Moisturizers are a billion-dollar-a-year industry.

They are not just a mere cosmetic product, but they can also serve a medical purpose. Many skin conditions benefit from moisturizers, such as eczema and psoriasis.

The numerous benefits of moisturizers make them the most recommended product in dermatology today.

There is a myriad of different moisturizers on the market, making it difficult to determine which one is right for you based on your particular skin issues.

This article will discuss everything you need to know about moisturizers–what a moisturizer is, is moisturizing necessary, what are the different types of moisturizers, is moisturizing good for your skin, the proper use of moisturizers, and how to pick the right one for you.

Moisturizers and the skin: The basics

Why is the stratum corneum of the skin so important?

The skin is made of 3 main layers: the epidermis (top layer), dermis (middle layer), and fat (bottom layer) (1, 2).

The top layer is further divided into several layers, the top one being the stratum corneum. It is the most important layer when discussing skin hydration and the importance of moisturizers. While it is a layer of dead cells held together with lipids (fats), it is vitally important.

The stratum corneum appears similar to bricks and mortar because of how the cells are arranged. If there is damage to the cells (bricks) or loss of lipids (mortar) in the stratum corneum, the barrier function of the epidermis is compromised.

The barrier function of the epidermis is important for several reasons (3). The epidermis keeps water from escaping. The normal water content of the stratum corneum is 10-30%. When it dips below 10%, the skin is considered dry.

Water in the skin keeps the enzymes functioning properly. These enzymes are responsible for keeping the skin healthy (4). Water maintains the elasticity of the skin, flushes out toxins, regulates the flow or transport of nutrients into the skin, as well as helps to regulate temperature.

The epidermis is also charged with the gatekeeper function (5, 6). It regulates what is allowed to enter the skin and subsequently the body. If the barrier is not working properly, microbes can enter and infections can occur.

It also keeps out the harsh environment, like UV and chemicals which can damage the skin and the body.

How do I know if I have dry skin?

The determination of dry skin is based on tactile and visible clues (1). If your skin is dry, it looks dull, rough, and flaky. It may feel tight, itchy, or stinging.

What is a moisturizer?

A moisturizer is a compound that hydrates the top layer of the skin (stratum corneum) and protects it by altering the chemical and physical nature of the skin (1, 2). Moisturizers accomplish this by direct (occlusives) or indirect (humectants) mechanisms.

It is a very important product in your skin care armamentarium, especially if you have certain skin conditions, like eczema, or use certain topical medications, like retinoids, which can dry out the skin.

Moisturizers are usually made of an emulsion of oil and water (7, 8). The purpose of moisturizers is not only to hydrate the skin, but also to deliver other ingredients, such as antioxidants for anti-aging and skin protection, anti-inflammatories to calm and soothe the skin, anti-microbials to prevent infection, sunscreens, and other nourishing ingredients.

What are the different types of moisturizers?

There are 3 types of moisturizers: humectants, occlusives, and emollients (1, 2, 9-11). Oftentimes, all 3 are present in moisturizers or 2 of the 3. The best moisturizers contain a combination of ingredients.

For example, humectants will pull water into the skin and occlusives will seal it in, making it a powerful combination to combat dry skin. Creams contain more occlusives, while lotions contain mostly humectants.

1. Humectants:

These moisturizers attract water from the atmosphere or from the dermis and pull it into the epidermis. Many humectants also have emollient properties. It is best if a moisturizer has a combination of a humectant and an occlusive because while the humectant pulls in the water, the occlusive keeps it in the epidermis.

The only problem arises when there is no water in the atmosphere to pull from, such as when the humidity is less than 70%. Then it will pull from the dermis only and lead to further dehydration of the skin.

Here are some examples:

• • Glycerin
  • Honey
  • Hyaluronic acid
  • Urea
  • Alpha-hydroxy acids (glycolic acid, lactic acid)

2. Occlusives:

These compounds lock in moisture so it cannot escape the epidermis through evaporation, like a protective blanket for the skin that is long-lasting.

