24 June 2020
If you have sensitive skin or dry skin that isn’t improving despite using layers of serums and moisturisers, this post is for you.
One reason you might feel that you’re losing the battle against dry skin and sensitive skin is: Ceramides. Ceramides are part of the skin’s natural barrier against water loss; a lack of ceramides can cause skin dryness and increased skin sensitivity. Dryness of the skin can cause premature skin aging and is related to conditions such as eczema and psoriasis.
● Why are ceramides essential to the skin
● What are ceramides
● How to replenish ceramides in the skin
● Skincare ingredients that increase ceramide levels in the skin
● How to select skincare products that contain ceramides
● The differences between ceramides vs hyaluronic acid vs collagen
● Safety and side effects of ceramides
● Foods that are rich in ceramides
● The science of ceramide nutritional supplements
● My reviews of a few ceramide boosting products: Dr Jart’s Ceramidin serum; Skinceutical’s Triple Lipid Restore 2:4:2 and ORBIS’ DEFENCERA
Ceramides are a component of the outermost layer of the skin called the stratum corneum. A simplified and easy way to understand the role of ceramides in the skin is with the bricks and mortar analogy. In this analogy, the stratum corneum is organised into two major units: bricks and mortar. The skin cells (corneocytes) are the bricks and a layer of lipids (the mortar) holds the bricks together. The mortar that holds the bricks together is made up of 50% ceramides; 25% cholesterol and 15% fatty acids1-3.
As an essential component of the skin’s natural barrier, ceramides have an important role in maintaining the integrity and health of the skin. Reduced levels of ceramides in the skin causes increased water loss from the skin4 and has been linked to conditions like eczema5; and psoriasis6. You might also experience dryness, flaking and irritation of your skin if you have too little or deranged proportions or arrangements of ceramides.
Ceramides belong to a complex family of fats (lipids) that naturally occur in the skin called sphingolipids. As an integral component of the skin barrier, ceramides have a vital role in protecting the skin against transepidermal water loss (TEWL) and damage from infections and chemicals like surfactants in soaps and cleansers.
Because of their lipid properties, ceramides form an occlusive barrier at the outermost layer of the skin. This water impermeable barrier formed by ceramides blocks against transepidermal water loss and helps to lock in moisture in the skin so that skin remains healthy and soft.
● Keep skin moisturised
Ceramides form an occlusive layer on the skin to reduce transepidermal water loss. This seals in moisture in the skin and keeps skin soft and supple.
● Restore skin’s barrier and protect skin
Ceramides are part of the natural protective barrier between the skin and the environment. This barrier protects the skin against penetration by harmful chemicals and infections.
● Reduced skin sensitivity
Ceramides reinforcing the skin’s barrier and strengthens the skin to avoid sensitivity. Skin care products that contain ceramides are suitable for most skin types including sensitive skin.
● Reduced inflammation
Strengthening the skin barrier reduces inflammation in the skin and prevents the onset of skin diseases and flare ups of eczema.
● Reduced signs of aging
Ceramides in the skin barrier delay age related loss of collagen and elastin. This delays the onset of signs of aging like fine lines.
Even for most of us who have healthy skin without conditions like psoriasis or eczema, ceramide levels will drop as we age. When the skin lacks ceramides, there is increased transepidermal water loss. This can result in skin dryness; irritation; skin sensitivity; visible aging and has also been linked to medical conditions like psoriasis and atopic dermatitis7.
When this natural protective barrier of the skin becomes affected because of a lack of ceramides, you may also experience increased sensitivity towards chemicals in skincare, makeup and the environment.
Ceramide levels naturally decline as we age, just like hyaluronic acid and collagen in the skin. Some studies show that the elderly have 30% less ceramide in their skin5,9,10.
If you expose your skin to chemicals in soaps, skincare and detergents that strip the skin of the lipids in the skin’s barrier, ceramides in the skin can also be depleted11. This is why I don’t recommend using facial washes with surfactants and astringent toners. Ceramide levels in the skin also drop during the winter season in temperate countries10. Why this phenomenon occurs is still unclear.
