Research Article| Volume 18, ISSUE 4, P597-607, October 01, 2000

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  • Author Footnotes
    * Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem; and Dermatology Consulting Services, High Point, North Carolina
    Zoe Diana Draelos
    * Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem; and Dermatology Consulting Services, High Point, North Carolina
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  • Author Footnotes
    * Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem; and Dermatology Consulting Services, High Point, North Carolina
      Moisturizers are complex formulations designed to maintain the water content of the skin between 10% and 30%. Water is essential to maintain skin plasticity and barrier integrity. Skin that is water deficient, such as the thickened skin commonly present over the heels, fissures readily with trauma and is rough to the touch. Water is necessary to allow skin distensibility, a mandatory requirement in an organ that is in constant motion. Skin hydration is important to maintain an intact skin barrier, tactilely perceived as smooth, soft skin.
      This article begins by reviewing the barrier function of the skin to gain an understanding of the physiologic role moisturizers play in skin barrier repair. Then, substances that are used to provide skin moisturization and how they function in this role are discussed. Specialty additives to enhance skin functioning are reviewed. Lastly, a discourse on the currently available therapeutic moisturizers and their efficacy is presented, including the incorporation of hydroxy acids and vitamins. Moisturizers are probably the one skin care product that affects the condition of skin dramatically. Proper moisturizer selection can aid in the treatment of disease, whereas poorly selected, poorly formulated products can initiate the disease process.
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        • Baker C.G.
        Moisturization: New methods to support time proven ingredients.
        Cosmet Toilet. 1987; 102: 99-102
        • Beyer R.E.
        The role of ascorbate in antioxidant protection of biomembranes: Interaction with vitamin E and coenzyme Q.
        Arch Bioeng Biomem. 1994; 26: 349-358
        • Boisits E.K.
        The evaluation of moisturizing products.
        Cosmet Toilet. 1986; 101: 31-39
        • Burton G.W.
        • Joyce A.
        • Ingold K.U.
        Is vitamin E the only lipid-soluble, chain-breaking antioxidant in human blood plasma and erythrocyte membrances?.
        Arch Biochem Biophys. 1983; 221: 281-290
        • Chan A.C.
        Partners in defense, vitamin E, and vitamin C.
        Can J Physiol Pharmacol. 1993; 71: 725-731
        • Darr D.
        • Combs S.
        • Dunston S.
        • et al.
        Topical vitamin C protects porcine skin from ultraviolet radiation-induced damage.
        Br J Dermatol. 1992; 127: 247-253
        • De Groot A.C.
        • Weyland J.W.
        • Nater J.P.
        Unwanted Effects of Cosmetics and Drugs Used in Dermatology. ed 3. Elsevier, Amsterdam1994: 498-500
        • Draelos Z.D.
        Hydroxy acids for the treatment of aging skin.
        J Geriatr Dermatol. 1997; 5: 236-240
        • Duell E.A.
        • Derguini F.
        • Kang S.
        • et al.
        Extraction of human epidermis treated with retinol yields retro-retinoids in addition to free retinol and retinyl esters.
        J Invest Dermatol. 1996; 107: 178-182
        • Elias P.M.
        Lipids and the epidermal permeability barrier.
        Arch Dermatol Res. 1981; 270: 95-117
        • Elias P.M.
        • Brown B.E.
        • Ziboh V.A.
        The permeability barrier in essential fatty acid deficiency: Evidence for a direct role for linoleic acid in barrier function.
        J Invest Dermatol. 1980; 75: 230-233
        • Ellis C.N.
        Skin and Allergy News. 1988; 19: 3
        • Fiverson D.P.
        • Breneman D.L.
        • Rosen G.B.
        • et al.
        Nicotinamide and tetracycline therapy of bullous pemphigoid.
        Arch Dermatol. 1994; 13: 753-758
        • Friberg S.E.
        • Ma Z.
        Stratum corneum lipids, petrolatum and white oils.
        Cosmet Toilet. 1993; 107: 55-59
        • Fuchs J.
        • Hufleijt M.E.
        • Rothfuss L.M.
        • et al.
        Acute effects of near ultraviolet and visible light on the cutaneous antioxidant defense system.
        Photochem Photobiol. 1989; 50: 739-744
        • Gensler H.L.
        Prevention of photoimmunosuppression and photocarcinogenesis by topical nicotinamide.
        Nutr Cancer. 1997; 29: 157-162
        • Goodman D.S.
        Vitamin A and retinoids in health and disease.
        N Engl J Med. 1984; 310: 1023-1031
        • Grubauer G.
        • Elias P.M.
        • Feingold K.R.
        Transepidermal water loss: The signal for recovery of barrier structure and function.
        J Lipid Res. 1989; 30: 323-333
        • Handfield-Jones S.
        • Jones S.
        • Peachey R.
        High dose nicotinamide in the treatment of necrobiosis lipoidica.
        Br J Dermatol. 1988; 118: 693-696
        • Hankes L.V.
        Nicotinic acid and nicotinamide.
        in: Machlin L.J. Handbook of Vitamins. Marcel Dekker, New York1984: 329-377
        • Holleran W.M.
