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Clinical, Cosmetic and Investigational Dermatology 2018:11 491–497
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ORIGINAL RESEARCH
open access to scientific and medical research
Open Access Full Text Article
http://dx.doi.org/10.2147/CCID.S177697
Skin hydration is signicantly increased by a
cream formulated to mimic the skin’s own natural
moisturizing systems
Fabrizio Spada
Tanya M Barnes
Kerryn A Greive
Research and Development, Ego
Pharmaceuticals Pty Ltd, Braeside,
VIC, Australia
Background: Moisturizers are topical products designed to improve and maintain the skin
barrier function and to help prevent dry skin.
Materials and methods: A new moisturizer (Ceramide cream) was formulated contain-
ing ingredients which mimic the skin’s own natural moisturizing systems. Corneometry was
performed at baseline, 2, 4, 6 and 24 hours following a single application of Ceramide cream
to healthy skin, and compared to three reference moisturizers available over-the-counter, and
placebo. Transepidermal water loss (TEWL) was also measured following a single application
of Ceramide cream compared to baseline, and its safety was assessed by repeat insult patch test,
ophthalmologist and pediatric testing.
Results: A single topical application of either the Ceramide cream or the three reference moistur-
izers resulted in a significant increase in skin hydration over time (P<0.001). The placebo cream
did not significantly increase skin hydration at any time point. At 24 hours post-application, skin
hydration measured for Ceramide cream was significantly greater (P<0.05) than that measured
for all three of the reference moisturizers tested. Ceramide cream was also found to significantly
decrease TEWL (P<0.001) over 24 hours, and was shown to be non-sensitizing to the skin of
both adults and children and non-irritating to the skin, eyes and related eye area.
Conclusion: Ceramide cream increases skin hydration and improves barrier function which
may make it suitable for use on dry skin.
Keywords: ceramide, moisturizer, stratum corneum, dry skin, humectant, emollient, occludent,
transepidermal water loss, natural moisturizing factor
Introduction
A properly functioning stratum corneum (SC) is essential for healthy skin.1 To maintain
integrity, the SC employs a number of natural systems to keep water in or on the skin.2
One of these systems is the natural moisturizing factor (NMF) which is composed
predominately of free amino acids, pyrrolidone carboxylic acid (PCA), urocanic acid,
lactic acid and urea.3 The NMF components are highly efficient humectants that attract
and bind water from the atmosphere, drawing it into the corneocytes.4 The structure of
the SC is arranged in a ‘brick and mortar’ mosaic of flattened corneocytes (‘bricks’),
embedded in a lipid-enriched extracellular matrix (‘mortar’), organized into parallel
stacks of lamellar bilayers.2 These water-repellent lamellar bilayers are composed of
a blend of ceramides, free fatty acids and cholesterol and restrict not only the outward
flow of water and electrolytes, but the inward absorption of chemical substances, aller-
gens and microbial pathogens.5 Further, sebum is produced by the sebaceous glands
and forms a film over the top of the skin.6
Correspondence: Fabrizio Spada
Ego Pharmaceuticals Pty Ltd, 21–31
Malcolm Road, Braeside, VIC 3195,
Australia
Tel +61 39 586 8874
Fax +61 39 580 7647
Email fabrizio.spada@egopharm.com
Journal name: Clinical, Cosmetic and Investigational Dermatology
Article Designation: ORIGINAL RESEARCH
Year: 2018
Volume: 11
Running head verso: Spada et al
Running head recto: Cream formulated to mimic skin natural moisturizing systems
DOI: http://dx.doi.org/10.2147/CCID.S177697
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Dry skin or xeroderma is an extremely common problem
which can be induced by complex interactions between envi-
ronmental and individual factors including, but not limited
to: low environmental temperature, low humidity, exposure
to chemicals, microorganisms, aging, psychological stress,
atopic dermatitis and eczema.7 Moisturizers are topical
products designed to improve and maintain the skin barrier
function and to help prevent dry skin. It is common to think
that a moisturizer adds water to the skin; however, this is a mis-
understanding. Rather, a moisturizer works by preventing or
reducing water evaporation from the skin.8 This action allows
the skin to rehydrate from within. There are three classes of
chemical ingredients that regularly serve as moisturizers:
occlusives, humectants and emollients.7,9 Often these chemi-
cals are either the same as or similar to natural components
in the SC. They are often used in combination, with some
ingredients providing overlap of characteristics.9
Occlusive agents serve to reduce transepidermal water
