Asia Pac Allergy.  2016 Apr;6(2):120-128. 10.5415/apallergy.2016.6.2.120.

A review on the role of moisturizers for atopic dermatitis

Affiliations
  • 1National Skin Centre, Singapore 308205, Singapore. ycgiam@nsc.com.sg
  • 2Departments of Dermatology and Pediatrics, University of Texas-Houston Medical School, Houston, TX 77030, USA.
  • 3Department of Dermatology, College of Medicine and Surgery, University of Santo Tomas, Manila, the Philippines.
  • 4Division of Paediatric Allergy, Immunology and Rheumatology, Khoo Teck Puat-National University Children's Medical Institute, Singapore 119228, Singapore.
  • 5Section of Allergy and Immunology, Department of Pediatrics, University of the Philippines, Manila, the Philippines.
  • 6Department of Dermatology, Seoul National University Hospital, Seoul 03080, Korea.
  • 7Department of Dermatology Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia.
  • 8Department of Allergy and Immunology, Department of Child Health, Medical Faculty, University of Indonesia, Jakarta, Indonesia.
  • 9Faculty of Medicine, Padjadjaran University/Division of Paediatric Dermatology, Hospital Dr. Hasan Sadikin, Bandung, Indonesia.
  • 10Department of Pediatrics and Adolescent Medicine, United Christian Hospital, Kwun Tong, Hong Kong.

Abstract

Effective management of atopic dermatitis (AD) involves the treatment of a defective skin barrier. Patients with AD are therefore advised to use moisturizers regularly. To date, there are few comparative studies involving moisturizers in patients with AD, and no classification system exists to objectively determine which types of moisturizers are best suited to specific AD phenotypes. With this in mind, a group of experts from allergy and immunology, adult and pediatric dermatology, and pediatrics centers within Southeast Asia met to review current data and practice, and to develop recommendations regarding the use of moisturizers in patients with AD within the Asia-Pacific region. Chronicity and severity of AD, along with patient age, treatment compliance, and economic background should all be taken into account when selecting an appropriate moisturizer for AD patients. Other considerations include adjuvant properties of the product, cosmetic acceptability, and availability over the counter. Well-defined clinical phenotypes of AD could optimally benefit from specific moisturizers. It is hoped that future studies may identify such differences by means of filaggrin mutation subtypes, confocal microscopic evaluation, pH, transepidermal water loss or presence of allergy specific IgE. Recommendations to improve the regular use of moisturizers among AD patients include measures that focus on treatment compliance, patient and caregiver education, appropriate treatment goals, avoidance of sensitizing agents, and collaboration with other relevant specialists.

Keyword

Dermatitis, atopic; Compliance; Asia Pacific; Moisturizer; Classification

MeSH Terms

Adult
Allergy and Immunology
Asia, Southeastern
Caregivers
Classification
Compliance
Cooperative Behavior
Dermatitis, Atopic*
Dermatology
Education
Hope
Humans
Hydrogen-Ion Concentration
Hypersensitivity
Immunoglobulin E
Patient Compliance
Pediatrics
Phenotype
Skin
Specialization
Water
Immunoglobulin E
Water

Figure

  • Fig. 1 Skin barrier dysfunction in patients with atopic dermatitis. TSLP, thymic stromal lymphopoietin; Th2, T helper 2 cells; PAR-2, proteaseactivated receptor 2. Reprinted from Kabashima K. J Dermatol Sci 2013;70:3-11, with permission from Elsevier [2].


Cited by  2 articles

The era of allergy
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A clinician's reference guide for the management of atopic dermatitis in Asians
Steven Chow, Chew Swee Seow, Maria Victoria Dizon, Kiran Godse, Henry Foong, Vicheth Chan, Tran Hau Khang, Leihong Xiang, Syarief Hidayat, M. Yulianto Listiawan, Danang Triwahyudi, Srie Prihianti Gondokaryono, Endang Sutedja, Inne Arline Diana, Oki Suwarsa, Hartati Purbo Dharmadji, Agnes Sri Siswati, Retno Danarti, Retno Soebaryo, Windy Keumala Budianti,
Asia Pac Allergy. 2018;8(4):.    doi: 10.5415/apallergy.2018.8.e41.


