DOI: 10.1111/jocd.

12490

REVIEW

The science behind skin care: Moisturizers

Zoe D Draelos MD

Dermatology Consulting Services, PLLC,

High Point, NC, USA Summary
Moisturizers provide functional skin benefits, such as making the skin smooth and
Correspondence
Zoe D Draelos, Dermatology Consulting soft, increasing skin hydration, and improving skin optical characteristics; however,
Services, PLLC, High Point, NC, USA. moisturizers also function as vehicles to deliver ingredients to the skin. These ingre-
Email: [email protected]
dients may be vitamins, botanical antioxidants, peptides, skin-lightening agents,
botanical anti-inflammatories, or exfoliants. This discussion covers the science of
moisturizers.

KEYWORDS
active cosmetics, botanicals, moisturizer, serums, skin creams, transepidermal water loss

1 | INTRODUCTION intercellular lipids are removed, the edges of the corneocytes fold
creating friction as the hand is rubbed across the skin surface. Creating
Skin cleansing and moisturization are two of the most basic aspects of smooth and soft skin utilizes emollients (Table 1), which are thin
human hygiene, affecting both skin health and disease. Cleansing is oily substances capable of depositing between the desquamating
the process of removing materials from the skin surface, and in some corneocytes temporarily until the next cleansing, at which time
respects, moisturization is the process of putting back what was mis- they must be reapplied.
takenly removed. It is unfortunate, but cleansers cannot distinguish
between sebum and intercellular lipids, removing them all efficiently.
2.2 | Increased skin hydration
Thus, moisturizers were developed to put lipids back on the skin sur-
face after cleansing but have now evolved into vehicles to deliver cos- Moisturizers that are medically relevant must increase skin hydration
metically active ingredients.1,2,3 The first part of this review addressed by retarding water loss from the skin surface, known as transepider-
cleansing, while this second installment addresses moisturizers. mal water loss (TEWL).5 This is accomplished by placing a water
impermeable film over the skin to retard evaporation and by apply-
ing substances to the skin surface to attract water. Moisturizers do
2 | MOISTURIZER GOALS not moisturize the skin, which is a misnomer.6 Only through skin,
barrier repair can TEWL be permanently returned to normal levels.
Moisturizers must fulfill 4 basic needs in order of consumer impor- Increased skin hydration is the mechanism by which most mois-
tance: make the skin smooth and soft, increase skin hydration, turizers decrease fine lines of dehydration, especially those around
improve appearance, and possibly deliver ingredients to the skin sur- the eye where the skin is thinnest. Retarding TEWL will hydrate this
face. A moisturizer that does not deliver on these 4 attributes can- skin temporarily until the moisturizer is removed with cleansing.
not be a success in the marketplace. While wrinkle reduction may appear to be a functional benefit, it is
a result of increased skin hydration that will be temporary unless
skin barrier repair occurs.
2.1 | Improved skin smoothness and softness
The most basic consumer need achieved by moisturizer application
2.3 | Improved optical appearance
is smooth and soft skin. All moisturizers in the current marketplace
make the skin smooth and soft; however, better formulations are A lesser moisturizer is goal is to improve skin appearance, a charac-
longer lasting. Skin that is smooth and soft is an assessment of the teristic known as radiance or luminosity. These attributes are the
organization of the corneocytes on the skin surface. As the appreciation of the amount of light reflected by the skin surface

138 | © 2018 Wiley Periodicals, Inc. wileyonlinelibrary.com/journal/jocd J Cosmet Dermatol. 2018;17:138–144.

