Basic Emollients for Xerosis Cutis in Atopic Dermatitis: A Review of Clinical Studies

Abstract

Xerosis cutis (dry skin) is a common and burdensome symptom of atopic dermatitis (AD). Topical emollients restore skin hydration and barrier function through the physicochemical properties of their nonactive constituents (e.g., glycerol, urea, lactic acid, liquid paraffin, petrolatum) and represent the mainstay of basic therapy for xerosis cutis associated with AD. Newer "emollients plus" containing active ingredients may expand the treatment options available to patients with AD; however, we believe that basic emollients remain an important strategy for the long-term management of xerosis cutis. To that end, this article aims to review the clinical value of basic emollients for treating xerosis cutis in AD. We performed a series of literature searches to identify clinical studies of basic emollients containing one or more of the following ingredients: almond and coconut oils, amino acids, chondroitin, dexpanthenol, glucose, glycerol, glycosaminoglycans, hyaluronic acid, lactic acid, lanolin, olive oil, paraffin, petrolatum, phospholipids, polyunsaturated fatty acids, pyroglutamic acid, squalene, triglycerides, urea, vegetable oils, and vitamin E. From these searches, the authors identified articles of interest that described the efficacy of basic emollients for the treatment of xerosis cutis associated with AD. Studies included in our review varied widely in terms of sample size, study design, interventions, and endpoints but collectively showed that most basic emollient formulations are safe and effective at improving objective and subjective measures of xerosis cutis. These studies also demonstrated the importance of ongoing emollient therapy to avoid xerosis relapse and the additive benefits of emollients that combine ingredients with complementary biophysical properties (e.g., glycerol with its humectant effect plus petrolatum with its occludent effect). Overall, the current body of literature reinforces the role of basic emollients as effective and accessible treatment options for the long-term management of xerosis cutis in patients with AD.

Keywords: atopic dermatitis; dry skin; eczema; emollient; moisturizer; xerosis cutis.

FIGURE 1

Changes in mean SCORAD xerosis score (a), mean xerosis visual analog scale score (b), mean skin hydration index (c), and mean objective SCORAD score (d) during a phase 3 study of a 15% glycerol and 10% liquid paraffin/petrolatum emollient in children with atopic dermatitis [27]. In this study, patients (n = 251) were randomized to apply study emollient or vehicle control twice daily during a 28‐day double‐blind period. Nonresponders on day 28 received study emollient until day 84 (open‐label period); responders on day 28 stopped emollient treatment until day 56 when they were reassessed and resumed study treatment until day 84 if relapse had occurred. Data are shown for responders who worsened and resumed study treatment on day 56. HI, hydration index; SCORAD, SCORing of Atopic Dermatitis index; XS, xerosis score; X‐VAS, xerosis visual analog scale score. Figure reproduced with permission from Boralevi F, et al. J Eur Acad Dermatol Venereol 2014; 28: 1456–62. 2013 John Wiley and Sons. All rights reserved.