Clinics in Dermatology
Volume 26, Issue 4 , Pages 380-386 , July 2008

Emollients, moisturizers, and keratolytic agents in psoriasis

  • Joachim W. Fluhr, MD

      Affiliations

    • Bioskin, Seydelstr. 18, D-10117 Berlin, Germany
    • Corresponding Author InformationCorresponding author.
  • ,
  • Claudia Cavallotti, MD

      Affiliations

    • Department of Dermatology, San Gallicano Dermatological Institute, Via Chianesi 53, I-00144 Rome, Italy
  • ,
  • Enzo Berardesca, MD

      Affiliations

    • Department of Dermatology, San Gallicano Dermatological Institute, Via Chianesi 53, I-00144 Rome, Italy

References 

  1. Christophers E, Mrowietz U. Psoriasis. In:  Freedberg IR,  Eisen AZ,  Wolff K, et al. editor. Fitzpatrick’s dermatology in general medicine. 2003;p. 407–427
  2. Philipp S, Wolk K, Kreutzer S, et al. The evaluation of psoriasis therapy with biologics leads to a revision of the current view of the pathogenesis of this disorder. Expert Opin Ther Targets. 2006;10:817–831
  3. Witman PM. Topical therapies for localized psoriasis. Mayo Clin Proc. 2001;76:943–949
  4. Greaves MW, Weinstein GD. Treatment of psoriasis. N Engl J Med. 1995;332:581–588
  5. Schopf E, Mueller JM, Ostermann T. Value of adjuvant basic therapy in chronic recurrent skin diseases. Neurodermatitis atopica/psoriasis vulgaris. Hautarzt. 1995;46:451–454
  6. Bikowski J. The use of therapeutic moisturizers in various dermatologic disorders. Cutis. 2001;68:3–11
  7. Nola I, Kostovic K, Kotrulja L, et al. The use of emollients as sophisticated therapy in dermatology. Acta Dermatovenerol Croat. 2003;11:80–87
  8. Watsky KL, Freije L, Leneveu MC, et al. Water-in-oil emollients as steroid-sparing adjunctive therapy in the treatment of psoriasis. Cutis. 1992;50:383–386
  9. Comaish JS, Greener JS. The inhibiting effect of soft paraffin on the Kobner response in psoriasis. Br J Dermatol. 1976;94:195–200
  10. Finlay AY. Emollients as adjuvant therapy for psoriasis. J Dermatolog Treat. 1997;8(Suppl 1):
  11. Tanghetti EA. An observation study evaluating the treatment of plaque psoriasis with tazarotene gels, alone and with an emollient and/or corticosteroid. Cutis. 2000;66:4–11
  12. Held E, Sveinsdottir S, Agner T. Effect of long-term use of moisturizer on skin hydration, barrier function and susceptibility to irritants. Acta Derm Venereol. 1999;79:49–51
  13. Gloor M, Hauth A, Gehring W. O/W emulsions compromise the stratum corneum barrier and improve drug penetration. Pharmazie. 2003;58:709–715
  14. Fluhr JW, Gloor M, Bettinger J, et al. On the influence of bath oils with different solvent characteristics and different amounts of a non-ionic tensile on the hydration and barrier function of the stratum corneum. J Cosmet Sci. 1998;49:343–350
  15. Rim JH, Jo SJ, Park JY, et al. Electrical measurement of moisturizing effect on skin hydration and barrier function in psoriasis patients. Clin Exp Dermatol. 2005;30:409–413
  16. van Duijnhoven MW, Hagenberg R, Pasch MC, et al. Novel quantitative immunofluorescent technique reveals improvements in epidermal cell populations after mild treatment of psoriasis. Acta Derm Venereol. 2005;85:311–317
  17. Penven K, Leroy D, Verneuil L, et al. Evaluation of Vaseline oil applied prior to UVB TL01 phototherapy in the treatment of psoriasis. Photodermatol Photoimmunol Photomed. 2005;21:138–141
  18. Birgin B, Fetil E, Ilknur T, et al. Effects of topical petrolatum and salicylic acid upon skin photoreaction to UVA. Eur J Dermatol. 2005;15:156–158
  19. Fetil E, Ozka S, Soyal MC, et al. Effects of topical petrolatum and salicylic acid on the erythemogenicity of UVB. Eur J Dermatol. 2002;12:154–156
  20. Lebwohl M. The role of salicylic acid in the treatment of psoriasis. Int J Dermatol. 1999;38:16–24
  21. Moncorps C. Untersuchungen über die Pharmakologie und Pharmakodynamik von Salben und salbeninkorporierten I.I. Medikamenten, Mitteilung: Über die Resorption und Pharmakodynamik der salbeninkorporiereten Salizylsäure. Arch Exp Pathol Pharmacol. 1929;141:
  22. Arnold W, Trinnes F, Schroeder I. Skin resorption of salicylic acid in psoriasis patients and persons with healthy skin. Beitr Gerichtl Med. 1979;37:325–328
