Content uploaded by Paul Baalham
Author content
All content in this area was uploaded by Paul Baalham on Dec 13, 2022
Content may be subject to copyright.
Title two-deck
Xerosis of the feet: a comparative study
on the effectiveness of two moisturizers
Paul Baalham, Ivan Birch, Maria Young, Clare Beale
Paul Baalham is a podiatrist working in private practice, Sheerness, Kent; Ivan Birch is Pro Dean of the Faculty of Health &
Human Sciences, Thames Valley University; Maria Young is Senior lecturer BSc(Hons) Podiatry, School of Health Professions,
University of Brighton; Clare Beale is a podiatrist working in private practice, Horsted Keynes, West Sussex
Email: paulbaalham@aol.com
ABSTRACT
The treatment for xerosis (dry skin) is the repeated use of moisturizers to
hydrate the skin. Their use is based on sound evidence of the importance
of maintaining the skin’s water content. Although the skin on the plantar
surface of the foot is very thick, it is highly visco-elastic and copes with
high levels of frictional, compressive and shear stresses applied to it by
being supple and well hydrated. Problems arise when the skin becomes dry
and loses its elastic properties. Fissures can occur which are often painful
and can act as portals for infection. This article describes a double-blind
clinical study to evaluate and compare the effectiveness of two commonly
used moisturizers and to see if one was significantly better than the other at
hydrating the skin of the feet. The two creams used were Aqueous Cream
BP and CCS Foot Care Cream. Skin hydration levels were measured before
any application of moisturizer and again after two weeks of twice daily
application. Results showed that the regular use of both moisturizers had a
significant hydrating effect on the skin. However, CCS Foot Care Cream had
a significantly greater hydrating effect than Aqueous Cream BP.
KEY WORDS
Xerosis w Skin w Moisturizer w Feet w Podiatry w Hydration
The use of moistur izers is based on sound evidence
of the importance of maintaining the water con-
tent of the skin (Rees, 2002). Dry skin can be
treated with a range of creams and ointments, and normally
aqueous cream or Diprobase is the first line of treatment
(Nazarko, 2007). These products are described as being light
and easily absorbed but people with very dry skin may
require different preparations. Choice is often made on the
basis of patient preference, or according to the health pro-
fessional’s individual choice (Holden et al, 2002). Decisive
factors can include how the emollient feels, or simply its
cost. Moistur izers with emollients should be promoted as a
preventative measure to keep the epidermal barr ier intact
(Peters, 2006). Emollients support the integrity of the lipid
barrier, potentially reducing immunoglobulin-triggered
events including infections (Peters, 2006).
Making decisions regarding the choice of which topi-
cal preparation to use as a moisturizer is difficult for the
health professional and patient alike, owing to the lack of
good quality evidence on their effectiveness or an adequate
comparison of the various compositions (Rees, 2002;
Clark, 2004).
Xerosis of the feet
Xerosis is the medical term for dry skin, and almost eve-
ryone will suffer episodes of xerosis at some stage in their
life (Voegli, 2007). It is associated with both skin thick-
ening and skin thinning, and is triggered by exogenous
(e.g. climate, environment, lifestyle) and endogenous (e.g.
medication, hormone fluctuations, organ disease) factors
(Chiodo, 2008).
Because the hydration of the surface tissue on the plantar
aspect of the foot relies solely on the secretions from the
sweat glands (Baird et al, 2003; Wood et al, 2008), it is
evident that any disturbance or lack of sweat production
would be problematic. A person who has a decrease or
loss of function of the sweat glands on the plantar surface
of the foot will experience xerosis of the feet (Pham et al,
2002). Xerosis is the main complication associated with
anhydrosis, an abnormal condition characterized by inad-
equate perspiration causing the skin to become excessively
dry (Anderson, 1998). Many instances of anhydrosis result
from poor peripheral blood supply in the elderly or in
diabetic patients with autonomic neuropathy (Pham et al,
2002; Tyrrell, 2002). Where this is the cause, O’Donnell et al
(2002) stated that there is little more that can be done other
than to apply emollients regularly. It is generally believed
that decreased autonomic function in the feet can lead to
drying, cracking, fissure formation (Figure 1), infection and
possible ulcer formation. Lubrication of the feet is impor-
tant to prevent this from happening (Greene et al, 1999).
