Efficacy of Nonprescription Moisturizers for Atopic Dermatitis: An Updated Review of Clinical Evidence

Abstract

Twice-daily moisturization is recommended by international guidelines as the bedrock of the management of atopic dermatitis (AD). Moisturizers should be selected based on proven clinical effectiveness in improving the skin barrier and improving the symptoms of AD. We searched the PubMed database for clinical trials assessing daily moisturization for the treatment of AD published between 2006 and 2019. Studies had to assess the efficacy of commercially available moisturizers using objective measures of corneometry, transepidermal water loss, or incidence of flare as endpoints, and treatments had to be currently available to patients. Clinical studies showed that moisturization (typically twice daily) significantly improved the skin barrier in adults and children with AD. Longer-term flare studies showed that daily moisturization reduced the incidence of flares and extended the time between flares. Proactive moisturization of infants at high risk of developing AD may reduce its manifestation. Therapeutic moisturizers for AD are specifically formulated with ingredients that target symptoms of AD, such as itch, inflammation, or compromised skin barrier. The US FDA requires that any moisturizer available in the USA and claiming to treat AD must contain colloidal oatmeal. Healthcare providers can maximize compliance and outcomes by educating patients on the benefits of liberally applying a therapeutic moisturizer twice daily to support the skin barrier and help reduce the incidence of flares. Specific recommendations should be for clinically tested moisturizers evaluated using objective, validated skin assessments.

Baricitinib Rapidly Improves Skin Pain Resulting in Improved Quality of Life for Patients with Atopic Dermatitis: Analyses from BREEZE-AD1, 2, and 7

“…Currently, there is no formal guidance on the treatment of skin pain in patients with AD as this symptom is often insufficiently acknowledged by treating physicians because of its perceived association with itch [9]. Emollients have not been shown to have any direct action on skin pain but may have a protective effect against the formation of painful lesions by reducing the number of flares [21], whereas TCI may induce pain hypersensitivity resulting in a burning sensation on application [22]. However, many of the treatments for AD which have been shown to have efficacy against itch have been poorly studied for their effect on skin pain [23], and some patients still experience skin pain despite otherwise controlled disease [20].…”

ARTICLE: Evolution of Skin Barrier Science for Healthy and Compromised Skin

“…In the case of chronic conditions such as AD and psoriasis, daily application of products that support skin barrier maintenance between flares can reduce the onset of symptoms and improve general quality of life. [62][63][64] Moisturizers, creams, and lotions, including cosmetics, are safe, readily-available, and inexpensive products that have been mainstays among the skin care community for years. Moisturizers, alone or in combination with other antiinflammatory/immunomodulatory agents, have demonstrated clinical benefit to reduce the onset, symptoms, and progression of diseases characterized by compromised barrier.…”

“…Moisturizers, alone or in combination with other antiinflammatory/immunomodulatory agents, have demonstrated clinical benefit to reduce the onset, symptoms, and progression of diseases characterized by compromised barrier. 50,[61][62][63][64] Clinical benefits have been observed in cohorts ranging from adults to neonates. A preventive role of such approach against declaration of AD has been evidenced in a study in which neonates benefited from daily moisturizer application for 32 weeks after birth.…”

“…56,62 This approach to maintain the protective and hydrating function of the skin barrier has made frequent and routine use of the skin care products the recommendation of many health care professionals. 64 Given the role of ceramides in epidermal barrier function, many moisturizers include ceramides to help support the restoration of the skin barrier. patients that replaced standard moisturizers with ceramidedominate lipid-based emollients experienced reduced injury severity, decreased TEWL, and increased hydration.…”

Daily Moisturization for Atopic Dermatitis: Importance, Recommendations, and Moisturizer Choices

“…This article builds on a recent publication by this group, 25 which presented details of nonprescription therapeutic moisturizers marketed in the United States with objective, proven benefits in patients with AD (extending the time to eczema skin flare and retaining moisture in both lesional and nonlesional skin). Studies on the use of single ingredients for skin barrier function and water loss (eg, petrolatum or virgin coconut oil) are not included.…”