The Effect of a Moisturizing Cream Containing Saccharide Isomerate
and Ceramide on Reducing Transepidermal Water Loss in Eczema
Helen Hartini
1
, Vlorensia
1
, Hairus Abdullah
2
, Ahmad Raif Martinus
1
, Refi Ikhtiari
1,2*
1
Laboratory of Biomolecular Chemistry, Graduate School of Biomedical Science
Universitas Prima Indonesia
2
Laboratory of Materials Chemistry, Faculty of Industrial Engineering,
Universitas Prima Indonesia
Keywords: Moisturizer, saccharide isomerates, ceramide, TEWL, eczema
Abstract: Dermatitis is a disorder of dry skin or a state of skin sensitization due to exposure to external substances.
Moisturizing treatments can reduce TEWL (transepidermal water loss). This study is aimed to determine the
effectiveness of using moisturizing creams that contain saccharide isomerates and ceramide to reduce TEWL
in eczema sufferers. The moisturizing creams have been applied in the lower limbs of eczema sufferers as
subjects. The research subjects were 12 people for each group, namely the Saccharide Isomerates (SI), non-
SI, Ceramide (S) and non-S. Tewameter/Corneometer 350 treatment used to measure TEWL values before
treatment (Week 0) and after treatment (Week II). Data analysis using the unpaired t-test. The results showed
that the use of moisturizing creams containing saccharide isomerates and moisturizing creams containing
ceramide effectively reduced the TEWL value in eczema sufferers (p = 0.032).
1 INTRODUCTION
The skin is a living organ that lines the entire surface
of the human body, functions to protect and receive
stimuli from the environment (Tyas, 2014). Aesthetic
functions are also an important function of the skin
because the skin can describe one's health, beauty,
social status, and economic status (Mescher, 2013).
Various factors both from outside and inside the
body can affect the structure and function of the skin,
for example, dry air, low humidity, sunlight, age,
various skin diseases and diseases in the body.
Because these factors can occur excessive
evaporation in the skin epidermis so that the water
content in the stratum corneum <10% and causes dry
skin (Wasiatmadja, 2011).
Dry skin is a disorder on the surface of the skin
due to reduced fluid or oil content in the skin so that
the moisture on the surface of the skin layer decreases
(Nuzantry, 2015). Dry skin is a condition
characterized by damage to the stratum corneum due
to lipid modification and disturbed hydration. Dry
skin is indicated by the condition of skin becomes
rough, scaly, wrinkled and less elastic than normal
and dry skin on touch (Kusumaningrum, 2017). Dry
skin occurs if the balance of oil content is disturbed.
The content of fat on dry skin is very small, so it is
easy to occur premature aging marked by wrinkles
and the skin looks tired and looks rough (Kusantati,
2008).
Dermatitis or eczema is a disorder of dry skin or a
state of skin sensitization due to exposure to external
substances. Based on its etiology, dermatitis can be
divided into exogenous dermatitis if it is caused by
factors outside the patient's body, and endogenous
dermatitis (constitutional) if caused by factors from
within the body itself (Harrianto, 2013). Dermatitis is
an inflammatory condition of the skin that varies in
terms of its severity, is non-infectious, and cannot be
transmitted from one person to another (Krishnan et
al., 2013).
In response to the influence of exogenous factors
or the influence of endogenous factors, Eczema or
dermatitis causing clinical abnormalities in the form
of polymorphic efflorescence (erythema, edema,
papules, vesicles, squama) and itching complaints
(Djuanda, 2011). Dermatitis is an inflammation of the
epidermis and dermis that is characterized by
objective symptoms in the form of lesions that are
polymorphic and subjective symptoms of itching, can
Hartini, H., Vlorensia, ., Abdullah, H., Martinus, A. and Ikhtiari, R.
The Effect of a Moisturizing Cream Containing Saccharide Isomerate and Ceramide on Reducing Transepidermal Water Loss in Eczema.
DOI: 10.5220/0009516204110417
In Proceedings of the International Conference on Health Informatics and Medical Application Technology (ICHIMAT 2019), pages 411-417
ISBN: 978-989-758-460-2
Copyright
c
 2020 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
411

be caused by endogenous or exogenous factors
(Maryunani, 2010).
