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Clinical Effectiveness of Moisturizers in Atopic Dermatitis and Related Disorders: A Systematic Review

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Abstract

Background

Moisturizers are widely used for atopic dermatitis (AD) and related conditions, but available evidence of their effectiveness has not been reviewed in a systematic fashion.

Objectives

Our objective was to investigate the effectiveness of emollients, as a group and individually, in the treatment of AD and related conditions, by means of a systematic review.

Data Sources

Studies indexed in MEDLINE and/or Embase before 16 January 2015.

Study Eligibility Criteria

Controlled clinical studies comparing the clinical effect of a moisturizer against its vehicle, another moisturizer, or no treatment were eligible. For the outcomes transepidermal water loss (TEWL) and stratum corneum hydration, uncontrolled before–after designs were also eligible.

Participants

Participants were patients with AD, irritant hand dermatitis, and/or ichthyosis vulgaris.

Results

Out of the 595 publications initially identified, 45 (48 studies, 3262 patients) were eligible for inclusion. A vast majority of studies indicate that moisturizers have beneficial effects on clinical symptoms [SCORAD (SCORing Atopic Dermatitis) reductions ranging from 0 to 2.7 points], TEWL (range 0 to −12.2 g/m2h) and stratum corneum hydration (range +8 to +100 %). Direct comparisons between individual moisturizers are still scarce, but the clinical effect appears to be much more well-documented for urea and glycerin than, for example, propylene glycol, lactate, ceramide, and aluminum chlorohydrate. Compared with urea studies, glycerin studies were more often associated with a high risk of bias.

Limitations

Due to differences in study designs and outcome measures, a quantitative meta-analytic approach was not deemed feasible, and formal indicators of publication bias such as funnel plots could not be used. However, a large number of moderately sized studies with positive outcomes could be compatible with selective publishing of favourable results.

Conclusions

The clinical effect of moisturizers is well-documented. Urea-based preparations may be preferable as a first-line treatment, but there is an unmet need for well-powered comparisons between individual moisturizers.

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Authors and Affiliations

  1. Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden

    Jonatan D. Lindh

  2. Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

    Maria Bradley

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  1. Jonatan D. Lindh
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Correspondence to Jonatan D. Lindh.

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Funding

No funding was received specifically for the preparation of this review. Jonatan Lindh holds a postdoc position funded by Karolinska Institutet and Stockholm County Council.

Conflict of interest

Neither Jonatan Lindh nor Maria Bradley have any conflict of interest to declare.

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Lindh, J.D., Bradley, M. Clinical Effectiveness of Moisturizers in Atopic Dermatitis and Related Disorders: A Systematic Review. Am J Clin Dermatol 16, 341–359 (2015). https://doi.org/10.1007/s40257-015-0146-4

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