What are emollients?
Emollients are medical moisturisers used to treat eczema. They come in different forms: creams, ointments, lotions, gels and sprays. They are different from cosmetic moisturisers in that they are unperfumed and do not have ‘anti-ageing’ additives. Emollients form an essential part of the therapy for all dry skin conditions. They are safe and effective – a good skin care routine using emollients can soothe, moisturise and protect the skin, helping to reduce the number of eczema flares.
What is the best emollient?
Eczema is a very individual condition and different emollients tend to suit different people. The best emollient is the one you like, because then you will use it more often. Always test new products on a small area of unaffected skin for 48 hours in case you have a reaction. You may need to use different types of emollient on different parts of the body to obtain the best hydration and to restore the skin’s barrier function to normal.
You may also like to alternate between a lighter emollient during the day and during the warmer months, and a greasier one at night and when the weather is colder.
When and how should I apply emollient?
Emollient therapy is not just about products but also about understanding how and when to use them. The following tips will help you to get the most out of your emollient therapy:
- Use your emollient of choice frequently. This should be at least twice a day, and every few hours if the eczema is flaring. It is recommended that an adult uses at least 500g per week (at least 250g for a child).
- Use your leave-on emollient or an emollient soap substitute to wash with, instead of soap or shower gel, which can dry out the skin further.
- Every time you wash or take a bath/shower, pat your skin dry afterwards with a soft towel and immediately re-apply your leave-on emollient.
- Apply emollient gently in the direction of hair growth. Never rub up and down vigorously as this could trigger itching, block hair follicles and create more heat in the skin. It is a good idea to dot blobs of emollient around your limbs and trunk first (you may need someone to help you with your back), as this helps to ensure that all areas of skin are moisturised.
- You should continue to use emollients alongside other treatments which your doctor may prescribe, such as topical steroids and topical calcineurin inhibitors.
- Apply a thicker-than-usual layer of emollient (the greasier the better) before swimming, to help protect the skin from the drying and irritant effects of swimming-pool water. After swimming, shower and apply your usual leave-on emollient.
- Protect your hands with emollient (and perhaps wear gloves) before handling substances such as sand, certain foods, paint and clay, so they don’t irritate your skin.
- Avoid putting hands into pots of emollient cream or ointment. Use a spoon or spatula to take out the correct amount each time and replace the lid of the tub after use. Alternatively, use a pump dispenser.
- Carry a small container of emollient with you whenever you are out and about.
- Continue to use the emollient, even when the eczema has improved. This will help prevent flare-ups.
- Apply the emollient to all of your skin, not just the area with eczema.
- You can store your emollient at room temperature, or in the airing cupboard if you like it warm (but do not put your emollient on a hot radiator as this will encourage the growth of bacteria). Coldness helps to soothe the itch, so you may prefer to store emollient cream in the fridge – but do not put ointments in the fridge.
Finding it difficult to get an emollient on prescription?
Please see our information here on obtaining an emollient that works well for you, in sufficient quantities, on prescription.
Emollients and sensory differences
This ‘Ask the Expert’ article was published in Exchange 180, June 2021.
Q My five-year-old son has always been very sensitive and has recently been diagnosed with autistic spectrum disorder (ASD). He has atopic eczema and very dry skin but he has increasingly found the feel and smell of emollients difficult to cope with. He is starting to refuse all emollients, which is gradually making his skin drier and, in turn, flaring his eczema. We’re finding it a real struggle – any suggestions?
Julie Van Onselen, Dermatology Nurse Adviser to NES, says: For people on the autistic spectrum or with sensory processing issues, managing eczema can be a real challenge. It is not uncommon for children and adults alike to have heightened or reduced sensitivity to sights, sounds, taste, smells, textures and touch. Adults with sensory issues have said that even a gentle touch can feel like fire or barbed wire, so it’s important to find the best solution.
As emollients are usually applied to the body with touch, this can cause problems. The result of not applying enough emollients can also alter sensation, with the feel of dry and scaly skin. Practically, to try and prevent itch and stop your son’s eczema from flaring, it is important to try and find an emollient he can tolerate. Emollients come in different formulations and have different textures, including greasy ointments, oily creams, lighter gels and even sprays. So, do try a variety – sprays can work well for people who don’t like being touched or dislike the texture of emollient on their skin.
Bath oils are not often prescribed, but this is one situation where a bath oil could really help restore the skin barrier without physical touch. Once your son is comfortable in an emollient bath, you could introduce a leave-on emollient as a soap substitute. This may be a good option for a formulation with a comfortable texture for your son. Over time, you might help him get into a routine of applying his own emollients – perhaps with a reward system if he finds this motivating.
When you do apply products, warn your son you are about to touch him and approach him from the front. Gradually introduce different textures to touch (for example, have a box of small pots of
different emollients that he can try). If clothing causes him sensitivity too, remove any tags or labels, turn clothes inside out so there is no seam touching his skin and (as for all children with eczema) opt for natural fibres.
If your son has a flare, he may be prescribed a short burst of topical steroids too. These are only applied once daily, so you could try and do this when he is asleep. However, sleep can be a challenge for children on the autistic spectrum, too, so if this causes problems do talk to your GP or dermatologist. If the problems are ongoing, an occupational therapist could provide strategies to help your son.
Find out more from the National Autistic Society at autism.org.uk/advice-and-guidance/topics/sensory-differences/sensory-differences.
Aqueous cream and eczema
Aqueous cream is no longer recommended either as a leave-on emollient or as a soap substitute. In addition to being a poor moisturiser it contains the ingredient sodium lauryl sulphate (SLS), which can irritate the skin and make eczema worse. Several emollients have been reformulated in recent years to remove SLS. Apart from aqueous cream and emulsifying ointment, no emollients available on prescription in the UK still contain it.
Here are some links to further information on aqueous cream and eczema:
- Use of emollients in dry-skin conditions: consensus statement. Moncrieff, Cork, Lawton, Kokiet, Daly, Clark. 2013
- Aqueous cream damages the skin barrier. Cork, Danby. 2011
- The effect of aqueous cream BP on the skin barrier in volunteers with a previous history of atopic dermatitis. Danby, Al-Enezi, Sultan, Chittock, Kennedy, Cork. 2011
Government safety advice
SLS is used as a skin irritant in patch testing, and is therefore an ingredient that should never be included in an emollient formulationUse of emollients in dry-skin conditions: consensus statement
To obtain more information on emollients in a PDF format, please download our Emollients factsheet, below.