This escape of water is called trans-epidermal water loss (TEWL). Occlusives are the best at preventing TEWL. They also act as a barrier to protect the skin from the harsh environment around it preventing the penetration of unwanted microbes or chemicals.

Occlusives are usually thick and greasy in texture. The classic example and best occlusive is petrolatum. Petrolatum cuts water loss from the epidermis by 99%. Some occlusives are also emollients. It is best to apply these to damp skin.

Also, since occlusives do not allow moisture to leave, they also do not allow air to penetrate. These are not the best choice for acne-prone patients. They also do not work well for daytime use as they are very greasy and make it difficult to apply makeup. Occlusives are also difficult to wear in hot humid environments.

Here are some examples:

• Petrolatum
• Mineral oil
• Silicones
• Lanolin
• Coconut or olive oil

3. Emollients:

These compounds are frequently oily or creamy in texture and serve to make the skin feel smooth, soft, and moisturized. Their job is to rebuild the lipids in the skin and thus improve the barrier function of the skin.

Some emollients are also occlusives or humectants. Some emollients can worsen acne-prone skin, so make sure you choose one that is not oil-based.

Here are some examples:

• Jojoba oil
• Cetyl alcohol
• Dimethicone
• Shea butter
• Safflower oil

The purpose of moisturizers

What does moisturizer do?

There are several benefits of moisturizing the face and body every day (1, 2, 12-14).

1. Prevent dry skin:

Moisturizing every day will prevent dry skin. When the skin gets dry and cracks, it is susceptible to problems. One of which is the possibility of infection. These cracks allow the entrance of bacteria into the skin. Dry skin also has impaired barrier function and cannot ward off these microbes.

2. Prevent exacerbation of skin conditions:

Dry skin can also exacerbate eczema, a skin condition caused by impaired immunity. Eczema causes rashes and leaves patients susceptible to infections. The best moisturizers for dry or sensitive skin are thick creams or ointments.

3. Prevent worsen of oily skin:

A common question I get asked is, does moisturizer prevent acne. If you do not moisturize oily skin, it will lead to a worsening of oily skin as well as acne. It is a myth that you should not moisturize if you have oily skin. Patients with oily skin should use a gel or lightweight lotion moisturizer.

 4. Treat wrinkles:

Hydrating dry skin will make the wrinkles less apparent. Also, moisturizers will give you a healthy glow that can help mask blemishes. Moisturized skin looks plump and firm like youthful skin.

How and when to use moisturizers for maximum benefit

When should I apply moisturizers?

It is important to use moisturizers twice a day to keep your skin hydrated and protected at all times.

Here are some reasons why:

1. The skin is constantly changing and sloughing dead skin cells
2. Products do not normally last more than a few hours
3. Washing your face removes the moisturizer

It is best to apply moisturizers twice a day after washing your face (1). However, some people with very dry skin or certain skin conditions, like eczema, may need to apply moisturizers more than twice a day.

Make sure you use warm water to wash your face. Hot water will irritate your skin and you will lose more moisture. It is important to use mild liquid cleansers to wash your face. Soaps usually have an alkaline pH and can upset the normal acidic nature of your skin.

When the pH is altered, this leaves your skin susceptible to infections and water loss.

Also, shower for short periods of time. Extended showers will rob your skin of moisture. Make sure you pat your face dry with a clean soft towel. Do not rub or scrub as it will irritate your skin.

If you have dry skin you should apply moisturizers right after washing your face and while it is still damp. This will help lock in the water to hydrate the skin.

How should I apply moisturizers?

You should massage the moisturizers gently into your skin with upward movements (1). Rubbing will just irritate the skin and inflame it. Massaging moisturizers into the skin will also help stimulate blood circulation to keep skin healthy and glowing.

You always want to massage in the direction of hair growth. Do not rub vigorously, as this may cause oil folliculitis.

What type of moisturizer should I use?

Moisturizers come in gel, lotion, cream, and ointment forms (1). The best one for your skin is based on skin type. If you use the wrong one, it could have unwanted side effects.

For example, if you have oily skin and you use an ointment on your face, it will clog your pores and lead to worsening of your oily skin and acne.

