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Emollients: Effects, Evidence, and Side Effects

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Kanerva’s Occupational Dermatology

Abstract

Emollients are traditionally used in all kind of skin diseases involving epidermal pathology and barrier dysfunction. In occupational settings, emollients are used both for treatment and prevention of skin disease. Emollients may also be used for cosmetic purposes, to avoid the look of dry skin. Although emollients are very widely used, and recommended by physicians, evidence for efficacy is sparse. In Europe, regulation of emollients is under the directive of cosmetics (Directive 76/768/EEC). More specific knowledge is needed concerning effects of different ingredients in the products. A future goal is that emollients may be more specifically designed for certain exposures and occupations and that randomized studies should be undertaken to confirm the effect of use.

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References

  • Agner T (1992) An experimental study of irritant effects of urea in different vehicles. Acta Derm Venereol Suppl (Stockh) 177:44–46

    CAS  Google Scholar 

  • Agner T, Serup J (1989) Skin reactions to irritants assessed by non-invasive bioengineering methods. Contact Dermatitis 20:352–359

    Article  CAS  PubMed  Google Scholar 

  • Aly R, Shirley C, Cunico B, Maibach HI (1978) Effect of prolonged occlusion on the microbial flora, pH, carbon dioxide and transepidermal water loss on human skin. J Invest Dermatol 71:378–381

    Article  CAS  PubMed  Google Scholar 

  • Andersen F, Hedegaard K, Petersen TK, Bindselv-Jensen C, Fullerton A, Andersen KE (2006) Anti-irritant I: dose–response in acute irritation. Contact Dermatitis 55:148–154

    Article  CAS  PubMed  Google Scholar 

  • Anderson PC, Dinulos JG (2009) Are the new moisturisers more effective? Curr Opin Pediatr 21:486–490

    Article  PubMed  Google Scholar 

  • Berson D (2005) Recommendation of moisturisers and cleaners: a study of unmet needs in dermatological patients. Cutis 76(Suppl 6):3–6

    PubMed  Google Scholar 

  • Buraczewska I, Loden M (2005) Treatment of surfactant damaged skin in humans with creams of different pH values. Pharmacology 73:1–7

    Article  CAS  PubMed  Google Scholar 

  • Clemmensen A, Andersen F, Petersen TK, Kalden H, Melgaard A, Andersen KE (2008) The irritant potential of n-propanol (nonanoic acid vehicle) in cumulative skin irritation: a validation study of two different human in vivo test models. Skin Res Technol 14:277–286

    Article  CAS  PubMed  Google Scholar 

  • Crowther JM, Sieg A, Blenkiron P, Marcott C, Matts PJ, Kaczvinsky JR, Rawlings AW (2008) Measuring the effects of topical moisturizers on change in stratum corneum thickness, water gradients and hydration in vivo. Br J Dermatol 159:567–577

    PubMed  CAS  Google Scholar 

  • De Paepe K, Derde MP, Roseeuw D, Rogier V (2000) Claim substantiation and efficiency of hydrating body lotions and protective creams. Contact Dermatitis 42:336–343

    Article  Google Scholar 

  • Diepgen TL, Andersen KE, Chosidow O, Coenraads PJ, Elsner P, English J, Fartasch M, Gimenez-Arnau A, Nixon R, Sasseville D, Agner T (2015) Guidelines for diagnosis, prevention and treatment of hand eczema. J Dtsch Dermatol Ges 13(1):e1–e22

    Article  PubMed  Google Scholar 

  • Directive 76/768/EEC (1976) http://ec.europa.eu/enterprise/sectors/cosmetics/documents/directive/

  • Duval C, Lindberg M, Bowman A, Johnsson S, Edlund F, Loden M (2003) Differences among moisturizers in affecting skin susceptibility to hexyl nicotinate, measured as time to increase skin blood flow. Skin Res Technol 9:59–63

    Article  PubMed  Google Scholar 

  • Ekholm IE, Brattsand M, Egelrud T (2000) Sratum corneum tryptic enzyme in normal epidermis: a missing link in the desquamation process? J Invest Dermatol 114:56–63

    Article  CAS  PubMed  Google Scholar 

  • Fagernes M, Lingaas E (2011) Factors interfering with the microflora on hands: a regression analysis of samples from 465 healthcare workers. J Adv Nurs 67(2):297–307

    Article  PubMed  Google Scholar 

  • Fisker M, Ebbehøj NE, Jungersted J, Agner T (2013) What does patients with occupational hand eczema know about skin care? Contact Dermatitis 69(2):93–98

    Article  PubMed  Google Scholar 

  • Giménez-Arnau A (2016) Standards for the protection of skin barrier function. Curr Probl Dermatol 49:123–134