loss (TEWL) by forming a hydrophobic barrier film over
the skin surface to prevent evaporation of water from the SC,
trapping water in the skin’s uppermost layers.10 Humectants
are hygroscopic substances which attract water and mois-
ture.10 When humectants are present on the skin, water from
the dermis is absorbed into the epidermis. Minimal water is
absorbed from the environment.11 Many of these chemicals
are the same molecules that form the NMF. The third class,
emollients, are chemicals that improve the “feel” of the skin
by filling the spaces in between corneocytes and also provide
what has been termed “skin slip” or lubricity, imparting a
sense of softness and plasticity.12
The newest generation of moisturizers also contain bar-
rier repair ingredients in addition to traditional moisturizer
components. The most common of such ingredients are
ceramides, free fatty acids and cholesterol which help replace
the deficient lipids in some skin diseases characterized by
barrier impairment, such as eczema and psoriasis.13
There are a vast array of moisturizers available in the
market today and consumer demand for these products is
growing. A US study found that moisturizers are the third
most commonly recommended over-the-counter (OTC) topi-
cal skin product (13.4%) after hydrocortisone (27.6%) and
anti-infectives (23.4%).14
The aim of this pilot study was to assess the effect of
a newly formulated moisturizer (referred to as Ceramide
cream) on skin hydration as measured by corneometry in indi-
viduals with normal skin compared to three reference OTC
moisturizers available in Australia. Ceramide cream contains
carefully selected ingredients designed to mimic the skin’s
own natural systems to enhance and maintain skin barrier
integrity and prevent dry skin. The effect of Ceramide cream
on TEWL was also measured by tewameter and its safety was
assessed by repeat insult patch test (RIPT), ophthalmologist
and pediatric testing. These studies will determine whether
Ceramide cream should be tested more extensively and for a
longer time period in clinical trials in patients with diseases
characterized by skin barrier impairment, such as eczema.
Materials and methods
Topical preparations
A moisturizer, QV Intensive with Ceramides – Light
Moisturizing Cream (referred to as Ceramide cream), was
formulated and tested containing a combination of carefully
selected ingredients as shown in Table 1. This moisturizer was
designed to mimic the skin’s own natural systems to enhance
and maintain skin barrier integrity (Ego Pharmaceuticals
Pty Ltd, Braeside, VIC, Australia). A placebo cream was also
formulated which did not include the skin active ingredients.
Topical moisturizers used as reference products in this
study which are available OTC include: Dermeze® Thick
Cream (referred to as Reference Product 1; Aspen Pharmacare
Australia Pty Ltd, St Leonards, NSW, Australia), Physiogel®
AI Cream (referred to as Reference Product 2; Glaxo Opera-
tions UK Ltd Trading as Glaxo Wellcome Operations, Dur-
ham, UK) and CeraVe® Moisturizing Lotion (referred to as
Reference Product 3; Valeant Consumer Products, a Division
of Valeant Pharmaceuticals, Bridgewater, NJ, USA). Ingredi-
ents present in these formulations are shown in Table 1. These
moisturizers were chosen as they were amongst the most
popular moisturizers used in Australia at the time of the study.
Study participants
The skin hydration and TEWL studies were approved by the
Independent Ethics Committee of Dermatest Pty Ltd (Rock-
dale, NSW, Australia), the RIPT and ophthalmology studies
were approved by the Institutional Review Board of Cantor
Research Laboratories, Inc. (Blauvelt, NY, USA) and the
pediatric studies were approved by the Institutional Review
Board of Essex Testing Clinic, Inc. (Verona, NJ, USA). All
operate in accordance with the International Conference on
Harmonization Good Clinical Practice guidelines.
Eligible participants included healthy men and women
aged between 18 and 70 years who: were not taking medi-
cation or under the care of a doctor for a period of 1 month
prior to commencement and throughout the entire test period;
completed an extensive medical history form; were free of
any dermatologica1 or systemic disorder that would interfere
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Cream formulated to mimic skin natural moisturizing systems
with the results; were available for the study duration and gave
written informed consent. Exclusion criteria were individu-
als: under doctor’s care; taking medication which could mask
or interfere with test results; with a history of sensitivity to
cosmetics in general and moisturizers in particular; with
any form of skin cancer or any disease that could interfere
with test results; diagnosed with chronic skin allergies; with
excessive hair on the test sites and females who indicated that
they were pregnant or nursing an infant.
