Why Is Moisturizing So Important for Managing Atopic Dermatitis?

close up of atopic dermatitis on brown skin

By Jodi L. Johnson, PhD

Published On: Jun 18, 2024

Last Updated On: Jun 18, 2024

It doesn’t matter if you have mild or severe atopic dermatitis (AD), one of the first things an AD patient learns about managing their eczema is the need to moisturize. “Moisturization is a foundational element of AD therapy across all disease severities,” said Dr. Raj Chovatiya, dermatologist and clinical associate professor at Rosalind Franklin University Medical School in Chicago. “The primary goal of moisturization is to address the dysfunctional skin barrier that underlies AD.”

But what is the science behind how moisturizing helps combat eczema symptoms? Also, out of the hundreds of moisturizing products available on the market, which ones should you use? This article aims to help eczema patients understand why and how moisturizing is important in eczema care.

What does moisturization do for the skin?

“Skin moisturizers protect the skin barrier, reduce water loss and enhance hydration, replenishing key structural components of the skin,” explained Dr. Chovatiya, who is also the founder and director of the Chicago-based Center for Medical Dermatology and Immunology Research.

There has been a lot of research in the last decade to determine why skin moisturization is so important and how it improves the skin barrier for AD.1 “It is imperative to keep a good barrier — not having one is like leaving your doors unlocked while you sleep!” said Dr. Peter Lio, dermatologist and clinical assistant professor of dermatology and pediatrics at Northwestern University. AD symptoms can be driven by a damaged skin barrier, increased skin pH, loss of water in the skin, changes in the microbiome (bacteria, yeast, fungi, etc.) that live on the skin and different factors in the immune system.2 Moisturizers can help many of the factors that make AD symptoms worse.3

A recent 2023 research review summarized how different types of moisturizers and different moisturizer ingredients can target each component of the skin to support overall skin health.3 For example, moisturizers with oil, water, petroleum jelly or beneficial fatty acids can improve the outer layer of the skin, supporting and sealing together the lipids (fatty molecules that repel water).3,4 Moisturizers with the chemical urea can draw moisture from the lower part of the skin (dermis) into the upper part of the skin (stratum corneum) to support lipids, weaving together and making a better barrier. However, the benefits of this ingredient depend on concentration and seen most with lower levels of urea, as higher levels can promote exfoliation.3

“One of the most remarkable findings in the past decade has been that a damaged skin barrier can actually allow allergens, irritants and even disease-causing bacteria, fungi and viruses to enter the body,” said Dr. Lio, a co-author on the 2023 research review. An emollient, a type of moisturizer meant to soften and soothe skin, can support a healthy skin microbiome and keep those disease-causing organisms, like too much Staphylococcus aureus, at bay.3 Each moisturizer may be formulated or contain ingredients to help different parts of the skin and restore a healthy skin pH.

There is not much science about how moisturization itself impacts the skin’s immune system, but it is thought that a healthier skin barrier leads to less dysregulation of the immune system. One study examined the use of emollients in adults 58 to 93 years old, who frequently have skin barrier problems and increased symptoms of itch, similar to AD patients. The study, which included 29 people, asked whether using an over-the-counter emollient with various lipids twice a day for 30 days could impact inflammatory signaling (circulation of chemical messengers called cytokines that activate portions of the immune system).5 The control group included 21 people over the age of 58 who did not get the cream. Compared to the control group, study participants given the emollient had significantly reduced levels of inflammatory signaling molecules (cytokines and interleukins) in their blood.5 While this study was not done with AD patients, it does suggest that moisturization may help decrease inflammation.3,6

All in all, moisturizers can improve the skin barrier throughout all the skin layers, support a healthy skin microbiome and potentially improve the immune system to help keep skin healthy, which is why patients with AD should regularly use them.

Do some moisturizers work better than others to improve AD?

Moisturizers come in many forms, including different types and combinations of ingredients, various amounts of ingredients and different vehicles (e.g., gels, lotions, creams and ointments). Due to the ever-growing number of available moisturizers, research comparing different ingredients and final formulations is limited. Here’s what scientists know so far.