British Journal of Community Nursing Vol 16, No 12 591
CLINICAL FOCUS
Figure 1. Heel fissures (cracks) due to xerosis
DermNetNZ.org
TOPIC HEADER
592 British Journal of Community Nursing Vol ?, No
CLINICAL FOCUS
592 British Journal of Community Nursing Vol 16, No 12
Xerosis can become a considerable problem causing much
pain and disability.
The differences between xerosis and healthy skin are
evident on examination. Dry skin will appear dull, often
with a flaky surface and patchy white areas. If severely dry,
cracks and fissures may be visible and the surrounding skin
may appear red indicating the presence of inflammation
and possibly secondary infection. Dry skin feels rough and
uneven, and the patient may experience a feeling of tight-
ness; this may be accompanied by sensory changes such as
tingling, itching or even stinging pain (Voegli, 2007).
Treatments for xerosis
Dry skin can be treated with a range of moisturizing prod-
ucts. Moisturizers contain varying combinations of emol-
lients, occlusives, and humectants to achieve their beneficial
effects (Kraft and Lynde, 2005). They are used to replace
natural skin oils, to cover tiny fissures, and to provide a
soothing protective film (Lynde, 2001).
Although water is the principal plasticizer of the stra-
tum corneum, the water within a topical moisturizer only
delivers a transient moisturization effect; it is the other
components of the product that truly define the level of
benefit to the hydration and health of the skin (Rawlings
et al, 2004). The terms moisturizer (to add moisture) and
emollient (to soften), appear to be interchangeable in com-
mon usage as they both serve to hydrate the skin (Chiodo,
2008). However, moisturizers often contain emollients and,
together with occlusives and humectants, are the mainstay
ingredients in cosmetic treatment preparations (Rawlings
et al, 2004).
Emollients sooth, smooth and hydrate the skin and are
indicated for all dry skin and scaling disorders (British
National Formulary (BNF), 2005). They are mainly lipids
and oils that hydrate and improve the skin’s appearance by
contributing to the skin’s softness, enhanced flexibility, and
smoothness (Kraft and Lynde, 2005). However, their effec-
tiveness is short-lived and they must be applied frequently
even after the skin improves (BNF, 2005).
Occlusives reduce transepidermal water loss (TEWL)
by physically blocking and creating a hydrophobic (water-
repelling) barrier over the stratum corneum and contrib-
uting to the matrix between corneocytes (Lynde, 2001).
Occlusives are most effective when applied to dampened
skin (Kraft and Lynde, 2005). They provide the skin with
a layer of oil to slow the rate of TEWL owing to evapora-
tion, and thus, increase the water content of the stratum
corneum (Chiodo, 2008).
Humectants have the ability to attract and hold water in
the skin. They enhance water absorption by acting on the
inside out, from the dermis to the epidermis and ultimately
the stratum corneum. They also enhance water absorption
from the outside in, drawing moisture from the external
environment to the skin (Rawlings et al, 2004; Kraft and
Lynde, 2005).
Common humectants used in emollients are:
w Glycerin (glycerol)
w Urea
w Lactic acid
w Propylene glycol
w Sodium pyrrolidone carboxylic acid
w Ammonium lactate
w Potassium lactate
w Sorbitol.
While aqueous (i.e. water-based) creams and emollients
are often the first line of treatment, urea-based creams have
been shown to significantly improve skin hydration (Baird
et al, 2003; Baker and Rayman, 2008). CCS Foot Care
Cream contains 10% urea. Both CCS Foot Care Cream
and Aqueous Cream BP can be bought without prescrip-
tion from chemists.
