Episode 55: “Smart” skin sprays, innovations in moisturizers and cleansers, and other “OTC” advances

May 21

Written By Global Parents for Eczema Research

In Part 2 of our conversation with Dr. Peter Lio, we take an in-depth look at non-prescription eczema strategies, focusing on over-the-counter (OTC) innovations, microbiome re-balancing treatments, and "green space" therapy. Tune in to learn more about the latest-latest in options you can access on your own, without a doctor's prescription.

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Peter Leo Part 2 - OTC April 2026
Korey Capozza: Welcome to the podcast. I'm Korey Capozza, Executive Director of Global Parents for Eczema Research. Today, I'm happy to welcome back Dr. Peter Lio, who needs no introduction. He joined us in our previous podcast for part one about new treatments for kids. Today, he will share more about moisturizers, complimentary and alternative treatments available now and coming soon.
Dr. Lio is well known in the eczema community by researchers, physicians, and patients alike. His training is extensive and cross-disciplinary. He's Clinical Assistant Professor of Dermatology and Pediatrics at Northwestern University and founding director of the Chicago Integrative Eczema Center.
Dr. Lio, welcome back
Dr. Lio: Thank you. Thank you so much for having me.
Korey Capozza: So last episode, we had a great chat about some of the prescription treatments that are coming soon for kids with eczema or newly available. And today, we wanted to talk about some of those non-prescription treatments, what have you got your eye on out there in terms of Over-the-counter or OTC strategies that might give us a completely different approach to tackling some of these symptoms?
Dr. Lio: I love it. Thank you for that question. 'cause this is my real passion lately, and I have a paper that's in press. We call it Active Dermatologic Care or ADC. And this is this idea of using all the OTCs to our advantage that I think dermatology does naturally, other specialties don't. Like when you go to your primary care doctor, maybe they'll recommend like an over-the-counter painkiller or something, but boy, in dermatology, almost every single patient I have multiple OTCs that I'm using. Be it a gentle cleanser, a good moisturizer, or some of these more kind of active agents.
So in the topical space, OTC wise: tremendous new innovation and moisturizers, there are some moisturizers that are using these, this special polymer technology that means they can feel lightweight like a gel, but actually feel like a cream on your skin and protect your skin like a cream or an ointment.
So they're great for kids. I have a lot of kids who have some sensory issues and they really don't like the feel of heavy things or occlusive things, but these can change the game. We have some new cleansers. I'm really a big fan of oil-based cleansers because I think not only are they gentle, like that's, to me, that's table stakes now, gentle cleansers. But these actually add oil and add good things to your skin, good fats and lipids that really help rebuild it.
Korey Capozza: That's great news, and I feel like this area is a little bit overlooked, these sort of, mainstay products that are used on a daily basis with eczema, where we don't always see a lot of innovation. So it's great to hear that we're starting to see some improvements in things like just daily moisturizers, cleansers, and things that help repair the skin barrier.
On the topic of moisturizers, I actually wanted to ask you about something related, which is I've noticed in some of the trials where there's an intervention, and then they compare its impact to a comparison arm, so not the treatment.
And a lot of times in this comparison arm, there's just moisturizer therapy for the people who don't get the treatment.
And we see in these trials this huge impact of just moisturizer therapy, and I've always wondered, could we get a lot of the way there just with really good moisturizer therapy if it's done right with the right moisturizer?
And related to that, it seems to me that we still don't know exactly what type of moisturizer works best for eczema or if there might even be some products that make it worse, and this is such a huge research gap that really needs to be addressed.
Could you comment a little bit on what I just said and what your thoughts are on those observations?
Dr. Lio: Sure. There's no doubt that they're incredibly powerful and the technologies keep changing, and they often are making leaps, but it's very tough to look at this subjectively because essentially all of the research for moisturizers are only put forth by the companies who make them. So we have this really inherent problem. There's almost no funding for people to do comparative work. And you're right it's a huge, complicated set of things because people say, which is the best, which one should I use? And it just keeps getting more and more.
So I don't have any easy answer. I do feel like I encourage there to be comparative studies. I really love to see comparative data, even against simple ones, against older moisturizer that can, even, that alone can help us benchmark good. And I do love to continue to stay abreast of all the new technological advancements and get feedback from my patients and families.