Measurement of skin hydration
In order to pre-condition the test sites and to keep topical
treatments consistent, participants were required to abstain
from using deodorant soaps, moisturizing soaps or cosmetic
moisturizers on the test area for a period of 1 week prior to
study commencement and during the course of the study.
At the completion of the washout period, participants were
randomized (n=10 for each moisturizer) to receive a single
application of either Ceramide cream, Reference Products 1–3
or placebo cream applied liberally and evenly to the volar fore-
arm through volumetric syringes in a double-blind manner.
The opposing volar forearm served as the untreated control.
Before each set of measurements, participants were
required to equilibrate in a closed environment with a con-
stant temperature (20°C±2°C) and humidity (45%–55%
RH). The relative water content in the SC, or skin hydra-
tion, was measured using a corneometer (Model CM 825
PC corneometer, Courage and Khazaka, Germany) at t=0
( pre-application) and at 2, 4, 6 and 24 hours post-application
in triplicate, expressed in arbitrary units.15 Participants were
required to remain in the laboratory for the first day of the
study and then return as required. Any adverse events that
were observed or reported during the entire study period were
documented by the investigator.
Measurement of TEWL
The pre-conditioning of test sites was the same as that
described for the measurement of skin hydration. A single
Table 1 Ingredients listed on the product labels of moisturizers tested in this study
Ingredient class Ceramide cream Placebo cream Reference product 1 Reference product 2 Reference product 3
Base Water Water Water Water Water
Humectant Glycerin Betaine Glycerin
Sodium PCAaGlycerin
Occludent Dimethicone White soft parafn Squalane Caprylic/capric triglyceride
Petroleum Dimethicone
Emollient Parafnium liquidum Liquid parafn Elaeis guineensis oil
1,2-hexanediol Olea europaea fruit oil
caprylyl glycol Olus
Ceramide promoter Niacinamide Phytosphingosine
Lactic acida
Ceramide/
cholesterol/fatty acid
Ceramide NP Ceramide 1
Ceramide EOP Ceramide 3
Cholesterol Ceramide 6-II
Carthamus tinctorius
(safower) seed oil
Cholesterol
Other Cetearyl alcohol Cetearyl alcohol Cetearyl alcohol Pentylene glycol Behentrimonium methosulfate
Ceteareth-20 Ceteareth-20 Ceteareth-20 Acetamide MEA Carbomer
Glyceryl stearate SE Glyceryl stearate SE Citric acid Carbomer Ceteareth-20
Laureth-3 Laureth-3 Methylparaben Hydrogenated lecithin Cetearyl alcohol
Sodium hydroxide Methylparaben Propylparaben Hydroxyethylcellulose Dipotassium EDTA
Stearic acid Propylparaben Trisodium citrate Palmitamide MEA (PEA) Hyaluronic acid
Xanthan gum Stearic acid Sarcosine Methylparaben
Xanthan gum Sodium carbomer Polyglyceryl-3 diisostearate
Xanthan gum Polysorbate 20
Potassium phosphate
Propylparaben
Xanthan gum
Notes: aAlso an NMF component.
Abbreviations: PCA, pyrrolidone carboxylic acid; NMF, natural moisturizing factor.
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application of Ceramide cream was applied liberally and
evenly to the volar forearm of participants through volumet-
ric syringes in a double-blind manner. The opposing volar
forearm served as the untreated control.
Before each set of measurements, participants were
required to equilibrate in a closed environment with a con-
stant temperature (20°C±2°C) and humidity (45%–55% RH).
Measurement of TEWL was performed using a Tewameter
(Model TM 210 Tewameter®, Courage + Khazaka, Germany)
at t=0 (pre-application) and at 2, 4, 6 and 24 hours post-
application in triplicate, expressed in g/hm2.16 Participants
were required to remain in the laboratory for the first day of
the study and then return as required. In addition, any adverse
events that were observed or reported during the entire study
period were documented by the investigator.
