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REVIEW ARTICLE

Moisturizers: The Slippery Road

Anisha Sethi, Tejinder Kaur1, SK Malhotra1, ML Gambhir1

Abstract From the Department of Skin

Moisturizers are an important part of a dermatologist’s armamentarium although little is and S.T.D, DMCH, Ludhiana,
written and well, a less is truly known about them. There is a cornucopia of projected skin
1
Department of Skin and S.T.D,
GMC, Amritsar, Punjab, India
products in the market whose real scientific role is not proven. These products although at
times are regarded as mere cosmetics but have a well‑known role in many skin disorders.
Adequate knowledge about their mechanism of action, dosage, usage, and adverse effects is
Address for correspondence:
must for a dermatologist in this era. This article aims to bring forth the ever hidden facts Dr. Anisha Sethi,
of the much‑hyped moisturizers. It is probably the first of its kind covering all aspects of C/O Sh. AK Sethi, Thakur
moisturizers ranging from basic science to clinical usage, a subject that receives a short shrift Singh Street, Inside Delhi Gate,
in the current dermatological text. Ferozepur City ‑ 152 002,
Punjab, India.
Key Words: Emollients, humectants, moisturizers role in dermatology E‑mail: [email protected]

What was known?

• Moisturizers are perhaps the most used therapeutic agents by dermatologists and nondermatologists alike
• They come in varied forms and mostly are neglected in academic discussions.

Introduction idea that they moisten the skin.[3] The desire to apply
There has been a recent migration in humankind’s oily materials to the skin is almost instinctive and
way of thinking toward a desire for holistic products, may be as old as humankind itself.[2] Traditionally,
especially pertaining to skin care. Moisturizers are moisturizers were believed to inhibit the transepidermal
perhaps the most prescribed products in dermatology water loss (TEWL) by occlusion. Stratum corneum (SC)
practice and also the most intriguing one. The incidence although a dead layer acts as an active membrane as
of dryness related dermatoses are on the increase suggested by the bricks and mortar model. It is the loss
courtesy urbanization, adulteration, pollution, increased of intercellular lipids, i.e., the ceramides, cholesterol,
life span, and abandonment of traditional oil massages and fatty acids that form the bilayers, damaging the
and baths. The majority of the human population water barrier formation thus leading to dry skin.[3] Dry
applies many moisturizers throughout their lifetime; it skin is noted when the moisture content is <10%, and
thus behooves a dermatologist to have a comprehensive there is a loss of continuity of the SC.[4]
knowledge of the same. The term “moisturizer” is a
marketing term with little or no scientific meaning.
Classification
Consumers regard them to increase the water content There are four main types of moisturizers depending on
of the skin while dermatologists consider them as bland their mechanism of action as shown in Table 1.[2‑5]
oleaginous substances.[1] Dryness is not a single entity Emollients
but is characterized by differences in chemistry and
They are mainly lipids and oils, which hydrate
morphology in the epidermis depending on the internal
and improve the skin softness, flexibility, and
and external stressors.[2]
smoothness. The skin slip or lubricity contributes to
consumer satisfaction.[6] Intracellular lipids comprising
History
multilamellar, which are located between SC play a
Curiously, there is no consensus regarding the definition major role in skin architecture. In SC, ceramides are the
of a moisturizer. The term itself is a neologism coined
by the Madison Avenue marketers, promoting the facile
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How to cite this article: Sethi A, Kaur T, Malhotra SK, Gambhir ML.
DOI: 10.4103/0019-5154.182427 Moisturizers: The slippery road. Indian J Dermatol 2016;61:279-87.
Received: October, 2015. Accepted: January, 2016.

