Current approach to moisturizer and emollient utilization in atopic dermatitis: a review Original paper

What was reviewed?

This paper reviewed current clinical and biological evidence on the use of moisturizers and emollients in the prevention and management of atopic dermatitis, with particular attention to skin barrier dysfunction, immune dysregulation, and microbiome-related factors. The author synthesized dermatological, immunological, and translational research to explain how impaired epidermal barrier function and Th2-driven inflammation interact to drive disease onset, chronicity, and flares. Rather than framing moisturizers as cosmetic adjuncts, the review positioned them as core therapeutic tools that directly influence transepidermal water loss, epidermal differentiation, immune activation, and microbial colonization. The article integrated randomized controlled trials, systematic reviews, and mechanistic studies to clarify where moisturizers are effective, where evidence is inconclusive, and how formulation composition alters clinical outcomes in atopic dermatitis.

Who was reviewed?

The review incorporated evidence from pediatric and adult patients with atopic dermatitis across a wide severity spectrum, including infants at high risk for disease development, children with early-onset eczema, and adults with persistent or late-onset disease. It also drew on studies involving healthy control skin to contrast normal barrier and microbial function with diseased states. The populations reviewed included patients with both lesional and non-lesional atopic skin, allowing assessment of subclinical barrier dysfunction and microbial imbalance beyond visibly inflamed areas. By synthesizing findings across age groups and disease stages, the review highlighted how barrier impairment and treatment response differ over time.

What were the most important findings?

The review demonstrated that atopic dermatitis is driven by a convergence of epidermal barrier defects, Th2-mediated immune signaling, and alterations in the skin microbiome. Reduced filaggrin expression, altered lipid composition, and increased transepidermal water loss create a permissive environment for inflammation and microbial overgrowth. Regular use of moisturizers and emollients improved barrier integrity, increased stratum corneum hydration, and reduced disease severity and flare frequency, particularly when used alongside anti-inflammatory therapies. Importantly for microbiome signatures, improved barrier function was associated with reduced bacterial colonization, particularly of pathogenic taxa such as Staphylococcus aureus, which is strongly linked to disease flares. Certain formulations were shown to upregulate antimicrobial peptides, including cathelicidin and beta-defensins, reinforcing innate defense mechanisms. However, the review also emphasized that emollients alone were insufficient for long-term primary prevention in infancy and that formulation composition, rather than frequency alone, determined clinical benefit.

What are the greatest implications of this review?

The most significant implication for clinicians is that moisturizers and emollients function as biologically active interventions that influence immune signaling and microbial balance, not merely symptom relief. The findings support early and sustained barrier repair as a strategy to reduce inflammation, microbial dysbiosis, and reliance on topical corticosteroids. At the same time, the review cautions against overestimating the preventive capacity of emollients in infancy when used in isolation. For clinical practice and microbiome-focused care, the paper reinforces that restoring barrier integrity is a prerequisite for stabilizing the skin microbiome and improving long-term disease control in atopic dermatitis.