RIPT
Participants were requested to bathe or wash as usual before
the test. A total of 0.2 mL of Ceramide cream was placed
onto a semi-occlusive, hypoallergenic patch (Parke-Davis
Hypoallergenic Readi-Bandage; 20×20 mm Webril affixed
to the center of a 40×40 mm adhesive bandage). The patch
was then affixed directly to the skin of the infrascapular
regions of the back, to the right or left of the midline and
the participant was allowed to return home with instructions
not to wet or expose the test area to direct sunlight. After 24
hours the patch was removed by the participant at home. This
procedure was repeated until a series of nine consecutive 24
hours exposures were made for every Monday, Wednesday
and Friday for three consecutive weeks.
In the event of an adverse reaction, the area of erythema
and edema was measured. Edema was estimated by the evalu-
ation of the skin in respect to the contour of the unaffected
normal skin. Reactions were scored just before applications
two through nine and at the next test date following appli-
cation nine. Subjects were then given a 10- to 14-day rest
period after which a challenge or retest dose was applied
once to a previously unexposed test site. The retest dose was
equivalent to any one of the original nine exposures. Reac-
tions were scored 24 and 48 hours after application. Scoring
was performed using the following scale; 0: no evidence of
any effect, ?: barely perceptible, minimal faint (light pink)
uniform or spotty erythema, 1: mild pink uniform erythema
covering most of the contact site, 2: moderate pink/red
erythema visibly uniform in entire contact area, 3: marked
bright red erythema with accompanying edema, petechiae
or papules, 4: severe deep red erythema with vesiculation
or weeping with or without edema.
Ophthalmologist testing
Additional inclusion criteria to that described in the study
participants section above were individuals: free of any ocular
disorder that would interfere with the results; wearing any
variety of contact lens every day; had no subjective ocular
irritation (stinging, burning, itching, dryness or foreign object
sensation). Additional exclusion criteria were individuals:
who were currently using ophthalmic drugs other than con-
tact lens solutions or disinfectants, rewetting solutions and
lubricants; with known allergies or skin and/or eye conditions
which would interfere with the results; any known abnormal
reaction to eye area products; who were currently using any
topical eye products.
Participants were randomized and required to apply
Ceramide cream to either the left or right eye area twice daily
for 4 weeks. The participant’s eyes and eye area, including
eyelids, were examined by an ophthalmologist using an
ophthalmoscope and scored at t=0 (pre-application), and
following 1, 2, 3 and 4 weeks of Ceramide cream application,
specifically looking for irritation, swelling, inflammation,
discharge, erythema or any other abnormalities. Skin grading
of the eye area was scored using the following scale; 0: no
reaction, 1+: weak (non-vesicular) showing erythema, infil-
tration and possible papules, 2+: strong reaction with vesicles
in addition to erythema and infiltration and 3+: extreme reac-
tion, bullous or ulcerative.17 Eye grading was scored using the
following scale: 0: no reaction, 1+: conjunctivae (palpebral
and bulbar) injected above normal with possible chemosis
(swelling) and no discharge, 2+: conjunctivae injected above
normal, obvious swelling and possible discharge and 3+:
conjunctivae more diffuse, crimson red, individual vessels
not easily discernible, excessive swelling and/or discharge.18
Pediatric testing
Ceramide cream was tested according to a single-blind, home-
use, pediatrician-monitored protocol that was conducted with
pediatric subjects aged 6–36 months who had sensitive skin.
A parent or legal guardian provided written informed consent
for the pediatric participants. Participants were randomized
and required to apply Ceramide cream to either the left or
right arm and leg at least once daily for 2 weeks. Comments
were noted in a daily diary and parents/legal guardians were
required to call the clinic to report on progress after 1 week.
Children were examined by a pediatrician pre- and post-test.
Statistical analyses
Statistical analyses were conducted using SPSS version 25
(IBM, Armonk, NY, USA). To compare hydration scores
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Cream formulated to mimic skin natural moisturizing systems
across the five moisturizers tested, mean difference scores for
the treated vs untreated conditions at each time point were
calculated. A repeated measures ANOVA with a Greenhouse-
Geisser correction was performed and least significant dif-
ference post hoc analyses conducted.
The percentage change in TEWL was calculated by the
following equation: Percentage change TEWL = [(a–b) /
b]×100, where a=individual value of TEWL at each individual
time point and b=zero hour value of TEWL. The Student’s
t-test was used to compare the mean values and % change
in TEWL at each time point compared to pre-application.
A statistical significance level of P<0.05 was applied to all
analyses.