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Sethi, et al.: Moisturizers action, types, role in dermatology

Table 1: The various classes of moisturizers

Class Emollients Humectants Occlusives Protein rejuvenators
Mechanism Saturated and unsaturated variable Mostly low molecular weight Oils and waxes which Small molecular
of action length hydrocarbons which help in substances with water form an inert layer on the weight proteins
skin barrier function, membrane attracting properties into the skin and physically block thought to help is
fluidity and cell signaling leading stratum corneum. Used along transepidermal water loss skin rejuvenation by
to overall improvement in skin with other components to replenishing essential
texture and appearance. Often used retain the water content proteins
in combination with emulsifiers
Indication Skin dryness, roughness, Xerosis, ichthyosis Xerosis, atopic dermatitis, Skin rejuvenation,
papulosquamous disorders, and prevention of contact aging, photodamaged
routine skin care dermatitis skin
Adverse Rarely contact irritant Irritation (urea, lactic acid) Messy to apply, Contact dermatitis
effects cosmetically unacceptable.
Folliculitis (mineral oil),
acneiform eruptions,
contact dermatitis (lanolin)
Examples Cholesterol, squalene, fatty acids, Glycerol, propylene glycol, Petrolatum, beeswax Collagen, elastin,
fatty alcohols, pseudoceramides panthenol sorbitol, urea, alpha mineral oil, silicones, keratin
hydroxy acids, hyaluronic acid lanolin, zinc oxide

major lipid constituents and along with neutral lipids, Squalane is a saturated form of squalene in which the
they form broad laminated intercellular sheets, which double bonds have been eliminated by hydrogenation.
act as barriers to our environment.[7] Natural ceramides Squalane is less susceptible to oxidation than squalene.
or the synthetic ones are too expensive. Hence, several Squalane is thus more commonly used as a moisturizer.[10]
pseudo‑ceramides are useful as emollients.[3] Lipophilic
An added boon of squalane is that even though it is
compounds such as cholesterol and ceramides are being
technically oil, it does not have an oily feel, is odorless,
used in topical skin creams. They get easily incorporated
noncomedonal, antibacterial, and is safe for sensitive
into liposomes and make the skin texture softer and
smoother. Nanoencapsulated triceramides are also being skin.[11] Besides its emollient action, it is also used in
used for increasing the hydration of the skin.[8] Long treating skin disorders such as seborrheic dermatitis,
chain saturated fatty acids, for example, stearic, linoleic, acne, psoriasis, or atopic dermatitis.[12] Various types of
oleic, and lauric acid and fatty alcohols are essential emollients are as shown in Table 2.[2‑5]
fatty acids that are found naturally in palm oil, coconut Humectants
oil, and wool fat. They influence skin physiology and They are basically hygroscopic compounds which mean
pathology via their effects on skin barrier functions, they attract water from two sources, from the dermis
eicosanoid production, membrane fluidity, and cell into the epidermis and in humid conditions from the
signaling.[2] Canola oil in specific is known to reduce environment. Many humectants have emollient properties
sodium lauryl sulfate (SLS) irritation.[4]
as well.[2] Natural moisturizing factor made of a mixture of
Squalene as moisturizer low molecular weight soluble hygroscopic substances such
Squalene is one of the most common lipids produced as lactic acid, pyrrolidone carboxylic acid, and amino acids
by human skin cells and is a component of human is a major player for hydration of the SC.[2] Table 3[2‑5]
sebum.[9] It is an isoprenoid compound and acts as an lists the various humectants available. Trihydroxylated
intermediate metabolite in the synthesis of cholesterol. molecule glycerol is the most effective humectant. The
In humans, about 60% of dietary squalene is absorbed. It mechanism of action[13-16] is as shown in Figure 1. Urea
is transported in serum generally in association with very has been shown to reduce TEWL in atopic and ichthyotic
low‑density lipoproteins and is distributed ubiquitously patients[17,18] and reduce SLS‑induced skin irritation.[19] It
in human tissues, with the greatest concentration in the is a humectant at a lower concentration (10%) but in
skin. Although squalane is produced naturally by the higher concentrations (20–30%) it disrupts the hydrogen
body, the production of this chemical slows drastically bonds of epidermal proteins leading to keratolysis.[4]
after age thirty, thus contributing to dry skin. It can Alpha hydroxy acids are effective in treating xerosis.
be derived from both plant and animal sources. It acts Lactic acid particularly the L‑isomer stimulates ceramide
as a quencher of singlet oxygen, protecting human synthesis leading to higher SC ceramide levels which
skin surface from lipid peroxidation due to exposure to result in superior lipid barrier and effective resistance
ultraviolet (UV), and other sources of ionizing radiation. against xerosis.[5]

