Moisturizers, commonly used in dermatitis care, were linked to adverse effects such as pruritus and worsening eczema in 35% to 40% of children with eczema studied, with possible connections to microbial dysbiosis and allergic reactions, according to a recent review.
The review evaluated the benefits and potential adverse effects of moisturizers in dermatitis management, suggesting moderation and personalized recommendations for their use. Although moisturizers remained a cornerstone of atopic dermatitis (AD) care, recent studies suggested their application warranted greater consideration based on individual patient responses.
Moisturizers contributed to microbial dysbiosis, increasing Staphylococcus aureus colonization and exacerbating dermatitis in some patients. Studies reported adverse effects in 35% to 40% of patients, including worsening eczema, pruritus, or localized exacerbation of disease. Additionally, allergens in moisturizers, such as oat extract and propylene glycol, were linked to allergic contact dermatitis and systemic contact dermatitis, particularly in children with AD.
While moisturizers demonstrated efficacy in delaying AD flares, with one randomized trial showing a 30% increase in children remaining flare-free at 12 weeks when applied to healed skin, the clinical impact on other measures, such as SCORing Atopic Dermatitis (SCORAD) scores, appeared modest. A Cochrane review of 77 studies revealed small reductions in SCORAD scores, often falling short of the minimal clinically important difference. No significant differences in efficacy were observed between lotion, cream, ointment, or gel forms, suggesting that patient preference and cost guided selection.
Research highlighted challenges in evaluating moisturizers, including a lack of placebo-controlled trials and potential bias from underpowered studies. Furthermore, most studies excluded patients with severe symptoms, such as crusting or oozing skin, limiting insights into their effects on this subgroup. Patient satisfaction with moisturizers often reflected improved appearance and texture of the skin, rather than clinical improvement.
Current recommendations included limiting moisturizer application to once daily, preferably after bathing, and avoiding use on crusted or oozing skin. Ceramide-rich, low-pH formulations were suggested to strengthen the skin barrier, but clinicians were advised to monitor for adverse reactions, particularly in patients reporting increased pruritus with moisturizers.
This review, published in the Journal of the American Academy of Dermatology, underscored the importance of individualized approaches to moisturizer use, enhanced patient education about potential risks, and further research to refine guidelines. The role of evidence-based strategies remained central to optimizing outcomes while addressing patient concerns and preferences.
Full disclosures could be found in the published review.