        • Man M.Q.
        • Wen N.G.
        • et al.
        Sphingolipids are required for mammalian epidermal barrier function.
        J Clin Invest. 1991; 88: 1338-1345
        • Honl B.A.
        • Elston D.M.
        Autoimmune bulous eruption localized to a breast reconstruction site: Response to niacinamide.
        Cutis. 1998; 62: 85-86
        • Idson B.
        Vitamins and the skin.
        Cosmet Toilet. 1993; 108: 79-92
        • Jackson E.M.
        Moisturizers: What's in them?.
        How do they work? Am J Contact Dermat. 1992; 3: 162-168
        • Kagan V.
        • Witt E.
        • Goldman R.
        • et al.
        Ultraviolet light-induced generation of vitamin E radicals and their recycling: A possible photosensitizing effect of vitamin E in skin.
        Free Radic Res Comm. 1992; 16: 51-64
        • Kagan V.E.
        Tocopherol stabilizes membrane against phospholipase A, free fatty acids, and lysophospholipids.
        Ann N Y Acad Sci. 1989; 570: 121-135
        • Kameyama K.
        • Sakai C.
        • Kondoh S.
        • et al.
        Inhibitory effects of magnesium L-ascorbyl-2-phosphate on melanogenesis in vitro and in vivo.
        J Am Acad Dermatol. 1996; 34: 29-33
        • Kligman L.H.
        • Do C.H.
        • Kligman A.M.
        Topical retinoic acid enhances the repair of ultraviolet damaged dermal connective tissue.
        Connect Tissue Res. 1984; 12: 139-150
        • Kraeling M.E.
        • Bronaugh R.L.
        In vitro percutaneous absorption of alpha hydroxy acids in human skin.
        J Soc Cosmet Chem. 1997; 48: 187-197
        • Ludwig A.
        • Dietel M.
        • Schafer G.
        • et al.
        Nicotinamide and nicotinamide analogues as antitumor promoters in mouse skin.
        Cancer Res. 1990; 50: 2470-2475
        • Mandrup-Poulsen T.
        • Reimers J.I.
        • Andersen H.U.
        • et al.
        Nicotinamide treatment in the prevention of insulin-dependent diabetes mellitus.
        Diabetes Metab Rev. 1993; 9: 295-309
        • Mayer P.
        • Pittermann W.
        • Wallat S.
        The effects of vitamin E on the skin.
        Cosmet Toilet. 1993; 108: 99-109
        • Meydani M.
        Vitamin E.
        Lancet. 1995; 345: 170-175
        • Murray J.
        • Darr D.
        • Reich J.
        • et al.
        Topical vitamin C treatment reduces ultraviolet B radiation-induced erythema in human skin [abstr].
        J Invest Dermatol. 1991; 96: 587
        • Noy N.
        Interactions of retinoids with lipid bilayers and with membranes.
        in: Livrea M.A. Packer L. Retinoids. Marcel Dekker, New York1993: 17-27
        • Pierard G.E.
        What does “dry skin” mean?.
        Int J Dermatol. 1987; 26: 167-168
        • Raab W.P.
        Uses of urea in cosmetology.
        Cosmet Toilet. 1990; 105: 97-102
        • Rieger M.M.
        • Deem D.E.
        Skin moisturizers II: The effects of cosmetic ingredients on human stratum corneum.
        J Soc Cosmet Chem. 1974; 25: 253-262
        • Robbins C.R.
        • Fernee K.M.
        Some observations on the swelling of human epidermal membrane.
        J Soc Cosmet Chem. 1983; 37: 21-34
        • Salka B.A.
        Cosmet Toilet. 1997; 112: 101-106
        • Smith W.P.
        Hydroxy acids and skin aging.
        Cosmet Toilet. 1994; 109: 41-48
        • Stratford M.R.L.
        • Rojas A.
        • Hall D.W.
        • et al.
        Pharmacokinetics of nicotinamide and its effect on blood pressure, pulse and body temperature in normal human volunteers.
        Radiother Oncol. 1992; 25: 37-42
        • Tsunoda T.
        • Takabayashi K.
        Stability of all-trans-retinol in cream.
        J Soc Cosmet Chem. 1995; 46: 191-198
        • Wehr R.F.
        • Krochmal L.
        Considerations in selecting a moisturizer.
        Cutis. 1987; 39: 512-515
        • Werninghaus K.
        • Meydani M.
        • Bhawan J.
        • et al.
        Evaluation of the photoprotective effect of oral vitamin E supplementation.
        Arch Dermatol. 1994; 130: 1257-1261
        • Wildnauer R.H.
        • Bothwell J.W.
        • Douglass A.B.
        Stratum corneum biomechanical properties.
        J Invest Dermatol. 1971; 56: 72-78
        • Wilkinson J.B.
        • Moore R.J.
        Harry's Cosmeticology. ed 7. Chemical Publishing, New York1982: 62-64
        • Wu M.S.
        • Yee D.J.
        • Sullivan M.E.
        Effect of a skin moisturizer on the water distribution in human stratum corneum.
        J Invest Dermatol. 1983; 81: 446-448