How to Find the Right Moisturizer for Eczema

Tips for picking an effective moisturizer

Credits: "David Schap at Unsplash.com"
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Skin affected by eczema is constantly dry and sensitive. Eczema is a chronic condition where the skin’s barrier is dysfunctional, leading to  inflammation, itching, and infections. Although there is no permanent cure for eczema, daily skin care is essential for managing eczema. One of the key steps in good skin care for eczema is the regular use of moisturizers. It also serves as a cost-effective way of keeping eczema under control.[1] 

With so many moisturizers to choose from, it can be very hard to decide which way to go. Here is a guide to help you choose more carefully. 

 

What Are the Different Types of Moisturizers 

Moisturizers come in many different types and have multiple effects, such as increasing skin hydration, smoothening the skin, and reducing the skin’s sensitivity.[2] Broadly speaking, moisturizers work by the following functions:

  • Directly hydrating the skin
  • Bolstering the skin barrier to prevent the skin from losing water

The ingredients in a moisturizer can give you a clue about how they function. Ingredients that can hold onto water and increase the direct hydration in skin are known as humectants. Examples of ingredients that act as a humectants include glycerin,[3] aloe vera,[4] and alpha-hydroxy acids.[2]

Ingredients can also bolster and support the skin barrier. These agents typically work by acting as an occlusive on top of the skin: 1) helping add to the barrier to prevent allergens from easily getting in and 2) reducing how quickly the skin loses water. Some examples of occlusive agents include petrolatum, beeswax, shea butter, and dimethicone.

When looking for the right moisturizer, you want to find one that has a mix of humectants and occlusive agents, so that the moisturizer can both hydrate the skin and help create a more healthy skin barrier.

 

What Herbal Ingredients Can Flare Your Skin? 

While the move toward organic and natural ingredients is increasing, it is important to be aware of the natural ingredients that can flare eczema. Several natural ingredients carry a higher risk to sensitize the skin for developing eczema.

  • Lavender oils: Lavender oils (essential oils) can cause skin allergies[5] and tend to become more irritating once they have become degraded through a process called oxidation.[6,7] In the process of oxidation, molecules within the oil can become altered and broken down. Essential oils that are oxidized may look cloudy, smell funny, and become thicker and more viscous.
  • Balsam of Peru: This ingredient is used commonly in many skin moisturizers and has been identified as a common culprit for skin allergies.[8]
  • Essential oils: Apart from lavender, essential oils (oils that evaporate quickly at room temperature) have a higher chance for causing skin allergies than fixed oils (oils that stay as an oil at room temperature).

It is always important to test a new product on a small spot on your skin prior to applying it over large areas of your body.

 

What Chemical Ingredients Can Flare Eczema? 

When selecting a moisturizer, it is important to know what ingredients to avoid. Here are a few ingredients that you should avoid  for skin that is sensitive and prone to eczema.

Fragrances

Fragrances are a frequent culprit of irritation and allergies in those with eczema.[8] Fragrances are commonly used in moisturizers with one study finding that fragrances were used in 68% of the moisturizers evaluated.[9] When looking at the ingredients of a moisturizer, fragrances are usually listed toward the end of the ingredient list and may be labeled generically as “Fragrance” or some variation of the word fragrance.

The challenge in selecting moisturizers without fragrance is to understand the difference between fragrance free and unscented moisturizers. The FDA defines fragrances as “…any natural or synthetic substance or substances used solely to impart an odor to a cosmetic product.”[10] Fragrance-free moisturizers do not use any chemicals that would act as a fragrance. On the other hand, unscented moisturizers may use a fragrance but then also include “masking agents” so that the final product does not have a smell. An unscented moisturizer, therefore, could still contain a fragrance and cause skin problems in those with sensitivity to fragrances. In many cases, the masking agents used in unscented moisturizers are chemicals known as phthalates, which have been controversial because of concerns regarding their health effects.[11,12] It is better to choose fragrance-free rather than unscented if the goal is to avoid fragrances.

Fragrance-free does not mean that there are no fragrances. Fragrances are defined as agents that are substances that are used “solely” to impart an odor to a moisturizer.[10] This means that fragrance chemicals used for other functions are technically not considered a fragrance according to the FDA’s definition. For example, if a chemical can function as both a fragrance and a preservative, it can be used for its preservative function and would not count as a fragrance ingredient even though it can also work as a fragrance.

Emulsifiers

Many moisturizers are made with components that dissolve more easily in oil or in water. Because oil and water do not mix well, emulsifiers are used to help oil and water components mix for a more even cream or moisturizer. Because emulsifiers can help mix oil with water, some emulsifiers can draw the skin’s natural oils out of the skin. This can ironically lead to more dryness in the skin and worsen eczema. Emulsifiers can be either oil-in-water or water-in-oil. Oil-in-water emulsifiers are able to more easily draw the natural oils from the skin out, potentially leading to drier skin. Some examples of oil-in-water emulsifiers include cetearyl alcohol and polysorbate-20. 