At this point, some of you might be confused about the difference between ceramides, hyaluronic acid and collagen. These three substances make up part of the skin and can be found in skincare too; but that’s where the similarities end.
Ceramides are a type of lipids (fats) that make up the protective barrier of the skin. Their role is to protect the skin from the environment and transepidermal water loss.
Hyaluronic acid is a big sugar molecule called glycosaminoglycan or mucopolysaccharide. It is located deeper in the skin (compared to ceramides)- namely the dermis, but also the epidermis.
Hyaluronic acid is a gel that has a great capacity to bind to water molecules. This property allows hyaluronic acid to maintain the water balance of the skin and hydrate skin. Hyaluronic acid dermal fillers are used to add volume to sculpt the face. Common areas where dermal fillers are injected are the laugh lines, cheeks and under eyes.
Like ceramides, hyaluronic acid levels in our skin decrease as we age. This is why skin feels drier, thinner and fine lines start to appear as we age. Replacing hyaluronic acid in the skin with injectable moisturisers such as Profhilo and Skinboosters is very popular in Singapore and Asia. You can also easily find hyaluronic acid in skin care products.
New to the scene of injectable moisturisers in Singapore is Profhilo. Profhilo is an injectable skincare that contains a mixture of low and high molecular weight hyaluronic acid to keep skin hydrated. The unique biomolecular structure of Profhilo also bioremodels the skin to builds collagen and elastin in the skin, so Profhilo is also used as anti-aging treatment to firm and smooth the skin. If you have dry skin and related conditions like eczema, Profhilo will be very useful. You can read about how Profhilo works and the treatment intervals in this post Is Profhilo the Injectable Skin Care of the Future?
Embedded in a gel like substance (that includes hyaluronic acid) in the dermis are collagen fibres. As the main protein in the skin, collagen fibres provide a framework for strength and support to the dermis and epidermis. Without collagen, our skin will lose firmness and become thinner. Many anti-aging dermatological treatments such as Rejuran Healer and Fractional CO2 lasers are also centered around replacing collagen in the skin.
Although ceramides, hyaluronic acid and collagen fibres have different structures and functions in the skin; all three of them are required to maintain healthy skin. A deficiency in any of these components leads to drier skin and premature aging.
Here’s an easy guide to replacing ceramide in the skin:
1. Skincare that contain ceramides
2. Skincare ingredients that help with boosting ceramide formation
3. Oral supplements that contain ceramides
Let’s look at the data for each of these steps.
It would seem logical to replenish ceramides in the skin directly using skincare products that contain ceramides. Ceramide-dominant moisturisers have been found to be beneficial in improving hydration of the skin and improving the skin’s protective barrier16,17. However, the large molecular size and fatty nature of ceramides make it difficult for ceramides to penetrate the deeper layers of skin18.
So if you’re intending to use a ceramide containing skin care product, here’s what you need to know:
There are 9 subtypes of ceramides, each conveniently named ceramide 1 to 9. The functions of each of them are quite similar so it does not really matter which one you use. You will find that Ceramide-1 (aka Ceramide EOP) and Ceramide-3 (aka Ceramide NP) are two of the more common subtypes of Ceramides in moisturisers.
Interestingly, using skincare products that contain only ceramides has been found to damage the skin barrier19,20. Instead, research shows that when ceramide is combined together with the 2 other components of the lipid barrier of the skin i.e. cholesterol and fatty acids, the skin barrier recovery improves and transpidermal water loss is reduced19,21,22. This triple combination of lipids is thought to be more physiological than ceramides alone.
When the ratio of ceramides, cholesterol and fatty acids is 1:1:1 or up to 3:1:1 for any of the lipid components, skin barrier is improved23. However, when this ratio is deviated from, skin barrier repair is instead delayed23. You can easily find skincare formulations with ratios that obey this rule and I’ll be reviewing one of them later in this post.
