Emollients
Introduction
Emollients are medical moisturisers used to treat eczema and other dry skin conditions. Unlike cosmetic moisturisers, they are unperfumed and do not have ‘anti-ageing’ additives.
Emollients have been used for over 5,000 years and form an essential part of the therapy for all dry skin conditions. Emollients 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.
How do emollients work?
Dry skin is one of the main symptoms of eczema. This defective skin barrier allows irritants, allergens and bacteria to enter it more easily. Itchiness leads to scratching which causes skin damage and also allows irritants, allergens and bacteria to enter the skin.
Emollients soothe and relieve itch, producing an oily layer on the surface of the skin, which traps water beneath it. The restoration of the skin’s barrier function by emollients prevents irritants, allergens and bacteria entering the skin, thereby avoiding or reducing eczema flares and infection.
How do I choose the right emollient for me?
There are over 120 emollient products that are approved for use by the NHS. However, healthcare professionals are usually only allowed to prescribe a few different brands, and the range available will depend on where you live. Healthcare professionals may sometimes provide samples of emollients for people to try. These emollients can also be purchased in pharmacies and some shops, although they may need to be ordered specially.
It can be difficult to find the right emollient – one that works well and that you like. You may prefer to use a cream or gel during the day and during the spring and summer months, and a greasier emollient just before bed and during the autumn and winter. You may also need to use different types of emollient on different parts of the body.
It’s therefore helpful to understand the different emollient formulations and how they work, and consider these in the context of your skin and lifestyle needs.
Read the FAQ’s below for guidance on how to apply emollients.
Lotions contain more water and less fat than creams. Because of their high water content, lotions need to contain preservatives, which people can become sensitised to, although this is rare. Lotions spread easily and are cooling, but are not that effective at moisturising very dry skin. This is because they are not thick enough to repair the skin barrier. They are useful for hairy areas and weeping eczema, or for quick absorption if time is short.
Creams contain a mixture of fat and water, and feel light and cool on the skin. They are quite easy to spread over sore and weeping skin and are not greasy, so many people prefer them to ointments for daytime use. Like lotions, creams need to contain preservatives, which can cause sensitivity in some people. Creams need to be used liberally and applied frequently (every 3-4 hours) to effectively repair the skin barrier and stop the skin drying out. Humectant creams (containing natural moisturisers such as glycerine or urea) effectively repair the skin barrier and only need to be applied twice a day.
Please note: 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.
Gels are formed, scientifically speaking, from molecules that make a three-dimensional network, which then traps other molecules in the spaces of the network. They are relatively light and non-greasy, despite having a reasonably high oil content.