DRAELOS | 139

T A B L E 1 Emollients for soft smooth skin4 4 | MECHANISMS OF MOISTURIZATION

1. Protective Emollients: diisopropyl dilinoleate and isopropyl
isostearate. Create longer lasting protective smooth film on skin All moisturizers work through 4 basic mechanisms of restoring skin
surface water content: occlusion, humectancy, hydrophilic matrices, and pho-
2. Fatting Emollients: castor oil, propylene glycol, jojoba oil, toprotection.23
isostearyl isostearate, and octyl stearate. Create a slightly greasy
longer lasting film on skin surface
3. Dry Emollients: isopropyl palmitate, decyl oleate, and isostearyl 4.1 | Occlusion
alcohol. Create a thin nongreasy film on skin surface
Occlusive moisturizers function by placing a water impermeable bar-
4. Astringent Emollients: dimethicones, cyclomethicones, isopropyl
myristate, and octyl octanoate. Create minimal greasy residue
rier over the skin surface creating an environment conducive to bar-
reducing the oily feel of other emollients rier repair. This is the most effective and most common mechanism
employed. There are numerous substances used by the cosmetic
chemist to achieve this goal with the combination of ingredients
back into the eye of the observer, which is directly related to the yielding the esthetics and efficacy of the final formulation. These
smoothness of the skin surface. With advancing age, skin melanin, substances are summarized in Table 2.24
hemoglobin, and collagen distribution become more irregular. Mois- The most occlusive and most physiologic moisturizer is said to
turizers capable of delivering a lightly pigmented film to the skin sur- be petrolatum; however, its esthetics are undesirable accounting for
face or enhancing light reflection from the skin surface may improve the myriad of moisturizers on the market.25 It reduces TEWL by
the optical appearance of the skin. Pigments, such as iron oxide, and 99%, allowing enough water vapor to leave the skin for initiation of
optically reflective materials, such as mica or fish scale, can be added barrier repair.26,27
to moisturizers to create anti-aging appearance benefits.

4.2 | Humectancy
3 | SKIN BARRIER AND MOISTURIZATION Humectants are substances that attract water acting like sponges on
and in the skin. All liquid and cream moisturizers contain humectants
Moisturizers can improve skin cosmesis but can also improve xerosis to prevent product desiccation, but the humectant may be present
and positively modify the skin barrier. Xerosis is a result of in insufficient concentration to have a physiologic function. The der-
decreased water content of the stratum corneum, which leads to mis possesses glycosaminoglycans, including hyaluronic acid, to func-
7
abnormal desquamation of corneocytes. For the skin to appear and tion as humectants; however, other humectants include the
feel normal, the water content of this layer must be above 10% with following: glycerin, honey, sodium lactate, urea, propylene glycol,
a maximum of 30% or over hydration will result.8 Water is lost sorbitol, pyrrolidone carboxylic acid, gelatin, vitamins, and some pro-
through evaporation to the environment under low humidity condi- teins.24,28 These topically applied ingredients can draw water from
tions and must be replenished by water from the lower epidermal the air; however, the moisturizer becomes sticky and unesthetic
and dermal layers.9 An intact skin barrier will maintain TEWL in a when this occurs. Most humectants, of which glycerin is the most
healthy range;10 however, skin barrier damage will result in xerosis effective, draw water from the deeper epidermis and dermis allowing
characterized by a stratum corneum that is thicker, fissured, and dis- the skin to feel smoother by filling holes in the stratum corneum
organized in electron micrographs. 11
through swelling.29 An unopposed humectant will draw water from
Three intercellular lipids are necessary to maintain the skin bar- the skin to the lower humidity atmosphere, thus a moisturizer must
rier: sphingolipids, free sterols, and free fatty acids.12-14 Ceramides contain both occlusives and humectants for optimal efficacy.30
are the major lipid by weight in the stratum corneum, which become
sphingolipids when glycosylated.15 Ceramides possess the majority T A B L E 2 Occlusive moisturizing ingredients
of the long-chain fatty acids and linoleic acid in the skin. When bar- 1. Hydrocarbons: petrolatum, mineral oil, paraffin, squalene
rier damage occurs, rapid lamellar body secretion and a cascade of 2. Silicones: dimethicone, cyclomethicone, amodimethicone
cytokine changes associated with adhesion molecule expression and 3. Animal and vegetable fats: lanolin, shea butter, grape seed oil,
growth factor production occur resulting in the production of cera- avocado oil, hemp oil, jojoba oil, sesame seed oil, nut oil
mides.16,17 The signal for this barrier repair, initiating the synthesis 4. Fatty acids: lanolin acid, stearic acid
of lipids, is an increase in TEWL.18-20 Thus, remoisturization of the 5. Fatty alcohols: lanolin alcohol, cetyl alcohol
skin must then occur in four steps: initiation of barrier repair, alter-
6. Polyhydric alcohols: propylene glycol, butylene glycol
ation of surface cutaneous moisture partition coefficient, onset of
7. Wax esters: lanolin, beeswax, stearyl stearate
dermal-epidermal moisture diffusion, and synthesis of intercellular
8. Vegetable waxes: carnauba, candelilla
lipids.21 It is generally thought in the cosmetics industry that a stra-
9. Phospholipids: lecithin
tum corneum containing between 20% and 35% water will exhibit
22 10. Sterols: cholesterol
the softness and pliability of normal stratum corneum.
140 | DRAELOS