When it comes to choosing a ceramide, cholesterol or fatty acid dominant skincare product to benefit your skin, knowing which particular class of lipid is decreased in your skin is the key. For example, in eczema or atopic dermatitis, ceramide levels are the predominant class of lipid that is decreased; so choosing a ceramide-dominant skincare product will benefit your skin better. Patients with older skin usually have reduced cholesterol synthesis in their skin, so a cholesterol-dominant formulation would suit their skin better. If in doubt, please speak to a doctor who understands dermatological conditions well.
We don’t have enough published studies that look at the optimum concentration of ceramides in skin care yet.
One study by one of the world’s leading experts on topical lipids in dermatology looked at mixture of ceramides, cholesterol and fatty acids (in a ratio of 1:1:3) with a total concentration of 1.6%24. Based on this study, for a triple lipid formulation with any component being dominant, the ceramide concentration should be at least 0.3%. We still need more studies to ascertain the optimal concentrations for the skin to benefit ceramide containing skin care products.
I would recommend using ceramide as your moisturiser or the step after your moisturisers and but before sunscreen. Ceramide is a lipid so it would form a seal against water. Moisturisers and serums usually contain water and active ingredients that are absorbed by the skin. If you were to use ceramide before your moisturisers and serums, the uptake in the moisturisers and serums may be blocked by ceramide.
Although people who have dry skin and conditions due to reduced ceramide levels like eczema and psoriasis will benefit using topical ceramides, just about anyone can use them. Topical ceramides are also very helpful after treatments to the skin such as Skinboosters and chemical peels.
I’ll now review three ceramide containing products that I’ve tried: Dr Jart’s Ceramidin Serum; Skinceuticals’ Triple Lipid Restore and ORBIS’ DEFENCERA.
Korean skincare brand Dr Jart is a globally recognised Asian skincare brand. Founded in Seoul in 2005, the brand’s products feature innovative active ingredients with playful and psychedelic merchandising. Dr Jart was very recently acquired by skincare giant Estee Lauder this year.
Dr Jart is well known for their skincare line containing ceramides and cica as well as face masks. I visited Dr Jart’s flagship store in Garosu-gil, Seoul last month and picked up a couple of Dr Jart’s bestsellers to try. This post, Cica in Skincare: Centella Asiatica Explained will share my review and a look inside Dr. Jart’s Filter Space in Seoul.
The Good About Dr Jart’s Ceramidin Serum
I used Dr Jart’s Ceramidin serum on top of my moisturiser in my daily skincare routine while in Seoul, which was experiencing an unusually early and bitter cold spell. Usually in colder climates, my skin tends to feel dry and flake. I did not experience any dryness or flaking during my time in Seoul with Dr Jart’sCeramidin serum. My skin also felt moisturised when using it.
I also did not experience any skin irritation or pimples; which I sometimes do with some creams and face oils. I’ve been using Dr Jart’sCeramidin Serum back in Singapore and I like how it feels on my skin. It sinks in and dries very quickly; so no sticky or gunky feeling even though I’ve layered it on top of a moisturiser. It’s a nice addition to my skincare routine on days when my skin feels dry.
The Bad About Dr Jart’s Ceramidin Serum
A look at the ingredient list of Dr Jart’s Ceramidin Serum will reveal that it contains five types of ceramides; all of which are not in first 20 ingredients listed. Four of these five ceramides are the last ingredients in the list. This implies that the concentration of ceramides is very low.
The ingredient also features cholesterol. There are a number of plant oils in Dr Jart’s Ceramidin serum; although fatty acids can be extracted from plants, I think that these plant oils are to add fragrance to the product rather than serve a dedicated role as fatty acids.
Although ceramides combined with cholesterol have been shown to improve skin barrier function; the addition of fatty acids would be more helpful. Again, the concentration of cholesterol is not known, so I cannot comment on whether the proportions of ceramides to cholesterol are appropriate.
I paid 42,000 Korean won (approx SGD$50) for a 40ml bottle of Dr Jart’s Ceramidin Serum. It’s a little pricey IMO for a product where the star ingredients are of a very low concentration.
