Best Moisturizers for Eczema and Scaly Skin

What Is Scaly Skin?

Eczema, also called atopic dermatitis, is a common inflammatory skin condition impacting about 11% of children and more than 7% of adults in the United States. The primary symptom is a scaly, itchy, inflamed rash.

People with eczema are believed to have a genetic mutation that weakens a protein called filaggrin in the epidermis (the outermost layer of skin). Filaggrin plays important roles in creating a protective barrier that protects skin cells and keeps them hydrated. The lack of filaggrin triggers numerous changes in your skin:

• Higher-then-normal loss of moisture
• Abnormal build-up of dead cells that results in a scaly appearance
• A weakened barrier that allows allergens to enter through the epidermis, which leads to an immune response and inflammation

To treat eczema, it's important to remove dead cells and restore moisture, which is where exfoliants and humectants come in.

Exfoliants remove dead cells from the surface of your skin. You may be most familiar with physical exfoliants, which are abrasive or gritty and manually remove dead cells. Lactic acid is a chemical exfoliant, meaning that it isn't abrasive. Instead, it helps loosen the bonds between cells and allows dry skin to be sloughed off.

Humectants help your skin retain moisture by binding with water molecules, drawing moisture from the second layer of skin (the dermis) to the epidermis and holding it there. That helps keeps your skin from flaking, cracking, and chafing. Humectants also break down cellular proteins in a way that helps your skin rid itself of dead cells.

Lactic Acid

Lactic acid is an alpha-hydroxy acid that can be derived from milk but is generally synthesized for skincare products. It's also a natural component of healthy skin.

You can buy over-the-counter eczema cream containing lactic acid or have a lactic acid peel performed by a professional in a day spa (superficial peels only) or medical setting (deeper peels).

With regular use, lactic acid exfoliates and speeds up cell renewal, which leaves your skin looking brighter and feeling softer. It also helps improve the process by which your skin keeps itself hydrated.

Products containing lactic acid can also improve skin in ways not related to eczema, including:

• Firming the skin
• Fading sun spots or age spots
• Smoothing fine lines and wrinkles

Additionally, lactic acid is used in products that treat psoriasis, rosacea, and combined with salicylic acid to treat several types of warts.

A 2018 study suggests that lactic acid reduces itching in eczema after the first use and restores skin barrier integrity. A review of moisturizers for eczema found some evidence that it shortened flares as well.

Over-the-counter products come in various formulations, including:

• Cleansers
• Creams
• Lotions
• Serums
• At-home peels and masks

They contain varying amounts of lactic acid, from 5% to 30% or even more.

Throughout use of these products, watch how your skin reacts so you don't irritate it, follow the directions, and don't go for too high a strength too fast.

Also be aware of what other ingredients are in the product you choose, as they can alter your results. Simpler products make it easier for you to determine what is working—or working against you.

If your skin has uneven pigmentation and fine wrinkles in addition to dryness, you may want to look into professional lactic-acid-containing peels. Several treatments generally need to be done to get desired results.

Talk to your dermatologist about whether peels or over-the-counter products are the right choice for you.

Urea

Urea, also called carbamide, is a natural component of healthy skin that's synthesized for use in lotions and other skincare products. You can buy a range of over-the-counter eczema creams and other formulations that contain this ingredient. Urea isn't used in any prescription eczema treatments.

Urea draws water to your skin cells and keeps it there while softening the dry cells on the surface of your skin so you can shed them more easily. With regular use, it improves the barrier layer and helps epidermal cells regenerate more efficiently.

It also has painkilling effects, which lessens the itchiness eczema can cause.

When used in corticosteroid creams, urea allows the drug to penetrate more deeply than it can alone.

Along with treating eczema, urea can help relieve symptoms of:

• Psoriasis
• Contact dermatitis
• Onychomycosis (a fungal nail infection)
• Athlete's foot
• Seborrheic keratosis (a skin growth, also called basal cell papilloma or seborrheic warts)
• Dystrophic nails

A 2017 review of moisturizers for eczema found some evidence that urea-containing cream improved dryness and led to fewer flares, and that it was superior to a placebo in terms of overall skin improvements.

A 2019 review of side effects from use of emollients, including urea, to treat eczema states that adverse events were generally mild and that these treatments are safe to use.

Urea is available in multiple preparations, including:

• Creams
• Lotions
• Shampoos
• Gels
• Body washes

Products range in strength from about 3% up to 40%. Concentrations of between 10% and 40% are commonly recommended for eczema.

Some products combine urea with other active ingredients; make sure you read ingredient labels to check for anything you know can irritate your condition.

Your dermatologist can help guide you toward the right products and concentrations for you.

Choosing and Using

While one study did suggest that urea may be more effective than lactic acid, it was a small, short-term study and doesn't indicate that urea is the best choice for everyone. Also, different products may be necessary during different stages of your condition.

When choosing between products, the National Eczema Association says to take these steps:

• Check the label to see if it contains any of your known allergens or irritants.
• Check reputable sources to see how well it's regarded as an eczema moisturizer. For example, reference the National Eczema Association's Seal of Acceptance list.
• Test a small amount of the product on the inside of your wrist or elbow. Leave it there without washing the area for a day or two and see if you have any negative reactions to it.

Also look for fairly simple formulations that don't contain fragrances or dyes.

If mild irritation or redness occur when you first apply the product, see if the symptoms goes away in about an hour. If so, the product is probably safe for you to use. If the skin changes are moderate or severe, don't go away, or cause a rash or swelling, wash the skin and don't use the product again. Call your dermatologist to see if your reaction warrants any further treatment.

Generally, eczema creams should be applied a couple of times a day. Apply a thick layer of moisturizer all over your skin within three minutes of bathing or showering to “lock in” moisture and protect the skin barrier.

Be sure to follow directions from the manufacturer or your healthcare provider.

Side Effects and Precautions

Never use a moisturizer or topical treatment if you know you're allergic to any of its ingredients.

The most common side effect of moisturizers for eczema is a burning sensation when applied, especially to broken skin. Itching and skin rash from urea are also common.

In studies, any side effects typically have been mild. Starting with a low concentration of urea or lactic acid can help you sidestep such concerns.

Lactic acid can lead to several other more significant side effects, including:

• Increased sensitivity to the sun
• Redness
• Peeling
• Dryness
• Swelling

Pregnancy and Lactation

Animal studies have not suggested that these creams will harm a fetus, but there are no well-controlled studies in humans. Only use these products while pregnant if approved by a member of your medical team.

Experts don't know whether topical urea or lactic acid make it into breast milk, so it's best to avoid them or talk to your healthcare provider about the risks if you are nursing.