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Humectants are a double‑edged weapon as they distribution of molecular weight, materials with different
increase TEWL by enhancing water absorption from the viscosity are obtained. During the refining process, the
dermis into the epidermis where it is easily lost to the hydrocarbon material is hydrogenated to create oxidation
environment. It is for this reason that they are mostly resistant molecules throughout from the liquid to the
combined with occlusive.[5] solid waxes. This gives a long shelf life to these products.
Among all petroleum jelly is one of the best moisturizers
Occlusives having a water vapor loss resistance 170 times that of
They are substances that physically block TEWL in the olive oil but is cosmetically less acceptable due to its
SC. They create a hydrophobic barrier over the skin, greasiness.[20] Lanolin secreted by sebaceous glands
contribute to the matrix between corneocytes and of sheep, is a complex structure of esters, diesters,
have the most pronounced effect when applied to the hydroxyesters of high molecular weight, lanolin alcohols,
slightly dampened skin.[5] A wide range of occlusives is and lanolin acids.[3,21] Unlike human sebum, it contains no
available as shown in Table 4.[2‑5] They are basically oils triglycerides.[3,22] Petrolatum in a minimum concentration
that are thought to diffuse into the intercellular lipid of 5% reduces TEWL by more than 98% followed by
domains thus contributing to their efficacy. Mineral oils lanolin, mineral oil, and silicones which only reduce TEWL
are derived from petroleum. The two most important by 20–30%.[4,20] The limiting factors with most occlusives
materials are liquid paraffin (also called mineral oil and being an odor, potential allergenicity, and the greasy feel.
paraffinum liquidum) and petrolatum, consisting of a
complex combination of hydrocarbons. Depending on the Role of Moisturizers
1. Moisturizing action[23-26]: Tshis is the most vital action
Table 2: Classification of emollients by which they increase the water content of the SC.
Dry Fatty Astringent Protective Hydration smoothes the skin surface by flattening the
emollients emollients Emollients emollients “valleys” between the skin contour ridges. It also makes
Decyl oleate, Castor oil, Cyclomethicone, Diisopropyl the skin surface soft, more extensible, and pliable. The
isopropyl glyceryl stearate, dimethicone, dilinoleate, moisturizing action of emollients is evident maximum
palmitate, jojoba oil, isopropyl isopropyl 30 min–1 h after their use and usually lasts for 4 h.
isostearyl octyl stearate, myristate, octyl isostearate 2. Anti‑inflammatory action: Many moisturizers inhibit
alcohol propylene glycol octanoate the production of proinflammatory prostanoids by
blocking cyclooxygenase activity thus have a soothing
effect on inflamed skin[23-26]
Table 3: The various humectants
3. Antimitotic action: Moisturizers containing mineral
Glycerin
oils have low‑grade antimitotic action on the
Alpha hydroxyl acids, for example, glycolic acid, lactic acid
epidermis and thus are useful in inflammatory
Sodium pyrrolidine carboxylic acid
dermatosis like psoriasis, where there is increased
Propylene glycol and butylene glycol
epidermal mitotic activity[23-26]
Hyaluronic acid
4. Antipruritic action: Emollients downregulate the
Urea cytokines thus reducing the itching. Furthermore,
Panthenol cooling effect following evaporation of water from
Aluminum lactate and Sodium lactate
Gelatin
Sorbitol
Honey

Table 4: Various classes of occlusives

Class Examples
Hydrocarbons Petrolatum, paraffin, mineral oil,
caprylic/capric triglyceride, squalene
Fatty acids Lanolin acid, stearic acid
Fatty alcohols Cetyl alcohol, stearyl alcohol, lanolin
Phospholipids Lecithin
Polyhydric alcohols Propylene glycol
Sterols Cholesterol
Vegetable waxes Carnauba, candelilla
Wax esters Beeswax, lanolin, stearyl stearate Figure 1: The mechanism of action of glycerol