1. Oily or acne-prone skin:

The best form of moisturizer for oily skin is a non-comedogenic gel or lightweight lotion. Anything thicker will make your face greasier and clog your pores leading to acne breakouts.

Skinceuticals makes a gel moisturizer, Hydrating B5 Gel, that is hydrating but not greasy. La Roche Posay has a light moisturizer called Hydraphase Intense Hyaluronic Acid Moisturizer.

2. Dry or sensitive skin:

If you have dry skin on your face, thicker creams will hydrate better. Ointments may be too thick for the face and lead to clogged pores. They are best used on other parts of the body.

La Roche Posay Toleriane Double Repair Face Moisturizer is great for dry skin on the face. Vaseline petroleum jelly, Cetaphil cream, or Aquaphor ointment are great for the body.

 3. Normal skin:

You have won the skin lottery. Use can use whatever feels best for your skin. The ZELEN Life Moisturizer is a good choice for normal skin but can be used in all skin types.

It contains several moisturizing ingredients, such as jojoba oil, coconut oil, sweet almond oil, and sunflower oil.

 4. Combination skin:

Listen to what your skin is asking for on the different parts of your face. Use a non-comedogenic gel or lotion for the oily areas and a cream for the dry areas.

Moisturizing ingredients that benefit the skin

Should I select a moisturizer with antioxidants?

Antioxidants are an essential part of your anti-aging skin care routine (1, 2, 16-18). They scavenge up free radicals that are produced by the UV rays of the sun, pollution, smoking, alcohol, and poor diet.

These free radicals are unstable molecules because they have an unpaired electron. Therefore, they are always searching for other molecules to steal an electron from, so they can become stable.

When they steal an electron from collagen, they destroy your collagen. Since collagen is what gives our skin thickness and firmness and a youthful appearance, you must protect your collagen.

Antioxidants will donate an electron to the free radicals and neutralize them to protect your collagen. Also, some antioxidants have other benefits as well.

Vitamin C:

Vitamin C is one of the strongest anti-oxidants (1, 2, 19). It can help to lighten dark sunspots and help to stimulate collagen production to decrease fine lines and wrinkles.

La Roche Posay makes a vitamin C cream called Active Vitamin C Wrinkle Cream which contains vitamin E and hyaluronic acid as well. If you are looking for a serum, Skinceuticals CE Ferulic is always at the top of the list.

Vitamin E:

Vitamin E can also help hydrate the skin by stabilizing the skin’s barrier function (1, 2, 20).

Green tea:

Green tea helps to prevent collagen breakdown to fight wrinkle formation, and it is also an anti-inflammatory to help with rosacea and chemopreventative to help fight skin cancer (1, 21). Birchbox makes a green tea cream called 100% Pure Green Tea EGCG Concentrate Cream.

Niacinamide (vitamin B3):

This can help hydrate the skin to reduce the appearance of fine lines and wrinkles and act as an anti-inflammatory to help with rosacea and acne (1, 22). Metacell Renewal B3 by Skinceuticals is a good choice.

Resveratrol:

Contained in red wine, resveratrol is also an excellent anti-inflammatory ingredient, as well as anti-microbial and chemopreventative (1, 23). A good selection is Resveratrol by Skinceuticals.

Will retinoids in my moisturizer help my skin?

Retinoids are an excellent addition to your anti-aging regimen (1, 2). They do many things that will help your skin. Not only do they stimulate collagen production, but they also exfoliate dead skin cells, help lighten dark spots on the skin, and decrease oil production to help with acne.

If you have dry or sensitive skin, you may need to start with low strength retinol or use it less frequently to start as it may irritate your skin. Oftentimes, you may need to use more moisturizers to help with the dryness it may cause.

If you are concerned about how your skin will react, you can always try a small test spot first, for a week or two, before you apply it to your entire face.

Retinol Refining Night Cream by Skinceuticals always ranks at the top of the list for facial moisturizers that contain retinol. Olay Regenerist and ROC retinol also have moisturizers with retinol, which are more affordable.