Reference

1. Vijayanand P, Seumois G, Simpson LJ, Abdul-Wajid S, Baumjohann D, Panduro M, Huang X, Interlandi J, Djuretic IM, Brown DR, Sharpe AH, Rao A, Ansel KM. Interleukin-4 production by follicular helper T cells requires the conserved Il4 enhancer hypersensitivity site V. Immunity. 2012; 36:175–187.
Article
2. Kabashima K. New concept of the pathogenesis of atopic dermatitis: interplay among the barrier, allergy, and pruritus as a trinity. J Dermatol Sci. 2013; 70:3–11.
Article
3. Akdis CA, Akdis M, Bieber T, Bindslev-Jensen C, Boguniewicz M, Eigenmann P, Hamid Q, Kapp A, Leung DY, Lipozencic J, Luger TA, Muraro A, Novak N, Platts-Mills TA, Rosenwasser L, Scheynius A, Simons FE, Spergel J, Turjanmaa K, Wahn U, Weidinger S, Werfel T, Zuberbier T. European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology. Diagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Report. J Allergy Clin Immunol. 2006; 118:152–169.
Article
4. Simpson E, Dutronc Y. A new body moisturizer increases skin hydration and improves atopic dermatitis symptoms among children and adults. J Drugs Dermatol. 2011; 10:744–749.
5. National Institute for Health and Care Excellence. NICE Pathways - Mapping our guidance. [Internet]. London: National Institute for Health and Care Excellence;c2016. cited 2016 Jan 28. Available from: http://pathways.nice.org.uk/pathways/atopic-eczema-in-children#path=view%3A/pathways/atopic-eczema-in-children/treatments-for-atopic-eczema-in-children.xml&content=close.
6. Ring J, Alomar A, Bieber T, Deleuran M, Fink-Wagner A, Gelmetti C, Gieler U, Lipozencic J, Luger T, Oranje AP, Schafer T, Schwennesen T, Seidenari S, Simon D, Stander S, Stingl G, Szalai S, Szepietowski JC, Taieb A, Werfel T, Wollenberg A, Darsow U. European Dermatology Forum (EDF). European Academy of Dermatology and Venereology (EADV). European Federation of Allergy (EFA). European Task Force on Atopic Dermatitis (ETFAD). European Society of Pediatric Dermatology (ESPD). Global Allergy and Asthma European Network (GA2LEN). Guidelines for treatment of atopic eczema (atopic dermatitis) part I. J Eur Acad Dermatol Venereol. 2012; 26:1045–1060.
Article
7. Australasian Society of Clinical Immunology and Allergy. Atopic dermatitis (eczema) [Internet]. Brookvale (AU): Australasian Society of Clinical Immunology and Allergy;c2016. cited 2016 Jan 29. Available from: http://www.allergy.org.au/health-professionals/hp-information/asthma-and-allergy/atopic-dermatitis.
8. Lynde C, Barber K, Claveau J, Gratton D, Ho V, Krafchik B, Langley R, Marcoux D, Murray E, Shear N. Canadian practical guide for the treatment and management of atopic dermatitis. J Cutan Med Surg. 2005; 8:Suppl 5. 1–9.
Article
9. Sinclair W, Aboobaker J, Green R, Jordaan F, Levin M, Lewis H, Manjra A, Puterman A, Todd G. Guidelines on the management of atopic dermatitis in South Africa [Internet]. London: Dermatology;c2015. cited 2016 Jan 28. Available from: http://www.derma.co.za/images/Guidelines_on_the_management_of_atopic_dermatitis_in_South_Africa.pdf.
10. Rubel D, Thirumoorthy T, Soebaryo RW, Weng SC, Gabriel TM, Villafuerte LL, Chu CY, Dhar S, Parikh D, Wong LC, Lo KK. Asia-Pacific Consensus Group for Atopic Dermatitis. Consensus guidelines for the management of atopic dermatitis: an Asia-Pacific perspective. J Dermatol. 2013; 40:160–171.
Article
11. Lindh JD, Bradley M. Clinical Effectiveness of moisturizers in atopic dermatitis and related disorders: a systematic review. Am J Clin Dermatol. 2015; 16:341–359.
Article
12. Moncrieff G, Cork M, Lawton S, Kokiet S, Daly C, Clark C. Use of emollients in dry-skin conditions: consensus statement. Clin Exp Dermatol. 2013; 38:231–238.
Article
13. Kraft JN, Lynde CW. Moisturizers: what they are and a practical approach to product selection. Skin Therapy Lett. 2005; 10:1–8.
14. Lynde CW. Moisturizers: what they are and how they work. Skin Therapy Lett. 2001; 6:3–5.
15. Loden M. Effect of moisturizers on epidermal barrier function. Clin Dermatol. 2012; 30:286–296.