Researchers have found that moisturizers that contain lipids, including ceramides, cholesterol and fatty acids can have great benefits for the skin barrier for people with AD.4,7,8 Similarly, some natural oils from coconut, sunflower seeds, safflower, borage, corn and sea buckthorn have essential fatty acids and/or linoleic acid that aid the skin barrier.9,10 However, caution should be taken since some of these natural ingredients like olive oil can actually worsen AD.10

Other ingredients in moisturizers can do more harm than good and can even increase moisture loss through the skin and let in allergens, irritants and microbes.11 For example, fragrances added to moisturizers can be AD triggers.4,11  

In a University of Sheffield Medical School study, researchers investigated specific ingredients and their effects on the skin barrier in patients with AD.12 Researchers looked at the effects of three prescribed emollients: one containing urea and glycerol; one containing glycerol; and one containing paraffin.12 Patients with AD applied all three formulations twice a day for four weeks to designated areas on their forearms. They also didn’t treat one area of their skin that was designated for no treatment. The study found that the paraffin-containing moisturizer did nothing to improve the skin barrier. The urea and glycerol emollient improved the skin barrier and protected against irritation. And the moisturizer containing glycerol by itself was better than the paraffin-containing emollient.12 This could suggest that it is a good idea to use moisturizers containing urea and glycerol, but remember some moisturizers contain dozens, if not hundreds, of different components at different concentrations, and no study has been done comparing them all in a controlled way.

Researchers have also looked at which moisturizers work best for children with AD. For example, in a 2023 study in the U.K., 550 children with eczema used emollients formulated as lotions, creams, gels and ointments for 16 weeks.13 The goal was to see if one helped control childhood eczema more than the other. The researchers found that all four formulations were equally effective. There was no difference between the children in what they or their caregivers reported about their symptoms using Patient-Oriented Eczema Measure scores (one way that researchers measure severity of AD symptoms). There were also no differences in adverse events or side effects of using the different formulations.

However, in this U.K. study, there were emollient “winners” in terms of patient and parent satisfaction — lotions and gels were the most favored.13 The factors that made a difference in how favorable children and their caregivers felt about the different types of moisturizers included: the way in which the formulation was administered (i.e., bottle or pump instead of tube); how well the formulation appeared to soak into the skin; if it felt oily, left a residue or left visible marks on clothing; whether it could easily be taken to school or family activities; and many other factors.13 These study results suggest that the type of moisturizer matters less than finding one that suits the child and family’s lifestyle and personal preferences.

In addition, in 2022, researchers investigated whether certain moisturizers were better than others for AD. The researchers reviewed 77 published studies that compared moisturizers.7 The studies they reviewed compared: moisturizers to each other; moisturizers against a placebo cream; moisturizers against no moisturizers; and moisturizers paired with other medical treatments.7 After this large study review, the scientists found that, in general, moisturizers reduce the severity of AD, and they also help improve the skin barrier, reduce water loss from the skin and decrease the number of flares for AD patients.7

However, many of the studies used different methodologies, making it difficult to make direct moisturizer comparisons between them.7 The authors of the literature review concluded that there is not enough evidence in the scientific literature to say one kind of moisturizer is better than another for AD.14 Just like with AD medications, there is no one-size-fits-all moisturizer formulation.

How do you select a moisturizer for your AD?

With all this research in mind, how do you decide which moisturizer is best for you? “I have about 20 trusted moisturizers that I rely on for a number of situations,” said Dr. Lio. “All of my favorites are listed in the National Eczema Association’s Seal of Acceptance™ program.” For a product to obtain the Seal, it must meet strict standards established by the National Eczema Association’s Scientific Oversight Committee, which is a panel of leading dermatologists, allergists and eczema experts who provide guidance on ingredients and formulations. The product must also undergo controlled testing for sensitivity, irritation and toxicity on individuals with sensitive skin.

When looking for a moisturizer, Dr. Lio suggests looking at the ingredient list first. “[You] want to look out for any ingredients known to be allergenic,” he said. “It can be helpful to have a detailed list of known allergens and all the different names they go by. I generally recommend avoiding things with fragrance, formaldehyde, formaldehyde releasers, Balsam of Peru and other ingredients found on the [Seal’s] Ecz-clusion List.” The Ecz-clusion list outlines ingredients that are known irritants and allergens, which are not allowed in any amount in products that are awarded the Seal.