According to Febriana (2012), eczema is
characterized by reddish, scaly, cracked skin, feeling
itchy especially at night, small bubbles appear filled
with water or pus, swollen, blistered, red, very itchy
and feel hot. The cause is an allergy to specific
chemical stimuli, or sensitivity to specific foods like
shrimp, sea fish, alcohol, MSG. Eczema prevention
can be done by avoiding things or ingredients that can
cause allergies. Dermatitis is characterized by
polymorphic skin inflammation that has broad
characteristics, including itching, erythema (redness),
edema (swelling), papules (solid protrusions with
diameters less than 55 mm), vesicles (protrusions
containing a liquid diameter of more than 55mm),
crust and squama.
The main symptom felt by people with eczema is
excessive itching of the skin. Then accompanied by
reddened skin, scaly and cracked, small bubbles arise
containing water or pus. Parts of the body that are
often affected by eczema are usually the hands, feet,
groin, and ears. Eczema is divided into two, namely
dry and wet eczema. In wet eczema, excessive heat
and cold will also feel on the skin. Eczema is caused
due to allergies to certain chemical stimuli such as
those found in detergents, soaps, drugs and cosmetics,
sensitivity to certain types of food such as shrimp, sea
fish, eggs, chicken meat, alcohol, MSG, etc.
(Djuanda, 2011).
Eczema can also be caused by allergies to plant
pollens, dust, climate disorders, even emotional
disturbances. Eczema is more common in people who
are prone to allergies. This disease often occurs
repeatedly or relapse. Therefore, it must be
considered to avoid things or substances that can
cause allergies (allergens.) However, with proper
treatment, this disease can be controlled properly so
that it reduces the recurrence rate. In some cases,
eczema will disappear with age as patients (Djuanda,
2011).
Moisturizers are commonly used to relieve dry
skin include those that cause eczema or dermatitis by
increasing barrier repair, creating temporary artificial
barriers, and restoring skin softness. Moisturizers are
complex formulations designed to improve the
hydration mechanism of the skin and maintain the
structure and function of the skin from various
influences such as dry air, sunlight, old age,
temperature, various skin diseases and diseases that
can accelerate evaporation of water (Nuzantry, 2015).
Moisturizing treatments can reduce TEWL
(transepidermal water loss) with a barrier repair
mechanism, prevent water evaporation from the
epidermis, play a role in replacing lipid compounds
and restore skin softness (Kurnia, 2017).
Cream formulations are the most widely used
dosage forms in drug and cosmetic delivery systems
through the skin. Preparations used in the skin include
physical effects, namely skin protectors, lubricants,
softeners, drying agents, etc., or for special effects of
existing medicinal ingredients. In general, the
administration of drugs or cosmetics through the skin
is intended to provide local effects. Absorption of
medicinal substances from outside the skin to the
bottom of the skin (percutaneous absorption) depends
on the physical-chemical properties of the drug
ingredients, drug carrier properties, and skin
conditions (Ansel, 2008; Yanhendri and Satya, 2012).
Drug-penetration after topical application to the
intact skin is mostly through the epidermis layer, and
the other small part through the walls of the hair
follicles, sweat glands or fat glands or between the
horn membrane cells. Percutaneous absorption of a
drug is generally caused by direct drug penetration
through the stratum corneum which has a thickness of
10─15 µm. The stratum corneum consists of
approximately 40% protein (generally keratin) and
40% water and fat especially triglycerides, free fatty
acids, cholesterol, and phosphate fat. The fat
component of the stratum corneum causes low drug
penetration through the stratum corneum. A drug that
can penetrate the stratum corneum can then continue
through deeper epidermal tissue and enter the dermis
when the drug reaches the blood vessels so the drug
can be absorbed into the systemic circulation. The
stratum corneum as a keratin tissue acts as a semi-
permeable membrane, and drug molecules penetrate
by passive diffusion. The amount of drug that can
pass through various layers of the skin depends on the
concentration of the drug, its solubility in water, and
the coefficient of the partition of the drug in oil or
water. Diffusion of drug molecules in the layers of the
skin can occur through transcellular penetration
(crossing cells), intercellular penetration
(intercellular), and penetration through hair follicles,
sweat glands, fat glands, and pilo sebaceous. Factors
that influence percutaneous absorption include
(Ansel, 2008).