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the skin surface after using water based moisturizers each category, there are specialized products geared for
has antipruritic effect[23-26] certain areas such as lips, under eyes, feet. Commercially,
5. Photo protective action: These days’ sunscreens with they are classified as:
variable sun protection factor are incorporated in the
1. Facial moisturizers[5,27,28]: Face in particular is prone to
moisturizers providing additional sun protection.[23-25]
effects of environment such as cold and hot weather,
6. Miscellaneous actions[23-26]:
arid conditions, humidity, dust, pollution, and UV
• Quality of life improvement: Having a smooth
rays. Hence, facial moisturizers have a unique place
and hydrated skin plays a good role in our
in daily skin care. They are designed to be nongreasy,
social life and psychological satisfaction
noncomedogenic with an emphasis on esthetics and
• Antimicrobial action: Act against skin surface
maximal skin benefits. Silicone‑based derivatives are
microbes
suitable for oily skin. Other ingredients are added
• Wound healing: Hyaluronic acid is known to
to reduce the appearance of excess shine such as
play a role.
oil absorbent compounds, for example, kaolin,
Dispensing Formulations talc.[5] Under eye creams are lightweight cream
formulas meant to restore firmness, diminish dry
Moisturizers are available in different
lines, reduce puffiness, and pigmentation. Essentially,
formulations [Table 5] depending on the dispensing
they are moisturizers, and their effects are limited to
medium. The predominant form of delivery is a cosmetic
those of other routine moisturizers.
emulsion. The process of emulsification combines various
2. Body and hand feet moisturizers: They are mostly
phases containing the active ingredients.[5,23,24]
aimed at prevention as well as treatment of dry skin,
Depending on the site of application, the moisturizers eczema, and xerosis. They are dispensed in the form
are generally marketed in various categories. Within of lotions, creams, and mousse. Some specialized

Table 5: Various dispensing formulations

Class Lotions Creams Ointments Gel
Phase Oil in water Water in oil (w/o) Water in oil (w/o) Hydrophobic or hydrophilic
(hydrophobic) or oil in water (hydrophobic) or oil in
(hydrophilic, vanishing cream) water (o/w) (hydrophilic)
Preparation Oil in water o/w creams are prepared at Does not contain sufficient Has a liquid phase within
prepared using elevated temperatures and water to separate into a three‑dimensional polymeric matrix
emulsifiers then cooled down to room a second phase at room with physical or sometimes chemical
for better temperature for the internal temperature. Mostly 80% cross‑linkage using suitable gelling
spreadability phase to solidify oil (50%) oil and 20% water agents
and water (50%)
Composition Propylene glycol, w/o: Emulsifying agents such w/o: Water‑insoluble Hydrophobic gel (oleogel): Liquid paraffin
mineral oil, and as wool fat, sorbitan esters, hydrocarbons such as hard, with polyethylene or fatty oils gelled with
water and monoglycerides soft, and liquid paraffin, colloidal silica, aluminum or zinc soaps
o/w emulsifying agents such vegetable oil, animal fats, Hydrophilic gel (hydrogel): Water,
as sodium or triethanolamine waxes, synthetic glycerides, glycerol, or propylene glycol
soaps, sulfated fatty and polyalkylsiloxanes gelled with suitable agents such as
alcohols, and polysorbates o/w: Mixtures of liquid tragacanth, starch, cellulose derivatives,
combined, if necessary, with and solid polyethylene carboxyvinyl polymers, and magnesium
w/o emulsifying agents glycols (macrogols) aluminum silicates
Features Nongreasy. Esthetic. Made of heavier Greasy. Give a glossy look Have a smooth finishing
Thinner, easily lipids when applied Nonoily, noncomedogenic
cover larger area Forms a protective layer on Easily absorbed
skin, especially beneficial
when humidity is low
(<60%)
Usage Daytime Where occlusive effect is Highly useful where degree Useful in intertriginous areas, being
moisturizers. not required. Nighttime of occlusive effect is quickly absorbed and noncomedogenic
Face (daytime), moisturizers. Face (night required have high acceptability on face
body and hairy time), hands and nonhairy Should not be applied
parts, after‑shave parts in intertriginous and
lotions moisture‑bearing areas
w/o: Water in oil, o/w: Oil in water