Should there be alpha hydroxy acids in my moisturizer?

Alpha hydroxy acids are humectant moisturizers that can pull water into the epidermis (1, 2). They also function to exfoliate dead skin cells, decrease oil production and even stimulate collagen production. They are a great addition to your skin care routine.

If you have sensitive skin or dry skin, these may irritate your skin. It is best to start at a low strength and use less frequently when starting so you can see how your skin will react to it. It is always worthwhile to try a test spot first to see how your skin will react. Amlactin makes an excellent lactic acid moisturizer for the body. Skinceuticals has a facial moisturizer with glycolic acid called Glycolic 10 Renew Face Cream.

Do I need ceramides in my moisturizer?

The addition of lipids, such as ceramides, fatty acids, cholesterol, and pseudoceramides, is a new technology in which moisturizers can help repair the barrier function of the skin(1, 2).

When the barrier of the skin becomes impaired through loss of lipids, such as in the case of eczema, there is increased water loss and subsequent dehydration of the skin.

These lipids plug the holes in the dysfunctional barrier and keep the skin safe. The correct ratio of ceramides, fatty acids, and cholesterol is critical to the repair of the skin.

Moisturizing ingredients that can affect the skin

What should ingredients should I avoid?

There are a few ingredients that you should avoid, depending on your skin type (1, 2, 15).

Oily skin:

Mineral oil, petrolatum, sulfates, and silicones may clog your pores and worsen your acne. Mineral oil and petrolatum are excellent occlusive moisturizers and can be used in non-acne-prone areas.

Dry or sensitive skin:

Avoid dyes, fragrances, alcohols, parabens, lanolin, propylene glycol, and sulfates as they may irritate your skin. You may have to avoid acids and retinoids, depending on your skin. You may need to try a test spot first to determine if you can tolerate acids and retinoids.

Fragrance:

Fragrance is probably the most common irritant in moisturizers. Even products that are unscented still have fragrances in them. Balsam of Peru is a common fragrance additive. Even essential oils added for fragrance can irritate the skin, especially those with sensitive skin. Just because they are natural ingredients does not mean that they cannot hurt you. Just remember poison ivy is natural.

Alcohol:

Alcohol can be very drying to the skin especially in people with eczema.

Parabens:

These are preservatives to keep bacteria and fungi from growing in cosmetic products, however, they can be irritating or even cause allergic reactions. It is controversial whether parabens can disrupt hormones leading to an increase in risk for breast cancer. Other irritating preservatives are benzyl alcohol and methylisothiazolinone.

Dyes:

Dyes like Yellow #6 have been shown to irritate the skin.

Acids

Like glycolic or lactic or salicylic acid can irritate the skin. While they are excellent products for anti-aging or acne control, they can irritate some people, especially those with eczema. Care should be exercised when starting these products.

Just, like with acids, retinoids are amazing products but can irritate people with sensitive skin. Care should be exercised when starting these products if you do have eczema, sensitive or dry skin.

Propylene glycol:

This is a humectant moisturizer but is also used as a preservative. It may irritate those with sensitive skin or even cause allergic reactions.

Lanolin:

Lanolin is an occlusive moisturizer that is made from the secretions of sheep’s skin, which is similar to our sebum. However, it can also irritate sensitive skin or cause allergic reactions.

Formaldehyde releases:

Such as, Quarternium 15, has caused irritation and allergic reactions. These function as preservatives and disinfectants.

Alkaline pH:

It is important to select skincare products that are slightly acidic since the skin functions optimally in an acid environment. The acid mantle, a protective film on the stratum corneum, functions best at a pH of about 5.

At the proper pH, the skin can protect against microbes, dehydration, premature shedding of skin cells, and prevention of diseases, like eczema or acne.

The benefits of moisturizers with other products

If I am already using a daytime facial moisturizer, do I need a night cream?

Having 2 different moisturizers, one for the day and a different one for the night will help your skin because each one does a different job besides just moisturizing the skin (1).

Daytime moisturizers are usually lightweight so that your face doesn’t look greasy and you can easily apply makeup.

