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 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 1  |  Issue : 1  |  Page : 19-22

Assessment of efficacy of six different moisturizing creams in maintaining the hydration of skin in healthy human volunteers: A randomized controlled study


1 Department of Dermatology, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, Maharashtra, India
2 Undergraduate Medical Student, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, Maharashtra, India

Date of Web Publication1-Dec-2015

Correspondence Address:
Sushil Pande
Department of Dermatology, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/WKMP-0110.170755

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  Abstract 

Introduction: Moisturizers are routinely prescribed so for adequate hydration of the skin. There are various preparations of these moisturizers in the market making it difficult for a dermatologist to choose the most effective moisturizer. Objectives: To compare the efficacy of six different commonly used commercial and prescription based skin moisturizers. Materials and Methods: A total of 30 human healthy volunteers of the same age group were enrolled in a study. We selected six sites on the dorsum of hand (A, B, C, D, E, and F) for the application of moisturizers. In this study, we used six different commercially available moisturizers namely Emoderm® cream, Secalia® cream, Amylac® 12% cream, Ponds® cream, Nivea® cream, Dove® cream. Baseline moisture level reading of the areas selected was taken (A, B, C, D, E, and F) with the help of digital skin moisture analyzer. Digital skin moisture analyzer is a portable device that uses bioelectric impedance analysis technology. Readings were taken at the end of 15 min, 30 min, and 1 h after application of the cream. Results: At the end of 15 min, only Dove moisturizer could retain the baseline moisture level in the skin without positive or negative change. Moisture levels were reduced in other groups. At the end of 30 min, Secalia® moisturizer produced an increase in moisture level over the baseline - 4.76%. Moisture levels were below baseline in other groups. Secalia® moisturizer produced the maximum increase in moisture level over the baseline at the end of 1 h - 21.99%. The only other moisturizers to produce moisture level above baseline after 60 min were Dove® 5.02% and Amylac®- 5.66%. Conclusion: We conclude that epidermal hydration produced by moisturizers influences the electrical properties of skin. Humectants cause a significant increase in moisture levels as assessed by digital skin moisture analyzer.

Keywords: Bioelectric impedance, commercial moisturizers, hydration, moisturizers


How to cite this article:
Dashore S, Pande S, Lambghare N. Assessment of efficacy of six different moisturizing creams in maintaining the hydration of skin in healthy human volunteers: A randomized controlled study. Indian J Drugs Dermatol 2015;1:19-22

How to cite this URL:
Dashore S, Pande S, Lambghare N. Assessment of efficacy of six different moisturizing creams in maintaining the hydration of skin in healthy human volunteers: A randomized controlled study. Indian J Drugs Dermatol [serial online] 2015 [cited 2021 Apr 14];1:19-22. Available from: https://www.ijdd.in/text.asp?2015/1/1/19/170755




  Introduction Top


One of the important functions of the skin is to avoid transepidermal water loss so that moisture is retained within the skin. There are a variety of skin diseases like atopic dermatitis, etc., in which barrier function is impaired leading to increased transepidermal water loss.[1] Moisturizers are routinely prescribed so that skin remains adequately hydrated.[2]

There are various types of moisturizers available in the market making it difficult for a dermatologist to choose the most effective moisturizer. Furthermore, moisturizers are extensively promoted by various cosmetic companies in the print and electronic media with tall claims of efficacy. Many of them enter into the market without proper clinical studies.[3] Similarly, in India, consumers using these creams have little knowledge of their safety and efficacy as they are sold over-the-counter without prescription by qualified dermatologists. To the best of our knowledge, there are no studies from India, where the efficacy of moisturizers is evaluated in a clinical setting. Recently, digital skin moisture analyzer has been made available which is precise, easy to use, and cost-effective.[4] We conducted a study to analyze average moisture levels over the skin site before and after application of moisturizers with an objective to compare efficacy of three different commonly used skin moisturizers in dermatology practice along with three commonly used over-the-counter moisturizers.