T A B L E 3 Moisturizer selection based on skin type and location

4.3 | Hydrophilic matrices
Moisturizer Formulation Skin type
Hydrophilic matrices are a less popular form of moisturization char- category characteristics suitability Unique attributes
acterized by the colloidal oatmeal bath where the oatmeal forms a Lotion Thinner film, Face and Less greasy, spread
physical protective coating over the skin preventing evaporation. oil-in-water body; normal more easily
Colloidal oatmeal is also used in moisturizers for much the same rea- emulsion skin

son. Other high molecular weight substances that can provide a bar- Cream Thicker film, oil- Face, body, Higher viscosity
in-water hands, feet; than lotions,
rier to evaporation include proteins, such as growth factors and
emulsion dry skin harder to spread
collagen fragments, that are not added for their ability to modify cel-
Ointment Thickest film, Hands and Greasy, sticky;
lular behavior, but rather to reduce TEWL. Occlusion and humec- contains no feet; barrier based on
tancy are much more effective methods of moisturization than water disrupted petrolatum, lanolin,
hydrophilic matrices. diseased skin dimethicone
Paste Ointment mixed Diaper area Greasy, sticky,
with powder resists water
4.4 | Photoprotection contains no removal; based on
water zinc oxide and
Finally, photoprotection is also considered a form of moisturization petrolatum
by the cosmetic industry, and moisturization claims can be based on Gel Thick until Face, hair Leave nongreasy
the inclusion of any sunscreen ingredient. Moisturizers claiming rubbed into film; based on
repair and replenishing qualities may have a sunscreen added to sup- the skin, then acrylic polymers,
flowable gums, and
port the claim. The sunscreen, whether organic or inorganic, is
cellulose
thought to prevent cellular damage and thus prevent dehydration.
thickeners
Serum Thin liquid to Face Minimal film, rapid
deliver evaporation,
5 | MOISTURIZER FORMULATIONS
cosmetic nongreasy
ingredients to
5.1 | Creams and lotions skin
Powder Blended small Intertriginous Absorbs water;
Creams and lotions are emulsions containing hydrophilic and
particle solid areas; foot based on talc,
hydrophobic ingredients. Creams generally have a higher viscosity,
materials powder, silicates, and
while lotions are thinner with a lower viscosity, but there is no vis- diaper starch
cosity that defines a cream or a lotion(Table 3). Acrylic-based poly- powder
mers, such as carbomers which are cross-linked polyacrylate Suspension Clear liquid with Oily skin, Liquid powder;
polymers, are used to thicken the product and control viscosity. In visible particles intertriginous based on
areas carbomer,
either viscosity, the emulsion can be oil-in-water (O/W), where the
bentonite clay
oil is emulsified into the water, or water-in-oil (W/O), where the
Stick Solid stroked Lips Melts at body
water is emulsified into the oil. O/W emulsions are the most popular over skin to temperature to a
for moisturizer use; however, emulsifiers are responsible for many of leave film film; based on
the problems associated with moisturizers as they can also solubilize contains no paraffin, candelilla,
intercellular lipids. Liquid crystal forming emulsifiers that do not water and carnauba wax

damage the intercellular lipids include lecithin or hydrogenated Aerosol Droplet film; Hair-bearing Inefficient
requires can, skin discontinuous film
lecithin. Other skin friendly emulsifiers include behentrimonium
propellant, and application
methosulfate and dicetyldimonium chloride. nozzle

5.2 | Ointments
5.3 | Serums
Ointments are anhydrous semisolid preparations composed of fats,
waxes, animal and plant oils, and hydrocarbons. Because they do not A new formulation in moisturizers is the serum, a thin water or oil-
include water necessary for microbial growth, they can be formu- based product applied to freshly washed skin. The serum provides
lated without preservatives or with a low preservative load. By defi- minimal moisturization benefits but is used to apply an active agent
nition, they are also waterproof; however, they possess poor to the skin beneath a moisturizer.31 As the serum formulation is not
esthetics because they are sticky and stain clothing. This moisturizer necessarily an emulsion, it does not require emulsifiers which could
formulation may be preferred in patients with extremely dry skin or damage the active ingredient. Usually, the serum has few ingredients
preservative allergies, but very few moisturizers and many therapeu- designed to optimize the availability of the active agent, which may
tic moisturizers fall into this category. be a vitamin, growth factor, botanical extract, etc.
DRAELOS | 141

