Role of Moisturisers in Atopic Dermatitis: Expert Group Recommendations from a Malaysian Panel via Modified Delphi Consensus Method

Abstract Atopic dermatitis (AD) is a chronic inflammatory skin condition, characterised by dry skin, pruritus and recurrent eczematous lesions. Challenges in the management of AD include fear associated with the use of corticosteroids, compliance issues and frequent flare-ups impacting the quality of life. Moisturisers are the cornerstone of AD management. In this study, we aim to develop the evidence-based consensus recommendations regarding the role and choice of moisturisers for AD. An electronic search of the PubMed/MEDLINE and Cochrane Library was undertaken to identify the relevant articles using keywords such as ‘atopic dermatitis’, ‘eczema’, ‘moisturiser’, ‘humectant’, ‘occlusive’, ‘emollient’, ‘selection’, ‘ingredients’, ‘efficacy’, ‘safety’, ‘formulation’, ‘paediatric’, ‘adult’, ‘prevention’ and ‘guidelines’. A modified Delphi consensus methodology was used to achieve the consensus. A committee of nine dermatologists from Malaysia constituted the panel. Twenty-five questions belonging to five domains were drafted: (i) challenges impacting the regular use of moisturisers in AD; (ii) selection criteria; (iii) role of bioactive ingredients in alleviating AD symptoms; (iv) clinical effectiveness of moisturisers and (v) early initiation of moisturisers for AD prevention. Consensus was set a priori as a minimum agreement of 80%. The panel agreed that moisturisers for AD management should contain humectants, occlusives and emollients to replenish epidermal lipids, retain moisture, reduce inflammation and restore skin barrier function. Regular moisturisation decreases flare-ups and enhances the effectiveness of topical corticosteroids. The experts recommended selecting moisturisers tailored to patient needs, considering factors such as the intensity of skin dryness, site of application, formulation, active ingredients, environmental humidity, climate and cost.