Emollients are specialised medical moisturisers designed to manage eczema as well as other dry skin disorders. Compared to cosmetic moisturisers, they are perfume-free and do not contain anti-ageing ingredients. Having been used for more than 5,000 years, emollients remain a cornerstone of treatment for dry skin conditions. They are both safe and effective, offering relief by soothing, hydrating, and protecting the skin. A consistent skincare routine with emollients can significantly reduce the frequency of eczema flare-ups.
Dry skin is a primary indicator of eczema, often caused by a genetically impaired skin barrier in individuals with atopic eczema. This weakened barrier makes the skin more susceptible to allergens, irritants, and bacteria.
Eczema also causes intense itching, leading to a distressing itch-scratch-damage cycle. Scratching not only worsens skin damage but also increases the risk of irritants and harmful microorganisms penetrating the skin.
Emollients work by soothing irritation and alleviating itchiness. They create an oily layer on the skin’s surface, which locks in moisture and helps restore the skin’s natural barrier. By strengthening this barrier, emollients minimise the entry of allergens, irritants, and bacteria, thus reducing the likelihood of eczema flare-ups and infections.
The NHS approves more than 120 emollient products (as listed in the ‘NHS Drug Tariff’). Nevertheless, healthcare providers can usually prescribe only a limited selection, depending on your location. These products can also be bought in pharmacies or stores, though some may require special orders.
Finding the appropriate emollient can be a challenge, as effectiveness and personal preference vary. You may require multiple types to meet your skin’s unique needs. Therefore, understanding the different formulations and how they work can help you choose the most suitable option for your skin and lifestyle.
Healthcare professionals often refer to emollients that provide prolonged hydration as “leave-on” emollients. These products form a protective layer over the skin to reduce water loss, a process known as an “occlusive” effect (a medicinal term that means to block or obstruct).
Many emollient creams, lotions, and gels offer a lighter occlusive effect, typically keeping the skin hydrated for 1 to 4 hours. On the other hand, ointments and sprays create a thicker layer and can provide moisture for up to 8 hours.
Some emollients contain additional ingredients like glycerine or urea with natural moisturising properties. They are called humectant emollients and can maintain hydration for 6-24 hours. Despite this, applying them two times per day is recommended for optimal results.
Emollients come in various formulations, including lotions, sprays, creams, gels, and ointments. Each is directly applied to the skin and serves different purposes:
Some emollients are enhanced with additional ingredients to provide specific benefits:
Skin cleansing is a key aspect of managing eczema. A daily bath or shower using an emollient is required to get rid of skin debris and dirt that could lead to infections. Plain water alone can dry out the skin, but adding an emollient helps to cleanse, soothe itchiness, and repair the skin barrier by locking in moisture. Ensure the water is lukewarm since hot water can worsen eczema. If the water itches your skin, consider applying your leave-on emollient all over your body before getting in, and then gently rinse it off.
Avoid regular wash products like soap, bubble baths, wipes, or other cosmetic gels or creams, as they often contain alkaline ingredients, detergents, and fragrances that can irritate and dry out the skin.
For showering, handwashing, and bathing, use soap substitutes instead of traditional soaps. During the COVID-19 pandemic, persons with eczema were instructed to thoroughly wash their hands with soap first to remove the virus and then apply an emollient. This is because emollients alone were not sufficient for this purpose.
You can use specially formulated emollient wash products or your regular leave-on emollient as a soap substitute. Apply it to your skin before or during your bath or shower, and rinse it afterwards. While soap substitutes do not foam like traditional products, they are effective at cleaning the skin. However, avoid using very greasy options like 50:50 Ointment for washing.
You can put emollient bath and shower oils in bath water or apply them directly to the skin during a shower. These products help hydrate the skin by forming an oily layer that holds moisture. Some oils are enriched with antimicrobial or anti-itch properties. While these products are widely available for purchase, they are rarely prescribed by the NHS.
Healthcare professionals normally recommend using a leave-on emollient as a soap substitute instead. Bath oils can be particularly helpful for individuals with sensory sensitivities who may find the texture of leave-on emollients uncomfortable.
The appropriate emollient is the one that suits your skin and that you enjoy using, as this increases the likelihood of consistent application. Healthcare professionals may offer samples of different emollients for you to try. Before starting a new product, test it on a small region of unaffected skin for at least 48 hours to check for any adverse reactions.
Different areas of your body may require distinct emollient types to achieve optimal hydration and restore the skin’s barrier function. You might prefer lighter options like gels or creams during the day or in the warmer months of spring and summer. Richer, greasier emollients may work better at night or in the colder autumn and winter.
Additionally, remember to apply your leave-on emollient as a soap substitute for washing (with the exception of 50:50 Ointment).
Emollients help reduce itchiness and make one feel more comfortable. They keep the skin hydrated and flexible, preventing cracks. However, they are often underused because people may see them as just moisturisers and may not fully understand their importance in managing eczema. When appropriately applied as part of a daily routine, emollients act as efficient ‘active treatments.’ To get the most benefit from emollient therapy, it’s essential to understand not only the products but also how and when you should use them. Here are some helpful tips:
Recent studies show that using emollient products before a topical steroid may limit the amount of steroid getting to the skin. Therefore, applying the steroid first is recommended—this can be done after a bath or shower. Leave about 30 minutes between the steroid and the emollient application to prevent steroid dilution and spreading to parts that don’t require treatment.
For topical calcineurin inhibitors, like tacrolimus (Protopic), a 2-hour gap should be left between applying an emollient and the medication, as recommended by the manufacturer. However, no gap is required with pimecrolimus (Elidel).
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