EmoEmollients in psoriasis
Emollients are agents designed to soften the stratum corneum and make it more supple by increasing its hydration and reducing superficial scales. They are the most frequently used products in dermatology.7 They induce an occlusive film that limits evaporation of water from deeper parts of the skin and allows the stratum corneum to rehydrate itself; furthermore, the application of natural moisturizing factors induces an increase in the water-binding capacity of the stratum corneum. Regular use of emollients and moisturizers is important. Several products are available today, for example, moisturizing creams, ointments, and bath oils. Creams and ointments are preferable to lotions. They tend to be thicker, more occlusive, and therefore more effective.3 Emollients do not work as a monotherapy. They should be used in combination with other therapies. It has been reported for chronic plaque psoriasis that water-in-oil emollients are useful as steroid-sparing agent.8 The hydration of the stratum corneum leads to an enhanced delivery of topical glucocorticosteroids. The replacement of one of the twice-daily applications of betamethasone dipropionate treatment by a water-in-oil emollient showed the same efficacy. An early study showed that white soft paraffin may inhibit the Koebner response in psoriasis.9 Finlay10 reported an effective cream therapy adjunct to dithranol for the treatment of chronic plaque psoriasis. Nola et al7 reported that the electrical properties of the stratum corneum change after application of an emollient and that these substances have an anti-inflammatory activity. A daily bath in warm water followed by a generalized application of a moisturizer (cream or ointment) has been encouraged for psoriasis.3 A second or third application of a moisturizer during the day should be also beneficial.3 The treatment of plaque psoriasis with tazarotene gel can be optimized through the additional use of an emollient or a topical corticosteroid.11 The use of an emollient or a corticosteroid enhanced the efficacy of tazarotene treatment and increased the percentage of patients who were satisfied with their treatment.11llients, moisturizers, and keratolytic agents in psoriasis