There are various moisturizing products on the
market with various active ingredients, namely those
made from active Saccaride isomerates (SI). The
Pentapharm pharmaceutical industry in Switzerland
ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology
412

in 2008 produced the active ingredient Saccaride
isomerates (SI) which is a mucopolysaccharide
carbohydrate complex (glycan) similar to that found
in the human skin's stratum corneum. The active
ingredient SI in the epidermis will form hyaluronic or
hyaluronic acid. In accordance with this hyaluronic
function, SI can function to maintain moisture by
increasing the water content in the stratum corneum
even in low air humidity (Pentapharm, 2009).
SI is a carbohydrate complex similar to that of the
stratum corneum of human skin. Functioning to
maintain humidity even in low humidity. SI can bind
to the skin even in very low pH condition, so it is ideal
when used together with moisturizers that contain
Alpha hydroxy acid (AHA). SI composition by HA
acts as an effective moisturizer to control skin
moisture by binding to the lysine amino acid group
present in the keratin stratum corneum. Because the
bond is very strong, it will remain effective even in
dry air and low humidity. SI has a strong bond with
the stratum corneum which can only be released by
the desquamation process, therefore it is very
effective at moisturizing the skin, while also making
the skin smoother and not itchy (Pentapharm, 2009).
A study of the effects of SI use on moisturizing
formulations was conducted by Dewi (2010) who
found that adding 5% saccharide isomerates in
moisturizing formulations can improve skin
hydration higher and maintain higher skin hydration
after the administration was stopped compared to
ordinary moisturizers.
SI can be an occlusive and humectant component.
The moisturizer components can also contain other
active ingredients that can improve skin softness by
lubricating and filling the gaps between cells between
dry cells, namely ingredients that are emollient
(Simion & Story, 2005).
The synthetic moisturizers can also help deal with
dry skin such as ceramide. Ceramid mimics natural
substances in the outermost layers of the skin to help
maintain moisture (Octavia, 2017). The original
ceramide is naturally in the skin which is a component
of epidermal lipids in the skin around the stratum
corneum which has the effect of keeping the skin
moist. Ceramide functions, among others, regulating
water loss through epidermis (KAME) or
transepidermal water loss (TEWL) (Trisnowati,
2015).
Ceramide is a water-retaining molecule in the
extracellular space in the stratum corneum and a
ceramide bond with a structural matrix protein that
forms the skin's defense function. The lack of
ceramide in the skin causes the skin barrier function
to be disturbed which results in increased fluid loss
(TEWL) through the skin, so the skin becomes drier
and sensitive to various physical and chemical
influences (Jafar, 2015).
The chemical bond between ceramide and water
will form a smooth emulsion so that it appears smooth
and soft. The administration of ceramide-containing
emollients has been carried out in cases of atopic
dermatitis, which is caused by impaired skin barrier
function. Research results show that the use of
ceramide not only improves TEWL and erythema
severity but also increases endogenous ceramide
levels in the stratum corneum (Partogi, 2008).
Ishikawa et.al's research (2013) shows that indicators
of dry skin (dry, rough and scaly) are closely related
to ceramide levels.
Ceramide formulation in moisturizing creams is
generally a solid lipid nanoparticle (SLN)
formulation. Nanoparticles in the form of very small
particles with a diameter between 1-100 nm.
Nanoparticles are a three dimensional particle, which
has a nanometer scale. The nature of the nanometer-
sized material has a difference with the properties of
the larger size (bulk). Where nano-sized material has
chemical, physical and biological properties that are
superior to larger sized materials (Backdropissa,
2017).