My favorite thing, I get a lot of kids who maybe don't like moisturizers at all or have had bad experiences, and I'll come in with a pallet of moisturizers and I'll say, why don't we try these together? And I'll have the kid put a little bit on his hand or his arm, and when they find one that they like, that can be a magical moment where they say, ‘Oh. I like this one. This is my moisturizer.’ And I'll say, ‘Okay, this is the one.’ And they're different brands. They're different formulations, but some of that can be a very personalized piece. But I agree. I would love to have a way to, to really figure out beforehand.
Korey Capozza: Yeah. How empowering for your patients. That's awesome.
A little plug for our research program. We are funding, uh, that type of study into optimal moisturizers for children in early childhood, and you can find out more about our grants program at www.gper.org/grants
We know that with eczema, Staph aureus bacteria is a problem, that people who have eczema are over-colonized with this particular type of bacteria, and controlling it has been an ongoing sort of riddle for eczema care. Are there any new products that get at this issue, this overdominance of Staph on the skin, and maybe new ways to control it to improve eczema?
Dr. Lio: Yes, there are different approaches here. We have the hypochlorous acid sprays and gels. Like a dilute bleach kind of concept. Get rid of some of the overgrowth of Staph. And then we have a whole bunch of more targeted ones coming. There are a couple on the market now that are enzymes that specifically target Staph, so you spritz it on and it kills only Staph aureus and leaves the other guys behind, which is really amazing.
There's a company that has put out one that is actually bacteria-phage viruses. You actually buy a little bottle of virus, which sounds a little scary, but they're viruses that only attack the bad bacteria, you spritz that on your skin or pour it on your skin and that can also do something.
Then the pipeline's super exciting. I get to advise for a company that's working on a new topical probiotic combination of three probiotics that they've studied and have a really powerful effect against Staph but support the rest of the microbiome.
Another company that I'm following closely has a botanical agent.
So this is actually, they call it the latex of the plant and it has a powerful anti-inflammatory effect and an antibacterial effect. So really fantastic to see these things.
Korey Capozza: Speaking of bacteria, we know these tiny bugs or microbes on the skin and in the gut are probably more important than we previously thought. Can we talk a little bit more about the gut and skin microbiome or this community of microbes that live on us and the role that they, maybe play in health and disease?
What are the most promising areas, in your opinion, for microbiome therapies for eczema, and where would you put your money if you had to bet on something?
Dr. Lio: I really do think the microbiome is going to open up a whole bunch of new ideas. I think it's playing a much bigger role than we've realized.
It's one of those things where it's been a hidden organ and now more and more we realize, oh boy, this is a huge part of the story. And in fact, some of the work I'm doing now is putting Staph at the center of the whole story. We've reframed it. In the old days, I was taught it's just an opportunistic infection, a colonizer. But now we go, oh my gosh, this really has multiple ways that it's directly damaging the barrier, directly driving itch, directly driving inflammation affecting the rest of the microbiome. So I do think that's gonna be important. I don't know what the solution will look like. It might be multi-pronged and it might be very individualized.
Korey Capozza: So, but talking about therapies, it seems like the strategy that we hear about the most is probiotics. So, um, taking some strains orally to impact the gut microbiome or even spraying on the skin beneficial bacteria, for example, to improve the skin microbiome. Can you talk a little bit more about those types of strategies?
Dr. Lio: Sometimes I hear people say, do probiotics work? And that's a very weird question because it really depends on the strain or strains, the dosage, the frequency, the background host. It's saying, do antibiotics work? It's yes, but you have to know a lot before you give someone an antibiotic, right? If I give you the wrong antibiotic at the wrong dose, you will conclude Antibiotics don't work. But that's not quite the right conclusion. It's just, it's a tool. We have to understand how to use it properly.
Korey Capozza: Absolutely. And I think it's still early days there, but there are some, I think, hints that we're getting closer to really understanding what the right mix is and the right strains and so on. So I'm really excited about that area too.
A minute ago, you talked about Staph bacteria, and I wanted to just delve in a little bit about why we're paying so much attention to this bacteria and why we think it has a bigger role in eczema flares than maybe we thought before. Staph has some unique abilities and let's, let's talk about those for a minute because I think it's driving some of this innovation in therapy.
