The Use of Emollients for Atopic Eczema

Atopic Eczema (AE) is a frequent inflammatory skin disease with chronic relapsing course. It can affect patients of all ages and have dramatic impact on their quality of life. The baseline therapy of AE is represented by environmental interventions together with topical treatment: moisturizers and emollients, corticosteroids or calcineurin inhibitors. Systemic therapy and phototherapy are reserved for severe cases. Emollients are the mainstay of first-line intervention: they hydrate and soften the skin and act as restorers or replacers of the epidermal barrier, which is often damaged or impaired in AE. Over and above the varying ingredients, formulations, strategy of action, costs and innovation, the three key-points of both the older and the latest emollients are: hydration against dryness, protection from pathogen bacterial colonization, relief from pruritus and from other symptoms. The purpose of our review was to describe the classes of emollients (firstgeneration, second-generation and third-generation emollients, together with most innovative products) and their composition (oils, ointments, creams, richin- water substances), and also to illustrate the main trials that established their efficacy and safety in adults and children. The use of emollients in AE is currently recommended with a Grade of Recommendation A and Level of Evidence I, and they can be administrated for primary prevention, as well as for acute treatment and for secondary prevention and maintenance. In conclusion, emollients are an optimal source for baseline therapy against AE, as they are appropriate and suitable for long-term schedules and for all ages. Moreover their use can lead to the control of the disease or reduce the need of topical steroids and of systemic drugs. Emollients must be used daily and consistently and they are especially appropriate for mild-moderate chronic AE.