My Verdict on Dr Jart’s Ceramidin Serum
I like that I can use Dr Jart’s Ceramidin Serum as an extra step on my usual skincare routine, especially on the days when my skin feels drier or when I travel I’m a divided on this; it is costly for a formulation that is not optimal. Might repurchase this if it goes on sale.
Skinceuticals’ Triple Lipid Restore is a cream contains 2% ceramides, 4% cholesterol and 2% fatty acids. This formulation keeps comprises of the 3 key physiological lipids in an appropriate ratio. In a company sponsored study, 55 subjects who used this product twice a day showed improvements in their fine lines/ wrinkles, skin roughness, clarity and firmness.
The good about Skinceuticals’ Triple Lipid Restore 2:4:2
Skinceuticals’ Triple Lipid Restore 2:4:2 packs in all the 3 essential lipids that make up the lipid barrier of the skin. The concentration of ceramides, fatty acids and cholesterol are 2%, 4% and 2% respectively- very commendable. Skinceuticals’ Triple Lipid Restore 2:4:2 also contains the highest concentration of ceramides that I have come across in skincare products. I used this as a moisturiser. It did make me my skin feel more moisturised without any comedones, irritation or new pimples. It dries nicely to leave a matt finish.
The bad about Skinceuticals’ Triple Lipid Restore 2:4:2
It is a splurge at $248. We do not know if there is a recommended maximum concentration for any of lipids, but it does feel excessive with Skinceuticals’ Triple Lipid Restore 2:4:2.
My verdict on Skinceuticals’ Triple Lipid Restore 2:4:2
Skinceuticals’ Triple Lipid Restore 2:4:2 is a decent product. It did not give me any comedones but I feel that it better suits someone with dry skin. It’s expensive, but you get what you pay for with this product.
Some of the limitations of using ceramide containing skin care products like incomplete penetration into the skin and inadequate concentrations can be overcome using ingredients that help the skin cells to produce ceramide.
One such ingredient is Niacinamide (vitamin B3). Niacinamide has been reviewed in detail in my blogpost on Niacinamide. You can read the post to learn more about the other benefits of using Niacinamide, what to know when selecting skincare containing Niacinamide and my review of a few Niacinamide skincare products.
Food and oral supplements containing ceramide has been proposed as another way to bypass the problems with ceramide uptake in the skin. Although ceramide supplements may not be as popular as collagen supplements (and certainly, have not found their way into hotpot soups-yet), ceramide supplements have been widely available for years now. Let’s look at whether it is possible to eat your way to healthier and moisturised skin.
Rice, wheat and potatoes are a rich source of ceramide25. Carbohydrate lovers, rejoice! Corn, soybean and konjac are also dietary sources of ceramide25. Plant sources of ceramide are sometimes referred to as phyto-ceramides. Phytoceramides are chemically similar to ceramides in human skin and are a common source of ceramide supplementation. One of the limitations of dietary sources of ceramide is that the amounts of ceramides is usually too little to rejuvenate the skin.
I’m going to move on to look at the topic of ceramide supplements. Even though the science and data for nutritional ceramide supplements are still preliminary, they seem promising because these oral supplements containing ceramide aim to overcome the limitations of low amounts of ceramides in food and skincare as well as poor absorption through the skin. These nutritional supplements and beauty drinks containing ceramide have been available in Japan as early as 199726 and are widely available today.
In this section, we will be looking at the science behind ceramides supplements and one of the newer and more interesting ceramide supplements in Singapore.
Ceramide supplements have been studied in small studies in animals26-29 and humans30-33. Though the data is not quite robust yet; the results so far are promising in my opinion. These studies have shown that ceramide supplements (phytoceramides) improve skin barrier function and hydration and reduce fine lines and wrinkles31,32. Ceramide supplements studied in subjects with eczema also showed improvements in their symptoms and reduction of allergy and inflammation in the skin30,33.