  Materials and Methods Top


A study of moisture level assessment with the help of digital skin moisturizer analyzer was conducted at our tertiary care hospital and referral center. A total of 30 human healthy volunteers of the same age group were enrolled in a study, after permission from Institutional Ethics Committee was obtained.

We selected six sites on the dorsum of hand with a diameter of 1 cm and labeled them A, B, C, D, E, and F. These sites were used for the application of moisturizers.[5] Volunteers were instructed not to apply any topical medicaments 2 weeks before the study. In this study, we used six different commercially available moisturizers namely Emoderm ® cream, Secalia ® cream, Amylac ® cream, Ponds ® cream, Nivea ® cream, Dove ® cream. Baseline moisture level of selected sites (A, B, C, D, E, and F) was measured with the help of digital skin moisture analyzer.

Digital skin moisture analyzer is a portable device that uses bioelectric impedance analysis technology.[6] Skin moisture analyzer immediately and automatically detects skin conditions and displays moisture level on the liquid-crystal display screen as a percentage number. The skin analyzer reads an electrical resistance of the skin which depends on hydration. The dryer the skin, the higher is the electrical impedance.[7] Moisturized skin has much lower resistance as water is the excellent conductor of electricity.

Allocation of above-mentioned moisturizers to labeled test sites was done randomly with the help of random allocation software. Moisturizers were applied and left at the site for 15 min. To get the appropriate readings, this moisturizing analyzer was brought in contact with the selected areas (A, B, C, D, E, and F), and readings are digitally shown on the analyzer. Readings were taken at the end of 15 min, 30 min, and 1 h after application.[8] Volunteers were not allowed any other activity during this period and were sited throughout the 1-h period. The evaluator was blinded for the type of moisturizing cream applied to minimize bias. Readings were taken, and the data were analyzed.


  Results Top


In our study, a group of 30 healthy volunteers were taken. Their ages ranged between 18 and 21 years. The study group consisted of 20 females and 10 males as shown in [Figure 1]. Results of different groups over time are shown in [Figure 2]. This showed a slight drop in moisture levels in all groups except Dove ®. Mean values in different groups are shown in [Table 1].
Figure 1: Graphical distribution of males and females in the study.

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Figure 2: Line graph showing the progression of changes in moisture levels over the period of the study in different study groups.

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Table 1: Mean values of the different groups in over the three observation points

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Change in moisture levels after 15 min

Dove ® moisturizer did not produce a change in the moisture level at the end of 15 min. However, moisture levels were reduced in other groups. With Emoderm ®, the decrease or drop was 27.18% (F vs. A, P = 0.000), with Secalia ® cream - 14.07% (P value-Not significant), Amylac ® - 32.3% (F vs. C, P = 0.000, significant), ponds moisturizer the drop was 32.28% (F vs. D, P = 0.00 significant), Nivea ® - 28.21% (F vs. E, P = 0.00, significant). This indicates the fact that only Dove ® moisturizer could retain the baseline moisture level in the skin without positive or negative change. The difference in the moisture levels after 15 min of the application was statistically significant between Emoderm ® and Dove ® group (P = 0.000) while the difference was statistically insignificant in other groups.

Change in moisture levels at the end of 30 min

Secalia ® moisturizer produced an increase in moisture level over the baseline - 4.76%. However, moisture levels were still below baseline in other groups. With Emoderm ®, the drop in moisture level decreased from 27.18% (at 15 min) to 15.68% (B vs. A, P = 0.005, significant). With Amylac ® - 16.19% (B vs. C, P = 0.001, significant), Ponds ® - 21.35% (B vs. D, P = 0.000, significant), Nivea ® - 16.68% (B vs. E, P = 0.001, significant), and Dove ® - 3.57% (B vs. F, P = 0.274, not significant). This indicates that Secalia ® moisturizer could increase the moisture levels above baseline at the end of 30 min. Dove, which showed no change in moisture level at 15 min interval showed a dip of 3.57% in moisture levels at 30 min. The difference in moisture levels after 30 min of application was statistically significant between Secalia ® and Emoderm ® group (P = 0.005), Secalia ® and Amylac ® group (P = 0.001), Secalia ® and Ponds ® (P = 0.000) and Secalia ® and Nivea ® group (P = 0.001) while the difference was statistically insignificant in other Emoderm ® and Dove ® groups (P = 0.274).

