Applying moisturizers is an integral part of eczema treatment, but is it effective?
Eczema is a chronic skin disease characterized by dry skin, intense itching, inflammatory skin lesions, and considerable impact on quality of life. Moisturizers are a cornerstone of eczema treatment, but it is unclear whether moisturizers are effective or whether one moisturizer is preferable to another.
A team of Cochrane Skin authors based in Bahrain, Denmark, and the Netherlands assessed the effects of moisturizers for eczema. Their review includes 77 studies, with a total of 6,603 people with mild to moderate eczema, and an average age of 18.6 years. Of the 77 studies, 46 were funded predominantly by pharmaceutical companies.
The review authors found that moisturizers appeared to have a beneficial effect, but the extent of the effect varied widely, and in only a few studies did moisturizers produce an important reduction in disease severity. There is a lack of convincing evidence that moisturizers improve eczema when used alone. However, the overall conclusion is that moisturizers are safe, prevent flares, prolong time to flare, reduce the amount of topical corticosteroids needed to achieve similar reductions in disease severity, and that topical active treatment is more effective when used in combination with moisturizer. Most of the comparisons included in this review were assessed in single studies, which did not allow the authors to assess consistency of results across studies for the various moisturizers.
“Moisturizers have always been an integral part of eczema treatment. Most guidelines suggest that consistent, frequent, and generous use of moisturizers is necessary to restore or maintain the skin barrier. However until the present there has not been a comprehensive summary of the totality of the available evidence whether moisturizers worked and which moisturizer you should use,” said Esther van Zuuren from the Department of Dermatology at the Leiden University Medical Center and the lead author of the Cochrane Review. “Since moisturizers are indeed effective it makes clinical sense to encourage adherence to moisturizer therapy. There is no evidence to support a ‘one size fits all’ approach as to which type of moisturizer should be used, so clinical decisions should be based on the currently available evidence, whilst taking into account the experiences and personal preferences of the person with eczema. And because moisturizers may need to be used in large amounts, it is also important that they are affordable to people with eczema.”