SLN was developed by Muller in the 1990s. In his
research, it was found that SLN can be applied for the
administration of drugs and cosmetics in the form of
liposomes, microemulsions and polymer
nanoparticles. The advantage of SLN is that its lipid
matrix is made of physiological lipids, thereby
reducing the danger of acute and chronic toxicity.
Because of these advantages, SLN has been
introduced as a new carrier system for active
compounds in the pharmaceutical and cosmetic fields
(Background, 2017).
According to Amalia (2015), solid lipid
nanoparticles offer unique properties such as
relatively small particle size, large surface area, high
drug absorption rate and potential as a
carrier/preparation that can improve the performance
of drugs and other nutraceutical ingredients.
Expansion of the use of nanomaterials in
technology and consumer applications has increased
the potential for accidental exposure to human skin.
This has generated considerable interest in
determining the conditions under which nanoparticles
can penetrate the skin. Its main benefit is for
therapeutic success but one that can also minimize the
The Effect of a Moisturizing Cream Containing Saccharide Isomerate and Ceramide on Reducing Transepidermal Water Loss in Eczema
413

potential for negative side effects. The wide use of
nanoparticles as a sunscreen and topical cosmetics
has resulted in the study of many nanoparticles
formulations (Delouise, 2012). This research limits
the effect of moisturizing creams containing
isomerate and ceramide in the formulation of solid
lipid nanoparticles on eczema.
2 RESEARCH METHODS
The research subjects consisted of 12 people for each
group, the subjects who received saccharides
isomerate (SI) moisturizing cream, non SI groups, the
subject group treated with Ceramide (S) moisturizing
cream and non Ceramide (non S). The research
material was a moisturizing cream containing
saccharides isomerate and ceramide in a solid lipid
nanoparticle formulation. The research instrument
used to measure the value of TEWL was Tewameter/
Corneometer 350. Measurement of TEWL values was
carried out before treatment (Week 0) and after
treatment (Week II).
The measurement data were analyzed for the
mean TEWL values before and after treatment and a
comparison between the SI treatment group and non
SI with the S treatment group and non S. The test used
when the normal data distribution was an unpaired t
test while the Mann-Whitney test was used when the
distribution was not normal. Data is processed
statistically using the SPSS program.
The interpretation of TEWL values are 0- <25 gr
/ m2 / hour for normal conditions and> 25 gr / m2 /
hour for disturbed conditions (high) (Black et al.,
2005).
3 RESULTS AND DISCUSSION
The characteristics of the subjects in the SI treatment
group and non-SI according to the age of the majority
aged 30-35 years 11 people (45.8%). Characteristics
of the respondents according to ethnic groups are
mostly Batak 11 people (45.8%). The characteristics
of respondents according to marital status mostly
married 20 people (83.3%). The characteristics of
respondents according to occupation of most
housewife’s were 11 people (45.8%). Characteristics
of subjects in the S treatment group and non S
(control group) according to age were mostly aged
30-35 years 14 people (58.3%). Characteristics of the
respondents according to ethnic groups are mostly
Javanese 11 people (45.8%). The characteristics of
respondents according to marital status mostly
married 22 people (91.7%). Characteristics of
respondents according to occupation of housewife are
12 people (50%). In more details, subject
characteristics is presented in the Table 1 with
statistical analysis of each group of treatment.
Table 1. Subjects characteristics based on ages, etnics,
marital status and occupations.
No
Subject
Characteristics
SI
Treatment
Group and
non SI
(n = 24)
S
Treatment
Group and
non S
(n = 24)
f
%
f
%
1.
Age
a. 30-35 years
11
45,8
14
58,3
b. 36-40 years
13
54,2
10
41,7
2.
Etnic
Batak
11
45,8
10
41,7
Java
8
33,3
11
45,8
Chinese
5
20,8
3
12,5
3.
Marital Status
a. Single
4
16,7
2
8,3
b. Married
20
83,3
22
91,7
4.
Occupation
Civil servants
1
4,2
-
-
Private
Employees
9
37,5
10
41,7
Housewife
11
45,8
12
50,0
Unemployment
3
12,5
2
8,3
Based on the homogeneity test using Levene’s
test, both the SI and non SI groups and the S and non
S groups at the time before and after the treatment,
obtained a significance value> 0.05, this means the
data is assumed to be homogeneous.
