Posted on Leave a comment

Moisturizers for Acne: What are their Constituents?

J Clin Aesthet Dermatol. 2014 May; 7(5): 36–44.

What are their Constituents?

Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

corresponding authorCorresponding author.This article has been cited by other articles in PMC.

Abstract

Acne is a chronic inflammatory disease of the pilosebaceous unit that affects almost all teenagers. Different treatments offer different modes of action, but aim to target acne pathology. Topical therapies, such as benzoyl peroxide, retinoids, antibiotics with alcohol-based preparations, and salicylic acid, can cause skin irritation resulting in a lack of patient adherence. Some physicians recommend patients use moisturizers as adjunctive treatment of acne, especially when either topical benzoyl peroxide or a retinoid is prescribed. Furthermore, some evidence shows that moisturizers can contribute independently to improve signs and symptoms of acne. Moisturizers contain three main properties, which are occlusive, humectant, and emollient effects. Currently, many moisturizers claim to be suitable for acne treatment. This article aims to provide a review of the active ingredients and properties of those moisturizers. Fifty-two moisturizers for acne were included for analysis. Most of the products (92%) have anti-inflammatory properties apart from occlusive, humectant, and emollient effects. Anti-acne medications, including salicylic acid, benzoyl peroxide, and retinol, were found respectively in 35, 10, and 8 percent of the moisturizer products containing anti-inflammatory properties. More than half of the products contain dimethicone and/or glycerin for its moisturizer property. Aloe vera and witch hazel are botanical anti-inflammatories that were commonly found in this study. Scientific data regarding some ingredients are discussed to provide a guide for physicians in selecting moisturizers for acne patients.

Acne is a chronic inflammatory disease of the pilosebaceous unit that affects almost all teenagers between the ages of 15 and 17 years.1 Clinical features include oily skin, noninflammatory lesions (open and closed comedones), inflammatory lesions (papules and pustules), and various degrees of scarring. Increased sebum production under androgen control, alteration of the keratinization, follicular colonization by Propionibacterium acnes, and inflammation are four main processes in the pathogenesis of the disease.

Different treatments of acne offer different modes of action, but aim to target the four aspects of acne pathology. Topical therapies, such as benzoyl peroxide (BP), retinoids, antibiotics with alcohol-based preparations, and salicylic acid (SA), can cause skin irritation resulting in a lack of patient adherence. Similarly, oral isotretinoin, which is the most effective medication for acne, usually causes dry skin, cheilitis, and photosensitivity.1 Dryness or skin irritation may cause barrier disruption of the stratum corneum leading to increased transepidermal water loss (TEWL) and production of inflammation.2 Thus, some physicians recommend patients use moisturizers as adjunctive treatment of acne, especially when either topical BP or retinoid is prescribed.3 Furthermore, some evidence shows that moisturizers can contribute independently to improve signs and symptoms of acne.1

Moisturizers contain three main properties, which are the occlusive, humectant, and emollient effects. The occlusive ingredients physically block TEWL by forming a hydrophobic film on the skin surface and within the superficial interstitium between corneocytes.45 Occlusive agents, such as petrolatum, lanolin, mineral oil, paraffin, squalene, and silicone derivatives (dimethicone, cyclomethicone), are usually greasy.4 Silicone derivatives are often used in combination with petrolatum, which make them greasy. However, silicone derivatives that have not been combined with other ingredients are not greasy. The second property of moisturizers is humectant, which attracts water from the dermis to epidermis. Examples of humectants are glycerin (glycerol), sodium lactate, ammonium lactate, hyaluronic acid, sorbitol, urea, and alpha hydroxyl acids.1,4 The other property of moisturizers is emollient, which smooths skin by filling space between skin flakes with a droplet of oil.1 Emollients include a vast array of compounds ranging from esters to long chain alcohols, such as isopropyl isostearate, caster oil, propylene glycol, octyl stearate, and dimethicone.1 One ingredient of moisturizers can have more than one property, such as dimethicone, which has both occlusive and emollient properties. Other ingredients including topical medications for acne and botanical antiinflammatory substances are sometimes added to moisturizers for acne.

Currently, many moisturizers that are available either over the counter or online claim that they are suitable for acne treatment. The current study was designed to investigate the active ingredients and properties of those moisturizers.

MATERIAL AND METHODS

The authors used the key words “moisturizers” and “acne” to search for moisturizers that are available online. Only moisturizers that claimed they are suitable for acne, blemishes, and pimples were selected to identify their ingredients and properties. The same inclusion criteria were used for moisturizers that are available over the counter. Each moisturizer with its corresponding ingredients was entered into a Microsoft Excel (Seattle, Washington) spreadsheet and then evaluated for their ingredients and properties.

