MOISTURIZERS IN
DERMATOLOGY
DR NANDAN , INTERN
BRICK AND MORTAR MODEL
• Bricks = Corneocytes.
• These are dead, flattened skin cells (keratinocytes) filled with
keratin.They provide structural integrity and mechanical
protection.
• Mortar = Lipid matrix.
• This is made up of ceramides, cholesterol, and free fatty
acids.It surrounds and “cements” the corneocytes together.
• Functions like mortar between bricks in a wall
STRATUM CORNEUM – THE SKIN BARRIER
CONTD
• .Functions of This Structure:
• 1. Barrier function : Prevents water loss (keeps skin hydrated)
and Blocks entry of allergens, irritants, and microbes
• 2. Maintains hydration: Lipids in the “mortar” reduce
transepidermal water loss (TEWL)
• 3. Desquamation: Controlled shedding of the “bricks” as new
ones form below, helps maintain integrity of the barrier
HOW DO THEY WORK ?
• Moisturizers are agents which make the stratum corneum
soft and pliable by increasing the hydration of the skin.
• They help the skin to retain water by decreasing
transepidermal water loss.
• They also increase the softness of the skin, thus producing
a soothing effect.
TYPES
1. Occlusive
2. Humectants
3. Hydrophyllic Matrices
4. Emollients
a. Protective
b. Dry emollients
c. Astringents
OCCLUSIVE MOISTURIZERS
• It prevents evaporation of water into the atmosphere thus
increasing the epidermal water content.
• They belong to categories like hydrocarbon oils and waxes,
silicone oils, vegetable and animal fats, fatty acids and alcohols,
polyhydric alcohols, vegetable waxes, lanolin and lanolin
derivatives.
• Common ingredients used are petrolatum, mineral oil, paraffin,
squalene, lanolin, propylene glycol, lecithin and cholesterol.
HUMECTANTS
• They attract water to the skin and are similar in action to
glycosaminoglycans such as hyaluronic acid present in the
dermis.
• Examples are urea, glycerin, sodium lactate, propylene
glycol, honey, sorbitol, hyaluronic, vitamin A, vitamin C and
vitamin B5.
HYDROPHILIC MATRICES
• It forms a barrier to cutaneous evaporation due to their large
molecular size.
• Hyaluronic acid is a naturally occurring physiological hydrophilic
matrix.
• Colloidal oatmeal is an example of a synthetic hydrophilic matrix.
EMOLLIENTS
• Emollients fill the space between desquamating
corneocytes thus making the skin soft and smooth without
increasing the epidermal water content.
• There are 3 types of emollients
PROTECTIVE EMOLLIENTS
• It allows the skin to feel smooth on application and remain
on the skin for more than 1 hour.
• Examples are isopropyl isostearate and diisopropyl
dilinoleate.
FATTING EMOLLIENTS
• Fatting emollients also remain on the skin for a long time,
but unlike protective emollients they are greasy.
• Examples are castor oil, propylene glycol, octyl stearate
and jojoba oil.
DRY EMOLLIENTS
• Dry Emollients produce a feeling of dryness without
offering much protection to the skin.
• Examples are isopropyl palmitate, isostearyl alcohol and
decyl oleate.
ASTRINGENT EMOLLIENTS
• Astringent (drying) emollients are less oily than other
emollients because they leave a less greasy residue.
• Examples are dimethicones, cyclomethicones and isopropyl
myristate.
OTHER ROLES
• Anti inflammatory action : by inhibiting production of pro
inflammatory prostanoids by blocking cyclooxygenase activity .
• Anti microbial action : some act against skin surface microbes
• Anti mitotic action : those containing mineral oils have low grade
mitotic action
• Anti pruritic effect : cooling effect after evaporation of water from
water based moisturizers has been said to reduce itching
INDICATIONS FOR MOISTURIZERS
1. Dry Skin Conditions (Xerosis) : Senile xerosis, Asteatotic eczema , Winter
itch
2. Eczematous Dermatoses: Atopic dermatitis (especially maintenance
therapy),Allergic contact dermatitis, nummular eczema
3. Psoriasiform Conditions : Psoriasis vulgaris, Palmo-plantar psoriasis
4. Ichthyoses: Ichthyosis vulgaris ,Harlequin ichthyosis (adjunctive care)
5. Occupational Dermatoses : Chronic hand dermatitis, Frictional
dermatitis, Dermatitis due to overuse of sanitizers/disinfectants
INDICATIONS CONTD
6. Infectious and Infestation: Recovery Post-scabies treatment, dryness
after topical antifungal therapy ,Post-healing phase of viral exanthems
like measles or chickenpox
7. Aging and Photoaging :Senile xerosis, Fine wrinkles, Dull skin tone.
8. Drug-induced Dryness : Isotretinoin-associated xerosis, Chemotherapy-
induced xerosis, Radiation-induced dermatitis
9. Other Dermatologic Conditions : Lichen simplex chronicus (to reduce
itching and barrier damage) Pruritus of renal/hepatic origin (symptomatic
relief)
10. Cosmetic and Preventive Use :Daily skincare in acne-prone skin (non-
ADDITIVES IN MOISTURIZERS
• Herbal : aloe vera, allantoin etc
• Antioxidants : Vit E etc
• Chelating agents : citric acid etc
• Vitamins and minerals
• Fragrances
• Sun protection elements
Allows to choose the required moisturizer based on skin
type, non comedogenic , fragrance free etc.
REFERENCE
• IADVL Textbook of Dermatology
• Neena khanna textbook of dermatology
THANK YOU