The results of the normality test using the Shapiro-
Wilk test, the TEWL value of the subjects in the SI
and non SI groups before being treated with
moisturizing cream each obtained a significance
value of> 0.05, this means that the data is assumed to
be normally distributed. The TEWL value of subjects
in the SI treatment group and non SI after receiving
treatment with each moisturizing cream obtained a
significance value of> 0.05, containing the meaning
that the data was assumed to be normally distributed.
The TEWL value of subjects in the S treatment
group and non S before receiving treatment with each
moisturizing cream, obtained a significance value of>
0.05, this means that the data is assumed to be
normally distributed. The TEWL value of subjects in
the S treatment group and non-S after receiving
ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology
414

treatment with each moisturizing cream, obtained a
significance value of> 0.05, containing the meaning
that the data was assumed to be normally distributed.
3.1 Effectiveness of the Use of
Moisturizing Cream Containing
Saccharide Isomerate Reducing
TEWL Value in Eczema
The data of TEWL values showed that the use of
saccharide isomerate moisturizing cream for 2 weeks
can significantly reduce TEWL in patients with
eczema. Compared to the control group (non SI) the
decrease in TEWL values in the SI group was higher.
The data of TEWL values has been evaluated
statistically as shown in Table 2.
Table 2. TEWL Value of Skin in Lower Limbs of SI and
Non SI Subjects Before and After Treatment.
Treat
ment
Groups
TEWLValue
(gr/m
2
/hour)
p
value
Mean
Before
SI
23,67 (21,65-26,25)
0,270
Non SI
24,31 (21,53-26,25)
After
SI
13,98 (11,55-15,25)
0,036
Non SI
15,22 (12,55-17,50)
Statistical data analysis of TEWL values showed
a significant decrease after treatment in the SI group
with saccharide isomerate moisturizing cream.
Decrease in TEWL value from 23.67 gr/m2/hour
range (21.65-26.25) before treatment to be 13.98
gr/m2/hour (11.55-15.25) with a significance value p
= 0.036.
We have not found a previous study of the use of
saccharide isomerate moisturizing cream in eczema
sufferers to be compared with this study. However,
there are studies in subjects that are normal (not
eczema sufferers), namely Dewi (2010) who found
that saccharide isomerates can improve skin
hydration higher and maintain higher skin hydration
after administration is stopped compared to ordinary
moisturizers.
3.2 Effectiveness of the Use of
Moisturizing Creams Containing
Ceramide in Reducing TEWL
Value in Eczema
The effectiveness of moisturizing cream has been
evaluated statistically and showed that a significant
decrease in TEWL value after treatment in group S
with moisturizing cream containing ceramide solid
lipid nanoparticle formulation. Decreasing of the
TEWL value from 24.50 gr/m2/hour range (22.95-
26.10) before treatment became 14.98 gr/m2/hour
(13.55-16.95) with a significance value p = 0.035.
These data show that the use of ceramide
moisturizing cream in solid lipid nanoparticle
formulation for 2 weeks can significantly reduce
TEWL in patients with eczema. Compared with the
control group (non-S) the decrease in TEWL value in
the S group was higher. In details, effectiveness data
shown in Table 3.
Table 3. TEWL Value of Skin in Lower Limbs of S and
Non S Subjects Before and After Treatment.
Treat
ment
Groups
TEWLValue
(gr/m2/hour)
p
value
Mean
Before
S
24,50 (22,95-26,10)
0,207
Non S
25,04 (23,68-26,52)
After
S
14,98 (13,55-16,95)
0,035
Non S
15,87 (14,50-17,37)
The results of this study was in accordance with
Ishikawa et al. (2013) which showed that indicators
of dry skin (dry, rough and scaly) were closely related
to ceramide levels. The Spada study (2018) which
found moisturizing creams containing ceramide
significantly reduced TEWL (p <0.001) for 24 hours.
