Emollients

A person smoothing out emollient cream on their hand

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.

Emollient formulations

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.

Spray-on ointments contain ingredients such as white soft paraffin, liquid paraffin and fractionated coconut oil dissolved in silicone (to enable the spray action). Emollient spray is particularly useful for treating hard-to-reach areas of skin.

Ointments are often stiff and greasy, and some people may find them cosmetically unacceptable. However, because they are very effective at holding water in the skin and repairing the skin barrier, they are useful for very dry and thickened areas of skin. They are often applied before bed or under wet wraps. They should be applied every 6-8 hours. Ointments should not be used on weeping eczema. Ointments contain less water than other emollients and therefore require fewer preservatives. This makes them ideal for people who react to preservatives.

How should I apply emollients?

Always test new products on a small area of unaffected skin for 48 hours in case you have a reaction.
Use your emollient of choice frequently. This should be at least twice a day, and every few hours when the eczema is flaring or the skin is very dry. It’s recommended that an adult uses at least 500g per week when the eczema is affecting a large area of the body (at least 250g for a child).
Every time you wash or take a bath/shower with your leave-on emollient, pat your skin dry afterwards with a soft towel and immediately re-apply your leave-on emollient (unless you’re also using a topical steroid – see advice below).
Apply emollient gently in the direction of hair growth. Never rub up and down, as this could trigger itchiness, block hair follicles and create more heat in the skin. It’s 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 ensure that all areas of skin are moisturised.
Apply emollient to all of your skin, not just the area/s with eczema.
Continue to use emollient even when your eczema has improved. This will help prevent flare-ups.
Remember to use a spoon to decant emollient from any tubs you may be using. If you dip your fingers into a tub, it can easily become contaminated with bacteria. A metal dessert spoon is good for decanting emollient and washes well under the tap. If you’re using pump handle dispensers for your emollients, you don’t need to decant – you can just pump the emollient onto your hand (avoid touching the nozzle).
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 soothe itch, so you may prefer to store emollient cream in the fridge (but do not freeze, and do not put emollient ointments in the fridge).
Carry a small container of emollient with you whenever you are out and about, to use as needed.
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.
For information on using emollients before and after swimming, see our Eczema and swimming factsheet.
You should continue to use emollients alongside other treatments prescribed.
- Steroid creams and ointments (topical steroids): Recent research has shown that applying an emollient before a topical steroid can reduce the amount of topical steroid that reaches the skin, so it’s best to apply the topical steroid first (you may choose to do this after a bath/shower). Leave 30 minutes if you can between applying the topical steroid and the emollient. The reason for the 30-minute gap is to avoid diluting the topical steroid with the emollient and spreading it to areas that don’t need it.
- For topical calcineurin inhibitors, the guidance is different. The manufacturer recommends that emollients should not be used within 2 hours of applying tacrolimus (Protopic). In practice, this means using leave-on emollients and/or soap substitutes, and then leaving a 2-hour gap before applying tacrolimus. With pimecrolimus (Elidel), no gap is needed

Caution: Emollients aren’t flammable on their own or on skin, but dried residue on bedding, clothing, or dressings can ignite more quickly. The risk is highest for smokers or anyone using naked flames or heat sources like halogen heaters or incense. Take extra care, keep flames away from clothing and bedding, and wash them regularly to reduce residue build-up.

FAQ's

Some emollients contain the following added ingredients:

Antimicrobials (antiseptics) are found in some leave-on lotions, creams and assorted wash products. They destroy bacteria. Some people become sensitised to the leave-on forms if they use them for a long time.
Humectants (for example, glycerine, propylene glycol and urea) are found in some leave-on lotions, creams and gels. They draw water into the epidermis (the outermost layer of skin) from the dermis (the second layer of skin). Emollients that contain humectants work for longer than those that don’t (see the list in the PDF at the bottom of the page for examples).
Anti-itch ingredients are found in several creams in the form of lauromacrogols, a local anaesthetic that helps relieve itch.
Ceramides are found in some leave-on lotions and creams. They aim to re-establish the balance of fats necessary for the appropriate functioning of the skin barrier.
Oatmeal is found in some lotions, creams and bath oils. It has antioxidant properties.

Cleansing the skin is an important part of eczema care. A daily emollient bath/shower is recommended to remove dirt and skin debris, which could cause infection. Plain water without emollient will dry out the skin, whereas an emollient will cleanse the skin, reduce itchiness and repair the skin barrier by trapping moisture. The water should be tepid, as too much heat can aggravate eczema. If you find that the water stings your skin, apply your leave-on emollient all over before getting into the bath/shower and then gently wash it off.

Ordinary wash products (soap, wipes, bubble bath and other cosmetic creams and gels for the bath and shower) should be avoided as they are alkaline and contain detergent and fragrance, which have the potential to dry out and irritate the skin.

Soap substitutes should be used for hand-washing, showering and bathing (although during the Covid-19 pandemic, people with eczema were advised to wash their hands first with soap and then with an emollient, as emollients were not considered effective at removing the Covid-19 virus). You can either use an emollient product designed specifically for washing, or your usual leave-on emollient as a soap substitute – simply apply it all over your body, just before or during showering or bathing, and then rinse it off. All leave-on emollients can be used for washing apart from 50:50 Ointment, which is very greasy. Soap substitutes may take a little getting used to as they don’t foam like ordinary products, but they are nevertheless effective at cleansing the skin.

Emollient bath and shower oils are added to the bath water or applied directly to the skin in the shower. They hydrate the skin, coating it with a film of oil, which traps moisture. Some bath and shower products have additional antimicrobial and anti-itch properties. Bath and shower oils are readily available to buy but are rarely offered on NHS prescription. Healthcare professionals will suggest you use a leave-on emollient as a soap substitute. Bath oils can be useful for people with sensory issues, who find it difficult to tolerate the feel of leave-on emollient on their skin.

Caution: Emollients make surfaces extremely slippery, so always use a bath/shower mat. Grab rails are also a good idea if you struggle to get out of the bath. Use a baby bath support for babies under six months. Wipe the bath surfaces with paper towels or tissues to absorb excess oil. White vinegar is a good cleaning product for the bath. The bath can also be cleaned with an ordinary bath cleaner, but make sure you rinse it thoroughly afterwards. Warn other bath users that the bath or shower may still be slippery.

Please read our guidance on obtaining an emollient that works well for you, in sufficient quantities, on prescription.

Read this article to learn how sensory sensitivities can make eczema care tricky for children with autism and how to find emollients they can tolerate.

Useful resources

Publications

Government safety advice

Aqueous cream: may cause skin irritation. 2014

“SLS is used as a skin irritant in patch testing, and is therefore an ingredient that should never be included in an emollient formulation” - Use of emollients in dry-skin conditions: consensus statement