title: Changes in skin barrier function following long-term treatment with moisturizers, a randomized controlled trial.
abstract: BACKGROUND
  Moisturizers are commonly used by patients with dry skin conditions as well as people with healthy skin. Previous studies on short-term treatment have shown that moisturizers can weaken or strengthen skin barrier function and also influence skin barrier recovery. However, knowledge of the effects on skin barrier function of long-term treatment with moisturizers is still scarce.
  
  
  OBJECTIVE
  To investigate the impact of long-term treatment with moisturizers on the barrier function of normal skin, as measured by transepidermal water loss (TEWL) and susceptibility to an irritant, and to relate those effects to the composition of the designed experimental moisturizers.
  
  
  METHODS
  Volunteers (n = 78) were randomized into five groups. Each group treated one volar forearm for 7 weeks with one of the following preparations: (i) one of three simplified creams, containing only a few ingredients in order to minimize the complexity of the system; (ii) a lipid-free gel; (iii) one ordinary cream, containing 5% urea, which has previously been shown to decrease TEWL. The lipids in the simplified creams were either hydrocarbons or vegetable triglyceride oil, and one of them also contained 5% urea. After 7 weeks, treated and control forearms were exposed for 24 h to sodium lauryl sulfate (SLS) using a patch test. TEWL, blood flow and skin capacitance of both SLS-exposed and undamaged skin were evaluated 24 h after removal of patches. Additionally, a 24-h irritancy patch test of all test preparations was performed on 11 volunteers in order to check their possible acute irritancy potential.
  
  
  RESULTS
  Changes were found in the barrier function of normal skin after 7 weeks of treatment with the test preparations. The simplified creams and the lipid-free gel increased TEWL and skin response to SLS, while the ordinary cream had the opposite effect. One of the simplified creams also decreased skin capacitance. All test preparations were shown to be nonirritant, both by short-term irritancy patch test and by measurement of blood flow after long-term treatment.
  
  
  CONCLUSIONS
  Moisturizers influence the skin barrier function of normal skin, as measured by TEWL and susceptibility to SLS. Moreover, the effect on skin barrier function is determined by the composition of the moisturizer. The ingredients which influence the skin barrier function need to be identified, and the mechanism clarified at the molecular level.
authors.affiliation: Department of Medical Sciences, Dermatology and Venereology, University Hospital, Uppsala, Sweden. izabela.buraczewska@acohud.se
authors.forename: I
authors.initials: I
authors.lastname: Buraczewska
authors.forename: B
authors.initials: B
authors.lastname: Berne
authors.forename: M
authors.initials: M
authors.lastname: Lindberg
authors.forename: H
authors.initials: H
authors.lastname: Törmä
authors.forename: M
authors.initials: M
authors.lastname: Lodén
mesh_terms: D000328:Adult; D004334:Drug Administration Schedule; D004643:Emollients / Q000008:administration & dosage / Q000737:chemistry / Q000494:pharmacology*; D005260:Female; D005712:Galvanic Skin Response / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010328:Patch Tests; D012039:Regional Blood Flow / Q000187:drug effects; D012867:Skin / Q000098:blood supply / Q000187:drug effects*; D023422:Skin Irritancy Tests; D014870:Water Loss, Insensible / Q000187:drug effects*
chemical_list: D004643:Emollients