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products aims include cellulite firming, bronzing, and Table 6: Uses of moisturizers
minimizing the signs of aging.[5]
Indications Examples
3. Anti‑aging products: The quest for a younger looking
Eczemas[1,3,4] Atopic dermatitis
skin has led to a boost in the anti‑aging technology.
Hand eczema
Special agents are especially useful for photoaged
skin and include sun protectants, alpha hydroxyl Nummular eczema
acids (e.g., glycolic acid), retinol, and its derivatives. Stasis eczema
These moisturizers play a role in treating and Asteatotic eczema
augmenting therapy for the aging face.[27,28] Disorders of Ichthyosis
keratinization[70-72] Ichthyosis vulgaris
Where to Use? Bullous ichthyosis erythroderma
Moisturizers have a wide array of usage and benefits for Lamellar ichthyosis
many dermatological conditions which have a common Acquired: Drugs and malignancies
underlying effect of dryness. The dry skin disorders are
Psoriasis
induced by complex interactions between environmental
Keratosis pilaris
and individual factors. Various factors contributing are
low environmental temperature,[29] low humidity,[30] Palmoplantar keratodermas
exposure to chemicals,[31] microorganisms,[32] aging Lichen planus
and psychological stress,[22,33] atopic dermatitis, and Dermatosis secondary to Diabetes
eczemas.[34‑37] Table 6[1‑5] (although not exhaustive) lists an underlying disorder[1] Thyroid disorders
the common indications for use of moisturizers. Pruritus of pregnancy
Xerotic skin Uremic pruritus
The appearance of the skin is essential for an individual, Pruritus secondary to hepatic disorder
and a flawed presentation often results in reduced Exfoliative dermatitis
self‑esteem by self and others.[38] The impression of Chemotherapy‑induced xerosis
dryness is formed by inherent sensory components Other dermatologic Lichen simplex chronicus
in skin along with visible and tactile changes of the disorders[73,74] Acne vulgaris
surface. A feeling of dryness, an uncomfortable skin Rosacea
that is, tight, painful, itchy, stings, and tingles are the Retinoid‑induced irritant dermatitis
symptoms of dry skin [Figure 2].[38,39] Application of Maintenance of Skin Elderly patients
moisturizers leads to increase in water content in the integrity in special Neonates and infants
SC,[40] and a smoothing of the surface can be observed, populations[75-77]
Amputee and bed ridden patients
as a result of the filling of spaces between partially
Miscellaneous uses Xerosis[71]
desquamated skin flakes.[41,42] Thereafter, skin mechanics
change[43] and the increased hydration will facilitate Contact dermatitis[30]
degradation of desmosomes keeping the corneocytes Anti‑aging[27,28]
together.[44,45] A possible strengthening of a weakened Skin cleansers[77]
skin barrier function may also occur, which can make
skin less susceptible to attacks from noxious substances should be lightly applied along the direction of the hair
and prevent the development of eczema.[17,46,47] This may follicles. To prevent the well‑known adverse effect of
explain why moisturizers are a useful adjunct in the oil folliculitis because of vigorous rubbing, the method
treatment of inflammatory dermatoses as steroid‑sparing of application should be repeatedly explained to the
therapy.[48] applicant.
Dosages and methods of application As for other actives, the efficacy of moisturizers is
Finding the most suitable moisturizer for an individual likely to depend on dosage where compliance is a great
may be a matter of trial and error. The right time challenge. It is often difficult to estimate the amount
and the right way to apply the moisturizers hold the applied making it difficult to compare the effectiveness
key to maximum benefits. Except for humectants of moisturizers and may also cause doubts about the
and hydrophilic matrices which can absorb water compliance. Intensive education from a dermatology
from atmosphere or underlying skin layers the more nurse has resulted in 800% increase in the use of
commonly used occlusive oils should be applied on moist moisturizers (426 g weekly of emollient cream/ointment)
skin.[2,3] The skin should be moistened as after dabbing and no overall increase in steroids accounting for potency
it following a bath or by rubbing a wet cloth (sponge and quantity used.[49] There is difference in dosing in
bath). After rubbing the moisturizer in both palms, it self and assisted application of creams. Self‑application