Night creams are thicker and contain important nutrients for the repair of your skin. Nighttime is the best time to apply these nutrients because your skin regenerates at night while you are sleeping.

During the day, your skin is too busy warding off free radicals from the sun and pollution, it doesn’t have time to repair. Some of my favorite night creams are Triple Lipid Restore by Skinceuticals or Dermal Repair Cream by Skin Medica.

If I am already using a facial moisturizer, do I need an eye cream?

Yes, you do need a special eye cream (1). The eye area is very delicate and prone to wrinkling and dehydration. It needs a special thicker formulation than what you would put on your face.

It is important to pat gently to apply eye creams. You do not need to rub vigorously because this may irritate this delicate area.

Oftentimes eye creams contain special ingredients just for the eye area to help rejuvenate it or fix a specific problem.

Dark circles:

Select creams with vitamin C, kojic acid, or hydroquinone, such as Revitalift Triple Power Eye Cream by L’Oreal

Puffiness or bags:

Caffeine can help constrict the blood vessels and lessen the puffiness, such as Pigmentclar Eye Cream by La Roche Posay. The diuretic and cooling effect of cucumber can help as well.

Wrinkles:

Look for retinoids to help with anti-aging, such as Redermic Retinol Eye Cream by La Roche Posay.

Oily skin:

Gels with hyaluronic acid can help hydrate without causing greasiness. Such as Skinceuticals Hydrating B5 Gel.

Dry skin:

Thicker creams or even petrolatum can help hydrate the skin in this area.

Do soaps and cleansers play a role in dry skin?

The selection of cleansers can impact positively or negatively on the dryness of your skin (24, 25). There are 4 types of cleansers: soap, syndet, combars, and lipid-free liquid cleaners.

• Soaps are great at cleaning the skin, but because they have a high alkaline pH, they can strip the skin of natural oils and damage it. These are not good for skin especially those with dry sensitive skin, like eczema.
• Syndet or synthetic detergents have very small amounts of soap so their pH is closer to acidic and preferable for the skin.
• Combars contain soap, syndet, and antibacterial agents, which are great at getting rid of bacteria, but not good for skin health especially those with dry sensitive skin.
• Lipid-free liquid cleansers have no soap and they leave behind moisturizers to protect the skin. This makes them ideal for people with dry sensitive skin.

Conclusion

Moisturizers are a very important part of your skin care regimen.

The benefits of facial moisturizers are twofold. Not only do they moisturize dry skin but they can also deliver antioxidants to help with anti-aging, as well as ingredients to help with certain skin conditions like acne and eczema.

When your skin is not moisturized and hydrated it does not function properly and does not look or feel good.

Proper hydration restores your skin to a healthy state, which is one of the most important benefits of moisturizing skin. When your skin looks good and feels good, this can be a huge boost to your self-esteem.

Choosing the right ingredients is critical to keeping your skin healthy. Oftentimes, it is trial and error until you find the right moisturizer for you, but it is worth the time and effort.

References

1. Baumann L (ed) 2015. Cosmeceuticals and Cosmetic Ingredients. McGraw-Hill Education, NY.

2. Draelos ZD (ed) 2005. Cosmeceuticals. Elsevier Inc, NY.

3. Harwood A, Nassereddin A, Krishnamurthy K. Moisturizers. 2020 Jun 2. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 31424755.

4. Palma L, Marques LT, Bujan J, Rodrigues LM. Dietary water affects human skin hydration and biomechanics. Clin Cosmet Investig Dermatol. 2015 Aug 3;8:413-21. doi: 10.2147/CCID.S86822. PMID: 26345226; PMCID: PMC4529263.

5. Schmid-Wendtner MH, Korting HC. The pH of the skin surface and its impact on the barrier function. Skin Pharmacol Physiol. 2006;19(6):296-302. doi: 10.1159/000094670. Epub 2006 Jul 19. PMID: 16864974.

6. Elias PM. Primary role of barrier dysfunction in the pathogenesis of atopic dermatitis. Exp Dermatol. 2018 Aug;27(8):847-851. doi: 10.1111/exd.13693. PMID: 29799646.