Change in moisture levels at the end of 60 min

Secalia ® moisturizer produced the maximum increase in moisture level over the baseline at the end of 1 h - 21.99%. The only other moisturizers to produce moisture level above baseline after 60 min were Dove ® - 5.02% (B vs. F, P = 0.003, significant) and Amylac ® - 5.66% (B vs. C, P = 0.014, significant). Moisture levels were still below baseline in other groups. With Emoderm ®, the drop in moisture level decreased from 15.68% (at 30 min) to 1.15% (B vs. A, P = 0.000, significant) below baseline at 60 min, with Ponds ® - 7.05% (B vs. D, P = 0.000, significant) and Nivea ® - 9.69% (B vs. E, P = 0.000, significant). This indicates that only Secalia ®, Dove ® and Amylac ® moisturizers could increase the moisture levels above baseline at the end of 60 min. The difference in moisture levels after 60 min of application was statistically significant between Secalia ® and all other groups, Emoderm ® group (P = 0.000), Amylac ® group (P = 0.014), Ponds ® group (P = 0.000), Nivea ® group (P = 0.000), and Dove ® group (P = 0003).


  Discussion Top


A total of 30 volunteers, ages ranging from 18 to 21 years, consisting of 20 females and 10 males in the months of May and June 2014 were included in the study. Volunteers were healthy with no preceding skin diseases. Noninvasive skin moisture measurements were carried out using moisture meter at 15 min, 30 min, and 60 min to determine the short-term improvement in skin properties after single application of moisturizer. Six different moisturizers containing different primary ingredients were compared which included three commercially available moisturizers and three medically approved prescription based moisturizers.

Interpretation of the results revealed that at 15 min, moisture levels dropped after application of five of the six moisturizers. Dove ® moisturizer did not produce a change in the moisture level. A maximum drop of moisture level was seen with Amylac ® cream (ammonium lactate). At the end of 30 min, only 1 moisturizer, that is, Secalia ® (glycerine) showed increase in moisture content over baseline. Dove moisturizer which showed no change in moisture content at 15 min, showed a drop of 3.57%. Ponds cream showed the maximum drop of moisture content. At the end of 60 min, three moisturizers, that is, Secalia ® (glycerine), Amylac ® (ammonium lactate) and Dove ® moisturizers showed an increase in moisture content above the baseline level. Nivea ® cream still showed lowered moisture content by 9.69% after 60 min.

The moisturizers that showed an improvement in moisture content over the baseline were predominantly humectants, that is, Secalia ® which contains glycerin, Amylac ® which contains ammonium lactate and Dove ® which is a mixture of many substances but predominantly contains humectants such as glycerin, potassium lactate, and lactic acid.

The three emollient moisturizers in the group, that is, Emoderm ® (liquid paraffin and white soft paraffin), Ponds ® cream (Volatile hydrocarbon and silicon emollient system) and Nivea ® cream (Aqua Glyceryl stearate citrate - predominantly) showed a decrease in the moisture content of the skin even after a period of 60 min. A possible explanation for this comes from the method of measurement. In our study, a moisture meter is used to measure the bioelectric impedance (electrical resistance to alternating current) of the skin to estimate the water content of the skin. The skin at higher moisture content has lower electrical impedance. Emollients are substances which form a water impermeable layer over the stratum corneum and reduce transepidermal water loss. These substances are usually oily in nature which themselves have higher electrical impedance. This might explain the findings that emollients such as Emoderm ®, Nivea ®, and Ponds ® creams produced a decrease in decrease in moisture level at the end of 60 min. This further suggests that the process of preventing transepidermal water loss to increase the moisture content of the skin might take a longer time to build up, indicating the need of longer study period to account for their effect.