However, for now, ceramide supplements are unlikely to be recommended as a first line treatment for dry skin, aging or eczema until there are bigger, randomised controlled trials that would lend greater support to using ceramide supplements.
At present, our understanding and data available on dietary ceramides is also incomplete, which presents another barrier to interpreting these studies on ceramide supplements. We know that ceramides are large molecules that get digested by the small intestine before being transported by the blood vessels34-37. The precise proportions of these oral ceramides in our diet that get eventually assimilated to the skin or instead, get directed elsewhere to other parts of the body are still obscure.
My take is that oral ceramide supplements provide additional substrates to the skin to build new ceramide molecules in the skin barrier after absorption in the gut. In conditions where the skin barrier is disrupted due to a lack of ceramides, this additional supply of substrates will be useful. These oral ceramide supplements probably have a role in complementing the use of topical skincare with ceramides and Skinbooster treatments in maintaining skin hydration and moisture.
Ceramide nutritional supplements are also likely useful in patients who have dry skin but are unable to use ceramides in their skincare (e.g. acne outbreaks) or want the skin of the entire body to be better moisturised (as opposed to moisturised skin only on areas where moisturiser has been applied).
Who is suitable for ceramide nutritional supplements?
People with dry skin and conditions that can cause dryness such eczema and psoriasis may benefit from using ceramide nutritional supplements.
What are the side effects of ceramide supplements?
Oral ceramide supplements are safe, unless you have an allergy to the ingredients. So far there’s no published information on the side effects and risks of consuming ceramide supplements.
What dosage should I use for results from oral ceramide supplements?
How soon can results be expected. Again, we don’t have enough studies that are large and robust to ascertain a minimum dose and duration. The findings of one randomised controlled trial with 51 participants recommends that 350mg of wheat extract oil (containing phytoceramides) be taken daily for 3 months to improve skin hydration in dry skin21.
Are oral ceramide supplements safe for pregnant and breastfeeding women?
Currently, there is also no data regarding the safety of using oral ceramide supplements during pregnancy and breastfeeding. Animal studies on rats did not show complications during pregnancy or developmental abnormalities38.
Phytoceramides are derived from foods like wheat, rice, potatoes and konjac and so, oral ceramide supplements should be safe for consumption during pregnancy and breastfeeding. In the absence of clear data, I would advise you discuss your choice with your doctor before proceeding.
Can collagen supplements be taken together with ceramide supplements?
Collagen supplements (and hotpots) are very popular in Singapore and Asia. I will not be discussing about collagen supplements in this post, but it is safe to take collagen supplements together with ceramide supplements if you are a believer.
Oral ceramide supplements in Singapore
Phytoceramides or nutritional supplements can be purchased over the counter in Singapore. There are many brands available but I’ll be reviewing one from Japanese skincare brand ORBIS called DEFENCERA.
DEFENCERA by ORBIS contains glucosylceramides; a type of phytoceramides obtained from brown rice. ORBIS DEFENCERA was launched this year and is one of the more popular ceramide nutritional supplements available in Singapore.
ORBIS DEFENCERA is marketed as an oral skincare product for people who have dry skin. What I find interesting about ORBIS DEFENCERA is that it has “Food for Specified Health Uses (FOSHU) approval from Japan’s Consumer Affairs Agency. This approval is given to foods in Japan that have shown to be safe and effective.
How does ORBIS DEFENCERA work?
The active ingredient in ORBIS DEFENCERA is DF-ceramide, a type of ceramide from brown rice. As we have learnt earlier, ceramide nutritional supplements get transported to the skin via the blood vessels.
The manufacturers have published their findings and results in a Japanese scientific journal. I was unable to access the study to scrutinise it; but a summary shows that 133 subjects with dry skin in the study who consumed this glucosylceramide over 12 weeks had reduced transepidermal water loss. The study was published in Japanese, so I am unable to comment on the strengths and weaknesses of the study.