7. Sethi A, Kaur T, Malhotra SK, Gambhir ML. Moisturizers: The Slippery Road. Indian J Dermatol. 2016 May-Jun;61(3):279-87. doi: 10.4103/0019-5154.182427. PMID: 27293248; PMCID: PMC4885180.

8. Draelos ZD. Active agents in common skin care products. Plast Reconstr Surg. 2010 Feb;125(2):719-724. doi: 10.1097/PRS.0b013e3181c83192. PMID: 20124857.

9. Draelos ZD. The science behind skin care: Moisturizers. J Cosmet Dermatol. 2018 Apr;17(2):138-144. doi: 10.1111/jocd.12490. Epub 2018 Jan 10. PMID: 29319217.

10. Baumann L (ed) 2009. Cosmetic Dermatology: Principles and Practice. McGraw-Hill Education, NY.

11. Lynde CW. Moisturizers: what they are and how they work. Skin Therapy Lett. 2001 Dec;6(13):3-5. PMID: 11813097.

12. Draelos ZD. Therapeutic moisturizers. Dermatol Clin. 2000 Oct;18(4):597-607. doi: 10.1016/s0733-8635(05)70210-2. PMID: 11059367.

13. Kottner J, Lichterfeld A, Blume-Peytavi U. Maintaining skin integrity in the aged: a systematic review. Br J Dermatol. 2013 Sep;169(3):528-42. doi: 10.1111/bjd.12469. PMID: 23773110.

14. Draelos ZD. Concepts in skin care maintenance. Cutis. 2005 Dec;76(6 Suppl):19-25. PMID: 16869178.

15. Zirwas MJ. Contact Dermatitis to Cosmetics. Clin Rev Allergy Immunol. 2019 Feb;56(1):119-128. doi: 10.1007/s12016-018-8717-9. PMID: 30421329.

16. Baumann L. Skin ageing and its treatment. J Pathol. 2007 Jan;211(2):241-51.

17. Kraft JN, Lynde CW. Moisturizers: what they are and a practical approach to product selection. Skin Therapy Lett. 2005 Jun;10(5):1-8. PMID: 15986082.

18. Chularojanamontri L, Tuchinda P, Kulthanan K, Pongparit K. Moisturizers for Acne: What are their Constituents? J Clin Aesthet Dermatol. 2014 May;7(5):36-44. PMID: 24847408; PMCID: PMC4025519.

19. Farris PK. Topical vitamin C: a useful agent for treating photoaging and other dermatologic conditions. Dermatol Surg. 2005 Jul;31(7 Pt 2):814-7; discussion 818.

20. Thiele JJ, Hsieh SN, Ekanayake-Mudiyanselage S. Vitamin E: critical review of its current use in cosmetic and clinical dermatology. Dermatol Surg. 2005 Jul;31(7 Pt 2):805-13; discussion 813.

21. Nichols JA, Katiyar SK. Skin photoprotection by natural polyphenols: anti-inflammatory, antioxidant and DNA repair mechanisms. Arch Dermatol Res. 2010 Mar;302(2):71-83.

22. Rolfe HM. A review of nicotinamide: treatment of skin diseases and potential side effects. J Cosmet Dermatol. 2014 Dec;13(4):324-8.

23. Farris P, Krutmann J, Li YH, McDaniel D, Krol Y. Resveratrol: a unique antioxidant offering a multi-mechanistic approach for treating aging skin. J Drugs Dermatol. 2013 Dec;12(12):1389-94.

24. Ananthapadmanabhan KP, Moore DJ, Subramanyan K, Misra M, Meyer F. Cleansing without compromise: the impact of cleansers on the skin barrier and the technology of mild cleansing. Dermatol Ther. 2004;17 Suppl 1:16-25. doi: 10.1111/j.1396-0296.2004.04s1002.x. PMID: 14728695.

25. Levin J, Miller R. A guide to the ingredients and potential benefits of over the counter cleansers and moisturizers for rosacea patients. J Clin Aesthetic Dermatol. 2011; 4: 31-49.