RESULTS

Fifty-two products were included for analysis. demonstrates the active ingredients and their properties that the authors were able to identify in the products. Some ingredients also have an oil-reducing property, which may be suitable for oily skin. Ninety-two percent (48/52) of the products have anti-inflammatory properties apart from occlusive, humectant, and emollient effects. demonstrates a list of the products and their ingredients that do not contain anti-inflammatory properties. Antiacne medications, including SA, BP, and retinol were found, respectively, in 35 percent (17/48), 10 percent (5/48), and 8 percent (4/48) of the moisturizer products containing anti-inflammatory effects ( and ). Twenty-two of 48 products (46%) contained other antiinflammatory substances without anti-acne medications (). More than one-half of all products contain dimethicone and/or glycerin for their moisturizing properties. Aloe vera and witch hazel, botanical antiinflammatories, were commonly found in the products as well.

TABLE 1

Active ingredients in moisturizers for acne

ACTIVE INGREDIENTS PROPERTIES
OCCLUSIVES HUMECTANTS EMOLLEINTS ANTI-INFLAMMATORY OIL-REDUCING
1. Almond oil
2. Aloe vera (Aloe barbadensis)
3. Arachidyl alcohol
4. Beeswax
5. Benzoyl peroxide
6. Betaine
7. Bisabolol
8. Butylene glycol
9. Caprylic/capric triglyceride
10. Cetearyl alcohol
11. Cetyl alcohol
12. Chamomile (Matricaria recutita)
13. Cholesterol
14. Cocoa butter
15. Coconut oil
16. Cetearyl isononanoate
17. Cucumber extract
18. Cyclomethicone
19. Cyclopentasiloxane
20. Decyl oleate
21. Dimethicone
22. Ethylhexylpalmitate
23. Fatty acids
24. Glycerin (glycerol)
25. Glyceryl stearate
26. Glycyrrhetinic acid
27. Grape seed oil
28. Green tea extract
29. Honey
30. Hyaluronic acid
31. Hypericum perforatum (St. John’s wort)
32. Jojoba oil
33. Isohexadecane
34. Isopropyl myristate
35. Lactic acid
36. Lanolin (wool alcohol)
37. Lecithin
38. Licochalcone A

TABLE 2

Moisturizers without anti-inflammatory properties

ACTIVE INGREDIENTS PRODUCTS
1 2 3 4
MOISTURIZER EFFECT
Cetyl alcohol
Glycerin (glycerol)
Isopropyl myristate
Jojoba oil
Mineral oil (Paraffinum liquidum)
Paraffin
Propylene glycol
Squalane
Stearic acid
Vitamin E

TABLE 3

Moisturizers containing salicylic acid

ACTIVE INGREDIENTS PRODUCTS
5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
MOISTURIZER EFFECT
Arachidyl alcohol
Butylene glycol
Caprylic/capric triglyceride
Cetearyl alcohol
Cetyl alcohol
Cyclopentasiloxane
Dimethicone
Ethylhexylpalmitate
Glycerin (glycerol)
Glyceryl stearate
Isohexadecane
Lactic acid
Lecithin
Mineral oil (Paraffinum liquidum)
Propylene glycol
Safflower oil
Sodium pyrrolidone carboxylic acid (PCA)
Sorbital
Squalane
Stearic acid
Stearyl alcohol
Sunflower seed oil (Helianthus annuus)
Vitamin E
Aloe vera (Aloe barbadensis)
Chamomile (Matricaria recutita)
Cucumber extract
Licochalcone A
SALICYLIC ACID
Tea tree oil (Melaleuca alternifolia)
Vitis vinifera (grape seed extract)
Witch hazel (Hamamelis virginiana)
Zinc gluconate

TABLE 4

Moisturizers containing benzoyl peroxide or retinol

ACTIVE INGREDIENTS PRODUCTS
22 23 24 25 26 27 28 29 30
MOISTURIZER EFFECT
Betaine
Butylene glycol
Caprylic/capric triglyceride
Cetearyl alcohol
Cetyl alcohol
Cholesterol
Cyclopentasiloxane
Dimethicone
Ethylhexylpalmitate
Glycerin (glycerol)
Glyceryl stearate
Grape seed oil
Honey
Hyaluronic acid
Isohexadecane
Jojoba oil
Lactic acid
Myristyl ether propionate
Olive oil
Panthenol
Propylene glycol
Sodium hyaluronate
Sodium pyrrolidone carboxylic acid (PCA)
Sorbital
Sugars
Sunflower seed oil (Helianthus annuus)
Vitamin E
Zinc oxide
ANTI-INFLAMMATORY
Aloe vera (Aloe barbadensis)
BENZOYL PEROXIDE
Bisabolol
Chamomile (Matricaria recutita)
Green tea extract
Marigold (Calendura officinalis)
Niacinamide/nicotinamide/vitamin B3
RETINOL
Tea tree oil (Melaleuca alternifolia)
Vitis vinifera (Grape seed extract)
Witch hazel (Hamamelis virginiana)