Results
Skin hydration following a single
application of moisturizers
Fifty participants (12 male, 38 female) aged between 18 and
63 years (43.0±13.5 years) were enrolled in this randomized,
double-blind study. All participants completed the study and
no adverse event was observed.
The mean difference in hydration scores (treated minus
untreated) for each of the moisturizers tested over 24 hours
are presented in Figure 1. There was no significant differ-
ence in hydration scores between any of the moisturizers at
baseline. A single topical application of either the Ceramide
cream or the three reference moisturizers resulted in a signifi-
cant increase in skin hydration over time (P<0.001). Topical
application of the placebo cream did not significantly increase
skin hydration at any time point. Ceramide cream showed
the greatest increase in hydration compared to the bare skin
control at 2 through to 24 hours post-application compared
to the three reference moisturizers and placebo (Figure 1).
Conversely, the placebo cream and Reference Product 1 had
the lowest increase in hydration, with differences between
these two products only statistically significant at 2 hours
post-application (P=0.017). At 24 hours post-application,
Ceramide cream continued to have a significantly greater
increase in hydration compared to Reference Product 1
(P=0.001), Reference Product 2 (P=0.003) and Reference
Product 3 (P=0.012).
TEWL following a single application of
Ceramide cream
Ten participants (two male, eight female) aged between 21
and 61 years (47.7±3.9 years) were enrolled in the study. All
participants completed the study and no adverse event was
observed. Table 2 shows the mean TEWL measurements (g/
hm2) as well as the mean percentage decrease in TEWL fol-
lowing a single topical application of Ceramide cream over
time. The mean baseline TEWL was 8.45±0.65 g/hm2. Tw o
hours post-application, TEWL significantly decreased by
~25% compared to baseline. Four hours post-application,
TEWL was still significantly decreased by ~22% compared to
baseline, which was maintained up to 24 hours post-application
(P<0.001 for all time points).
RIPT
A total of 103 participants (19 male, 84 female) aged between
21 and 70 years were enrolled in the study. Two participants
were discontinued from the study due to their absence on
moisturizer application days. The RIPT showed that none
of the participants had an adverse reaction of any kind to
Ceramide cream when tested neat under semi-occlusion,
and therefore Ceramide cream may be considered as non-
irritating and non-sensitizing to the skin.
0
0246 24
Time (h)
5
10 ***
***
15
20
25
30
‡
‡
†
#
*
Mean difference for hydration scores
(treated-untreated)
Figure 1 Mean difference for hydration scores (treated minus untreated) over time
(h) following the single application of (•) Ceramide cream, (•) placebo cream, (•)
Reference Product 1, (•) Reference Product 2 and (•) Reference Product 3 (n=10
for each group).
Notes: *P<0.0001 vs Ceramide cream, #P<0.001 vs Ceramide cream, ^P<0.01 vs
Ceramide cream and ‡P<0.05 vs Ceramide cream.
Table 2 TEWL measurements (g/hm2) following a single
topical application of Ceramide cream over time (h). The mean
percentage change in TEWL compared to baseline (t=0) is given
in parentheses.
Time (h) TEWL (g/hm2)
08.45±0.65
26.35±0.56 (–25.4±1.2)*
46.56±0.44 (–21.6±2.2)*
66.58±0.40 (–21.0±2.6)*
24 6.54±0.38 (–21.2±3.0)*
Notes: *P<0.001 vs t=0. Results are presented as mean ± SEM.
Abbreviation: TEWL, transepidermal water loss.
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Ophthalmologist testing
Fifty-two participants (four male, 48 female) aged between
22 and 60 years (41.3±1.5 years) were enrolled and com-
pleted the study, including 26 non-contact lens wearers and
26 contact lens wearers. None of the participants had an
adverse reaction of any kind to the Ceramide cream over the
4-week test period. Therefore, when tested neat under exag-
gerated conditions, Ceramide cream may be considered as
non-irritating to the eyes and related eye area.
Pediatric testing
Sixteen boys and 15 girls aged from 6 to 36 months (21.7±1.6
months) were enrolled in the study, with six children in each
age group: 6–12 months, 13–18 months, 19–24 months,
25–30 months and 31–36 months. One child was discontin-
ued from the study for reasons unrelated to the study protocol.
No test-related irritation was observed by the pediatrician and
no safety-related comments were made by any participants
or their parents or guardians at any time during the course
of the study.