  23. Gabard B, Treffel P, Schwarb F, Surber C, Bieli E, Lüdi S. Salicylic acid release from topical formulations does not predict in vitro skin absorption. Dermatology. 1997;195
  24. Schwarb F, Gabard B, Jost G, Rufli TH, Surber C. Percutaneous absorption of salicylic acid in man following topical administration of different formulations. Dermatology. 1997;195:
  25. Weirich EG, Longauer JK, Kirkwood AH. Effect of topical salicylic acid on animal epidermopoiesis. Dermatologica. 1978;156:89–96
  26. Pullmann H, Lennartz KJ, Steigleder GK. The effect of salicylic acid on epidermal cell proliferation kinetics in psoriasis. Autoradiographic in vitro-investigations(author's transl). Arch Dermatol Forsch. 1975;251:271–275
  27. Roberts DL, Marshall R, Marks R. Detection of the action of salicylic acid on the normal stratum corneum. Br J Dermatol. 1980;103:191–196
  28. Davies M, Marks R. Studies on the effect of salicylic acid on normal skin. Br J Dermatol. 1976;95:187–192
  29. Huber C, Christophers E. “Keratolytic" effect of salicylic acid. Arch Dermatol Res. 1977;257:293–297
  30. Nook TH. In vivo measurement of the keratolytic effect of salicylic acid in three ointment formulations. Br J Dermatol. 1987;117:243–245
  31. Gloor M, Beier B. Keratoplastic effect of salicylic acid, sulfur and a tensio-active mixture. Z Hautkr. 1984;59:1657–1660
  32. Going SM, Guyer BM, Jarvie DR, et al. Salicylic acid gel for scalp psoriasis. Clin Exp Dermatol. 1986;11:260–262
  33. Hulsebosch HJ, Ponec-Waelsch M. The interaction of anthralin, salicylic acid and zinc oxide in pastes. Dermatologica. 1972;144:287–293
  34. Runne U. Anthralin-salicylic acid therapy of psoriasis. Cignolin-salicylic acid-Vaseline treatment and Lasan paste in a right-left comparison. Hautarzt. 1974;25:199–200
  35. Diem E, Fritsch P. Salicylate poisoning by percutaneous resorption. Hautarzt. 1973;24:552–555
  36. Zesch A. Short and long-term risks of topical drugs. Br J Dermatol. 1986;115(Suppl 31):63–70
  37. Chapman BJ, Proudfoot AT. Adult salicylate poisoning: deaths and outcome in patients with high plasma salicylate concentrations. Q J Med. 1989;72:699–707
  38. Pec J, Strmenova M, Palencarova E, et al. Salicylate intoxication after use of topical salicylic acid ointment by a patient with psoriasis. Cutis. 1992;50:307–309
  39. Luderschmidt C, Plewig G. Chronic percutaneous salicylic acid poisoning. Hautarzt. 1975;26:643–646
  40. Germann R, Schindera I, Kuch M, et al. Life threatening salicylate poisoning caused by percutaneous absorption in severe ichthyosis vulgaris. Hautarzt. 1996;47:624–627
  41. Vonweiss JF, Lever WF. Percutaneous salicylic acid intoxication in psoriasis. Arch Dermatol. 1964;90:614–619
  42. Taylor JR, Halprin KM. Percutaneous absorption of salicylic acid. Arch Dermatol. 1975;111:740–743
  43. van de Kerkhof PC, Vissers WH. The topical treatment of psoriasis. Skin Pharmacol Appl Skin Physiol. 2003;16:69–83
  44. Waller JM, Dreher F, Behnam S, et al. 'Keratolytic' properties of benzoyl peroxide and retinoic acid resemble salicylic acid in man. Skin Pharmacol Physiol. 2006;19:283–289
  45. Bashir SJ, Dreher F, Chew AL, et al. Cutaneous bioassay of salicylic acid as a keratolytic. Int J Pharm. 2005;292:187–194
  46. Klimowicz A, Farfal S, Bielecka-Grzela S. Evaluation of skin penetration of topically applied drugs in humans by cutaneous microdialysis: acyclovir vs. salicylic acid. J Clin Pharm Ther. 2007;32:143–148
  47. Klimowicz A, Bielecka-Grzela S, Groth L, et al. Use of an intraluminal guide wire in linear microdialysis probes: effect on recovery?. Skin Res Technol. 2004;10:104–108
  48. Loden M. Urea-containing moisturizers influence barrier properties of normal skin. Arch Dermatol Res. 1996;288:103–107
  49. Loden M. Barrier recovery and influence of irritant stimuli in skin treated with a moisturizing cream. Contact Dermatitis. 1997;36:256–260
  50. Treffel P, Gabard B. Stratum corneum dynamic function measurements after moisturizer or irritant application. Arch Dermatol Res. 1995;287:474–479
  51. Bettinger J, Gloor M, Gehring W, Wolf W. Influence of emulsions with and without urea an water-binding capacity of the stratum corneum. J Soc Cosmet Chem. 1995;46
  52. Muller KH, Pflugshaupt C. Urea in dermatology I. Hautarzt. 1989;40(Suppl 9):1–12
