Clinically, moisturizers are well known for their role in hydration, moisture retention, and symptom control in psoriasis; however, these products may be underused.14,15,26
Published treatment guidelines on adjunctive skincare for psoriasis recommend gentle cleansers with a near physiologic stratum corneum pH4-6 and moisturizers containing lipids and humectants.28-33 Some authors suggest using keratolytic agents in the initial phase of treating psoriasis plaques and switching to moisturizing products and emollients in the intermediate and chronic/remission phases of psoriasis.14,31 Keratolytics such as salicylic acid, urea, lactic acid, allantoin, glycolic acid, and trichloroacetic acid cause swelling and hydrolysis of skin to remove scales and calluses.31 These keratolytics can irritate the skin, enhancing inflammation and potentially worsening the disease.31 In a study of 30 patients with psoriasis who received a moisturizing cream for 4 weeks, skin hydration had increased with no change in transepidermal water loss measurements.32 A significant percentage of patients showed improvements in desquamation measurements from very dry to dry or normal skin condition (P=.0001 for all time points).32
Two skincare products containing ceramides, salicylic acid, and urea (the first a body cleanser and the second a body cream) showed efficacy in a study of 33 patients with psoriasis.33 Skin appearance overall had improved in 72.7% of patients who used body cream alone and in 75.8% of patients with the combination regimen of the body cream and the body cleanser. For the combined regimen, 84.8% reported that it provided relief from psoriasis, and 90.9% reported that their skin felt soft and smooth.33
The stratum corneum serves as an effective barrier against moisture loss.9,24 Depletion of ceramides in the stratum corneum, which can result in increased moisture loss, has been reported in patients with psoriasis, leading to xerosis, which can benefit from skincare using gentle cleansers and moisturizers.23-25
Statement 4: Studies of patients with psoriasis applying topical moisturizers showed softened plaques, enhancing the absorption of topical treatments such as corticosteroids.
Epidermal barrier dysfunction is a clinically manageable feature of psoriasis.33 Skincare, including gentle cleansers and moisturizers, is recommended for the prevention, treatment, and maintenance of psoriasis, together with prescription topical and systemic therapy.14,34-37
Ceramides are the predominant lipids in the stratum corneum, contributing to the intercellular lipid bilayer important for TEWL regulation. Ceramide-containing products promote a healthy skin barrier, reduce TEWL, and maintain stratum corneum hydration.33,37 Keratolytics, such as salicylic acid and urea (a component of natural moisturizing factors), can be added to moisturizers to minimize xerosis, scaling, and hyperkeratosis.33,37 Moreover, salicylic acid promotes a physiological stratum corneum pH.38
