What ingredients do therapeutic moisturizers contain?

Zoe Diana Draelos, M.DWhat ingredients do therapeutic moisturizers contain?

Many companies market excellent therapeutic moisturizers that do contain higher concentrations of barrier repair ingredients. A good therapeutic moisturizer should contain ingredients that both occlude the surface to reduce transepidermal water loss and attract water to the skin through humectancy. 

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Ingredients that should be in the formulation to retard transepidermal water loss include petrolatum, mineral oil, silicone derivatives (dimethicone, cyclomethicone), polymers (methacrylate derivatives, polyvinyl pyrrolidone). Some manufacturers are now eliminating petrolatum and mineral oil, as they are petroleum distillates, in favor of plant derived renewal products, such as cocoa butter, shea butter, hemp oil, sesame see oil, etc.

The plant butters and oils do not retard transepidermal water loss as well as petrolatum and mineral oil, but can be quite efficacious and do allow the manufacturer to make a consumer appealing natural claim.

In addition to occlusive agents, the therapeutic moisturizer should also contain humectants, such as glycerin, hyaluronic acid, sodium hyaluronate, sodium PCA, etc. Of these, glycerin is the most valuable as it also modulates aquaporins, which are the water channels in the skin. I would suggest that all therapeutic moisturizers should contain glycerin as a requirement.

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Many therapeutic moisturizers marketed to dermatologists also contain urea or lactic acid. Urea and lactic acid can function as exfoliants by encouraging desquamation of the stratum corneum by breaking the intercellular bonds. However, urea and lactic acid can also increase the water holding capacity of the skin by opening up water binding sites on the protein. This is how urea and lactic acid aid in the removal of calloused skin and the tenacious white scale associated with psoriasis. 

Once the skin becomes hydrated, natural desquamation can resume hastening the return of the skin to a more normal appearance with better functioning. Lactic acid and urea are usually relegated to therapeutic moisturizers because they can cause stinging and burning when used in the manner of a normal moisturizer after activities, such as leg shaving.