Aims of the study
The objective of this double-blind quantitative study was
to evaluate and compare the effectiveness of two read-
ily available moisturizers: Aqueous Cream BP (Pinewood
Laboratories Ltd, Tipperary, Ireland) and CCS Foot Care
Cream (EC DeWitt & Co Ltd, Warrington, England) in the
treatment of xerosis of the feet.
Figure 2. The Digital Moisture Monitor for Skin (Shenzhen Jinsuifeng
Plastic Model Manufacture Co, Ltd).
Figure 3. Site of measurement
TOPIC HEADER
594 British Journal of Community Nursing Vol 16, No 12
CLINICAL FOCUS
It aimed to determine:
w If each moisturizer had a significant hydrating effect on
the skin of the feet
w If one moisturizer produced a significantly greater
hydrating effect than the other moisturizer on the skin
of the feet, or
w If neither moisturizer had a significant hydrating effect
on the skin of the feet.
The sample group comprised 15 female patients with
xerosis of the feet who attended the researcher’s private
clinic in Sheerness, Kent, UK. Participation in the trial was
wholly voluntary and patients were recruited from those
who responded to a poster placed in the clinic explaining
that volunteers were required to test the efficacy of two
different types of foot cream in the treatment of dry skin.
Participants were asked to apply one moisturizer to one
foot and another moisturizer to the other foot twice daily
for a period of two weeks. Skin hydration levels were
measured prior to starting the regime and again afterwards.
Comparisons were made pre- and post-application to
determine the differences, if any, on the effectiveness of the
two creams in terms of skin hydration.
Ethical approval was obtained from the University of
Brighton School of Health Professions, School Research
Ethics and Governance Panel (SREGP).
For inclusion in the trial, patients had to be adult, present
with bilateral xerosis of the feet (determined by visual
appearance) and be clinically healthy. Patients with known
allergies, skin disease and lesions on the feet were excluded.
The hydration level of the stratum cor neum was meas-
ured with a digital moisture monitor for skin (Figure 2).
This device works by measuring the skin’s electrical resist-
ance, or what the manufacturers call bioelectric imped-
ance analysis (BIA) technology. It gives a digital reading in
percentages of the skin’s water content and has a range of
0–99.9%. It has a claimed accuracy of 0.5% and is powered
by two AAA batteries. Other measur ing instruments were
considered but were simply outside the price range for
this project. The digital moisture monitor was found to be
inexpensive, easy to use and adequate for the purpose of
this trial.
The raw data from the hydration measurements taken
from the left (L) and right (R) feet pre and post two weeks
of twice daily moisturizer application were entered into
tables in an Excel spreadsheet on a computer for analysis.
The means and standard deviations were calculated to
show the statistical average (norm) and the range of disper-
sion of the raw data. The student t-test was chosen as a way
of testing the null hypothesis; in this case the null hypoth-
esis was that there is no significant difference between the
effectiveness of two different moisturizers in the treatment
of xerosis of the feet. The t-test assesses whether the means
of two groups are statistically different from each other.
Once a t value is determined, a probability (p value) can
be found. By looking for significance of p<0.05 we have a
95% chance of the means being significantly different, thus
allowing the null hypothesis to be rejected.
A significant difference was looked for in:
w The difference between the hydration levels L and R pre
two weeks of cream application
w The difference between the hydration levels pre and post
two weeks of cream application L
w The difference between the hydration levels pre and
post two weeks of cream application R
w The difference between the hydration levels L and R
post two weeks of cream application.
Method
Participants were asked to confirm they had not applied any
topical preparations to their feet for seven days. This was to
ensure that the first measurements were taken with the skin
in its natural, uncontaminated condition. Participants were
allowed to wash their feet as usual.
Before measurements were taken, participants were
requested to remove their footwear and allow their feet to
be exposed to the air for 15 minutes. This was to allow any
surface sweat to evaporate.
Skin hydration measurements were then taken using the
digital moisture monitor on both feet.
