emollients in dry skin conditions

Last edited 06/2023 and last reviewed 07/2023

• emollients result in a reduction of water loss from the epidermis. If used regularly the use of emollients may reduce eczema flare-ups and the need for topical steroids (1)
  
  
  • the degree of oiliness in different emollients varies 'light' creams (least oily) to 'greasy' emmolients (most oily). The best emollient effect, in general, is achieved with the use of 'greasy' products.
    • 'light' or creamy emollients include aqueous cream, E45 cream, diprobase, oilatum cream.
    • 'greasy' emollients include emulsifying ointment,BP; white soft paraffin,BP; white soft paraffin 50%/ liquid paraffin 50%
      
      
  • ointments are better than creams at retaining skin moisture and preventing further dryness and cracking. Therefore ointments are favoured for the treatment of flaky, very dry skin or for overnight application

NICE suggest:

• children with atopic eczema should be offered a choice of unperfumed emollients to use every day for moisturising
  • may be a combination of products or one product for all purposes
  • prescribe large quantities of leave-on emollients (250 g to 500 g weekly) that are easily available to use at nursery, pre-school or school
• explain to children with atopic eczema and their parents or carers that they should use emollients:
  • in larger amounts and more often than other treatments
    
  • on their whole body, both when the atopic eczema is clear and while using all other treatments
• show children with atopic eczema and their parents or carers how to apply emollients, including how to smooth emollients onto the skin rather than rubbing them in
• if their current emollient causes irritation or is not acceptable, offer a different way to apply it or offer an alternative emollient
• review repeat prescriptions of individual products and combinations of products with children with atopic eczema and their parents or carers at least once a year
• when children with atopic eczema are using emollients and other topical products at the same time of day, explain that:
  • they should apply one product at a time, and wait several minutes before applying the next product
  • they can choose which product to apply first
• offer personalised advice on washing with emollients or emollient soap substitutes, and explain to children with atopic eczema and their parents or carers that:
  • they should use leave-on emollients or emollient soap substitutes instead of soaps and detergent-based wash products leave-on emollients can be added to bath water
  • children aged under 12 months should use leave-on emollients or emollient soap substitutes instead of shampoos
  • older children using shampoo should use a brand that is unperfumed and ideally labelled as suitable for eczema, and they should avoid washing their hair in bath water
• do not offer emollient bath additives to children with atopic eczema
  • Evidence from the BATHE trial indicated that emollient bath additives are not clinically or cost effective when used in addition to standard care (which included applying leave-on emollients and washing with emollients or emollient soap substitutes)

Reference:

• MeReC Bulletin (1998), 9 (12), 45-8.
• NICE (June 2023).Atopic eczema in children Management of atopic eczema in children from birth up to the age of 12 years.