Moisturizing is necessary for managing eczema, a chronic inflammatory skin condition. This practice is a targeted medical strategy to restore the skin’s protective barrier, not just relieve dryness. Eczema causes this barrier to become defective, allowing moisture to escape and irritants to enter. This defect leads to characteristic inflammation and itching. Applying the right moisturizing products consistently supports the primary goal of treatment: skin barrier repair.
The Compromised Skin Barrier in Eczema
The outermost layer of the skin, the stratum corneum, functions like a protective wall, operating on a “brick and mortar” principle. Corneocytes are the bricks, and a lipid matrix composed of ceramides, cholesterol, and fatty acids acts as the mortar. In healthy skin, this arrangement prevents excessive Transepidermal Water Loss (TEWL) and blocks the entry of foreign substances.
In eczema, this barrier structure is compromised, often due to genetic factors and inflammation. Individuals frequently have a deficiency in lipids, particularly ceramides, which disrupts the integrity of the “mortar” layer. A common genetic link is a mutation in the FLG gene, which codes for the protein filaggrin.
A lack of functional filaggrin leads to a deficit in Natural Moisturizing Factor (NMF), which helps skin cells retain water. This structural defect increases TEWL, causing the characteristic dryness and cracking. The weakened barrier allows environmental allergens, bacteria, and irritants to penetrate easily, triggering the inflammatory immune response that results in flares and intense itching.
Mechanisms of Barrier Repair Through Hydration
Moisturizing products supplement the deficient components of the skin barrier. Hydration helps reorganize the disordered lipid matrix within the stratum corneum. This process seals the gaps between skin cells, slowing the rate of water loss from the deeper layers of the skin.
Key ingredients mimic the skin’s natural composition. Ceramides are fatty molecules incorporated into the skin barrier to restore the lamellar structure of the lipid matrix. This helps rebuild the “mortar” missing in the compromised barrier.
Humectant ingredients, such as hyaluronic acid and glycerin, draw water into the upper layers of the skin, increasing water content. Hyaluronic acid may come in different molecular weights, allowing it to hydrate at various depths. Humectants attract moisture while applied lipids, like ceramides and fatty acids, create a seal to prevent evaporation.
Selecting Appropriate Product Formulations
Moisturizers contain three main categories of ingredients for barrier repair.
Ingredient Categories
Humectants pull water into the skin’s surface from the environment or deeper layers. Emollients are lipids and oils that fill the spaces between skin cells, softening and smoothing the skin’s texture. Occlusives are the heaviest components, forming a physical layer on the skin’s surface to prevent water from escaping.
The best formulation depends on the severity of dryness. Ointments contain the highest proportion of occlusives, making them thickest and most effective for very dry or severely compromised skin. Creams balance water and oil content, suitable for most forms of eczema. Lotions are the lightest due to high water content, less effective for significant barrier repair but useful for weeping or hairy areas.
When selecting a product, avoid ingredients known to worsen eczema symptoms. Common irritants such as fragrances, dyes, and alcohol can strip the skin of its natural oils and trigger inflammation. Products labeled as fragrance-free and hypoallergenic are the safest choice for maintaining the skin barrier.
Establishing an Effective Moisturizing Routine
Consistency and timing are important for moisturizing in eczema management. The most effective approach is the “soak and seal” method, which involves applying moisturizer immediately after bathing or washing the skin. The skin should be patted lightly, leaving it slightly damp, and the product must be applied within two to three minutes to trap the absorbed water.
Moisturizer should be applied liberally and frequently, at least twice daily, even when the skin appears clear. Use a sufficient quantity so the skin feels slick after application, ensuring thorough coverage of all vulnerable areas. Regular, generous application reinforces the barrier against environmental stressors.
If a prescription topical medication, such as a steroid, is required, the order of application is important. The topical medication is applied thinly to the inflamed areas first. A short interval, usually around 30 minutes, should pass before the moisturizer is applied to the rest of the skin. This separation prevents the moisturizer from diluting the medication or spreading it to unaffected areas.