Clinical Effectiveness of Moisturizers in Atopic Dermatitis and Related Disorders: A Systematic Review.
BACKGROUND
Moisturizers are widely used for atopic dermatitis (AD) and related conditions, but available evidence of their effectiveness has not been reviewed in a systematic fashion.


OBJECTIVE
Our objective was to investigate the effectiveness of emollients, as a group and individually, in the treatment of AD and related conditions, by means of a systematic review.


METHODS
Studies indexed in MEDLINE and/or Embase before 16 January 2015.


METHODS
Controlled clinical studies comparing the clinical effect of a moisturizer against its vehicle, another moisturizer, or no treatment were eligible. For the outcomes transepidermal water loss (TEWL) and stratum corneum hydration, uncontrolled before-after designs were also eligible.


METHODS
Participants were patients with AD, irritant hand dermatitis, and/or ichthyosis vulgaris.


RESULTS
Out of the 595 publications initially identified, 45 (48 studies, 3262 patients) were eligible for inclusion. A vast majority of studies indicate that moisturizers have beneficial effects on clinical symptoms [SCORAD (SCORing Atopic Dermatitis) reductions ranging from 0 to 2.7 points], TEWL (range 0 to -12.2 g/m(2)h) and stratum corneum hydration (range +8 to +100%). Direct comparisons between individual moisturizers are still scarce, but the clinical effect appears to be much more well-documented for urea and glycerin than, for example, propylene glycol, lactate, ceramide, and aluminum chlorohydrate. Compared with urea studies, glycerin studies were more often associated with a high risk of bias.


CONCLUSIONS
Due to differences in study designs and outcome measures, a quantitative meta-analytic approach was not deemed feasible, and formal indicators of publication bias such as funnel plots could not be used. However, a large number of moderately sized studies with positive outcomes could be compatible with selective publishing of favourable results.


CONCLUSIONS
The clinical effect of moisturizers is well-documented. Urea-based preparations may be preferable as a first-line treatment, but there is an unmet need for well-powered comparisons between individual moisturizers.
Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden. jonatan.lindh@ki.se.
Jonatan D
JD
Lindh
Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Maria
M
Bradley
D003876:Dermatitis, Atopic / Q000188:drug therapy*; D017453:Dermatitis, Irritant / Q000188:drug therapy; D004643:Emollients / Q000494:pharmacology / Q000627:therapeutic use*; D004817:Epidermis / Q000187:drug effects; D005990:Glycerol / Q000627:therapeutic use; D006229:Hand Dermatoses / Q000188:drug therapy; D006801:Humans; D007057:Ichthyosis / Q000188:drug therapy; D019946:Propylene Glycol / Q000627:therapeutic use; D012720:Severity of Illness Index; D063465:Skin Cream / Q000494:pharmacology / Q000627:therapeutic use*; D014508:Urea / Q000627:therapeutic use; D014870:Water Loss, Insensible / Q000187:drug effects*
D004643:Emollients; D019946:Propylene Glycol; D014508:Urea; D005990:Glycerol