6 | SITE-SPECIFIC MOISTURIZER 7 | MOISTURIZING INGREDIENTS

FORMULATIONS
There is tremendous diversity in moisturizer formulation; however,
Moisturizers have been formulated for everybody area to expand most moisturizers contain the same basic ingredients to which “hero”
the market and generate more sales. Most moisturizers consist of substances are added for market distinction. For example, petrola-
water, lipids, emulsifiers, preservatives, fragrance, color, and specialty tum and dimethicone are the primary occlusive moisturizers, but sea-
additives with water accounting for 60%-80% of any moisturizer; weed extract may be added as a “hero” ingredient, as this particular
however, externally applied water does not remoisturize the skin. line of moisturizers is based on the concept of “back to nature sea
The water functions as a diluent and evaporates leaving the active harvested products.” Here, the most dermatologically relevant mois-
agents behind.21 The major moisturizer categories are face, body, turizing ingredients are discussed.
and hand/feet (Table 3).

7.1 | Petrolatum
6.1 | Face
Petrolatum has a rich dermatologic history. It was originally manufac-
Facial moisturizers account for the majority of the moisturizing mar- tured and patented by Robert A. Chesebrough in 1872 as a chemical
ket with O/W formulations dominating. O/W emulsions can be iden- to treat leather; however, its value was soon recognized as a remedy
tified by their cool feel and nonglossy appearance, while W/O for chapped hands and as a hair pomade. Later, petrolatum was
emulsions can be identified by their warm feel and glossy appear- adapted to the pharmaceutical and skin care industry as a vehicle
ance.32 Facial moisturizers are generally composed of vegetable/min- instead of lard, which frequently turned rancid.35 Petrolatum offered
eral oil or dimethicone, propylene glycol, glycerin, and water in the benefit of preservative-free stability, due to its anhydrous nat-
sufficient quantity to form a lotion or cream. Products can be devel- ure.
oped for every complexion type with slight variation. Petrolatum is a semisolid mixture of hydrocarbons obtained
Oily complexion products are generally oil-free composed of through the dewaxing of heavy mineral oils. Pure cosmetic-grade
water and dimethicone, which is noncomedogenic and hypoaller- petrolatum is practically odorless and tasteless but has not been syn-
genic. Products designed for normal/combination skin contain pre- thetically duplicated. Petrolatum is the most effective moisturizing
dominantly water, vegetable/mineral oil or dimethicone, and ingredient on the market today, reducing transepidermal water loss
propylene glycol with very small amounts of petrolatum. Dry skin by 99%. It functions as an occlusive to create an oily barrier through
moisturizers contain water, vegetable/mineral oil, propylene glycol, which water cannot pass. Thus, it maintains cutaneous water content
and petrolatum. By adjusting the occlusivity of the primary moistur- until barrier repair can occur. Petrolatum is able to penetrate into
izing ingredient, many different formulations can be developed for the upper layers of the stratum corneum and aid in the restoration
many different facial needs. of the stratum corneum barrier. Petrolatum impacts all 4 phases of
skin remoisturization: initiation of barrier repair, alteration of surface
cutaneous moisture partition coefficient, onset of dermal-epidermal
6.2 | Body
moisture diffusion, and synthesis of intercellular lipids.
Body moisturizers come in a variety of preparations including Petrolatum is a remarkably inert substance as it does not bind
lotion, cream, mousse, and ointment.33 Lotions are the most popu- proteins or undergo chemical alteration in the skin, thus allowing it
lar formulation. Body lotions are generally O/W emulsions contain- to be hypoallergenic. Pure cosmetic-grade petrolatum, which is free
ing 10%-15% oil, 5%-10% humectant, and 75%-85% water. More of tar impurities, is also noncomedogenic. Petrolatum decreases the
specifically, they are composed of water, vegetable/mineral oil, appearance of fine lines on the face and body due to dehydration. It
propylene glycol, stearic acid, and petrolatum. Most also contain an functions to reduce itching and mild pain by creating a protective
emulsifier, such as triethanolamine stearate, which is also a surfac- film overexposed lower epidermal and dermal nerve endings. It acts
tant. Humectants such as glycerin or sorbitol may be used. Other as an emollient by entering the space between the rough edges of
additives include vitamins, such as A, D, and E, and soothing desquamating corneocytes, restoring a smooth skin surface. It can
agents, such as aloe or allantoin. also function as an exfoliant by loosening desquamating corneocytes,
which are physically removed as the petrolatum is rubbed into the
skin. Petrolatum is the basis for many moisturizer formulations.
6.3 | Hand and feet
Hand creams are O/W emulsions with 15%-40% oil, 5%-15%
7.2 | Silicone
humectant, and 45%-80% water.34 The addition of silicone deriva-
tives can render the hand cream water-resistant through 4-6 wash- After petrolatum, the most significant cosmetic ingredient to be dis-
ings. Most hand creams are based on petrolatum, glycerin, waxes, covered is silicone. Topical silicone is hypoallergenic, noncomedo-
and dimethicone. genic, and nonacnegenic. It is a remarkable nongreasy moisturizer
142 | DRAELOS

