Topical Moisturizer Meaningfully Reduces Disease Severity in Atopic Patients With Xerosis

December 2023 | Volume 22 | Issue 12 | e51 | Copyright © December 2023


Published online November 10, 2023

doi:10.36849/JDD.7036e

Katherine A. Kelly BSa, Madison K. Cook BSa, Rohan Singh BSa, Patrick O. Perche BSa, Esther A. Balogh MDa, Irma M. Richardson MHAa, Steven R. Feldman MD PhDa,b,c,d

aCenter for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC
bDepartment of Pathology, Wake Forest School of Medicine, Winston-Salem, NC 
cDepartment of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC  
dDepartment of Dermatology, University of Southern Denmark, Odense, Denmark 

Abstract
Background: Repairing the epidermal barrier is critically important in atopic dermatitis (AD), but the effect of moisturizer on quality of life (QOL) is not well characterized. 
Objective: To assess whether the use of a moisturizer improves QOL in atopic patients with xerosis. 
Methods: Thirty-five (35) adults with xerosis and AD received a moisturizer designed for AD to apply daily for three months. Adherence was assessed with electronic monitors. Quality of life (QOL) was assessed with the Dermatology Life Quality Index (DLQI) at baseline and follow-up. 
Results: Mean adherence to the moisturizer was 46%. Dryness improved from 1.9 at baseline to 1.4 at follow-up (P=0.02). DLQI improved from 3.3 at baseline to 1.5 at 3 months (P=0.005). The "feeling self-conscious or embarrassed due to their skin condition" DLQI item improved from 0.79 at baseline to 0.14 at 3 months (P=0.0009). 
Conclusion: Moisturizers are the foundation of AD treatment. Even non-medicated topical emollients can improve QOL in patients with AD. 

J Drugs Dermatol. 2023;22(12):e51-e52.     doi:10.36849/JDD.7036e

INTRODUCTION

Repairing the epidermal barrier is critically important in the treatment of atopic dermatitis (AD) and the associated skin dryness (xerosis).1 While frequently recommended, the effectiveness of moisturizer treatment in AD is not well characterized.2 We assessed whether the use of a moisturizer designed for atopic dermatitis improves objective and subjective disease severity in atopic patients with xerosis.

MATERIALS AND METHODS

Thirty-five (35) adult subjects with a diagnosis of xerosis in the context of current or historic AD were recruited from the Department of Dermatology clinics at Atrium Wake Forest Baptist Medical Center. Six patients were excluded due to loss of follow-up. Patients received Cetaphil Pro Eczema moisturizer (Galderma, Ft Worth, TX) equipped with an electronic monitor to measure adherence and were instructed to apply the moisturizer once daily for three months. The use of electronic monitoring was not disclosed until the final visit. Patients were not permitted to apply any other topical moisturizers or prescription treatments during the study period except for daily sunscreen. Xerosis severity was assessed with the Overall Skin Dryness Severity (ODS) score at baseline and follow-up visits. Effect on QOL was assessed with the total and individual Dermatology Life Quality Index (DLQI) scores at baseline and follow-up. At follow-up, the data from the electronic adherence monitors were downloaded. Data were analyzed using the SAS Software 9.4 Differences in group comparisons by mean score were analyzed with a Student's t-test.

RESULTS

Patient demographics included 57% female and 42% male, an average age of 64, and 96% Caucasian. Mean adherence to the moisturizer was 46%. After three months of using the moisturizer, dryness improved from 1.9 at baseline to 1.4 at follow-up (P=0.02). DLQI improved from 3.3 at baseline to 1.5 at 3 months (P=0.005). The "feeling self-conscious or embarrassed due to their skin condition" DLQI item improved from 0.79 at baseline to 0.14 at 3 months (P=0.0009).

DISCUSSION

Xerosis is a common symptom associated with AD that may negatively impact QOL with discomfort, pruritus, and the undesirable appearance of skin.3 Both disease severity and overall QOL improved with the use of a daily moisturizer alone,
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