You should also try to stick to moisturizers that are designed for moisturizing only. “[You] want to be careful of moisturizers designed for things like ‘anti-aging’ or ‘exfoliating,’” said Dr. Lio. “These [moisturizers] serve a different purpose and can cause lots of trouble for [AD] patients who need something soothing and restoring for eczema.”

In the end, the science behind moisturizers is still unfolding, and many products on the market have not been tested with people with irritated skin in mind.9

How should moisturizers be used in daily life for AD?

“While there are variations in the approach to moisturization for AD, most guidelines recommend a relatively consistent approach,” said Dr. Chovatiya. “Daily moisturization should be the goal for AD patients and the best time for moisturization is typically immediately after bathing or showering when the skin is still moist.”

When it comes to moisturizing specific parts of your body, does it matter which type of emollient you use? For example, is it better to use a cream on legs or a gel on the face? Unfortunately, scientists still don’t really know which moisturizers are most appropriate for specific body areas as there isn’t enough data yet.14

Researchers have discovered that using moisturizers together with topical corticosteroids (medications commonly used to treat AD) can be beneficial for AD symptoms.14,15 In fact, moisturizers may help improve penetration of corticosteroids into the skin.14,15 However, a very recent publication by Dr. Lio brings up the point that there are currently no formal guidelines around whether to apply moisturizers or steroid treatments first.16 This literature review showed that many studies suggest application of moisturizer before medication, since applying moisturizer after medication can cause the medication to spread out over a wider area of skin, reducing its effectiveness on the target area.16 The jury is still out though. There are many studies that suggest it is best to put medication on first, wait up to an hour, and then apply moisturizer.16 Further studies, specifically clinical trials, are needed to make definitive conclusions.

What’s next with moisturization research for AD?

“We are living in a golden age of therapeutic evolution for AD,” said Dr. Chovatiya. “This extends not only to prescription therapies but also over-the-counter therapeutic moisturizers.” He explained that nowadays, it’s common for over-the-counter moisturizers to include unique lipid combinations and skin protectants that can be beneficial for AD.

“This does not mean that every product is going to work for every patient,” Dr. Chovatiya added. “Just like AD treatments are not one size fits all, moisturizers also need to be optimized for each individual.” He suggests that AD patients work with their dermatologist to select the best emollient for their skin.

Dr. Lio also believes great strides and progress have been made in the world of moisturizers for AD. “We now have moisturizers with ingredients that may help soothe inflammation, further restore the skin barrier or even rebalance the microbiome,” he said. “More and better research — and more experiences — are needed to help every individual patient find a great moisturizer for their needs and budget.”

Several researchers are in the process of developing and validating a survey for AD patients to rate moisturizers called the emollient satisfaction questionnaire. The goal of the survey is to get patient feedback on moisturizers in a standard, uniform format, allowing more head-to-head comparisons between moisturizers.17 The questionnaire asks about each product’s appearance, odor, absorbency, application, packaging, effectiveness and acceptability.17 Many moisturizers may be equally effective, but they are only really effective if they are comfortable and user-friendly to go along with the user’s lifestyle. Researchers will continue to investigate what makes moisturizers work best for skin health and are most appreciated by patients with AD and their caregivers.

Key takeaways:

  • Diligent skincare, including daily moisturization (especially after bathing/showering), is a crucial part of taking care of atopic skin regardless of disease severity.
  • Moisturizers can help address and restore the dysfunctional skin barrier of AD.
  • There is little data to suggest which moisturizers are better than others for AD, but the science is unfolding.  Ultimately, the best moisturizer may be the one that will be used regularly and does not aggravate AD symptoms.
  • There is not enough data on what type of emollient is best for specific parts of the body.
  • The ingredients in moisturizers can either help alleviate AD flares or they can be a trigger of AD symptoms.
  • When selecting a moisturizer, it’s best to know common allergens associated with AD so you can avoid them. The Seal of Acceptance outlines known irritants and allergens on the Ecz-clusion List.
  • It is best to talk to your healthcare provider about your moisturization practice so you can get personalized, expert advice.


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