    Article  PubMed  Google Scholar 

  • Hachem JP, Roelandt T, Schürer N, Pu X, Fluhr J, Giddelo C, Man MQ, Crumrine D, Roseeuw D, Feingold KR, Mauro T, Elias PM (2010) Acute acidification of the stratum corneum membrane domains using polyhydroxyl acids improves lipid processing and inhibits degradation of corneodesmosomes. J Invest Dermatol 130:500–510

    Article  CAS  PubMed  Google Scholar 

  • Halkier-Sørensen L, Thestrup-Peder K (1993) The efficacy of a moisturizer among cleaners and kitchen assistants during every day exposure to detergents. Contact Dermatitis 29:266–271

    Article  PubMed  Google Scholar 

  • Halling-Overgaard AS, Kezic S, Jakasa I, Engebretsen KA, Maibach H, Thyssen JP (2017) Skin absorption through atopic dermatitis skin: a systematic review. Br J Dermatol 177(1):84–106

    Article  PubMed  Google Scholar 

  • Hartmann AA (1983) Effect of occlusion on resident flora, skin-moisture and skin pH. Arch Dermatol Res 275:251–254

    Article  CAS  PubMed  Google Scholar 

  • Held E, Agner T (2001) Effect of moisturizers on skin susceptibility to irritants. Acta Derm Venereol 81(2):104–107

    Article  CAS  PubMed  Google Scholar 

  • Held E, Johansen JD, Agner T, Menné T (1999a) Contact allergy to cosmetics: testing patients’ own products. Contact Dermatitis 40:310–315

    Article  CAS  PubMed  Google Scholar 

  • Held E, Sveinsdottir S, Agner T (1999b) Effect of longterm use of moisturizers on skin hydration, barrier function and susceptibility to irritants. Acta Derm Venereol 79:49–51

    Article  CAS  PubMed  Google Scholar 

  • Held E, Lund H, Agner T (2001) Effect of different moisturizers on SLS-irritated human skin. Contact Dermatitis 44:229–234

    Article  CAS  PubMed  Google Scholar 

  • Held E, Mygind K, Wolff C, Gyntelberg F, Agner T (2002) Prevention of work related skin problems: an intervention study in wet work employees. Occup Environ Med 59:556–561

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Held E, Skøt R, Johansen JD, Agner T (2005) The hand eczema severity index (HECSI): a scoring system for clinical assessment of hand eczema. A study of inter- and intraobserver reliability. Br J Dermatol 152(2):302–307

    Article  CAS  PubMed  Google Scholar 

  • Ibler K, Gluud C, Jemec G, Diepgen T, Thomsen SF, Agner T (2012) The hand eczema trial (HET): results of a randomised clinical trial of skin care education and individual counselling versus treatment as usual in health-care workers with hand eczema. BMJ 12:345 e7822

    Google Scholar 

  • Kampf G, Ennen J (2006) Regular use of a hand cream can attenuate skin dryness and roughness caused by frequent hand washing. BMC Dermatol 6:1–5

    Article  PubMed  PubMed Central  Google Scholar 

  • Kraft JN, Lynde CW (2005) Moisturizers: what they are and a practical approach to product selection. Skin Therapy Lett 10:1–8

    PubMed  CAS  Google Scholar 

  • Kucharekova M, Van De Kerkhof PC, Van Der Valk PG (2003) A randomized comparison of an emollient containing skin-related lipids with petrolatum-based emollient as adjunct in the treatment of chronic hand dermatitis. Contact Dermatitis 48:293–299

    Article  CAS  PubMed  Google Scholar 

  • Loden M (1997) Barrier recovery and influence of irritant stimuli in skin treated with a moisturizing cream. Contact Dermatitis 36:256–260

    Article  CAS  PubMed  Google Scholar 

  • Lodén M (2016) Treatments improving skin barrier function. Curr Probl Dermatol 49:112–122

    Article  PubMed  Google Scholar 

  • Loden M, Andersson AC (1996) Effects of topically applied lipids on surfactant irritated skin. Br J Dermatol 134:215–220

    Article  CAS  PubMed  Google Scholar 

  • Loden M, Barany E (2000) Skin identical lipids versus petrolatum in the treatment of tape-stripped and detergent perturbed human skin. Acta Derm Venereol 80:412–415

    Article  CAS  PubMed  Google Scholar 

  • Loden M, Wessman C (2001) The influence of a cream containing 20% glycerin and its vehicle on skin barrier properties. Int J Cosmet Sci 23:115–119