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Miller leaf extract), of which more than 300

species are available. Evidence to support its
SENSORY
Dry feel, role as a moisturizer is lacking although its role
uncomfortable,
itchy, stingy ,
in healing of skin ulcers and burns due to its
painful and anti‑inflammatory, antibacterial, and vasodilator
tingles
action has been propounded from time to
time[56]
VISUAL • Allantoin (comfrey root) is a synthetic derivative
Redness, flaky
appearance, TACTILE known as aluminum dihydroxy allantoinate. It
lackluster, Rough and
fissures, dry uneven has been marketed for its role as moisturizer as
whilte patches well as keratolytic. However, supportive studies
CHARACTERITICS OF DRY SKIN are lacking[57]
• Oatmeal (Avena sativa) baths for soothing rashes
have been part of nursing practice since decades
and are considered to be highly reliving to the
FUNCTIONAL CHEMICAL
Increased Reduced water
patient[55]
permeability i.e
higher TEWL
content and level • Bioflavonoids, i.e.,  plant derived polyphenols
of natural
Less resistance to moisturizing are being promoted as topical antioxidants. As
absorption of factor, Changed
noxious lipid composition a result, they have found a suitable place as an
substances
additive to the moisturizers. However, how far
they are useful in relieving the oxidant stress of
Figure 2: Various characteristics of dry skin
the skin is yet to be proved.[57]
2. Antioxidants[58]: Are the agents which inhibit
resulted in larger amount applied per unit area. [50,51]
oxidation of ingredients by reacting with free
Furthermore, distribution of the moisturizer depends radicals and blocking the chain reaction. Typical
on the vehicle used.[52] A thick ointment (with a few antioxidants are tocopherols (Vitamin E), butylated
percent of water) is more evenly distributed whereas hydroxytoluene, and alkyl gallates.[20] Reducing
the formulations with lower viscosity and more volatile agents, such as ascorbic acid, may also act by
ingredients were less evenly spread on the skin.[52] reacting with free radicals, as well as oxidize more
Furthermore, dispensing jars promoted more consumption readily than the ingredients they are intended to
of larger quantities than same in a tube (1.7 vs. protect[20]
0.7 mg/cm2, respectively).[51] Once applied to the skin, 3. Chelating agents[58]: Citric acid, tartaric acid
the ingredients can stay on the surface, be absorbed ethylenediaminetetraacetic acid, and its salts have
into the skin, metabolized or disappear from the body limited antioxidant activity themselves, but enhance
by evaporation, and sloughing off or by contact with the efficacy of antioxidants by reacting with heavy
other materials. Only 50% of applied creams were found metal ions. Such substance is called chelating agents.
to remain on the surface after 8 h.[53] Transfer of the 4. Vitamins[22,23]: There have been poorly substantiated
actives to the surrounding surfaces is easier for creams claims of skin rejuvenation by the addition of Vitamins
and ointments than lotions and tinctures.[54] Depending such as A, C, and E. However, their penetration
on the severity of xerosis, the frequency of application through the skin is doubtful. They should be in
can vary between 1 and 3 times daily, especially after water soluble form to be absorbed percutaneously
bath. hence oral/parenteral supplementation is preferred
over topical application of the same.
Special Additives in Moisturizers 5. Fragrances and coloring agents[22,23]: Added more for
1. Botanical substances: In this era of going natural, their cosmetic enhancement rather than any actual
the use of herbal products and extracts has caught role as moisturizers. They may vary from cinnamic
everyone’s attention. These herbal products are being acid, cinnamates, menthol, benzoin resin, etc.
used in topical preparations since time immemorial. Coloring agents impart subtle hues and other optical
However, the rationale to include herbal extracts in effects leading to more acceptance although at times
moisturizers has not always been based on controlled can lead to irritant dermatitis.
studies or evidence‑based meta‑analysis of clinical 6. Preservatives[58]: They are meant to kill or inhibit the
trials.[55] Instead, they may be added for marketing growth of microorganisms inadvertently introduced
reasons to nurture consumer interest in the perceived during use or manufacturing. Contaminating
benefits of natural ingredients on the skin organisms may be either pathogens or nonpathogens.
• The most famous of all is Aloe (Aloe barbadensis The ideal preservative must have a broad spectrum of