Alcohol

Alcohol based ingredients can be drying to the skin, as they can remove the oils that are important for maintaining a healthy skin barrier. As a result, products that contain alcohol in significant quantities can lead to further dryness and irritation in those with eczema. Alcohol is frequently found as denatured alcohol referring to the use of alcohol not safe for consumption and not taxed in the same manner consumable alcohol is taxed. 

Dyes

Dyes are used to give skin products different colors and looks. Unfortunately, some of these dyes can cause sensitivities for the skin. One example is yellow 5, which is also known as tartrazine. It is a color additive that can cause inflammation in the skin[13] and may flare those with eczema.

 

Alternatives to Standard Moisturizers

There is a wide array of natural products that do not need preservatives, emulsifiers, or other chemical additives that you may be sensitive to. These products are called anhydrous, or without water. Basically, most moisturizers and lotions have a mixture of water and fats, such as oils and butter. Have you heard the saying, "water and oil don’t mix?"  Well, the way you can get them to mix together is by adding emulsifiers and stabilizers that make a product viable. 

If you use products and substances that do not have water in them, such as balms, whipped butters, and pure oils, then you can avoid those chemicals. 

Oils 

As mentioned above, the oils to use directly on the skin and for eczema are not essential oils, which have a greater chance for irritation. Rather, fixed oils (oils that do not evaporate at room temperature) tend to be easier on the skin and can serve as moisturizers as well. Here are several examples of fixed oils that have been studied for the skin:

  • Virgin sunflower seed oil: Sunflower seed oil has been shown to be beneficial to the skin barrier.[14]
  • Virgin coconut oil: Topically applying coconut oil was found to have antibacterial effects[15] and improve the skin in a study among those with eczema.[16]
  • Virgin olive oil: Olive oil has been touted to have many nutritional properties, but it was not found to be as effective as coconut oil[15] in its antibacterial effects, nor was it found to be as effective as sunflower seed oil in supporting the skin barrier.[14] 

When selecting an oil, “nonvirgin” or refined oils may have additives and chemicals that may be irritating to the skin.[14] Naturally-derived ingredients also have a risk for skin allergies, and oils should be tested on a small part of the skin several days prior to using them over the rest of the body. Contact your doctor or health provider for guidance if you have known allergies to these ingredients or have concerns about allergies.

Balms 

Balms are a thick moisturizer usually made of oils, vegetable butters, and a wax (often beeswax). They have a long history of being used for skin problems and are generally anhydrous, so it does not require preservatives and emulsifiers.[17] Because people may be sensitive to beeswax or other oils, it is always important to test on a small area of the skin as well as contact your physician or health provider for guidance.

Whipped Butters

A vegetable butter, such as shea or cocoa butter, is a solid fat collected from nuts or seeds. They are hard at room temperature and not easy to spread on your skin in the raw form. As oils and balms, however, they are anhydrous and do not require emulsifiers and preservatives.

These fats are great for moistening your skin and helping retain moisture. Melting, mixing with oil, and whipping them makes it much softer and easier to spread on your skin. Read more about how to make whipped shea butter.

  

Ointment Versus Cream Versus Lotion?

Ointment

Ointments are greasy and thick and are good at preventing water loss from the skin. Ointments are very good at retaining skin moisture but some people may not like their greasiness. Ointments can also stain clothing and may be difficult to wash off.

Cream

Creams are less greasy than ointments. They are also easier to apply onto the skin than an ointment because they are not as thick. However, creams often contain preservatives and stabilizers to prevent the chemical ingredients from separating from each other, and they may cause irritation or allergic reactions in some people.

Lotions

Lotions have more water content and are lighter than either ointments or creams. They do not work as well for people with very dry skin because the water evaporates quickly after it is applied on the skin.

People with dry skin should use a thicker moisturizer on the body, such as a cream or ointment. Creams and ointments generally come in jars or capped containers, whereas other creams and lotions usually come in pump bottles.

 

Tips for Finding the Right Moisturizer 

Besides avoiding irritating ingredients such as fragrances, dyes, emulsifiers, and alcohol, the best tip for finding the right moisturizer is picking one that you would actually want to use every day and for the long haul. You may not realize this, but several factors influence your preferences and selection of a moisturizer, such as texture, how easily it gets smeared onto the skin, thickness, greasiness, affordability, and even the type of container for the moisturizer. One way to shop for the most suitable moisturizer is to first get some recommendations from your dermatologist or skin health practitioner, then purchase small quantities of each to test them out. Pay close attention to how easily the moisturizer can be applied to the skin, how easily it gets washed off, whether you like the thickness or texture of the product, and whether your skin can tolerate the product. One tip to test whether your skin will react to a moisturizer is to test it on a small spot on the inner arm several times a day and wait up to 2-3 days to see if you will develop a rash or itching at the application site.