All measurements were taken from as near possible the
same site on all the patients (Figure 3). The centre of the
dorsal aspect of the foot was chosen as this proved to be
the most reliable in obtaining repeatable readings with the
digital moisture monitor.
Participants were given a tube of both the test moistur-
izers and instructed to apply the creams twice daily for
a period of two weeks, then return to the clinic. A two-
week period of application was felt to be adequate for this
trial. Baird et al (2003) used a six-week period for their
trial comparing two types of urea-based creams. However,
Lodén and Wessman (2001) measured a significant increase
in skin hydration using a moisturizer containing glycer ine
after only ten days.
To make this a double-blind trial a third party had previ-
ously masked the names on the tubes of creams with tape
and relabelled them ‘R’ (‘right’) and ‘L’ (‘left’). Information
regarding which cream was in which tube was kept in a
locked cabinet. Only after the trial was it revealed which
cream was used on which foot.
To prevent cross-contamination when applying the
creams, patients were requested to apply the cream labelled
L to the left foot with the right hand, and the cream
labelled R to the right foot with the left hand
After 14 days of twice-daily moistur izer application, the
participants returned to the clinic to have their skin hydra-
tion measurements taken, again after allowing the feet to be
exposed to the air for 15 minutes.
Results
On completion of the trial it was revealed that the cream
applied to the left feet was CCS Foot Care Cream, and the
cream applied to the right feet was Aqueous Cream BP.
All measurements were taken using the digital moisture
monitor, which measured skin hydration and gave readings
TOPIC HEADER
British Journal of Community Nursing Vol 16, No12 595
TOPIC HEADERTOPIC HEADER CLINICAL FOCUS
as percentages of water content in the stratum corneum
(SC).
The means and standard deviations were calculated from
the raw data. Statistical comparisons were made using the
one tailed, paired student’s t-test in Microsoft Office Excel
and significance was set at p<0.05.
Baseline skin hydration measurements were taken at
the start of the trial prior to the first application of any
moisturizer.
Table 1 shows the mean, standard deviation and t-test
results of the percentage readings of SC water content taken
from the left and right feet pre-moisturizer application.
Analysis of the differences between left and right base-
line measurements taken at the start of the tr ial showed a
p value of 0.393 (p>0.05) and therefore, no significant dif-
ference between left and right feet was seen in the subjects
before the first application of any moisturizer.
Figure 4 shows the percentage readings of SC water
content taken pre-cream application of the left and right
feet for each participant. No significant difference was seen
between the left and right feet prior to the first application
of moisturizer (p>0.05).
Skin hydration measurements were taken after two weeks
of twice-daily cream application and compared against the
baseline measurements. There was a significant increase
(p<0.05) in skin hydration seen in both feet.
Comparisons were made between skin hydration meas-
urements of the left feet after two weeks of twice-daily
application of CCS Foot Care Cream and the right feet
after two weeks of twice daily application of Aqueous
Cream BP.
Table 2 shows the mean, standard deviation and t-test
results of the percentage readings of SC water content of
both feet after two weeks of twice-daily application of
creams.
Figure 5 shows the percentage readings of SC water con-
tent of the left and right feet post two weeks of twice-daily
application of cream. Hydration percentages were found to
be higher in the left foot of every subject after two weeks’
moisturizer use.
The results show that both CCS Foot Care Cream and
Aqueous BP cream significantly improved skin hydration,
with the differences between baseline measurements and
post-application measurements giving a p value of <0.05.
However, after comparing the differences in measurements
of both feet after two weeks of twice-daily moisturizer
application, it was found that the CCS Foot Care Cream,
which had been applied to the left feet, had a significantly
greater hydrating effect than Aqueous Cream BP which
had been applied to the right.
The results indicate that there is a significant difference
between the effectiveness of two different moisturizers in
the treatment of xerosis of the feet.
Discussion
Comparing the results
Both Aqueous Cream BP and CCS Foot Care Cream
resulted in a significant increase in skin hydration. However,
the CCS Foot Care Cream increased skin hydration signifi-
cantly more than the Aqueous Cream BP.
