Moisturizer therapy in prevention of atopic dermatitis and food allergy: to use or disuse?

Objective: To critically appraise the evidence for the role of regular moisturizer application in early life to prevent atopic dermatitis (AD) and food allergy (FA).

Data Sources: Primary peer-reviewed literature.

Study Selections: Original research articles based on systematic reviews, interventional studies, retrospective studies, case-control studies, and cohort studies related to the subject matter.

Results: There is good evidence to show that epicutaneous sensitization through a defective skin barrier is important in the development of AD and FA. This supports moisturizer use in prevention because some of them have been proven to restore skin barrier with clear benefits in AD, whereas there is some limited evidence that these products may reduce allergic sensitization. However, moisturizers have varied effects depending on ingredients and formulation, some of which are paradoxical, such as increasing transepidermal water loss and enhancing penetration of substances in the skin. These effects may be responsible for some of the conflicting outcomes of prevention studies, some of which suggest that moisturizers are not useful in prevention of AD and FA, whereas others show a positive trend. Interestingly, there is some suggestion that moisturizers may increase the risk for allergy development perhaps through these paradoxical effects.

Conclusion: Although moisturizer use is beneficial in the management of AD, current evidence suggests that it may be ineffective in prevention of AD and FA. Further studies are needed to determine the effects of moisturization on allergic sensitization and inflammation and to investigate whether moisturizer type, frequency, duration, and age of application substantially affect the prevention and development of these allergies.