Are emollients (moisturizers) helpful in managing itchy and excoriated plaque psoriasis, in addition to medications?

Emollients in the Management of Itchy and Excoriated Plaque Psoriasis

Emollients are strongly recommended as an adjunctive therapy for itchy and excoriated plaque psoriasis, helping to reduce itching, desquamation, and total body surface area involvement when used alongside medications. 1

Benefits of Emollients in Psoriasis

• Emollients exert their action by retaining moisture in the stratum corneum, improving skin hydration and barrier function 1
• They help reduce itching and desquamation (scaling), which are particularly problematic in excoriated plaque psoriasis 1
• Emollients make the epidermis more resistant to external stressors and reduce the induction of Koebner phenomena (development of psoriatic lesions at sites of trauma) 2
• They can prevent quick relapse of psoriasis when topical corticosteroids are discontinued 1

Evidence Supporting Emollient Use

• An RCT showed that the combination of mometasone plus emollient improved the area of palmoplantar skin affected, desquamation, and symptoms compared with mometasone alone after 4 weeks of treatment 1
• A prospective observational study demonstrated that 4-week daily application of an emollient containing 10% urea, ceramides, glycerin, and glyceryl glucoside resulted in significant improvement in quality of life and clinical outcomes in patients with mild to moderate psoriasis 3
• A pilot randomized open-label study showed significantly greater improvement of desquamation, surface area affected, and subjective symptoms when an emollient was used alongside topical corticotherapy compared to corticotherapy alone 4

Practical Recommendations for Emollient Use

• Apply emollients once to three times daily to affected areas 1
• Use emollients in conjunction with topical corticosteroids for 4 to 8 weeks to help reduce itching, desquamation, and total body surface area 1
• Consider emollients particularly valuable for:
  • Itchy psoriasis (as in your case)
  • Excoriated psoriasis (as in your case)
  • Psoriasis of the folds
  • Psoriatic skin damaged by previous local treatments 5

Special Considerations

• Emollients have no known contraindications unless there is hypersensitivity to their ingredients 1
• There is a small risk of contact dermatitis with some emollients 1
• Emollients are considered safe during pregnancy and lactation 1
• For excoriated psoriasis, gentle application is important to avoid further trauma to the skin 2

Integration with Other Therapies

• Emollients can be used as part of a rotational therapy approach with topical vitamin D analogues, topical calcineurin inhibitors, and topical corticosteroids as steroid-sparing regimens 1
• The use of emollients with topical calcipotriene may reduce irritation and enhance the efficacy of calcipotriene 1
• A thin coat of an emollient such as petrolatum applied to areas of psoriasis after bathing may be particularly beneficial 1

Conclusion

Emollients represent an internationally accepted standard adjunctive therapeutic approach to the treatment of psoriasis 1. They are particularly beneficial for itchy and excoriated plaque psoriasis by reducing irritation, improving skin barrier function, and enhancing the efficacy of other topical medications 1, 2, 5.