The results of this study are also in accordance with
the results of the Partogi (2008) study which found
that the bond between ceramide and water will form
a smooth emulsion, making it appear smooth and soft.
Giving emollients containing ceramide has been
carried out in cases of atopic dermatitis, which is
caused by impaired skin barrier function. Research
shows that administration of ceramide not only
improves TEWL and erythema severity, but also
The Effect of a Moisturizing Cream Containing Saccharide Isomerate and Ceramide on Reducing Transepidermal Water Loss in Eczema
415

increases levels of endogenous ceramide in the
stratum corneum.
We found a previous study supporting the results
of this study but with different research subjects,
Spada (2018) who found that 24 hours after
application of Ceramide cream was significantly
greater (P <0.05) than measured for the three
reference moisturizers tested. Ceramide cream
significantly reduces TEWL (P <0.001) for 24 hours,
and is proven to not cause sensitization to the skin of
adults and children and does not cause irritation to the
skin, eyes and related eye area.
3.3 Effectiveness of the Use of
Moisturizing Cream Containing a
Combination of Saccharide
Isomerate and Ceramide on
Reducing TEWL Value in Eczema
To the best of our knowledge on literature, still no
report on the differences in the use of moisturizing
creams containing saccharides isomerate and
ceramide in eczema sufferers to be compared with
this study.
The effectiveness of combination of moisturizing
cream showed that the results of the measurement of
TEWL values in the SI and S groups before the
treatment had no difference (p = 0.092). After
treatment there were differences in TEWL values
between the Saccharide Isomerate group and the
Ceramide group (p = 0.032). In details, the statistical
data analysis of TEWL values of combination cream
is presented in the Table 4.
Table 4. TEWL Value of combination SI and S in eczema
sufferers.
Treat
ment
Groups
TEWLValue
(gr/m
2
/hour)
p
value
Mean
Before
SI
-0,84083
0,092
S
After
SI
-1,00167
0,032
S
Based on the statistical results of the independent
t test, it was found the significant difference in the use
of moisturizing creams containing saccharide
isomerate and ceramide in solid lipid nanoparticles
formulations in reducing TEWL values in eczema
sufferers.
The results of this study prove that the use of
moisturizing creams containing saccharide isomerate
can significantly reduce TEWL in eczema sufferers.
Compared to the control group (non saccharide
isomerate) the decrease in TEWL values in the SI
group was higher. To the best of our knowledge, we
have not found a previous study of the use of
saccharide isomerite moisturizing cream in eczema
sufferers to be compared with this study.
Voegeli et.al (2019) has reported that remarkable
gradients of skin hydration, TEWL, skin surface pH
and sebum exist within short distances across the face
and the gradients are distinctive among different
ethnic groups. In addition, these studies have
demonstrated that darkly‐ pigmented individuals do
not necessarily have a better skin barrier function than
their less‐ pigmented counterparts and that
Caucasians have a lower facial skin surface pH
compared with more pigmented subjects. Overall,
there are no correlations between capacitance, TEWL
and skin surface pH including individual topology
(Voegeli et. Al 2019).
The results of this study are in accordance with the
results of Pentapharm (2009) study that the active
ingredient of saccharide isomerate in the epidermis
will form hyaluronic or hyaluronic acid. In
accordance with this hyaluronic function, the
isomerate saccharide can function to retain moisture
by increasing the water content in the stratum
corneum even in low air humidity (Pentapharm,
2009).
The results of this study are also supported by
Kurnia's statement (2017) that moisturizing
treatments can reduce TEWL (transepidermal water
loss) with a barrier repair mechanism, prevent water
evaporation from the epidermis, play a role in
replacing lipid compounds and restore skin softness.
4 CONCLUSION
The use of moisturizing creams containing
Saccharide Isomerate and Ceramide in solid lipid
nanoparticle formulations effectively reduced the
TEWL value in eczema sufferers.
ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology
416

ACKNOWLEDGEMENTS
This research supported by Ministry of Research,
Technology and Higher Education by Funding
Contract No. 7/E/KPT/2019 and No.
T/63/L1.3.1/PT.01.03/2019.
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