The application of both creams showing significant
improvement in skin hydration (p<0.05) after two weeks
of twice-daily application would seem to agree with
O’Donnell et al (2002) when they say that the choice
of emollient for the treatment of xerosis matters little,
as the purpose is to prevent moisture loss from the skin,
and it is the regular daily application that is important.
Schwartz et al (2009) agreed, saying that almost any
emollient will provide symptomatic relief for mild xero-
sis, but added that for moderate xerosis, humectant and
occlusive systems may provide a more active mechanism
to hydrate the stratum corneum. They also stated that for
moderate to severe xerosis, alpha hydroxyl acids (AHAs)
and/or lactate offer the superior therapy. Although
effective moisturizers/emollients can improve dry skin
conditions immediately, their effects are often thought
of as being transient, because the materials applied to
the stratum corneum are easily shed from the skin sur-
face by the daily desquamation process. However, there
is some clinical, as well as experimental, evidence sug-
gesting that, once application of effective moisturizers is
repeated daily, it may produce persistent effects without
being influenced by the desquamation of the skin surface
(Tabata et al, 2000).
Table 1. Water content readings pre-moisturization
Left feet pre moisturizer application Right feet pre moisturizer application
Mean 19.02 19.13
Standard deviation 2.29 2.82
p value 0.393
Table 2. Water content readings after two weeks of twice-daily moisturization
Left feet post-moisturizer application Right feet post-moisturizer application
Mean 32.61 27.53
Standard deviation 6.59 4.97
p value <0.001
TOPIC HEADER
596 British Journal of Community Nursing Vol 16, No 12
CLINICAL FOCUS
Serup et al (1989) also report a long-lasting hydrating
effect after twice-daily applications of a moisturizer for
seven days, reporting an increase in hydration even after
one week of the last moisturizer application. This trial
showed that both creams significantly improved skin hydra-
tion of the feet but it did not show how long the hydrating
effect lasted.
Central to their efficacy, moisturizers are designed to
improve stratum corneum hydration (Crowther et al, 2008).
Although both the test creams gave a significant improve-
ment in skin hydration, CCS Foot Care Cream had a sig-
nificantly greater hydrating effect which could potentially
be attributed to the cream’s ingredients.
Active ingredients
The active ingredients in Aqueous Cream BP are liquid
paraffin 6% w/w and white soft paraffin 15% w/w; these
act as occlusives that physically block and slow the rate of
transepidermal water loss. They also have emollient proper-
ties that smooth the skin by filling in the spaces between
the corneocytes (Schwartz et al, 2009). Cetostearyl alco-
hol and sodium laurilsulfate are other ingredients and are
emulsifiers which also have emollient properties. Aqueous
Cream BP contains no listed humectant.
The active ingredients of CCS Foot Care Cream are
paraffinum liquidum (liquid paraffin) 18.5%, which is an
occlusive, and glycerin 13.32% and urea 10% which are
humectants. It also contains an unpublished percentage of
lactic acid which acts as a pH regulator and is often found
in moisturizers in the form of alpha hydroxyl acid (AHA).
Alpha hydroxyl acid is a good humectant and exfoliating
agent of the epidermis that sloughs off the dry skin cells
and promotes new skin growth (Pham et al, 2002; Schwartz
et al, 2009).
CCS also contains cetyl alcohol and stearyl alcohol,
which are both emulsifiers with emollient properties.
Both creams contained preservatives which are includ-
ed in formulations to kill or inhibit the growth of
microorganisms introduced during use or manufacturing
(Lodén, 2005). Only CCS cream contained any fragrance
(Eucalyptus globulus and limonene).
Most moisturizers contain a combination of emollients,
occlusives and humectants. When occlusives and humect-
ants are combined, the water-holding capacity of the skin
is enhanced (Kraft and Lynde, 2005). Moisturizers serve
to return water to the skin, not only by the water con-
tent contained within the formulation, but also through
the humectants attracting water from the lower layers of
the epidermis into the stratum corneum, and occlusive
ingredients preventing transepidermal water loss (Flynn et
al, 2001).