The good about ORBIS DEFENCERA
Safety is the number one concern personally when it comes to consumption of oral supplements. Ceramide nutritional supplements are generally safe but ORBIS DEFENCERA’s approval of safety from Japan’s Consumer Affairs Agency gives me better reassurance, as compared to the sea of ceramide supplements available. I’ve also not had any side effects like gastritis or diarrhea with consuming ORBIS DEFENCERA.
I’ve been trying this out for 4 weeks now and so far I’ve noticed that I do not experience dryness, flaking or skin irritation that I usually get with using topical retinoids. I noticed this at the 3 week mark of using ORBIS DEFENCERA. I do not see any obvious improvement in how moisturised my skin feels and this may be because I do not have dry skin, so this may be why I am not seeing earlier results as compared to someone with dry skin. I’ll update this post with my results when I complete 12 weeks of ORBIS DEFENCERA, so hopefully my efforts for better moisturised skin will pay off.
As opposed to using topical ceramide creams alone, the advantage of orally ingested ceramide allows ceramides to be delivered to the skin of the whole body. ORBIS DEFENCERA is yuzu flavoured and it tastes quite refreshing when you mix it with cold water. You can also take it as-is but I prefer it as a drink.
Nothing major here. I’m hoping to see more robust data for this product because oral ceramide supplements are going to be the next big thing after collagen supplements. Do note that ceramide nutritional supplements are not meant to brighten and lighten skin tone, but specifically to reduce dry skin and fine wrinkles related to dry skin.
There is no published long term data on ORBIS DEFENCERA or ceramide nutritional supplements yet with regards to its efficacy. If you have dry skin due to conditions that damage the skin barrier like eczema, you might find that your effects of this supplement will wear off eventually. If this happens and your dry skin returns, continuing ceramide nutritional supplements may have to be a consideration.
My verdict on ORBIS DEFENCERA
People who have dry skin and conditions like eczema and psoriasis are most likely to benefit from ORBIS DEFENCERA and nutritional ceramide supplements. If you have a healthy skin barrier; or oily skin, the benefits may not be as obvious.
Ceramides can also be used to complement anti-aging skincare products; especially if retinoids cause you to experience dryness. I would say that ORBIS DEFENCERA probably works better as a complement to your skincare routine and not to replace any step. If you have dry skin and ceramide creams cause you to break out, this is an alternative to consider.
Update on ORBIS DEFENCERA reivew March 2020:
It’s been about 4 months since I started using ORBIS DEFENCERA and I will say that my skin doesn’t feel dry or get flaking when I use products or treatments that dry my skin. However, it doesn’t replace the use of moisturisers, which can reduce transepidermal water loss. The feedback I get from some of my friends and patients whom I’ve recommended to try ORBIS DEFENCERA has also been mostly positive. No negative reviews about side effects or irritation and the skin feels more moisturised.
One of the reasons for dry and sensitive skin is a lack of ceramides in the skin. Ceramides are part of the skin’s protective barrier that also reduces water loss to the environment. If ceramides are lacking in the skin, dry skin, skin sensitivity and premature aging can result. In dermatological conditions like eczema and psoriasis, ceramides are recommended as part of the treatment to replenish the damaged skin barrier and seal in the skin’s moisture.
Almost anyone will benefit from increasing ceramide levels in the skin. Two ways to increase ceramide levels in the skin are: using skincare and ceramide nutritional supplements.
For skin care products containing ceramides, choosing formulations that also contain fatty acids and cholesterol in a ratio of up to 3:1:1 are very helpful in protecting the skin barrier and reducing water loss. If these lipids are replaced in isolation or in inappropriate ratios, skin barrier function can be negatively affected.
Nutritional ceramide supplements are another novel way to increase ceramide levels in the skin. Although studies and data are somewhat limited, preliminary results are promising. People who suffer from dry skin and conditions like eczema and psoriasis are more likely to benefit from using oral ceramide supplements. I would also recommend continuing to use skincare products that protect and moisturise the skin when using nutritional ceramide supplements. The consumption of ceramide nutritional supplements is safe and the recommended minimum duration for consumption of ceramide supplements is 3 months, based on the studies conducted so far.
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