TABLE 5

Anti-inflammatory moisturizers without anti-acne medications

ACTIVE INGREDIENTS PRODUCTS
31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
MOISTURIZER EFFECT
Almond oil
Beeswax
Butylene glycol
Caprylic/capric triglyceride
Cetearyl alcohol
Cetearyl isononanoate
Cetyl alcohol
Cocoa butter
Cyclopentasiloxane
Decyl oleate
Dimethicone
Fatty acids
Glycerin (glycerol)
Glyceryl stearate
Grape seed oil
Jojoba oil
Lactic acid
Lanolin
Lecithin
Marigold
Octyldodecanol
Olive oil
Panthenol
Propylene glycol
Saccharide isomerate
Sodium hyaluronate
Sodium pyrrolidone carboxylic acid (PCA)
Squalane
Stearic acid
Stearyl alcohol
Sugars
Vitamin E
ANTI-INFLAMMATORY
Aloe vera (Aloe barbadensis)
Chamomile (Matricaria recutita)
Cucumber extract
Glycyrrhetinic acid
Green tea extract
Licochalcone A
Marigold (Calendula officinalis)
Niacinamide/ Nicotinamide/ Vitamin B3
Shea butter (Butyrospermum parkii)
Tea tree oil (Melaleuca alternifolia)
Vitis vinifera (Grape seed extract)
Witch hazel (Hamamelis virglnlana)
Zinc gluconate

DISCUSSION

Topical therapies, including SA, BP, retinoids, and antibiotics are effective in managing acne, but are associated with local adverse effects, such as irritation and dryness. A concomitant use of moisturizers can enhance efficacy, alleviate dryness, and improve skin comfort. The study by Laquieze et al6 showed that using moisturizers provided a significant improvement in skin dryness and comfort to the patients who were treated with oral or topical isotretinoin. From the study described herein, the authors found that SA was the most common anti-acne medication added in the moisturizers for acne. SA has comedolytic effects by breaking down follicular plugs because of its lipophilic nature and anti-inflammatory capability by affecting arachidonic acid cascade.710

However, SA is likely to cause local skin peeling when used at concentrations of 2% or more.11 Thus, moisturizing properties in the products can relieve the irritation effect of SA. O’Goshi et al12 demonstrated an increase in skin hydration of the skin of swine after applying 10% SA in petrolatum once daily for five days. The continuous effect was also detected over two weeks after cessation of application.12

Similarly, BP and retinols are regarded as irritative agents. BP has greater activity than topical (iso) tretinoin against inflammatory lesions while retinoids work well for comedolytic effects and decrease sebum excretion.1 Although the concentration of BP used for acne is limited by local skin irritation, there were no significant differences in frequency and severity of irritation between the use of 5% and 2.5% BP.13 The study by Matsunaga et al showed that the adjunctive use of a moisturizer (Cetaphil®, Galderma Laboratories, L.P) improved local tolerance of adapalene gel.6

Dimethicone and glycerin were the most common ingredients found in the products. Dimethicone and cyclomethicone are silicone derivatives and usually used in oil-free facial moisturizers.4 The term “oil-free” implies that this substance does not contain either mineral oil or vegetable oil.4 Dimethicone reduces TEWL without a greasy feel and contains both occlusive and emollient properties. It is suitable for acne and sensitive patients as it is noncomedogenic and hypoallergenic. Cyclomethicone is a thicker silicone that has similar properties as dimethicone. The authors found that other ingredients, such as petrolatum, lanolin, and mineral oil, were occasionally added in the 52 products analyzed, as they have some drawbacks for acne-prone skin. The use of lanolin is limited by odor, expense, and the fact that it is a common cause of allergic contact dermatitis.4,14 Mineral oil is a lightweight inexpensive oil that is odorless and tasteless. One of the main concerns for its use is that it is comedogenic. However, there are different grades of mineral oil, including industrial grade and cosmetic grade. Some experts believe that cosmetic grade mineral oil is noncomedogenic.4,15

Glycerin is the most effective humectant available to increase stratum corneum hydration.16 If the concentration of glycerin is too high, it will create a sticky feeling on skin. Hyarulonic acid and sodium pyrrolidone carboxylic acid (PCA), which are humectants, may be used in addition to glycerin to decrease stickiness. It should be noted that application of a humectant alone can increase TEWL. For example, glycerin (glycerol) can increase TEWL by 29 percent.4 Thus, a humectant agent is usually combined with an occlusive ingredient when used as a moisturizer. The authors found that glycerin (humectant) and dimethicone (occlusive agent) were usually used in combination in the 52 products analyzed.

