What Role Does Dry Skin Have with Atopic Dermatitis?

Atopic dermatitis (AD) is a chronic skin condition caused by a combination of genetic, environmental, and immune system factors. AD damages the barrier of the skin, which plays an important role in protection of the body. As a chronic condition, AD has periods of remission and flares of worsened symptoms. AD can be triggered by a number of factors, including dry skin. While AD causes the affected areas of the skin to become dry, as well as red and itchy, flares of AD can also be triggered by having dry skin.1,2

One of the proteins in the skin that is key to its structure and formation is called filaggrin. Some people with AD have a decreased amount or lack of filaggrin, which leads to a reduced ability to maintain the skin’s natural amount of water. Excess water loss can lead to dry skin. In addition, the lack of filaggrin leads to a compromised barrier, allowing allergens and germs to penetrate the skin.1

Dry skin and itchiness

When skin becomes dry, it can also cause itchiness, and the itch-scratch cycle of AD is one of the processes that seems to continue the disease. Scratching the areas of skin affected by AD can cause breaks in the skin, which increase the risk of infection. Repeated scratching also leads to areas of lichenification, thickened skin that may have knots or be lighter or darker than surrounding skin. Lichenified plaques are continuously itchy, causing significant distress for the person with AD.2,3

One of the recommendations for AD is to avoid situations that trigger the itch sensation. In one survey of people with AD, 71% said that dryness increased the severity of their itch. Treating and preventing dry skin can reduce the itch as well as reduce the possibility of it triggering a flare of AD.2

Preventing dry skin

Since AD is a chronic and relapsing skin condition, treatment strategies include treating and preventing flares. Treating and preventing triggers like dry skin can help prevent the flare. Doctors recommend using thick moisturizers to treat and prevent dry skin. Moisturizers are one of the basic necessities for people with AD, regardless of the severity of their disease.

There are a variety of moisturizers, including lotions, creams, gels, and ointments. For people with AD, dermatologists frequently recommend ointments and creams as they are thicker. Some of the anti-inflammatory medications available for treating AD also come in moisturizer formulations, which can help provide additional barrier repair and control itchiness.

Ingredients in moisturizers

There are different types of ingredients in moisturizers that may be used by people with AD and many moisturizers contain a combination of these ingredients, including humectants, emollients, and occlusives.

Humectants

Humectants attract and bind water from deeper layers of the skin.

Emollients

Emollients which contain lipids (fats) naturally found on the skin and smooth skin by lubricating the skin.

Occlusives

Occlusives form a hydrophobic film to reduce the loss of water from the skin.4

Due to their high lipid content, ointments tend to have the greatest moisturizing effect, followed by creams, then lotions. However, the best moisturizer is usually individually determined by a number of factors, including individual preference, safety, effectiveness, cost, and the absence of fragrances or other chemicals that may cause sensitivity. Regardless of which product is used, the regular application of moisturizers to the skin is an important part of the therapy for AD.1,4,5

Examples of Moisturizer Ingredients by Type4

Humectants
Emollients
Occlusives
Glycerin
Collagen
Carnauba wax
Alpha hydroxy acids
Colloidal oatmeal
Lanolin
Hyaluronic acid
Elastin
Mineral oils
Sorbitol
Glyceryl state
Olive oil
Urea
Isopropyl palmitate
Petrolatum
Shea butter
Silicone
Stearic acid
Emily Downward | June 2017
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