and skin conditioning agent providing the basis for “oil-free” moistur- accounts for the inability of particles larger than 13 nm to penetrate
izers. the skin.
Silicone was developed in the 1930s when Franklin, Hyde, and It is theorized that supplementing the skin with free fatty acids
McGragor discovered a method of extracting pure silica from raw can lead to barrier repair. One such 510K approved barrier cream
quartzite and converting it to dimethyl silicone. contains palmitamide monoethanolamine (PEA), a fatty acid that is
Silicone originates from silica, which is found in sand, quartz, and said to be deficient in atopic skin and it is theorized that replacing
granite. It derives its properties from the alternating silica and oxy- this fatty acid can hasten disease resolution. It is also thought that
36
gen bonds, known as siloxane bonds, which are exceedingly strong. PEA, an analog of cannabis may affect the itch pathways. In an
The silicone used in topical preparations is odorless, colorless, non- open-label study of 2456 patients, the intensity of erythema, pruri-
toxic liquid insoluble in water, but permeable to water vapor. This tus, excoriation, scaling, lichenification, and dryness was significantly
characteristic is important in cosmetic manufacture, as perspiration reduced with a combined score reduction of 58.6% when subjects
must be allowed to evaporate under facial moisturizers. The insolu- applied the PEA-based barrier cream.41 However, this was an uncon-
bility of silicone in water also prevents perspiration from removing trolled prospective cohort study, yet this idea is used in cosmeceuti-
the product from the skin surface. Silicone also forms a cohesive film cal moisturizers.
on the keratin surface, a characteristic known as substantivity, con-
veying water-resistant and rub-proof properties to moisturizers and
7.5 | Natural moisturizing factor (NMF)
sunscreens.37
Silicone acts as nongreasy occlusive agent that can have an Natural moisturizing factor (NMF) is a commonly used scientific and
astringent effect on other oily substances, such as petrolatum. Sili- cosmetic terms to delineate the combination of chemicals the body
cone can also function as an emollient, filling in spaces between uses to regulate the moisture content of the stratum corneum. Natu-
desquamating corneocytes, to create a smooth skin surface patients ral moisturizing factor (NMF) has been synthetically formulated as a
desire until the product is removed with rubbing or washing creating mixture of amino acids, derivatives of amino acids, and salts. Natu-
a smooth surface. Dimethicone and cyclomethicone are the two rally occurring epidermal NMF contains amino acids, pyrrolidone car-
most common derivatives utilized in moisturizer formulations. boxylic acid, lactate, urea, ammonia, uric acid, glucosamine,
creatinine, citrate, sodium, potassium, calcium, magnesium, phos-
phate, chlorine, sugar, organic acids, and peptides.42 About 10% of
7.3 | Ceramides
the dry weight of the stratum corneum cells is composed of NMF
Endogenous ceramide synthesis is the first step in barrier repair. broken down from filaggrin; however, formulations attempt to
Nine different ceramides have been identified and synthetically
duplicated for inclusion in moisturizer formulations distinguished by T A B L E 4 Active skin care mechanisms of action
their polar head group architecture, as well as by their hydrocarbon
• Modify skin barrier
chain properties.38 A ceramide-dominant, triple-lipid barrier repair
o Smooth skin scale
formulation containing capric acid, cholesterol, conjugated linolenic o Exfoliate skin scale
acid, candelilla wax, and petrolatum was designed to correct the
• Enhance intercellular lipids
lipid-biochemical abnormalities in atopic dermatitis.39 It was com- o Cholesterol
pared to fluticasone cream in 121 patients with moderate-to-severe o Triglycerides
atopic dermatitis for 28 days. The researchers found that the cera- o Essential fatty acids
o Ceramides
mide device reduced SCORAD scores, decreased pruritus, and
o Natural moisturizing factor (NMF)
improved sleep habits; however, faster improvement was seen with
the topical corticosteroid at day 14.40 This 510K approved device • Activate a receptor
o Retinoids
possessed a triple-lipid combination ratio mimicking physiologic
intercellular lipids paving the way for many ceramide-based moistur- • Function to protect DNA
o Antioxidants
izers.
o Sunscreens