This is an incredibly smart bacteria, for lack of a better word. We're learning how it uses something called biofilms. A force field to protect itself, how it communicates through this, something called quorum sensing. It, this is a very sophisticated bacteria. Could you talk a little bit more about all the tools that Staph uses to perpetuate itself and maybe contribute to inflammatory skin conditions like eczema?
Dr. Lio: Sure and I think you put it perfectly the force field or these incredible abilities that it has to create a biofilm, which protects it in a layer. So antibiotics can't reach it very easily, nor can our bodies' defenses. It has these different toxins that it releases. And some of them, we know their names like Alpha Toxin and Delta Toxin and V Eight protease. These things can actually directly damage the skin cells. They can hurt our barrier. They can directly activate things like our mast cells, which we know can release histamine and cause itch and inflammation, they can directly activate itch neurons. So now we can really see all these different pathways that it's going to worsen the disease and drive the disease.
And the hard part is it's not a hundred percent because we know some people, there's a strong correlation having more Staph correlates heavily with bad eczema. Most bad eczema patients do have a lot of Staph, but not everybody. So I think we can't call it an infectious disease. I've had people say, wait, so are you saying that maybe atopic dermatitis is really just an infection?
Could we treat it like an infection? It's unfortunately no, because it'd be great if we could, if we just get rid of Staph and it would be all better. It seems like it's more complex than that because even if you do the nuclear option and blast the Staph with a powerful antibiotic, both topical and oral, you can help, but you don't fix the whole problem.
So again, it's one of these funny things where I think we have to fix multiple parts at once to pushback Staph, we have to help support the good guys so they can make a better kind of soil, if you will. The background has to grow the good guys and support them. We have to cool the inflammation down. We have to break some of the behavioral cycles. So I think for me at least, and maybe in 20 years people will laugh that this is naive, but I view it as a much more holistic problem where the there are multiple systems and just to focus on one thing too much often leads us astray.
Korey Capozza: Yeah, great points. And I think, this has been a topic of some debate in the eczema community for years.
So, I guess, one last question. Our organization is really focused on this prevention piece. And before this call, you shared a really interesting paper with me looking at early life exposure to green space. And I thought we could end with this question because in some ways it's a very appealing strategy: Just get your child into green space and you may have, a powerful effect, but could you share the findings of that study and why it might be important and perhaps what it points to in terms of future directions for research?
Dr. Lio: Sure. I think it's neat to think where it comes from. Why would they even go down that route? And I think the big pieces that we understand, eczema is associated with modern life, with urban life. There's a strong correlation if you live close to a highway. Isocyanates can directly poison our microbiome and probably directly damage our skin barrier. And these are released by car exhaust and also of course sometimes in volatile organic compounds and things like that. So in the modern world, we're exposed to these things. Of course, also wildfire smoke for what it's worth. And that would make us think, boy, if we could get away from some of these pollutants and contaminants, would it be better? And this study in Japan showed that kids who are exposed to more green space that have this outdoor space with trees and plants, they actually have a lower risk of atopic dermatitis.
And this isn't the only paper that's shown that there's, this is, there's a literature about this. It's soft, I would say, it's not overwhelming, but I really believe in it. I think that there probably is something to it. We're meant to be outdoors. We're meant to be in these environments. There are microbiome things that are affecting us. The literally the microbes themselves in the soil and in the earth, but also the, the humidity, the other exposures that we're having that shapes us and affects us. So all these pieces, I think, come together. Plus when you're outside, you're not looking at a screen, your stress levels go down all these pieces. So I think it's hard to explain exactly why that might be, but I'm pretty convinced that's part of it.
And what an amazing health initiative would it be to say, Hey, we gotta get these kids outside. We gotta have more green spaces. We can't just live in a kind of a toxic, modern wasteland where everybody's locked inside all the time, breathing recycled air.
Korey Capozza: Yeah.
On that note, I think it's really hopeful, why not do that? Why not get outdoors into green space now? It certainly will help many different things, including possibly your skin microbiome. So a great prescription, I think. Dr. Leo, thanks for this super interesting discussion. We covered a ton of ground. And also thank you for what you do for eczema patients here in the US and around the world.
Dr. Lio: Thank you for having me.