Discussion
Moisturizing treatment involves a four-step process: 1)
repairing the skin barrier, 2) increasing water content, 3)
reducing TEWL and 4) restoring the lipid barriers’ ability to
attract, hold and redistribute water.19,20 In addition, an ideal
moisturizer should be cosmetically elegant and acceptable,
moisturizing to sensitive skin (hypoallergenic, non-sensi-
tizing, fragrance free and non-comedogenic), offered at an
affordable price, long lasting and absorbed rapidly providing
immediate hydration.19,20
All moisturizers tested in this study were shown to
significantly increase skin hydration for up to 24 hours.
At 24 hours post-application, skin hydration measured
for Ceramide cream was found to be significantly greater
compared to that measured for the reference moisturizers.
Ceramide cream was also found to significantly decrease
TEWL for up to 24 hours, was non-sensitizing to the skin of
both adults and children and non-irritating to the skin, eyes
and related eye area.
The effect of Ceramide cream on enhancing skin barrier
function and hydration might be explained by its unique
ingredients. Specifically, PCA which is a filaggrin breakdown
product and part of the skin’s NMF is present as sodium
PCA in Ceramide cream, the form of PCA most used in
topical preparations, which helps to restore the hydration
of the SC.3 Lactic acid also forms part of the NMF, and
together with nicotinamide have been shown to promote
ceramide biosynthesis and thus strengthen the skin barrier.21,22
Ceramide cream also contains ceramides 1 and 3, cholesterol
and linoleic acid from safflower oil in a 3:1:1 molar ratio as
it has been shown that these ingredients must be delivered
in the correct ratio to have a positive effect on the integrity
of the skin barrier.4
In addition to these novel ingredients, Ceramide cream
contains humectants which act similarly to NMF in corneo-
cytes, an occludent which simulates sebum and natural lipids
found on the skin, and emollients which act like the intracel-
lualar bilayers of the SC (Table 1).7 The ingredients in this
“triple moisturizing system” are combined in a specific ratio
to mimic the natural SC components as it has been shown that
each of these components are important to maintain healthy
skin barrier function.1,2 Ceramide cream is also fragrance and
preservative free as these ingredients are known to be some of
the most common allergens.23 Furthermore, Ceramide cream
is formulated with an acidic pH which has been shown to be
optimal for healthy skin.24
The level of ceramides has been shown to be greatly
reduced in the SC of patients with atopic dermatitis. It has
subsequently been concluded that an insufficiency of cerami-
des in the SC is an important factor in atopic dry skin.2,25 As
a result of this finding, ceramides have been added to many
moisturizers used in the treatment of both atopic and normal
skin. Further clinical studies are underway to determine longer
term effects of Ceramide cream on skin hydration, signs of
eczema and patient quality of life in patients with eczema.
A limitation of this study is that a lotion (Reference
Product 3) was included in the panel of reference products
tested and compared to a cream. This choice was made on
the basis that this product was a popular moisturizer available
in Australia at the time of the study. A further limitation is
that the effect of the reference products on TEWL was not
determined, however, given the hydration results all other
parameters were studied on ceramide cream alone to under-
stand the properties of this newly formulated cream.
In conclusion, topical application of the Ceramide cream
moisturizer leads to increased skin hydration and decreased
TEWL making it suitable to help restore xerotic skin. Main-
tenance of skin barrier function is vital to mitigate the skin’s
susceptibility to irritants, allergens, and microbes.
Acknowledgments
The authors would like to thank John Staton, Dermatest Pty.
Ltd (Rockdale, NSW, Australia), for assistance in performing
these studies. Ego Pharmaceuticals Pty Ltd sponsored this
study and is the manufacturer of Ceramide cream.
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Clinical, Cosmetic and Investigational Dermatology
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Clinical, Cosmetic and Investigational Dermatology is an interna-
tional, peer-reviewed, open access, online journal that focuses on
the latest clinical and experimental research in all aspects of skin
disease and cosmetic interventions. This journal is included
on PubMed. The manuscript management system is completely online
and includes a very quick and fair peer-review system, which is all easy
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Dovepress
497
Cream formulated to mimic skin natural moisturizing systems
Disclosure
FS, TMB and KAG are employed by Ego Pharmaceuticals,
Pty Ltd. The authors report no other conflicts of interest in
this work.
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