• Modulate a pathway
7.4 | Fatty acids and lipid trilayers o Peptides

A different approach to skin moisturization is the use of free fatty • Activate or inhibit an enzyme
o Skin-lightening agents
acids, which are found in the intercellular lipids that reside between
corneocytes to create a waterproof, moderately impermeable barrier. • Reduce inflammation
o Botanical antioxidants
Scanning electron micrographs show the intercellular lipid bands as
o Plant sterols
trilayer entities with a dimension of 3.3 nm. These bands usually
occur in groups of 6 or 9 and are essential for human life. It is esti- • Alter hormone balance
o Soy phytoestrogens
mated that the lipid layer has a total thickness of 13 nm and
DRAELOS | 143

remoisturize the skin through synthetic NMF composed of ingredi- increased hydration. This is especially important in calluses, which
ents and ratios mimicking the naturally occurring substance. can be improved by foot products containing these ingredients to
increase stratum corneum pliability in direct proportion to the
amount of lactic acid or urea absorbed.30
7.6 | Sodium PCA
One ingredient of synthetic NMF is sodium PCA, which is a sodium
salt of 2-pyrrolidone-5-carboxylic acid. Synthetic sodium PCA has 8 | SUMMARY
been shown to be a better moisturizer than glycerol and is found in
several moisturizer products functioning as a humectant when used Moisturizers are purported in the current marketplace to perform many
in concentrations of 2% or higher.43 functions as listed in Table 4; however, they can make no substantive
claims and are considered cosmetics. For example, there are many
ingredients included in moisturizers purported to lighten skin, mimic
7.7 | Urea and lactic acid
botulinum toxin chemodenervation, provide vitamin supplementation,
Urea and lactic acid are also components of synthetic NMF and can function as antioxidants, and exfoliate the skin; however, documenta-
diffuse into the outer stratum corneum disrupting hydrogen bonding tion is sparse and unscientific (Table 5). Moisturizers can claim to
exposing water binding sites on the corneocytes and facilitating improve the “appearance” of the skin, but no more. This in many ways

T A B L E 5 Common cosmetic moisturizer additives

Cosmetic ingredient Derivation Purported cosmetic functionality (in vitro)
Skin lighteners
1. Liquiritin Licorice extract containing flavonoids Disperses melanin
2. Aleosin Aloe vera derived glycoprotein known as Inhibits tyrosinase by competitive inhibition at the
hydroxymethylchromone DOPA oxidation site
3. Arbutin Derived from the leaves of the Vaccinium vitis-idaea Decreases tyrosinase activity and inhibits melanosome
plant containing glucopyranoside maturation
4. Vitamin C L-ascorbic acid Interrupts melanin production by interacting with copper
ions to reduce dopaquinone and blocking
dihydrochinindol-2-carboxyl acid oxidation
Peptides
1. Carrier peptides GHK-Cu (glycine, histidyl, lysine linked to copper) Delivers copper to facilitate wound healing
2. Signal peptides Pal-KTTKS (lysine, threonine, threonine, lysine, serine Procollagen I fragment to stimulate collagen I, III, IV
linked to palmitic acid) synthesis
3. Neurotransmitter Acetyl hexapeptide-3 Inhibits vesicle docking through prevention of SNARE
peptides complex formation
Vitamins
1. Vitamin A (Retinoids) Retinyl palmitate, retinol, retinyl esters Cutaneously may convert to retinoic acid and bind to
retinoid receptors
2. Vitamin E Alpha-tocopherol Oil-soluble antioxidant
3. Niacin Vitamin B3 Anti-inflammatory, epidermal lipid increase
4. Panthenol Vitamin B5 Humectant able to hold water
5. Essential fatty acids Unsaturated linoleic, linolenic, and arachidonic acid Component of the intercellular lipids
Botanicals
1. Soy Isoflavones genistein and daidzein Phytoestrogens functioning as antioxidants
2. Curcumin Tetrahydrocurcumin Antioxidant
3. Silymarin Flavonoids silybin, silydianin, and silychristine Antioxidant
4. Pycnogenol Marine pine bark Pinus pinaster containing taxifolin, Antioxidant
catechin, and procyanidins
5. Ginkgo Maidenhair tree containing bilobalide, ginkgolides, and Antioxidant
ginkgolic acid
Exfoliants
1. Alpha hydroxy acid (AHA) Glycolic acid Water-soluble keratolytic
2. Beta hydroxy acid (BHA) Salicylic acid Oil-soluble keratolytic
144 | DRAELOS