Metals and botanical extracts are sometimes added in the moisturizers for their anti-inflammatory properties. Ginkgo biloba, green tea, aloe vera, allantoin, and licochalcone are botanical anti-inflammatory agents that are commonly used in the current market.17 Aloe vera and witch hazel, which were found commonly in this study, also have skin-soothing properties.17 The anti-inflammatory effect of aloe vera results from inhibition of cyclooxygenase in the arachidonic pathway. The concentration of aloe vera should be at least 10 percent in order to have a moisturizing effect.4,17 Witch hazel is commonly used as an astringent in people with oily skin. Its high tannin content obtained by steam distillation of the plant may cause astringent action. Hamamelis ointments, known as witch hazel ointments, are used as acne cosmeceuticals.4,17

Currently, there are many metals, such as zinc, copper, selenium, aluminum, and strontium, that are used in cosmeceuticals.17 Well-established scientific data support the anti-inflammatory and wound healing benefits of zinc. Alkaline phosphatase requires multiple zinc ions, which are involved in adenosine monophosphate metabolism.4,17 This action has a role in restraining an inflammatory response.

In conclusion, the authors aim was to investigate the ingredients and properties of moisturizers claimed to be suitable for use in acne patients. Some scientific data regarding the properties and mechanisms of action were provided to aid physicians in selecting a suitable moisturizer for their acne patients.

Footnotes

DISCLOSURE:The authors report no relevant conflicts of interest.

REFERENCES

1. Williams HC, Dellavalle RP, Garner S. Acne vulgaris. Lancet. 2012;379:361–379. [PubMed] [Google Scholar]2. Lynde C. Moisturizers for the treatment of inflammatory skin conditions. J Drugs Dermatol. 2008;7:1038–1043. [PubMed] [Google Scholar]3. Gollnick H, Cunliffe W, Berson D, et al. Management of acne: a report from a global alliance to improve outcomes in acne. J Am Acad Dermatol. 2003;49:S1–S37. [PubMed] [Google Scholar]4. Del Rosso JQ. Moisturizers: Function, formulation and clinical applications. In: Draelos Z, Dover JS, Alam M, editors. Cosmeceuticals. 2nd ed. China: Saunders Elsevier; 2009. pp. 97–102. [Google Scholar]5. Nemes Z, Steinert PM. Bricks and mortar of the epidermal barrier. Exp Mol Med. 1999;31:5–19. [PubMed] [Google Scholar]6. Laquieze S, Czernielewski J, Rueda MJ. Beneficial effect of a moisturizing cream as adjunctive treatment to oral isotretinoin or topical tretinoin in the management of acne. J Drugs Dermatol. 2006;5:985–990. [PubMed] [Google Scholar]7. Akarsu S, Fetil E, Yucel F, et al. Efficacy of the addition of salicylic acid to clindamycin and benzoyl peroxide combination for acne vulgaris. J Dermatol. 2012;39:433–438. [PubMed] [Google Scholar]8. Cunliffe WJ, Holland DB, Clark SM, et al. Comedogenesis: some new aetiological, clinical and therapeutic strategies. Br J Dermatol. 2000;142:1084–1091. [PubMed] [Google Scholar]9. Bowe WP, Shalita AR. Effective over-the-counter acne treatments. Semin Cutan Med Surg. 2008;27:170–176. [PubMed] [Google Scholar]10. Lee HS, Kim IH. Salicylic acid peels for the treatment of acne vulgaris in Asian patients. Dermatol Surg. 2003;29:1196–1199. [PubMed] [Google Scholar]11. Bikowski J, Callender VD, Del Rosso JQ, et al. Combining clindamycin 1%-benzoyl peroxide 5% gel with multiple therapeutic options. Cutis. 2006;78:13–20. [PubMed] [Google Scholar]12. O’ Goshi KI, Tabata N, Sato Y, Tagami H. Comparative study of the efficacy of various moisturizers on the skin of the ASR miniature swine. Skin Pharmacol Appl Skin Physiol. 2000;13:120–127. [PubMed] [Google Scholar]13. Mills OH, Kligman AM, Pochi P, Comite H. Comparing 2.5%, 5%, and 10% benzoyl peroxide on inflammatory acne vulgaris. Int J Dermatol. 1986;25:664–667. [PubMed] [Google Scholar]15. Draelos ZD. Acne cosmeceutical myths. In: Draelos Z, Dover JS, Alam M, editors. Cosmeceuticals. 2nd ed. China: Saunders Elsevier; 2009. pp. 179–181. [Google Scholar]16. Draelos ZD. Dry skin. In: Draelos Z, Dover JS, Alam M, editors. Cosmeceuticals. 2nd ed. China: Saunders Elsevier; 2009. pp. 173–174. [Google Scholar]17. Draelos ZD. Cosmetics and Dermatological Problems and Solutions. 3rd ed. London: Informa Healthcare; 2011. [Google Scholar]

Source

Leave a Reply

Your email address will not be published.