Barrier Cream vs. Moisturizer: What's Actually Different?

Once you're on tretinoin or azelaic acid, a "barrier cream" can look like an obvious thing to add to your routine. Often, though, it's just a moisturizer by another name, since barrier creams and moisturizers are frequently built from the same ingredients. So look past the name to the ingredient list, and check whether the formula is built to shield your skin, to help its barrier rebuild, or to do both. If your moisturizer already has ingredients for shielding and rebuilding, and your face feels comfortable, you can skip the extra product.

Whatever you decide about the barrier cream, keep moisturizing alongside a retinoid. In one study, people with healthy skin put tretinoin on their whole face and a moisturizer on just one side. Both sides got irritated, but the moisturized side mostly stayed mild, and it was the side people preferred.¹⁴ A barrier cream earns its place when some areas still feel tight with your current moisturizer. It can replace that moisturizer or go over it on just the tight areas, and the ingredient list tells you which.

Where does the name come from?

Dermatologists have long used "barrier cream" for something you put on your skin to keep irritants off.² Diaper creams belong to the same family, and nurses and parents treat diaper rash with creams built on zinc oxide, petroleum jelly or panthenol, in various combinations.³

Even on hands, where the name was born, the case for barrier creams as protection is thin. When researchers pooled workplace trials of creams meant to protect hands from water, detergents and chemicals, the products sold as barrier creams barely moved the numbers. Among the workers using them, 29% developed irritated hands, compared with 33% of workers who didn't. Plain moisturizers looked more useful, at 13% against 19%, though the evidence is weak for moisturizers and barrier creams alike.¹ That's an awkward result for a product named after its job.

A review of controlled studies in people found that the plain cream base, without the protective ingredients, often seemed to protect about as well as the finished barrier cream.⁴ Much of the protection, then, may come simply from having a layer of cream on your skin, the way almost any coat keeps off some rain.

A cream can shield your skin, rebuild its barrier, or both

When you read a cream's ingredient list, you're looking for two jobs. The first is to shield, leaving a layer on the surface that slows the water leaving your skin and keeps irritants from reaching it. The classic shielding ingredients are petroleum jelly (petrolatum), dimethicone (a silicone), zinc oxide, lanolin and mineral oil, and all five are on the US list of ingredients allowed in products sold as skin protectants.⁵ Shielding is what the guide to occlusives, emollients and humectants calls the occlusive role.

The second job is to rebuild, supplying the lipids packed between your skin's outer cells, mainly ceramides, cholesterol and free fatty acids. Picture the outer cells as bricks and the lipids as the mortar between them. A shielding ingredient throws a tarp over the wall, while a rebuilding ingredient helps patch the mortar itself.

In mice whose skin barrier had been disrupted, a mix of ceramides, cholesterol and fatty acids in equal amounts let the barrier recover normally, while raising any one of the three to as much as three times the others sped recovery up. The researchers saw similar early results in damaged human skin.⁶ Creams sold for "barrier repair" are built on the same kind of lipid mix.

The two jobs overlap more than the marketing suggests. Petrolatum, the classic shield, also has an immediate barrier-repairing effect on skin that's been stripped of its lipids. A formula's other ingredients can push the opposite way, and some emulsifiers (the ingredients that keep a cream's oil and water mixed) may weaken the barrier.⁷ So it's worth reading the whole ingredient list, not just the ingredient printed on the front.

On a US label, "barrier" can mean three different things

A product's legal category in the US depends on its intended use, not its name, so the word "barrier" doesn't settle what kind of product a cream is.⁸ The rest of the label tells you which kind it is:

• A cosmetic. Moisturizers are cosmetics, so a barrier cream sold without drug claims is, legally, a moisturizer by another name.⁸
• An over-the-counter drug. Products that "temporarily protect injured or exposed skin," such as chafed, chapped or cracked skin, are regulated as drugs called skin protectants. They can use only listed ingredients within set ranges, such as dimethicone at 1 to 30%, zinc oxide at 1 to 25% (up to 40% in an ointment) and petrolatum at 30 to 100%.⁵ Like other over-the-counter drugs, skin protectants carry a Drug Facts label that lists the active ingredient.⁸
• A prescription medical device. At least one barrier-repair cream built on ceramides, cholesterol and fatty acids has been cleared by the FDA for prescription use, to improve dry skin and relieve the burning and itching of eczema and other skin conditions. On paper, it's classified as a wound and burn dressing, which isn't how most people picture a moisturizer.⁹

Does a barrier-repair cream beat a good moisturizer?

Prescription or not, if you're paying extra for a barrier-repair cream, you'd want it to clearly beat an ordinary moisturizer. Most of the head-to-head studies of barrier-repair creams were done in eczema, often in children, so they describe skin with a damaged barrier, not an adult face that's merely dry. Even so, they point the same way, and it isn't toward a clear win for the specialty cream.

The clearest example is a small trial in children with mild to moderate eczema. Two prescription barrier-repair creams did no better than a petroleum-based ointment sold over the counter, which was at least 47 times more cost-effective. At least one author was affiliated with the ointment's maker, and the trial was too small to show that the ointment was better.¹⁰ Still, an over-the-counter ointment keeping pace with two prescription creams is hard to dismiss.

The ointment result doesn't mean barrier repair does nothing. In a study of children with moderate to severe eczema, a prescription cream built on ceramides, cholesterol and fatty acids trailed a steroid cream at two weeks but had caught up by four.¹¹ Catching up with a steroid is no small thing. Lipid creams can hold their own in eczema; they just haven't clearly beaten a plain shielding ointment.

