Table 2: Summary of studies of emollient use in neonates, infants, children, and adults with AD.

Study populationTreatmentStudy durationEfficacySafety

Neonates

Neonates (N = 22) at high risk for AD [124]Petrolatum-based emollient barrier cream (Cetaphil, Galderma Laboratories, Fort Worth, TX, USA)At least once daily for up to 2 yearsObserved cases: 15% developed AD. Intent-to-treat: 23% developed ADNo adverse events related to treatment

Infants

Infants with moderate-to-severe AD, age <12 months (N = 173) [120]Oat extract-containing emollient (Exomega, Laboratories Pierre Fabre, France)Twice daily for 6 weeksSignificantly reduced use of high-potency topical corticosteroids and improved SCORAD index and QoLGood/Very good tolerance in 94% of infants at study end. Two serious adverse events

Children

Children with mild-to-moderate AD, age 2 months–6 years (N = 25) [79]Occlusive colloidal oatmeal cream and colloidal oatmeal glycerin cleanser (AVEENO, JOHNSON and JOHNSON Consumer Companies, Inc., Skillman, NJ, USA)Cream: twice daily for 4 weeks. Cleanser: all bathingSignificantly improved IGA scores, dryness, roughness, and mean itch scores at 2 and 4 weeks. Significantly improved QoL scores at 4 weeksWell tolerated; no serious adverse events related to treatment
Children with mild-to-moderate AD, age 3 months–16 years (N = 65) [125]
Ceramide-dominant barrier emulsion (EpiCeram)Twice daily for 3 weeksImproved IGA, patient satisfaction, and QoLNo serious adverse events related to treatment
Children with AD, age 6 months–12 years (N = 76) [85]
Moisturizer milk (Exomega) versus controlTwice daily for 2 monthsSignificantly improved xerosis, pruritus, and QoLTolerance rated as satisfactory or excellent in 97%
Children with mild-to-moderate AD, age 6 months–12 years (N = 142) [114]
Glycyrrhetinic acid-based cream (Atopiclair) versus vehicleThree times daily for 43 daysSignificantly improved IGA, reduced use of rescue medication (topical corticosteroid)No serious adverse events related to treatment
Children with moderate-to-severe AD, age 6 months–18 years (N = 121) [87]
Ceramide-dominant barrier emulsion (EpiCeram) versus fluticasone cream (Cutivate, PharmaDerm, Melville, NY, USA)Twice daily for 28 daysSignificantly improved SCORAD index. Comparable efficacy between treatment armsNo serious adverse events related to treatment
Children with stubborn-to-recalcitrant AD, age 1.5–12.0 years (N = 24) [116]
Ceramide-dominant barrier emollient (TriCeram, Osmotics Corp, Denver, CO, USA) replaced prior moisturizer. Topical tacrolimus or corticosteroid was continuedTwice daily for 12 weeks, then once daily for 9 weeksSignificantly improved SCORAD in 92% of patients by 3 weeks, 100% by 21 weeks; decreased TEWL; improved SC hydration and integrityNo serious adverse events related to treatment
Children with mild-to-moderate AD, age 2–17 years (N = 39) [122]Glycyrrhetinic acid-based cream (Atopiclair) versus ceramide-based barrier cream (EpiCeram) versus petrolatum-based ointment (Aquaphor Healing Ointment, Beiersdorf Inc, Wilton, CT, USA)Three times daily for 3 weeksAll treatment arms improved, with no significant difference between treatments. Petrolatum-based ointment had greatest improvement across assessmentsWell tolerated; no serious adverse events related to treatment

Adults

Children to adults with mild-to-moderate AD, age 2–70 years [123]
(Study 1, N = 66; study 2, N = 127)
Cetaphil Restoraderm moisturizer (Galderma Laboratories, Fort Worth, TX, USA) Study 1: Twice daily for 4 weeks; study 2: twice daily for 4 weeks as adjuvant treatment with topical steroid Study 1: significantly decreased itching and improved hydration and QoL. Study 2: versus steroid only: significantly improved hydration, decreased EASI scores and faster onset of actionNo serious adverse events related to treatment
Adolescents to adults with mild-to-moderate AD, age 12–60 years (N = 25) [80]Oat-based occlusive cream and oatmeal-glycerin body wash (AVEENO)Cream: twice daily for 8 weeks. Wash: once daily Significantly improved: EASI and IGA scores at 2, 4, and 8 weeks; QoL at 4 and 8 weeksWell tolerated; no serious adverse events related to treatment
Adults with mild-to-moderate AD, age >16 years (N = 30) [111]Glycyrrhetinic acid-based cream (Atopiclair) versus vehicleThree times daily for 3 weeksSignificantly improved itch and EASI scores symptomsNo serious adverse events related to treatment
Adults with mild-to-moderate AD, age 2–70 years (N = 2456) [119]
PEA-containing barrier (MimyX)Twice daily for 4–6 weeksSignificantly improved symptoms versus baseline, reduced use of topical corticosteroidsNo serious adverse events related to treatment
Adults with AD (N = 197) [121]20% glycerin versus cream base control versus cream with 4% urea + 4% sodium chlorideOnce daily for 30 daysSimilar improvements in drynessModerate-to-severe stinging in 10% of glycerin group and 24% of urea/saline group
Adults with mild-to-moderate AD (N = 24) [115]20% glycerin emollient versus placebo Twice daily for 4 weeksImproved SC hydration, restored epidermal barrier function (TEWL)Not reported
Adults with allergic contact dermatitis, irritant contact dermatitis, or AD (N = 580) [112]Ceramide-3 plus patented nanoparticles with or without corticosteroidsOnce or twice daily until clearance (8 weeks)Significantly improved symptoms in both treatment arms. Significantly improved pruritus, erythema, fissuring, and overall severity in combination armNot reported
Adults with mild-to-moderate AD (N = 100) [113]5% urea moisturizer versus 10% urea lotion twice dailyTwice daily for 42 daysSimilar reduction in SCORAD from baseline, no difference between productsBoth products well tolerated; 5 adverse events possibly related to study treatment; 3 patients withdrew from study because of adverse events
Adults with mild-to-moderate AD (N = 60) [117]Mineral oil, petrolatum, and paraffin-based moisturizer (Albolene) versus barrier cream MimyX (plus 0.1% triamcinolone cream for moderate AD) Twice daily for 4 weeksNo difference between treatment groups in clinical efficacyNo serious adverse events related to treatment
Adults with mild-to-moderate AD (N = 20) [118]Hyaluronic acid-based emollient foam (Hylatopic, Onset Therapeutics, Cumberland, RI, USA) versus ceramide-containing barrier cream (EpiCeram)Twice daily for 4 weeksSignificantly improved symptoms at weeks 2 and 4 for foam; at week 4 for cream. Patients preferred foamNo serious adverse events related to treatment
Adults with mild-to-moderate AD (N = 218) [110]Glycyrrhetinic acid-based cream (Atopiclair) versus vehicleThree times daily for 3 weeksSignificantly improved EASI and IGA, and reduced rescue medicationNo serious adverse events related to treatment

AD: atopic dermatitis; SCORAD: scoring atopic dermatitis index; QoL: quality of life; IGA: investigator global assessment; TEWL: transepidermal water loss; SC: stratum corneum; EASI: eczema area and severity index; PEA: palmitoylethanolamide.