## 4 Emollients and Their Role in the Treatment of Psoriasis
### Emollients \"Plus\"  
It is common to enrich emollients with additional natural substances. Such action is aimed at enhancing the properties of the applied substance with, for example, anti-inflammatory, antipruritic or immunomodulatory effects [55]. The enrichment of emollients with other specific substances shows a synergistic effect in the treatment of psoriatic lesions compared to basic emollients such as petroleum jelly or paraffin wax [56]. The enrichment of emollients with additional substances and the positive effects resulting from their use have been identified by the authors of papers [54; 57; 58]. Studies have shown that emollients occurring with substances such as ceramides, dexamethasoneol, celastor or polidocanol have shown an enhanced therapeutic effect in the treatment of psoriasis skin. One of the studied ingredients with positive effects on psoriatic skin is ceramides, which belong to the sphingolipid group [59]. A reduction in the amount of sphingolipids in the skin is associated with epidermal barrier dysfunction, and consequently causes excessive water loss. In addition, ceramides are the main lipid component of the intercellular spaces in the stratum corneum, playing a significant role in differentiation, proliferation and cell cycle inhibition. Their main role is to limit excessive water loss and prevent the penetration of pathogenic microorganisms into the skin [60; 61]. Reduced levels of ceramides are observed in patients with psoriasis. The result is an impaired anti-apoptotic effect, resulting in characteristic skin lesions [62; 63]. In addition, in a study conducted by the authors [54], it was observed that the decrease in ceramide levels was proportional to the area of skin affected by psoriasis. In contrast, [PERSON] et al. [54] studied the effect of an emollient containing ceramides and linoleic acid. The authors showed that the use of emollients before and after the application of glucocorticoids resulted in a prolonged state of skin improvement, while preventing relapse after treatment. Dexpanthenol, due to its properties in restoring the skin's protective barrier and alleviating symptoms of dry skin, has become the subject of intensive scientific research regarding its use in emollients [64]. It forms, along with other components, coenzyme A, which participates in the metabolism of fatty acids and sphingolipids. The resulting lipid compounds create a lipid layer in the stratum corneum of the epidermis. A tight stratum corneum ensures proper skin function by protecting the skin from external factors and excessive water loss [65]. In a study conducted by [PERSON] et al. in 2022, it was found that after applying an emollient with dexamethasoneol, the skin remained hydrated, making it less prone to damage and preventing the formation of scales [64]. In 2024, [PERSON] and others demonstrated the effectiveness of dexamethasoneol in treating dry skin [66]. In another study by [PERSON] et al. in 2015, the effects of petrolatum and a 5% dexamethasoneol on the healing process of damaged skin were compared [57]. After a few days of using the ointment containing 5% dexamethasoneol, clinicians observed a significant reduction in skin lesions compared to those treated with petrolatum. Furthermore, after 7 days of using both substances, it was observed that the ointment enriched with dexamethasoneol, compared to petrolatum, improved epidermal regeneration through faster reepithelialization and more quickly restored the normal function of the skin barrier. [PERSON]. [PERSON] et al. in 2020 [58] conducted a study comparing the effectiveness of a standalone emollient to an emollient enriched with celastrol and polidocanol in patients with psoriasis [58]. Celastor is an immunomodolator whose properties inhibit interleukin-17A. One of the main cytokines involved in the pathogenesis of psoriasis is IL-17A, whose values are elevated in psoriasis patients [67]. The emollient also contained polidocanol, whose antiposriatic effect is based on its antipruritic action.