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Sethi, et al.: Moisturizers action, types, role in dermatology

activity; it must be safe to use; it should be stable The Indian perspective

in the product, and it should not affect the physical Moisturizers have found a comfortable seat in the Indian
properties of the product. No single preservative meets market, and are used widely and variedly. Although
all these requirements, and usually a combination there is paucity of Indian literature, few reports on
of substances is used. Phenoxyethanol and usage of moisturizers in some specific dermatoses do
parabens (methyl‑, propyl‑, ethyl‑ and butyl‑paraben) throw some light.[78,79] The exact knowhow’s of their
are the most frequently used in moisturizers. usage pertaining to Indian skin is still lacking. Mostly
7. Emulsifying agents[22,23]: The natural tendency of Indian skin types are of Fitzpatrick type IV–V though
any oil and water to separate in different phases a wide variability does exist.[80] Saying this does
is undone by the addition of emulsifying agents implement that moisturizers can be used solely with
mostly detergents. The most commonly used ones little additives like sun blocking agents. Variability of
are Laureth 4 and 9, ethylene glycol monostearate, skin type depending on dry, oily, combination or normal
octoxinols, and nonoxinols. Liposomes dispersion skin does guide the amount, frequency, and type of
moisturizers like in any other ethnicity as discussed
is the newer technique which delivers the active
earlier.
ingredients into the epidermis for enhanced action.
8. Sunscreens[22,23,25]: Last but not the least, they have Ideal moisturizer[2,4,5]
found a comfortable berth as an important ingredient The search for an ideal moisturizer is a vain task, for
in many moisturizers serving a dual function, for the needs and results are highly subjective. However,
example, replenishing creams. Cinnamates, titanium an ideal moisturizer should have some attributes which
dioxide, and zinc oxide have replaced the much toxic make them suitable in most of the conditions and for
para‑aminobenzoic acid agents. most of the applicants.

Adverse Effects An Ideal Moisturizer Should

As compared to various topical drugs used by • Reduce and prevent further TEWL
dermatologists, moisturizers are rarely associated • Restore lipid barrier, i.e.,  duplicating and enhancing
with health hazards, although they may be used on the skin’s moisturizing retention mechanisms
large body surface areas over a major part of the life • Hypoallergenic, nonsensitizing, fragrance free,
span. Various forms of skin discomfort from topical noncomedogenic
preparations are more common encountered, as virtually • Absorbed immediately, providing immediate hydration
• Cosmetically acceptable
any substance can cause skin reactions in sensitive areas
• Affordable.
in some individuals. Atopics are particularly at risk for
adverse skin reactions because of the impaired barrier
function. Facial skin is also more sensitive than other
Table 7: Adverse effects of moisturizers
body regions[59,60] possibly the result of a less efficient
Adverse effect Plausible causes
barrier with a smaller number of SC cell layers and the
Subjective irritation Humectants e.g., lactic acid,[62]
presence of large follicular pores.[61] urea,[60,63] PCA,[64] preservatives
Skin irritation[2,62] e.g., benzoic acid,[64] sorbic acid[60]
Irritant reactions Proteins in vegetable oils,[65] urea,[3]
It is the most common adverse effect of moisturizers, hydroxyl acids, propylene glycol,[3]
can be visible and invisible. They are basically sensory solvents[3]
reactions or subjective sensations with/without signs Allergic contact dermatitis Lanolin,[66] propylene glycol,
and symptoms of inflammation. Common presenting Vitamin E, Kathon CG, preservatives,
complaints are in the form of smarting, tingling, and fragrances,[3] Sunscreens, herbal
stinging sensations. Based on the skin response, it is products, e.g., Aloe, chamomile oil,
classified into four mechanisms:[62] olive oil, tea tree oil[67]
Occlusive folliculitis Petrolatum,[3] mineral oils[3]
• Sensory/subjective irritation
Photosensitivity eruptions Fragrances,[3] hydroxyl acids,
• Allergic contact dermatitis
and photomelanosis preservatives, sunscreens[19,22,23]
• Nonimmunologic contact urticaria
Cosmetic acne Occlusive oils used in water in oil
• Irritant contact dermatitis. preparations[19,22,23]
Table 7 provides a plausible list of adverse effects Contact urticaria Preservatives, e.g., sorbic acid,
encountered with moisturizers. By keeping them in fragrances, balsam of peru[3]
mind, an astute clinician can change or select the Poisoning in burn patients Propylene glycol[68]
appropriate moisturizer preventing much discomfort. Intoxication Salicylic acid[69]

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