EczemaNet Article
Moisturizing and Cleansing Key to Treating Atopic Dermatitis

When it comes to treating atopic dermatitis, dermatologists consider moisturizing and gentle cleansing to be indispensable. Yet, a recent survey revealed that 23% of adults living with atopic dermatitis say they do not do not apply moisturizer and 29% do not use a cleanser. The researchers also found that most of the people who participated in the survey wanted more information about moisturizers and cleansers.

Why is Moisturizing So Important?
Our skin is our barrier. It protects us from unseen invaders such as bacteria, viruses, and other potentially harmful organisms and toxins. Our skin also prevents us from losing large amounts of water. The outermost layer of skin, the stratum corneum, serves as our first line of defense. Some dermatologists call this our “bricks and mortar.”

When atopic dermatitis develops, the stratum corneum breaks down. With gaps in our bricks and mortar, the skin is more easily irritated. These gaps also make it easier for bacteria and viruses to enter the body. Easier access and the weakened immune system of atopic dermatitis make people more susceptible to infection. The skin also loses moisture more readily, causing dry skin.

Studies have shown that when patients with atopic dermatitis properly use a recommended moisturizer, it can help:

• Alleviate dry skin. Moisturizer forms a protective coating that reduces the amount of water lost through the skin. This, in turn, decreases dryness, itch, and cracking skin.
  
  Depending on the patient’s signs and symptoms, it may be necessary to apply moisturizer 4 or more times per day. Moisturizer should always be applied after a shower or bath while the skin is still damp. This locks in moisture.
   

• Boost the skin’s protective abilities. Moisturizer forms a protective membrane on the skin. One type of product called a barrier-repair emollient may provide the skin with essential components that can actually repair the damaged stratum corneum.
  
  Two small studies showed that a barrier-repair emollient produced dramatic improvement. In one of these studies, 24 children with stubborn to recalcitrant (not responding to treatment) atopic dermatitis were treated with a barrier-repair emollient containing ceramide (a molecule that helps regulate our skin cells and an effective emollient). Fifteen of the children were previously treated with other emollients.
  
  The emollient containing ceramide was applied twice a day for 12 weeks. All 24 children showed improvement within 3 weeks. By the end of 12 weeks, there was such significant improvement in all children that the researchers asked for the emollient be applied once a day. With regular once-a-day use, the skin continued to improve.
  
  Larger studies are needed to determine if a barrier-repair emollient actually repairs the skin. Research, to date, has not shown whether or not barrier-repair emollients offer any benefit not provided by other emollients.
   

• Increase the effectiveness of topical corticosteroids, and possibly reduce the need for long-term corticosteroid treatment. Researchers have found that using both a topical corticosteroid and a moisturizer decreases the signs and symptoms of atopic dermatitis better than use of a topical corticosteroid alone. Studies also have found that proper use of a moisturizer along with a topical corticosteroid can reduce the amount of corticosteroid needed. This suggests that using an appropriate moisturizer may reduce the need for long-term corticosteroids.
   

• Reduce skin irritation. One study found that pre-treating skin affected by atopic dermatits with moisturizer before exposing it to dust mite or grass pollen significantly reduced patients’ reactions to these substances. More than half of the patients said they would continue using the moisturizer after the study ended. The researchers concluded that moisturizer may help prevent exacerbation in patients with atopic dermatitis; however, more research is needed.
   

• Improve the skin’s appearance. A large-scale study found that applying certain lipid-rich moisturizers significantly improved the condition of skin affected by atopic dermatis. During this study, patients either applied a lipid-rich moisturizer alone or the lipid-rich moisturizer and a topical corticosteroid. In many cases, the moisturizer alone was as effective as the moisturizer plus corticosteroid in relieving dryness and scaling in patients. However, when it came to reducing the redness and itch, the corticosteroid plus moisturizer was more effective. This finding suggests that once the atopic dermatitis is under control, a moisturizer alone may be all that is needed.

Gentle Cleansing Essential
Cleansing the skin helps keep it healthy. Washing removes oils, dirt, bacteria, dead skin cells, and a number of other substances. The key to cleansing skin affected by atopic dermatitis is to be gentle because the outer layer of skin, the stratum corneum, is damaged and fragile.

Rubbing, scrubbing, peeling, microdermabrasion, and exfoliating can cause more damage as can harsh soaps. Soap can dry the skin and worsen itching. Mesh sponges, abrasive scrubs, and woven face cloths should not be used as they also can further damage the skin. Anything that increases damage to the skin can cause a flare-up and block the effects of treatment.

When washing, be sure to use a mild cleanser and to gently apply it with your fingertips. Cleanser should be rinsed off with lukewarm water. Dermatologists recommend that cleanser never be applied to skin that has flared. Even the mildest cleanser can be quite irritating when skin has flared.

Ask a Dermatologist for Product Recommendations
With the number of moisturizers, emollients, and cleansers on the market, trying to choose suitable products can boggle the mind. Typing the word “moisturizer” in a popular Internet search engine yields more than 2 million results. If that is not challenge enough, certain ingredients in these products can cause folliculitis (a type of skin inflammation that may resemble acne) or prickly heat in people living with atopic dermatitis. And, did you know that products containing glycerin and rose water — ingredients used to effectively moisturize skin — can increase dryness in skin affected by atopic dermatitis?

To help sort through the options, you may want to schedule an appointment with a dermatologist. After considering a number of factors, such as the severity of your atopic dermatitis and overall health, the dermatologist can recommend suitable products. This can save you time and money. During this appointment, the dermatologist also can show you how to apply cleanser and moisturizer to get optimal results.

References:
Berson D. “Recommendation of Moisturizers and Cleansers: A Study of Unmet Needs Among Dermatology Patients.” Cutis. 2005 December;76(6S):3-6.

Chamlin SL et al. “Ceramide-dominant barrier repair lipids alleviate childhood atopic dermatitis: Changes in barrier function provide a sensitive indicator of disease activity.” Journal of the American Academy of Dermatology. 2002 August; 47(2):198-208.

Draelos, ZD. “Concepts in Skin Care Maintenance.” Cutis. 2005 December;76(6S):19-25.

Eichenfield LF et at. “Consensus conference on pediatric atopic dermatitis.” Journal of the American Academy of Dermatology. 2003 December; 49(6)1088-95.

Ghali FE. “Improved Clinical Outcomes with Moisturization in Dermatologic Disease.” Cutis. 2005 December;76(6S):13-18.

Lebwohl M et al. “Impaired Skin Barrier Function in Dermatologic Disease and Repair with Moisturization.” Cutis. 2005 December;76(6S):7-12

All content solely developed by the American Academy of Dermatology