16. Rawlings AV, Canestrari DA, Dobkowski B. Moisturizer technology versus clinical performance. Dermatol Ther. 2004; 17:Suppl 1. 49–56.
Article
17. Breternitz M, Kowatzki D, Langenauer M, Elsner P, Fluhr JW. Placebo-controlled, double-blind, randomized, prospective study of a glycerol-based emollient on eczematous skin in atopic dermatitis: biophysical and clinical evaluation. Skin Pharmacol Physiol. 2008; 21:39–45.
Article
18. Eichenfield LF, Tom WL, Berger TG, Krol A, Paller AS, Schwarzenberger K, Bergman JN, Chamlin SL, Cohen DE, Cooper KD, Cordoro KM, Davis DM, Feldman SR, Hanifin JM, Margolis DJ, Silverman RA, Simpson EL, Williams HC, Elmets CA, Block J, Harrod CG, Smith Begolka W, Sidbury R. Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014; 71:116–132.
19. Arkwright PD, Motala C, Subramanian H, Spergel J, Schneider LC, Wollenberg A. Atopic Dermatitis Working Group of the Allergic Skin Diseases Committee of the AAAAI. Management of difficult-to-treat atopic dermatitis. J Allergy Clin Immunol Pract. 2013; 1:142–151.
Article
20. Lynde C. Moisturizers for the treatment of inflammatory skin conditions. J Drugs Dermatol. 2008; 7:1038–1043.
21. Varothai S, Nitayavardhana S, Kulthanan K. Moisturizers for patients with atopic dermatitis. Asian Pac J Allergy Immunol. 2013; 31:91–98.
22. Simpson EL. Atopic dermatitis: a review of topical treatment options. Curr Med Res Opin. 2010; 26:633–640.
Article
23. Carr WW. Topical calcineurin inhibitors for atopic dermatitis: review and treatment recommendations. Paediatr Drugs. 2013; 15:303–310.
Article
24. Paediatric Dermatology Subspecialty Core Group of the Philippine Dermatological Society. A guide to understanding moisturizers in atopic dermatitis. Quezon (PH): Philippine Dermatological Society;2014.
25. Abramovits W, Perlmutter A. Atopiclair: its position within a topical paradigm for the treatment of atopic dermatitis. Expert Rev Dermatol. 2007; 2:115–119.
Article
26. Abramovits W, Boguniewicz M. Adult Atopiclair Study Group. A multicenter, randomized, vehicle-controlled clinical study to examine the efficacy and safety of MAS063DP (Atopiclair) in the management of mild to moderate atopic dermatitis in adults. J Drugs Dermatol. 2006; 5:236–244.
27. Baum ew, Del Rosso J, Dwyer GA, Eastern JS, Herron MD. MAS063 (Atopiclair®) for the treatment of atopic dermatitis in infants and children: proceedings of a roundtable discussion. J Clin Aesthet Dermatol [Internet]. 2008. 11. 1:Suppl B. 1–16. cited 2016 Jan 28. Available from: http://www.jcadonline.com/wp-content/uploads/2009/04/atopiclair_roundtable_supplb_to_nov08.pdf.
28. Atopiclair [prescribing information]. Bristol (TN): Graceway Pharma-ceuticals, LLC;2007. cited 2016 Jan 28. Available from; http://www.flexus.com/atopiclair/Atopiclair%20Prescribing%20Info.pdf.
29. Boguniewicz M, Zeichner JA, Eichenfield LF, Hebert AA, Jarratt M, Lucky AW, Paller AS. MAS063DP is effective monotherapy for mild to moderate atopic dermatitis in infants and children: a multicenter, randomized, vehicle-controlled study. J Pediatr. 2008; 152:854–859.
Article
30. Schneider L, Tilles S, Lio P, Boguniewicz M, Beck L, LeBovidge J, Novak N, Bernstein D, Blessing-Moore J, Khan D, Lang D, Nicklas R, Oppenheimer J, Portnoy J, Randolph C, Schuller D, Spector S, Tilles S, Wallace D. Atopic dermatitis: a practice parameter update 2012. J Allergy Clin Immunol. 2013; 131:295–299.e1-27.
31. Madison KC. Barrier function of the skin: "la raison d'etre" of the epidermis. J Invest Dermatol. 2003; 121:231–241.
32. Chua-Ty G, Goh CL, Koh SL. Pattern of skin diseases at the National Skin Centre (Singapore) from 1989-1990. Int J Dermatol. 1992; 31:555–559.
Article
33. Lee BW, Detzel PR. Treatment of childhood atopic dermatitis and economic burden of illness in Asia Pacific countries. Ann Nutr Metab. 2015; 66:Suppl 1. 18–24.
Article
