombic packing. The results of this study also suggest that the ceramide composition is important for the lateral lipid packing. Finally, using freeze fracture electron microscopy, changes in the lamellar organization in stratum corneum of both patient groups could be observed.Keywords: ceramides, cryoelectron microscopy, diseased human skin, electron diffraction, freeze fracture

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    ABSTRACT: 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.
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