Both creams used in this trial contained similar amounts
of occlusive and emollient ingredients. Aqueous Cream BP
had 21% (made up of liquid and soft white paraffin) and
CCS Foot Care Cream had slightly less at 18.5% (liquid
paraffin). The important difference between the creams
was the humectant ingredients in the CCS Foot Care
Cream. From the small sample used in this trial it appears
that a cream which contains a combination of humectants,
exfoliating agent (AHA), emollients and occlusives is bet-
ter at hydrating the skin than a moisturizer containing just
occlusives and emollients.
Limitations
It is recognized that not all of the participants may have
stuck rigidly to the protocol for the application of the
cream, even though all reported that they had, and this may
have some influence on the results. It is also recognized that
the trial is underpowered regarding the subject numbers.
The importance of moisturizers
Lodén (2005) states that many health professionals and
patients overlook the importance of moisturizers in main-
taining an intact healthy skin and do not consider them to
be ‘active treatments’. She goes on to say that the health
professional’s role should emphasize continuity of care,
patient satisfaction and product selection, which are all
Figure 4. Hydration levels before moisturization
Figure 5. Hydration levels after 2 weeks of moisturization
British Journal of Community Nursing Vol 16, No 12 597
TOPIC HEADERCLINICAL FOCUS
vital to protecting skin integrity and enhancing the qual-
ity of life. The frequent use of moisturizers supports the
epidermal barrier and reduces the potential for infection
and inflammation.
Although moisturizers play an important (but underesti-
mated) role in the treatment and ongoing management of
dry skin conditions (Voegli, 2007), choosing a moisturizer
can be difficult for both the health professional and patient
alike owing to the huge array of moisturizers in the mar-
ketplace (Kraft and Lynde, 2005). This study has shown that
regular application of a moisturizer is beneficial in hydrat-
ing the skin in patients with xerosis and that difference
in the formulations can have a greater or lesser hydrating
effect. The more understanding the health professional has
regarding the actions of the various ingredients within for-
mulations, the better equipped they will be in prescribing
what is most suitable for the patient with xerosis.
Conclusion
This study achieved its aims by showing that there is a
significant difference between the effectiveness of two dif-
ferent moisturizers in the treatment of xerosis of the feet
in women. The results showed that CCS Foot Care Cream
had a significantly greater hydrating affect than Aqueous
Cream BP. However, what was also demonstrated clearly in
the results was that both moisturizers achieved significant
improvement in skin hydration when applied frequently.
It can be suggested from the results of this study that for
mild cases of xerosis of the feet, either of the two creams
trialled may be suitable if applied frequently. However, for
drier skin conditions CCS Foot Care Cream, with its com-
bination of humectant, emollient and occlusive ingredients,
would be more suitable due to its higher hydrating effect.
On the basis of this study, it is recommended by the
researcher that regular applications of CCS Foot Care
Cream be used for the treatment of xerosis of the feet, in
preference to Aqueous Cream BP. BJCN
Anderson KN (1998) Mosby’s Medical, Nursing, and Allied Health Dictionary. 5th edn.