When researchers pooled five studies comparing ceramide moisturizers with other moisturizers in eczema, the ceramide creams improved eczema severity scores slightly more than the other moisturizers, but showed no clear edge in water loss through the skin.¹² Water loss is the measure of the barrier itself, so the ceramide creams' small advantage showed up in the eczema scores rather than in the barrier.

The word "moisturizer" on a label doesn't promise much for your barrier, either. In a seven-week study of moisturizers on healthy forearms, three simple test creams and a lipid-free gel left skin losing more water and reacting more to a harsh detergent, while a cream containing urea did the reverse. The difference came down to what was in each formula.¹³ A moisturizer that leaves your barrier worse off sounds like a contradiction, but over weeks of daily use, a formula can push your barrier either way. That includes the moisturizer already on your shelf, which is why the checks below look at both products.

How to tell what a barrier cream would add

Put the barrier cream next to the moisturizer you already use and compare their labels:

1. Check for the shielding job. If petrolatum, dimethicone, zinc oxide, lanolin or mineral oil sits near the top of a list, that product leaves a protective layer.
2. Check for the rebuilding job. Look for ceramides as part of a mix of lipids rather than on their own, because the research behind barrier repair used a mix.
3. Look for a Drug Facts label. An active ingredient with a percentage means the product is sold as a skin protectant, a drug with set ingredients and amounts.

Where does a barrier cream fit with tretinoin or azelaic acid?

Follow the treatment's own directions about timing; the routine guide shows where the moisturizing step goes.

If your moisturizer already does both jobs and your face feels comfortable, you can skip the barrier cream. If your moisturizer is light and some areas still feel tight, a barrier cream can earn its place in one of two ways. You can use it as a richer moisturizer instead of your current one, or as a thick shielding layer over your moisturizer on just the tight areas.

Say your moisturizer lists ceramides, cholesterol and fatty acids but nothing from the shielding list, and your cheeks still feel tight. Layering a petrolatum-based barrier cream over your moisturizer on your cheeks adds the shielding it skips, and the guide to slugging covers when a layer over your moisturizer makes sense.

Why we built Omnia to do both jobs

We designed Omnia so one product covers shielding and rebuilding. Squalane and two plant waxes, sunflower seed wax and jojoba esters, leave the shielding layer. Ceramide NP and a plant-sterol lipid complex supply barrier lipids, and we chose the plant sterols as a counterpart to the cholesterol in skin's own lipid mix.

Omnia is also a waterless solid serum, so there's no oil and water to hold together and no need for emulsifiers. We think that matters in something you put on every day, because some emulsifiers may weaken the barrier and the forearm study showed that a daily cream's formula decides which way it moves your barrier. So we'd rather build a formula that doesn't need emulsifiers than count on the rest of a formula to make up for them.

The next time a product says "barrier," turn it over before it joins your routine. Its ingredient list, plus a Drug Facts label if there is one, tells you which job it's built for, and your moisturizer's list tells you whether that job is already covered.

Sources

1. Bauer A, et al. Interventions for preventing occupational irritant hand dermatitis. Cochrane Database of Systematic Reviews, 2018.
2. Corazza M, et al. Barrier creams: facts and controversies. Dermatitis, 2014.
3. Reick S, et al. Local barrier creams for skin care in newborns, infants and toddlers with incontinence-associated dermatitis (IAD): narrative review. Pflege, 2017. In German, with an English abstract.
4. Mostosi C, Simonart T. Effectiveness of barrier creams against irritant contact dermatitis. Dermatology, 2016.
5. US Food and Drug Administration. Over-the-Counter (OTC) Monograph M016: Skin protectant drug products for over-the-counter human use. Posted September 24, 2021.
6. Man MQ, et al. Optimization of physiological lipid mixtures for barrier repair. Journal of Investigative Dermatology, 1996.
7. Lodén M. Role of topical emollients and moisturizers in the treatment of dry skin barrier disorders. American Journal of Clinical Dermatology, 2003.
8. US Food and Drug Administration. Is it a cosmetic, a drug, or both? (Or is it soap?).
9. US Food and Drug Administration. 510(k) summary K052643: EpiCeram skin barrier emulsion. 2006.
10. Miller DW, et al. An over-the-counter moisturizer is as clinically effective as, and more cost-effective than, prescription barrier creams in the treatment of children with mild-to-moderate atopic dermatitis: a randomized, controlled trial. Journal of Drugs in Dermatology, 2011.
11. Sugarman JL, Parish LC. Efficacy of a lipid-based barrier repair formulation in moderate-to-severe pediatric atopic dermatitis. Journal of Drugs in Dermatology, 2009.
12. Nugroho WT, et al. The efficacy of moisturisers containing ceramide compared with other moisturisers in the management of atopic dermatitis: a systematic literature review and meta-analysis. Indian Journal of Dermatology, 2023.
13. Buraczewska I, et al. Changes in skin barrier function following long-term treatment with moisturizers, a randomized controlled trial. British Journal of Dermatology, 2007.
14. Schorr ES, et al. Adjunctive use of a facial moisturizer SPF 30 containing ceramide precursor improves tolerability of topical tretinoin 0.05%: a randomized, investigator-blinded, split-face study. Journal of Drugs in Dermatology, 2012.