The Comparative Effects of Various Moisturizers on Epidermal Barrier Function Recovery After Bathing in Atopic Dermatitis.

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Vivian Y Shi
Negar Foolad
Jennifer Ornelas
Waqas Burney
Melody Maarouf
Lauren Hassoun
Gabriela Monico
Nicole Takeda
Suzana Bosanac
Lawrence F Eichenfield
Raja K Sivamani


atopic dermatitis, epidermal barrier function, moisturizers


Background/Aims: An important pillar of AD management involves moisturizer application following bathing to restore epidermal barrier function (EBF). In this study, we aim to bring additional evidence to the “soak-and-smear” regimen, comparing EBF recovery by various moisturizers following bathing in AD and healthy subjects. 

Methods: Volar forearms of 10 AD patients and 10 healthy controls were immersed in water for 10 minutes to simulate bathing. Immediately after bathing, ceramide-containing emollient (CER), a humectant (10% glycerin, GLY), an occlusant (white petrolatum, PETR), and aloe vera 5% extract (ALOE) were applied to separate test sites on the forearm. One test site did not receive any moisturizer and served as control. EBF parameters (hydration, TEWL, and pH) were recorded at baseline, and 15, 30, and 60-minutes post-bathing.

Results: AD and controls shared similar trends. ALOE had the most significant pH decrease while GLY had the highest pH increase. Hydration significantly increased in all moisturizers compared to control. GLY led to the highest increase, peaking at 15-minutes for both AD and healthy subjects. AD subjects had higher hydration following CER than healthy subjects throughout the entire study. All four moisturizers increased TEWL compared to control, though PETR had the lowest initial TEWL increase. 

Conclusion: All moisturizers has an immediate effect on improving SC hydration. Their initial effects on TEWL increase recovers toward control levels by 60-minutes. Future studies are needed to examine the effect of repeated moisturizer post-bathing over longer study periods.


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3 Shi VY, Foolad N, Ornelas JN, Hassoun LA, Monico G, Takeda N, Saric S, Prakash N, Eichenfield LF, Sivamani RK: Comparing the effect of bleach and water baths on skin barrier function in atopic dermatitis: a split-body randomized controlled trial. Br J Dermatol 2016; 175: 212-4.

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