Emollients: their role in treating atopic dermatitis and psoriasis

Atopic dermatitis and psoriasis are two of the most common chronic skin disorders.

  • Atopic dermatitis causes red patches on the skin, which can be accompanied by blisters, scabs and itching. These symptoms tend to appear on the cheeks, forehead and scalp of newborn babies. As children grow older, the symptoms can occur on the hands, around the mouth, in the crook of the elbows and the backs of the knees.
  • Psoriasis, on the other hand, has raised red patches covered in white lamellar scales in its most common form, which is known as “plaque psoriasis”.

Although their symptoms may be different, atopic dermatitis and psoriasis both share the same underlying cause: a skin barrier defect. And while a skin barrier defect has long been associated with atopic dermatitis, only in the past couple of years has it been recognised as one of the causes of psoriasis.

Epidermal lipids and skin disease

Skin suffering from psoriasis and atopic dermatitis has insufficient epidermal lipids, especially ceramides.

These molecules, together with cholesterol and fatty acids, are essential skin lipids. When in the right ratio, they ensure a healthy skin barrier structure. Epidermal lipids are actually the cellular “cement” we need to keep our corneocytes, the “bricks” in our epidermal barrier, properly organised.

When we don’t have enough of these lipids, the barrier function of our skin, which protects it against the outside world, can be impaired. Our skin is no longer able to retain water and stop harmful agents from penetrating it.

With both atopic dermatitis and psoriasis, a skin barrier imbalance can trigger or worsen symptoms, stimulating excessive proliferation of skin cells and inflammation. The result is a vicious circle of itching and inflammation.

Supplementing epidermal lipids through emollients

Using emollient products containing epidermal lipids can therefore be a great help when managing atopic dermatitis and psoriasis. In patients with the severest forms of these skin disorders, emollients act as an adjuvant to the pharmacological treatment prescribed by the doctor, while in milder forms they can be the primary treatment.

Their mechanism of action is not down to the epidermal lipids alone: all the ingredients in the formula play a part.

Products containing highly emollient substances (such as paraffin) form a semi-occlusive barrier over the skin which helps prevent excessive moisture loss and protects it from external agents at the same time.

Why is daily use of an emollient so important?

For an emollient to be an effective adjuvant, it must be applied regularly.

In the acute stage, a generous amount of emollient should be applied and reapplied several times a day. It should always be used after bathing, when skin suffering from psoriasis or atopic dermatitis is particularly vulnerable.

When the symptoms have cleared up, you should still continue applying the emollient to maintain the results obtained with the drug therapy and prevent recurrence.