BACKGROUND: Atopic dermatitis (AD) poses a challenge due to its chronic inflammatory nature. Recent research highlights microbiome dysbiosis as a key contributor. Emollients "plus" are modern moisturizers containing bacterial lysate, improving skin barrier function and reducing Staphylococcus aureus colonization, thus mitigating AD symptoms. Emollient "plus" containing Vitreoscilla filiformis biomass (Aqua Posae filiformis) is efficient in AD, as single adjunct for milder forms or adjunctive to systemic treatments in more severe forms. Standard recommended moisturizers for AD in Indonesia contain urea 10%. AIMS: This trial compared an emollient "plus" (Group A) with urea 10% moisturizer (Group B) in the treatment of mild-to-moderate AD. PATIENTS/METHODS: Sixty subjects with mild-to-moderate AD were randomized into Groups A and B (30 subjects/group). Test products were applied twice daily for 12 weeks. Clinical and instrumental endpoints assessed at Weeks 0, 4, 8, and 12 included Severity Scoring of AD (SCORAD), Pruritus Visual Analog Scale (PVAS), Eczema Area and Severity Index (EASI), Dermatology Life Quality Index (DLQI), Transepidermal Water Loss (TEWL), skin hydration, skin pH, as well as tolerance evaluation. RESULTS: Significant differences in favor of the emollient "plus" versus urea 10% were observed on TEWL and skin pH values at Weeks 4, 8, and 12, on SCORAD and skin hydration values at Weeks 8 and 12. EASI, DLQI, and PVAS values differed significantly at Week 12 in favor of Group A. Both products were well tolerated. CONCLUSIONS: This emollient "plus" has superior efficacy in improving AD symptoms and skin barrier function compared to urea 10% moisturizer.