has hampered development of more sophisticated functional cosmet- 21. Jackson EM. Moisturizers: what’s in them? How do they work? Am J
ics, yet the ingenuity of the cosmetic chemist continues to develop bet- Contact Dermat. 1992;3:162-168.
22. Reiger MM. Skin, water and moisturization. Cosmet Toil.
ter and more sophisticated products to optimize skin appearance on
1989;104:41-51.
the face, body, and hands/feet. Examining the number of annual pro- 23. Baker CG. Moisturization: new methods to support time proven
duct introductions, the diversity of product offerings, and the amount ingredients. Cosmet Toil. 1987;102:99-102.
of money spent on moisturizers reveals the sophistication of this cate- 24. De Groot AC, Weyland JW, Nater JP. Unwanted Effects of Cosmetics
and Drugs Used in Dermatology, 3rd edn. Amsterdam, The Nether-
gory and the necessity of the dermatologist understanding basic mois-
lands: Elsevier; 1994:498-500.
turizer concepts. This article presented an overview of moisturizers, 25. Friberg SE, Ma Z. Stratum corneum lipids, petrolatum and white oils.
which hold great promise for future innovation and development. Cosmet Toil. 1993;107:55-59.
26. Grubauer G, Feingold KR, Elias PM. Relationship of epidermal lipoge-
nesis to cutaneous barrier function. J Lipid Res. 1987;28:746-752.
DISCLOSURE 27. Ghadially R, Halkier-Sorensen L, Elias PM. Effects of petrolatum on
stratum corneum structure and function. J Am Acad Dermatol.
The author involved with this journal-based CME activity has 1992;26:387-396.
reported no relevant financial relationship with commercial interests. 28. Spencer TS. Dry skin and skin moisturizers. Clin Dermatol.
1988;6:24-28.
29. Robbins CR, Fernee KM. Some observations on the swelling of
REFERENCES
human epidermal membrane. J Soc Cosmet Chem. 1983;37:21-34.
30. Idson B. Dry skin: moisturizing and emolliency. Cosmet Toil.
1. Draelos ZD. Cosmeceuticals. Dermatol Clin. 2014;32:137-143.
1992;107:69-78.
2. Draelos ZD. Cosmeceuticals: undefined, unclassified, and unregu-
31. Mayoral FA, Kenner JR, Draelos ZD. The skin health and beauty
lated. Clin Dermatol. 2009;27:431-434.
pyramid: a clinically based guide to selecting topical skincare prod-
3. Draelos ZD. Cosmetics, categories, and the future. Dermatol Ther.
ucts. J Drugs Dermatol. 2014;13:414-421.
2012;25:223-228.
32. Idson B. Moisturizers, emollients, and bath oils. In: Frost P, Horwitz
4. Brand HM, Brand-Garnys EE. Practical application of quantitative
SN, eds. Principles of Cosmetics for the Dermatologist. St. Louis, MO:
emolliency. Cosmet Toil. 1992;107:93-99.
CV Mosby Company; 1982:37-44.
5. Anderson PC, Dinulos JG. Are the new moisturizers more effective?
33. Lynde CW. Moisturizers: what they are and how they work. Skin
Curr Opin Pediatr. 2009;21:486-490.
Therapy Lett. 2001;6:3-5.
6. Draelos ZD. Concepts in skin care maintenance. Cutis. 2005;76(6
34. Schmitt WH. Skin-care products. In: Williams DF, Schmitt WH, eds.
suppl):19-25.
Chemistry and Technology of the Cosmetics and Toiletries Industry.
7. Goldner R. Moisturizers: a dermatologist’s perspective. J Toxicol
