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Body Moisturizer Usage Compliance and Its Impact On Dry Skin Improvement

Keith Ertel, PhD; Richard Farris, MS; Victor Rodriguez, BS; Paula Hartwig, BS; Robert Bacon, BS;

The Procter & Gamble Company, Cincinnati, OH

Introduction

Moisturizers are often recommended to help mitigate dry skin and can be useful therapeutic adjuncts in the treatment of dermatologic conditions. Published studies report that some moisturizers can impact stratum corneum barrier homeostasis, and 93.3% of dermatologists surveyed agreed that moisturized skin is in better health than dry skin.1 As with any intervention, a moisturizer is only effective if it is used regularly and therein lies a potential issue. Surveys show that from 60%2 to 70%1 of dermatologists believe that 50% or less of their adult female patients moisturize as recommended. Patients are often advised to apply moisturizer within 3 minutes of showering or bathing for the maximum benefit. Over 83% of the respondents cited lack of convenience as a factor responsible for the perceived lack of compliance among their patients.

Objective

To assess dry skin improvement provided by common leave-on moisturizer usage practices, and to compare these to the potential dry skin benefit from a routine that incorporates moisturization into the showering process.

Methods

Identification of Model Lotion Usage Regimens

  • A body moisturizer usage habits and practices study was conducted among a representative population of adult females (n = 3323). Of these, 78.6% had dry skin and applied a leave-on moisturizer.
  • The three most common body moisturizer usage patterns among the dry skin subpopulation were: use daily (42.1%), use 4-6 times a week (18.5%), or use 2-3 times a week (18.0%). Assuming that daily moisturization is desirable from a therapeutic standpoint, the percentage of consumers with dry skin who moisturize daily agrees well with dermatologists' perceptions of their patients' compliance with recommendations to moisturize.
  • Based on these habits and practices data dosing regimens of daily, 2 out of 3 days, and every other day were chosen to represent common body moisturizer usage patterns.

Clinical Testing

  • Two randomized studies were conducted to accommodate the schedules necessitated by the different treatment regimens. Daily application was examined in one study; the alternative application frequencies were examined in a second study. Healthy adult females with dry leg skin were enrolled. Both studies included a dermatologist-recommended leave-on lotion benchmark, an inshower body lotion, and a control (syndet bar wash only).
  • The protocol was based on a published leg wash procedure4 modified to reflect expected usage practices for the in-shower body moisturizer. The benchmark lotion was applied after the leg was washed with the syndet bar, rinsed and patted dry. The in-shower body lotion was applied to the leg after the syndet bar washing and rinsing, then the leg was rinsed a second time and patted dry. Both products were dosed at 1L/cm2, which reflects expected use of these types of products.
  • Evaluations were conducted 6 and 24 hours post-treatment after one and two weeks of treatment. Subjects acclimated under controlled environmental conditions for at least 30 minutes prior to evaluation. The grader and instrument operator (CM-825) were blind to treatment identities and assignments.
  • Mixed model techniques adjusting for study design parameters were used to analyze the data. Results from the 2 studies are expressed relative to the control treatment to facilitate comparisons.

Results

  • The benchmark lotion provided significant visible dry skin improvement relative to the control when applied daily (Figure 1). Not surprisingly, the magnitude of this benefit decreased with reduced application frequency (Figure 3, Figure 5). However, under the alternative treatment regimens the benchmark lotion still provided a significant improvement in dry skin appearance relative to the control.
  • The benchmark lotion also provided a significant stratum corneum hydration benefit (increased skin capacitance) relative to control when applied daily (Figure 2). As with expert dryness scoring the magnitude of this benefit decreased when the product was used less than once daily, but for the alternative treatment regimens the increase in hydration was not significantly different from the control (Figure 4, Figure 6). This suggests that hydration level, which is an important factor determining the physical characteristics of the stratum corneum, is more responsive to infrequent lotion usage than is dry appearance.
  • The studies presented here, which employed protocols using treatment application frequencies modeled on consumer habits and practices, showed a limited extended treatment effect for the leave-on lotion, as evidenced by the decreased dry skin improvement benefit under the alternative application schemes. This highlights the importance of daily moisturizer usage to maintain improvements in dry skin condition.
  • An in-shower body lotion was included in these studies for comparison purposes. On average, consumers shower once daily,5 and this in-shower body lotion is intended to incorporate moisturization into an existing consumer habit and to take advantage of the warm, moist shower environment. The study involving once daily application of the in-shower body lotion and the benchmark leave-on lotion showed that the products provide comparable dry skin improvement (Figure1, Figure 2).
  • A significantly (P<0.05) greater percentage of subjects who used the in-shower body lotion in an instruction-aided, 2 week home use test volunteered favorable comments about the product's convenience, compared to subjects who used a mass market leave-on lotion benchmark (Figure 7).5 This outcome demonstrates the benefit of incorporating body moisturization into an existing habit.
  • Since convenience is a factor that dermatologists believe contributes to patient non-compliance with recommendations to moisturize,1,2 the in-shower body lotion could provide a way to improve moisturizer usage compliance. Results from the 2 week home use test are consistent with this hypothesis: a significant (P<0.05) percentage of subjects indicated that they used the in-shower lotion more frequently than they currently use their leave-on body lotion (Figure 8).5 Attributes such as satisfaction with the in-shower moisturizing routine and overall rating of the in-shower body lotion also support the expectation for higher usage compliance.

Conclusions

Dry skin improvement studies modeling common moisturizer application habits demonstrate the importance of daily moisturization. By integrating moisturization into an existing habit and providing improved convenience, an in-shower body lotion could provide a way to improve patients' compliance with recommendations to moisturize.  

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