An algorithm for topical treatment of AD from the Middle East advises using moisturizers as needed as part of topical treatment.33 Consensus papers from Taiwan, South Africa, Singapore, and South Korea all include routine skin care regimens as an integral part of AD management.33 The Korean practical guidelines specifically considered patient adherence for their evidence-based recommendations.35,36 Additionally, the guidelines discussed psychotherapeutic approaches and behavior therapy for managing individual emotional factors that triggered such as vicious itch-scratch cycles, comorbidities such as anxiety and depression, and low Quality of Life (QoL).36,37
A Canadian algorithm for topical treatment of mild-to-moderate AD for adults and pediatric patients as well as US guidelines for topical treatment of AD include education and avoiding triggers. In addition, routine skincare with gentle cleansers and moisturizers is considered an integral part of AD management regardless of disease severity and prescription treatment.8 Conventional moisturizers contain occlusives, humectants, and emulsions. Newer classes of moisturizers designed to restore skin barrier defects include distinct ratios of lipids that resemble physiological compositions, such as CERs, cholesterol, and essential fatty acids.39
Some individuals with AD may produce inadequate amounts of certain CERs. Many exhibit baseline increases in TEWL even within their unaffected, normal-appearing skin.40-43 Racial and ethnic differences have been reported in the stratum corneum
