Expert Consensus on Moisturisers for Atopic Dermatitis: Insights from a Malaysian Panel

Atopic dermatitis (AD) is a chronic inflammatory skin disease that often begins in childhood and may persist into adulthood. It is marked by dry skin, persistent itching, and recurrent eczematous lesions, all reducing quality of life. The condition arises from several factors, including immune dysregulation, deficiencies in skin barrier proteins such as filaggrin, changes in lipid composition of the stratum corneum, alterations in the skin microbiome, and environmental triggers like irritants, heat, sweating, pollution, and smoking. 

In Malaysia, the prevalence of AD increased from 9.5% in 1995 to 12.6% in 2003, highlighting its growing burden. Moisturisers are central to AD treatment because they improve hydration, restore the skin barrier, reduce inflammation, and limit flare-ups. A panel of nine Malaysian dermatologists conducted a modified Delphi consensus to develop evidence-based recommendations for their use. 

Most of the experts had extensive experience treating both children and adults with AD. A systematic search of PubMed/MEDLINE and the Cochrane Library used terms related to AD and moisturisers. The panel addressed 25 questions across five domains: challenges in adherence, criteria for product selection, role of bioactive ingredients, clinical effectiveness, and prevention through early initiation. 

The consensus threshold was set at 80%, and final consensus statements were developed. The draft report was shared with the panel for review and approval. 

The experts concluded that moisturisers should include humectants, occlusives, and emollients, with product choice tailored to individual needs, skin site, climate, humidity, formulation, and cost. Regular use enhances corticosteroid efficacy, reduces pruritus, and lowers the frequency of disease flare-ups.

References:

1. Affandi AM, How KN, Kwan Z, Yap FB, Chng CC, Tan WC, Yap EWY, Selvarajah L, Raja T, Kon KM. Role of moisturisers in atopic dermatitis: expert group recommendations from a Malaysian panel via modified Delphi consensus method. Malays J Dermatol. 2024;52(2):23-34. doi:10.4103/MJD.MJD_20_24; https://journals.lww.com/mjd/fulltext/2024/52020/role_of_moisturisers_in_atopic_dermatitis__expert.1.aspx