Mosby-Year Book Inc, USA
Baird SA, Skinner CM, Trail S, Frankis JS (2003) Anhydrosis in the diabetic foot: a
comparison of two urea creams. Diabet Foot J 6(3): 122–36
Baker N, Rayman G (2008) Effects of a urea-based moisturizer on foot xerosis in
people with diabetes. Diabet Foot J 11(2): 179–82
British Medical Association and Royal Pharmaceutical Society of Great Britain
(2005) British National Formulary, Number 50. BMJ/RPSGB, London
Chiodo B (2008) The use of emollients in dry skin therapy. J Community Nurs
22(10): 22–6
Clark C (2004) How to choose a suitable emollient. Pharm J 273: 351–3
Crowther JM, Sieg A, Blenkiron P et al (2008) Measuring the effects of topical
moisturizers on changes in stratum corneum thickness, water gradients and
hydration in vivo. Br J Dermatol 159(3): 567–77
Flynn TC, Petros J, Clark RE, Vieham GE (2001) Dry skin and moisturizers. Clin
Dermatol 19(4): 387–92
Greene DA, Stevens MJ, Feldman EL (1999) Diabetic neuropathy: scope of the
syndrome. Am J Med 107(2B): 2S–8S
Holden C, English J, Hoare C et al (2002) Advised best practice for the use of emol-
lients in eczema and other dry skin conditions. J Dermatolog Treat 13(3): 103–6
Kraft JN, Lynde CW (2005) Moisturizers: what they are and a practical approach to
product selection. Skin Therapy Lett 10(5): 1–8
Lodén M (2005) The clinical benefit of moisturizers. J Eur Acad Dermatol Venereol
19(6): 672–88
Lodén M, Wessman C (2001) The influence of a cream containing 20% glycerin
and its vehicle on skin barrier properties. Int J Cosmet Sci 23(2): 115–19
Lynde CW (2001) Moisturizers: what they are and how they work. Skin Therapy
Lett 6(13): 3–5
Nazarko L (2007) Maintaining the condition of aging skin. Nurs Resid Care 9(4):
160–3
O’Donnell M, Lorimer DL, Forster MSK (2002) Clinical Therapeutics. In: Lorimer
D L, French G, O’Donnell M, Burrow J G, eds. Neal’s Disorders of the Foot: diagno-
sis and management. 6th edn. Churchill Livingstone, London: 431
Peters J (2006) Exploring the use of emollient therapy in dermatological nursing.
Br J Community Nurs 11(5): 194–201
Pham HT, Exelbert L, Segal-Owens AC, Veves A (2002) A prospective, randomized,
controlled double-blind study of a moisturizer for xerosis of the feet in patients
with diabetes. Ostomy Wound Manage 48(5): 30–6
Rawlings AV, Canestrari DA, Dobkowski B (2004) Moisturizer technology versus
clinical performance. Dermatol Ther 17(s1): 49–56
Rees M (2002) Managing atopic eczema. Prim Health Care 12(8): 27–37
Schwartz AR, Centurion SA, Thomas I (2009) Moisturizers. eMedicine
Dermatology http://tinyurl.com/7zcgjrt (accessed 17 November 2011)
Serup J, Winther A, Blichman CW (1989) Effects of repeated application of a mois-
turizer. Acta Derm Venereol 69(5): 457–9
Tabata N, O’Goshi K, Zhen YX, Kligman AM, Tagami H (2000) Biophysical assess-
ment of persistent effects of moisturizers after their daily applications: evaluation
of corneotherapy. Dermatology 200(4): 308–13
Tyrrell W (2002) Podiatric Management Of The Elderly. In: Lorimer DL, French G,
O’Donnell M, Burrow JG, eds. Neal’s Disorders of the Foot: diagnosis and manage-
ment. 6th edn. Churchill Livingstone, London: 187
Voegli D (2007) The role of emollients in the care of patients with dry skin. Nurs
Stand 22(7): 62–8
Wood BC, Kirman CN, Molnar JA (2008) Skin, Grafts. eMedicine http://tinyurl.
com/cy6kdcx (accessed 17 November 2011)
LEARNING POINTS
w Xerosis of the feet can cause cracks (fissures) around the heels and under
the big toe which can often be painful and lead to infection
w Frequent use of moisturizers help maintain the skin’s barrier function,
reducing the potential for infection and inflammation by improving its
hydration
w A moisturizer containing a humectant, such as urea, was shown to be
significantly better at hydrating the skin of the feet than a cream without
w A greater understanding of the various ingredients found in moisturizers
could help health professionals provide their patients with advice on
appropriate moisturizer selection