The skin of people with eczema lacks ceramide, a natural waxy material that is made of fats which helps to form our skin’s natural barrier. Without ceramide, our skin becomes “leaky,” allowing moisture to evaporate out, and microbes and irritating chemicals to enter the skin, all of which worsen itch and eczema.[18] There are a number of moisturizers on the market that contain ceramides to replenish the skin barrier and are marketed specifically for eczema therapy. Also, certain companies have utilized special technology so the moisturizers are slowly released throughout the day after it has been applied onto the skin[19] and may help to keep the skin hydrated for a longer period of time.

 

References

  1. Xu S, Immaneni S, Hazen GB, et al. Cost-effectiveness of Prophylactic Moisturization for Atopic Dermatitis. JAMA Pediatr.2017;171(2):e163909; PMID: 27918774.
  2. Loden M. Effect of moisturizers on epidermal barrier function. Clin Dermatol.2012;30(3):286-296; PMID: 22507043.
  3. Ventura SA, Kasting GB. Dynamics of glycerine and water transport across human skin from binary mixtures. Int J Cosmet Sci.2016;10.1111/ics.12362PMID: 27566278.
  4. Dal'Belo SE, Gaspar LR, Maia Campos PM. Moisturizing effect of cosmetic formulations containing Aloe vera extract in different concentrations assessed by skin bioengineering techniques. Skin Res Technol.2006;12(4):241-246; PMID: 17026654.
  5. Sugiura M, Hayakawa R, Kato Y, et al. Results of patch testing with lavender oil in Japan. Contact Dermatitis.2000;43(3):157-160; PMID: 10985632.
  6. Hagvall L, Skold M, Brared-Christensson J, et al. Lavender oil lacks natural protection against autoxidation, forming strong contact allergens on air exposure. Contact Dermatitis.2008;59(3):143-150; PMID: 18759894.
  7. Skold M, Hagvall L, Karlberg AT. Autoxidation of linalyl acetate, the main component of lavender oil, creates potent contact allergens. Contact Dermatitis.2008;58(1):9-14; PMID: 18154552.
  8. Giordano-Labadie F, Rance F, Pellegrin F, et al. Frequency of contact allergy in children with atopic dermatitis: results of a prospective study of 137 cases. Contact Dermatitis.1999;40(4):192-195; PMID: 10208505.
  9. Zirwas MJ, Stechschulte SA. Moisturizer allergy: diagnosis and management. J Clin Aesthet Dermatol.2008;1(4):38-44; PMID: 21212847.
  10. http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=700.3. Accessed February 18, 2017.
  11. Katsikantami I, Sifakis S, Tzatzarakis MN, et al. A global assessment of phthalates burden and related links to health effects. Environ Int.2016;97:212-236; PMID: 27669632.
  12. Heudorf U, Mersch-Sundermann V, Angerer J. Phthalates: toxicology and exposure. Int J Hyg Environ Health.2007;210(5):623-634; PMID: 17889607.
  13. https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm048951.htm. Accessed February 20, 2017.
  14. Danby SG, AlEnezi T, Sultan A, et al. Effect of olive and sunflower seed oil on the adult skin barrier: implications for neonatal skin care. Pediatr Dermatol.2013;30(1):42-50; PMID: 22995032.
  15. Verallo-Rowell VM, Dillague KM, Syah-Tjundawan BS. Novel antibacterial and emollient effects of coconut and virgin olive oils in adult atopic dermatitis. Dermatitis.2008;19(6):308-315; PMID: 19134433.
  16. Evangelista MT, Abad-Casintahan F, Lopez-Villafuerte L. The effect of topical virgin coconut oil on SCORAD index, transepidermal water loss, and skin capacitance in mild to moderate pediatric atopic dermatitis: a randomized, double-blind, clinical trial. Int J Dermatol.2014;53(1):100-108; PMID: 24320105.
  17. Al-Waili NS, Saloom KS, Al-Waili TN, et al. The safety and efficacy of a mixture of honey, olive oil, and beeswax for the management of hemorrhoids and anal fissure: a pilot study. ScientificWorldJournal.2006;6:1998-2005; PMID: 17369999.
  18. van Smeden J, Bouwstra JA. Stratum Corneum Lipids: Their Role for the Skin Barrier Function in Healthy Subjects and Atopic Dermatitis Patients. Curr Probl Dermatol.2016;49:8-26; PMID: 26844894.
  19. Zeichner JA, Del Rosso JQ. Multivesicular Emulsion Ceramide-containing Moisturizers: An Evaluation of Their Role in the Management of Common Skin Disorders. J Clin Aesthet Dermatol.2016;9(12):26-32; PMID: 28210396.