Efficacy of Nonprescription Moisturizers for Atopic Dermatitis: An Updated Review of Clinical Evidence
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REVIEW ARTICLE
Efficacy of Nonprescription Moisturizers for Atopic Dermatitis: An Updated Review of Clinical Evidence Adelaide A. Hebert1 · Frank Rippke2 · Teresa M. Weber3 · Noreen Heer Nicol4
© The Author(s) 2020
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.
1 Introduction Atopic dermatitis (AD) affects more than 18 million people in the USA [1]. Daily moisturization is the standard or “bedrock” of the basic disease management of AD [2, 3]. A comprehensive review of 14 independent published guidelines from across the globe (USA, UK, Europe, Japan, Korea, Singapore, Canada, South Africa, and individual European countries) revealed that daily moisturization was a consistent recommendation for AD management [4].
* Adelaide A. Hebert [email protected] 1
Department of Dermatology, University of Texas McGovern Medical School, 6655 Travis, Suite 980, Houston, TX 77030, USA
2
Research and Development, Beiersdorf, Hamburg, Germany
3
Research and Development, Beiersdorf Inc., Wilton, CT, USA
4
College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
Key Points Daily moisturization is the bedrock of atopic dermatitis (AD) management, as recommended by all international guidelines. Therapeutic moisturizers developed specifically for the treatment of AD demonstrate improved skin barrier and reduced incidence of flares in clinical trials. Healthcare providers can help improve the skin condition o
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