In our study, the Secalia ® (glycerin) moisturizer produced the highest increase in moisture content of the skin. However, the study was performed in the summer (month of May) when very dry weather condition exists. This is contradictory to a common consensus that humectants conversely increase transepidermal water loss and decrease the moisture content of the skin in dry weather. This might be due to good overall hydration of the volunteers as most water absorbed by the humectants is from the dermis when the environmental moisture content is less than 70%.

Our findings do not coincide with the study conducted by Kapoor andSaraf on the hydrating effect of herbal moisturizers which showed 70–80% increase in moisture content of skin at the end of 1 h.[3] In our study, the mean increase in moisture content was with Secalia ® moisturizer which showed 21.99% increase. A possible reason for this could be the sole use of commercial moisturizers in their study. Commercial moisturizers contain a mixture of different compounds making comparison difficult.

None of the volunteers in our study developed irritant or allergic contact dermatitis during the period of application.


  Conclusion Top


The main objective of this study was to evaluate the hydration effect of three medically approved and three commercially available moisturizers using noninvasive bioelectrical techniques. We conclude that epidermal hydration produced by moisturizers influences the electrical properties of skin. Noninvasive skin electrical measurements are appropriate for an objective and quantitative evaluation of the complex effect of different moisturizers on epidermal water content. Commercially available moisturizers are a mixture of various substances while the many of the medically approved moisturizers contain single active ingredient making them reliable for specific treatment. Humectants cause a significant increase in moisture levels as assessed by digital skin moisture analyzer. Further studies with multiple instruments are needed to assess the moisturizing potential of various moisturizers.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Rawlings AV, Harding CR. Moisturization and skin barrier function. Dermatol Ther 2004;17 Suppl 1:43-8.  Back to cited text no. 1
    
2.
Marty JP. NMF and cosmetology of cutaneous hydration. Ann Dermatol Venereol 2002;129 (1 Pt 2):131-6.  Back to cited text no. 2
    
3.
Kapoor S, Saraf S. Assessment of viscoelasticity and hydration effect of herbal moisturizers using bioengineering techniques. Pharmacogn Mag 2010;6:298-304.  Back to cited text no. 3
    
4.
Bettinger J, Gloor M, Vollert A, Kleesz P, Fluhr J, Gehring W. Comparison of different non-invasive test methods with respect to the effect of different moisturizers on skin. Skin Res Technol 1999;5:21-7.  Back to cited text no. 4
    
5.
Bazin R, Fanchon C. Equivalence of face and volar forearm for the testing of moisturizing and firming effect of cosmetics in hydration and biomechanical studies. Int J Cosmet Sci 2006;28:453-60.  Back to cited text no. 5
    
6.
Alanen E, Nuutinen J, Nicklén K, Lahtinen T, Mönkkönen J. Measurement of hydration in the stratum corneum with the MoistureMeter and comparison with the Corneometer. Skin Res Technol 2004;10:32-7.  Back to cited text no. 6
    
7.
Kinoshita K, Hattori K, Ota Y, Kanai T, Shimizu M, Kobayashi H, et al. The measurement of axillary moisture for the assessment of dehydration among older patients: A pilot study. Exp Gerontol 2013;48:255-8.  Back to cited text no. 7
    
8.
Li F, Conroy E, Visscher M, Wickett RR. The ability of electrical measurements to predict skin moisturization. II. Correlation between one-hour measurements and long-term results. J Cosmet Sci 2001;52:23-33.  Back to cited text no. 8
    


    Figures

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    Tables

  [Table 1]



 

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