London, UK: Blackie Academic & Professional; 1992:121.
Cutaneous Ocul Toxicol. 1992;11:193-197.
35. Morrison DS. Petrolatum: a useful classic. Cosmet Toil. 1996;111:59-
8. Boisits EK. The evaluation of moisturizing products. Cosmet Toil.
69.
1986;101:31-39.
36. Ruiz MA, Hernandez A, Llacer JM, Gallardo V. Silicone chemistry.
9. Wu MS, Yee DJ, Sullivan ME. Effect of a skin moisturizer on the
Cosmet Toil. 1998;113:57-62.
water distribution in human stratum corneum. J Invest Dermatol.
37. Disapio AJ, Starch MS. New silicone emulsifier technology. Cosmet
1983;81:446-448.
Toil. 1981;96:55-57.
10. Wildnauer RH, Bothwell JW, Douglass AB. Stratum corneum biome-
38. Garidel P, Fo€ lting B, Schaller I, Kerth A. The microstructure of the
chanical properties. J Invest Dermatol. 1971;56:72-78.
stratum corneum lipid barrier: mid-infrared spectroscopic studies of
11. Pierard GE. What does “dry skin” mean? Int J Dermatol.
hydrated ceramide: palmitic acid: cholesterol model systems. Biophys
1987;26:167-168.
Chem. 2010;150:144-156.
12. Elias PM. Lipids and the epidermal permeability barrier. Arch Derma-
39. Madaan A. Epiceram for the treatment of atopic dermatitis. Drugs
tol Res. 1981;270:95-117.
Today (Barc). 2008;44:751-755.
13. Holleran WM, Man MQ, Wen NG, Gopinathan KM, Elias PM, Fein-
40. Sugarman JL, Parish LC. Efficacy of a lipid-based barrier repair for-
gold KR. Sphingolipids are required for mammalian epidermal barrier
mulation in moderate-to-severe pediatric atopic dermatitis. J Drugs
function. J Clin Invest. 1991;88:1338-1345.
Dermatol. 2009;8:1106-1111.
14. Downing DT. Lipids: their role in epidermal structure and function.
41. Eberlein B, Eicke C, Reinhardt H-W, Ring J. Adjuvant treatment of
Cosmet Toil. 1991;106:63-69.
atopic eczema: assessment of an Emollient Containing N-Palmitoy-
15. Petersen RD. Ceramides key components for skin protection. Cosmet
lethanolamine (ATOPA Study). J Eur Acad Dermatol Venereol.
Toil. 1992;107:45-49.
2008;22:73-82.
16. Nickoloff BJ, Naidu Y. Perturbation of epidermal barrier function
42. Wehr RF, Krochmal L. Considerations in selecting a moisturizer.
correlates with initiation of cytokine cascade in human skin. J Am
Cutis. 1987;39:512-515.
Acad Dermatol. 1994;30:535-546.
43. Wilkinson JB, Moore RJ. Harry’s Cosmeticology, 7th edn. New York,
17. Elias PM. Epidermal lipids, barrier function, and desquamation. J
NY: Chemical Publishing; 1982:62-64.
Invest Dermatol. 1983;80:44s-49s.
18. Jass HE, Elias PM. The living stratum corneum: implications for cos-
metic formulation. Cosmet Toil. 1991;106:47-53.
19. Holleran W, Feingold K, Man MQ, Gao W, Lee J, Elias PM. Regula-
How to cite this article: Draelos ZD. The science behind skin
tion of epidermal sphingolipid synthesis by permeability barrier func-
tion. J Lipid Res. 1991;32:1151-1158. care: Moisturizers. J Cosmet Dermatol. 2018;17:138–144.
20. Grubauer G, Elias PM, Feingold KR. Transepidermal water loss: the https://doi.org/10.1111/jocd.12490
signal for recovery of barrier structure and function. J Lipid Res.
1989;30:323-333.