34. Chen H, Common JE, Haines RL, Balakrishnan A, Brown SJ, Goh CS, Cordell HJ, Sandilands A, Campbell LE, Kroboth K, Irvine AD, Goh DL, Tang MB, van Bever HP, Giam YC, McLean WH, Lane EB. Wide spectrum of filaggrin-null mutations in atopic dermatitis highlights differences between Singaporean Chinese and European populations. Br J Dermatol. 2011; 165:106–114.
Article
35. Nomura T, Sandilands A, Akiyama M, Liao H, Evans AT, Sakai K, Ota M, Sugiura H, Yamamoto K, Sato H, Palmer CN, Smith FJ, McLean WH, Shimizu H. Unique mutations in the filaggrin gene in Japanese patients with ichthyosis vulgaris and atopic dermatitis. J Allergy Clin Immunol. 2007; 119:434–440.
36. Chan YC, Tay YK, Sugito TL, Boediardja SA, Chau DD, Nguyen KV, Yee KC, Alias M, Hussein S, Dizon MV, Roa F, Chan YH, Wananukul S, Kullavanijaya P, Singalavanija S, Cheong WK. A study on the knowledge, attitudes and practices of Southeast Asian dermatologists in the management of atopic dermatitis. Ann Acad Med Singapore. 2006; 35:794–803.
37. Shin JY, Kim DW, Park CW, Seo SJ, Park YL, Lee JR, Kim MB, Kim KH, Ro YS, Cho SH. An educational program that contributes to improved patient and parental understanding of atopic dermatitis. Ann Dermatol. 2014; 26:66–72.
Article
38. Hon KL, Wang SS, Pong NH, Leung TF. The ideal moisturizer: a survey of parental expectations and practice in childhood-onset eczema. J Dermatolog Treat. 2013; 24:7–12.
Article
39. Santer M. Childhood eczema treatment: the barriers. Nurs Times. 2014; 110:23–25.
40. Cork MJ, Britton J, Butler L, Young S, Murphy R, Keohane SG. Comparison of parent knowledge, therapy utilization and severity of atopic eczema before and after explanation and demonstration of topical therapies by a specialist dermatology nurse. Br J Dermatol. 2003; 149:582–589.
Article
41. Holden C, English J, Hoare C, Jordan A, Kownacki S, Turnbull R, Staughton RC. Advised best practice for the use of emollients in eczema and other dry skin conditions. J Dermatolog Treat. 2002; 13:103–106.
Article
42. Long CC, Mills CM, Finlay AY. A practical guide to topical therapy in children. Br J Dermatol. 1998; 138:293–296.
Article
43. Weingarten SR, Henning JM, Badamgarav E, Knight K, Hasselblad V, Gano A Jr, Ofman JJ. Interventions used in disease management programmes for patients with chronic illness-which ones work? Meta-analysis of published reports. BMJ. 2002; 325:925.
Article
44. Staab D, von Rueden U, Kehrt R, Erhart M, Wenninger K, Kamtsiuris P, Wahn U. Evaluation of a parental training program for the management of childhood atopic dermatitis. Pediatr Allergy Immunol. 2002; 13:84–90.
Article
45. Futamura M, Masuko I, Hayashi K, Ohya Y, Ito K. Effects of a short-term parental education program on childhood atopic dermatitis: a randomized controlled trial. Pediatr Dermatol. 2013; 30:438–443.
Article
46. Kupfer J, Gieler U, Diepgen TL, Fartasch M, Lob-Corzilius T, Ring J, Scheewe S, Scheidt R, Schnopp C, Szczepanski R, Staab D, Werfel T, Wittenmeier M, Wahn U, Schmid-Ott G. Structured education program improves the coping with atopic dermatitis in children and their parents-a multicenter, randomized controlled trial. J Psychosom Res. 2010; 68:353–358.
Article
47. Lawton S. Atopic eczema and evidence-based care. J Dermatol Nurse Assoc. 2011; 4:131–139.
Article
48. Substance Abuse and Mental Health Services Administration. S.M.A.R.T. treatment planning [Internet]. Rockville (MD): SAMHSA;c2016. cited 2016 Jan 28. Available from: http://www.samhsa.gov/samhsa_news/volumexiv_5/article2.htm.
49. Saint Vincent Catholic Medical Centers. Treatment plans using the S.M.A.R.T. model [Internet]. Rockville (MD): SAMHSA;c2016. cited 2016 Jan 28. Available from: https://www.decisionhealth.com/content/articles/Facilities/SMART_Train_the_trainer.pdf.
50. US Consumer Product Safety Commission. CPSC staff's strong sensitizer guidance document [Internet]. Bethesda (MD): US Consumer Product Safety Commission;c2016. cited 2016 Jan 28. Available from: http://www.cpsc.gov/Global/Regulations-Laws-and-Standards/Regulated-Products-Rules/strongsensitizerguidance.pdf.
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