  53. Wohlrab W. Effect of urea on the water binding capacity of the human stratum corneum. Dermatol Monatsschr. 1988;174:622–627
  54. Fluhr JW, Vrzak G, Gloor M. Hydratisierende und die Steroidpenetration verbessernder Effekt von Harnstoff und Glycerin in Abhänigkeit von der verwendeten Grundlage. Z Hautkr. 1998;73:
  55. Wohlrab W, Schiemann S. Investigations on the mechanism of the activity of urea upon the epidermis (author's transl). Arch Dermatol Res. 1976;255:23–30
  56. Wohlrab W. Harnstoff-ein bewährter Wirkstoff in der Dermatologie und Kosmetik. P. Z. 1992;33:
  57. Wohlrab W. Recovery rate of externally administered glucocorticoids on the skin surface. Dermatol Monatsschr. 1986;172:615–619
  58. Feldmann RJ, Maibach HI. Percutaneous penetration of hydrocortisone with urea. Arch Dermatol. 1974;109:58–59
  59. Wohlrab W. The influence of urea on the penetration kinetics of topically applied corticosteroids. Acta Derm Venereol. 1984;64:233–238
  60. Stuttgen G. Promoting penetration of locally applied substances by urea. Hautarzt. 1989;40(Suppl 9):27–31
  61. Gloor M, Lindemann J. The influence of keratolytics and moisturizers on the bio-availability of triamcinolone acetonide following topical application (author's transl). Dermatol Monatsschr. 1980;166:102–106
  62. Kalbitz J, Neubert R, Wohlrab W. Modulation of drug penetration in the skin. Pharmazie. 1996;51:619–637
  63. Fluhr JW, Gloor M, Gehring W. Physiology of Skin cleaning and functional mechanism of bath oils. In:  Berardesca E,  Picardo M,  Pigatto P editor. Irritant contact dermatitis—Proceedings of the 3rd International Symposium (ISICD). Milano: Medical Publishing & New Media; 2000;p. 291–307
  64. Müller KH, Pflugshaupt Ch. Harnstoff in der Dermatologie. Zbl Hautkr. 1979;142
  65. Gabard B, Bieli E. Salicylic acid and urea—possible modification of the keratolytic effect of salicylic acid by urea. Hautarzt. 1989;40(Suppl 9):71–73
  66. Hagemann I, Proksch E. Topical treatment by urea reduces epidermal hyperproliferation and induces differentiation in psoriasis. Acta Derm Venereol. 1996;76:353–356
  67. Sasaki Y, Tadaki T, Tagami H. The effects of a topical application of urea cream on the function of pathological stratum corneum. Acta Dermatol Kyoto. 1989;84
  68. Shemer A, Nathansohn N, Kaplan B, et al. Treatment of scalp seborrheic dermatitis and psoriasis with an ointment of 40% urea and 1% bifonazole. Int J Dermatol. 2000;39:532–534
  69. Gloor M, Fluhr J, Wasik B, et al. Clinical effect of salicylic acid and high dose urea applied according to the standardized New German Formulary. Pharmazie. 2001;56:810–814
  70. Hardening CR, Watkinson A, Rawlings AV, Scott IR. Dry skin, moisturization and corneodesmolysis. Int J Cosmet Sci. 2000;22:21–52
  71. Lynde CW. Moisturizers: what they are and how they work. Skin Therapy Lett. 2001;6:3–5
  72. Kostarelos K, Teknetzis A, Lefaki I, et al. Double-blind clinical study reveals synergistic action between alpha-hydroxy acid and betamethasone lotions towards topical treatment of scalp psoriasis. J Eur Acad Dermatol Venereol. 2000;14:5–9
  73. Berardesca E, Piero Vignoli G, Distante E, et al. Effects of glycolic acid on psoriasis. Clin Exp Dermatol. 1998;23:190–191
  74. Escobar SO, Achenbach R, Iannantuono R, et al. Topical fish oil in psoriasis—a controlled and blind study. Clin Exp Dermatol. 1992;17:159–162
  75. Dewsbury CE, Graham P, Darley CR. Topical eicosapentaenoic acid (EPA) in the treatment of psoriasis. Br J Dermatol. 1989;120:581
  76. Kragballe K, Voorhees P, Darley CR, Goetzl EJ. Leukotriene B5 derived from eicosapentaenoic acid does not stimulate DNA synthesis of cultured human keratinocytes but inhibits the stimulation induced by leukotriene B4. J Invest Dermatol. 1985;84
  77. Williams ML. Lipids in normal and pathological desquamation. Adv Lipid Res. 1991;24:211–262
  78. Berardesca E, Borroni, G. Oral and topical supplementation of linoleic acid and skin disease.
  79. Henneicke-von Zepelin HH, Mrowietz U, Farber L, et al. Highly purified omega-3-polyunsaturated fatty acids for topical treatment of psoriasis. Results of a double-blind, placebo-controlled multicentre study. Br J Dermatol. 1993;129:713–717

PII: S0738-081X(08)00016-3

doi: 10.1016/j.clindermatol.2008.01.015

Clinics in Dermatology
Volume 26, Issue 4 , Pages 380-386 , July 2008