    Article  CAS  PubMed  Google Scholar 

  • Man MQ, Feingold KR, Elias PM (1993) Exogenous lipids influence permeability barrier recovery in acetone-treated murine skin. Arch Dermatol 129:728–738

    Article  CAS  PubMed  Google Scholar 

  • Mauro T, HolleranWM GS, Gao WN, Man MQ, Kriehuber E, Behne M, Feingold KR, Elias P (1998) Barrier recovery is impeded at neutral pH, independent of ionic effects; implications for extracellular lipid processing. Arch Dermatol Res 290:215–222

    Article  CAS  PubMed  Google Scholar 

  • Menon GK (2002) New insights into skin structure: scratching the surface. Adv Drug Deliv Rev 54:3–17

    Article  Google Scholar 

  • Moyle M, Keegel T, Noonan A, Nixon R (2006) Skin care in occupational contact dermatitis of the hands. Australas J Dermatol 47:97–101

    Article  PubMed  Google Scholar 

  • Mygind K, Sell L, Flyvholm MA, Jepsen KF (2006) High-fat petrolatum-based moisturizers and prevention of work-related skin problems in wet-work occupations. Contact Dermatitis 54(1):35–41

    Article  PubMed  Google Scholar 

  • Noiesen E, Munk MD, Larsen K, Høyen M, Agner T (2007) Use of complementary and alternative treatment for allergic contact dermatitis. Br J Dermatol 157:301–305

    Article  CAS  PubMed  Google Scholar 

  • Proksch E, Holleran WM, Menon GK, Elias PM, Feingold KR (1993) Barrier function regulates epidermal lipid and DNA synthesis. Br J Dermatol 128(5):473–482

    Article  CAS  PubMed  Google Scholar 

  • Ramsing DW, Agner T (1997) Preventive and therapeutic effects of a moisturizer. Acta Derm Venereol (Stockh) 77:335–337

    CAS  Google Scholar 

  • Schreiner V, Gooris GS, Pfeiffer S, Lanzendörfer G, Wenck H, Diembeck W, Proksch W, Bouwstra J (2000) Barrier characteristics of different human skin types investigated with x-ray diffraction, lipid analysis and electron microscopy imaging. J Invest Dermatol 114:654–660

    Article  CAS  PubMed  Google Scholar 

  • Serup J (1992) A double-blind comparison of two creams containing urea as the active ingredient. Acta Derm Venereol Suppl 177:34–38

    CAS  Google Scholar 

  • Serup J, Winther A, Blichmann CW (1989) Effects of repeated application of a moisturizer. Acta Derm Venereol 69:457–459

    PubMed  CAS  Google Scholar 

  • Waterwig S, Neubert RHH (2007) Properties of ceramides and their impact on stratum corneum structures. Skin Pharmacol Physiol 20:220–229

    Article  CAS  Google Scholar 

  • Wertz PW, Downing DT (1983) Ceramides of pig stratum epidermis, structure determination. J Lipid Res 24:753–758

    PubMed  CAS  Google Scholar 

  • Williams C, Wilkinson SM, McShane P, Lewis J, Pennington D, Pierce S, Fernandez C (2010) A double-blind, randomised study to assess the effectiveness of different moisturizers in preventing dermatitis induced by hand washing to simulate healthcare use. Br J Dermatol 162:1088–1092

    Article  CAS  PubMed  Google Scholar 

  • Wood LC, Elias PM, Sequeira-Martin SM, Grunfeld C, Feingold KR (1994) Occlusion lowers cytokine mRNA levels in essential fatty acid-deficient and normal mouse epidermis, but not after acute barrier disruption. J Invest Dermatol 103:834–838

    Article  CAS  PubMed  Google Scholar 

  • Zachariae C, Held E, Johansen JD, Menné T, Agner T (2003) Effect of a moisturiser on skin susceptibility to NiCl2. Acta Derm Venereol 83(2):93–97

    Article  CAS  PubMed  Google Scholar 

  • van Zuuren EJ, Fedorowicz Z, Christensen R, Lavrijsen A, Arents BWM (2017). Emollients and moisturisers for eczema Cochrane Database Syst Rev 2:CD012119

    Google Scholar 

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Correspondence to Tove Agner .

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Agner, T., Jungersted, J.M. (2018). Emollients: Effects, Evidence, and Side Effects. In: John, S., Johansen, J., Rustemeyer, T., Elsner, P., Maibach, H. (eds) Kanerva’s Occupational Dermatology. Springer, Cham. https://doi.org/10.1007/978-3-319-40221-5_94-2

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  • DOI: https://doi.org/10.1007/978-3-319-40221-5_94-2

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  • Print ISBN: 978-3-319-40221-5

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