Barrier Creams: Limited Evidence for General Use
For general skin protection, regular use of emollient-containing hand lotions or creams is more effective than barrier creams, which have questionable efficacy and should not be relied upon as primary protection against irritants. 1
Evidence Against Barrier Creams
The most recent high-quality guidelines demonstrate that barrier creams have failed to prove their effectiveness:
The British Association of Dermatologists (2017) found that barrier creams did not yield better results than control lotions in preventing irritant contact dermatitis, with efficacy in the workplace remaining uncertain despite some promise in laboratory settings 1
Two randomized controlled trials specifically evaluating barrier creams for healthcare workers showed they performed no better than standard lotions or vehicle controls 1
Barrier creams by themselves are of questionable value in protecting against contact with irritants and should not be overpromoted, as they may confer a false sense of security and encourage complacency in implementing appropriate preventive measures 1
Superior Alternative: Emollient Lotions and Creams
Instead of barrier creams, the evidence strongly supports regular use of moisturizing products:
Hand lotions and creams containing humectants, fats, and oils that increase skin hydration and replace depleted skin lipids are proven effective in preventing and treating irritant contact dermatitis when used regularly (e.g., twice daily) 1
Scheduled use of oil-containing lotions led to 50% higher handwashing frequency among healthcare workers compared to barrier creams, with 69% achieving complete healing of skin breaks versus 52% with barrier cream 2
Emollient-containing products help maintain skin barrier function by replenishing lipids and improving hydration, which is the cornerstone of preventing contact dermatitis 1, 3
When Barrier Products May Be Appropriate
Limited situations where barrier-type protection has FDA approval or specific indication:
Dimethicone (silicone-based) is FDA-approved as a skin protectant that forms a moisture barrier for diaper rash prevention and temporarily protects chapped or cracked skin 4
For neonatal epidermolysis bullosa, barrier creams may be useful in nappy/diaper areas when combined with emollient ointments and liners to reduce friction 1
In intertriginous areas (like under-breast), occlusive barrier creams should be avoided as they trap moisture and promote bacterial overgrowth; powder is preferred instead 5
Practical Recommendations for General Use
Choose regular moisturizers over marketed "barrier creams":
Select fragrance-free, hypoallergenic formulations with petrolatum or mineral oil as the base, avoiding products with fragrances, preservatives, or dyes that can cause allergic contact dermatitis 5, 6
Apply moisturizing products at least twice daily on a scheduled basis, not just when skin feels dry, as regular use prevents barrier breakdown 1
Use products packaged in tubes rather than jars to prevent contamination 5
Apply to completely dry skin after gentle cleansing with lukewarm water and pH-neutral soap 5
Critical Pitfalls to Avoid
Do not rely on barrier creams as primary protection in occupational settings where gloves and avoidance of irritants are more effective 1
Avoid oil-based occlusive products in moisture-prone areas as they trap irritants and promote folliculitis 5
Do not apply barrier products to wet or damp skin, as this defeats moisture management purposes 5
Recognize that more frequent application does not improve efficacy and may increase adverse effects; twice daily is optimal 6