Why are emollients so important?

Emollients reduce dry skin symptoms, protect the skin and decrease the need for other treatments. Applying emollient regularly, as often as is required to keep the skin soft, and not scaly, has important benefits.

In eczema the number of flare-ups is reduced. This means less time having itchy eczema and more time having normal skin. It also means less need for steroid treatment. Emollients are also used to protect eczematous skin to decrease severity of eczema. They are used long term.

In psoriasis using moisturiser clears superficial scale. Cosmetically, the plaques look better and there is less shedding of skin on clothing. Scale removal allows easier application, and enhanced penetration of other topical treatments. Softening is another benefit as flexible patches are more comfortable and less likely to crack. In itchy psoriasis, emollients can relieve irritation. In other dry skin conditions reversing the dryness by moistening can also decrease symptoms such as; itchy painful cracked skin and skin scale shedding.

Whilst applying emollient is time consuming and laborious people often find it is worth the effort.

Which emollient should I choose?

The best product for you is really the one you like best.

The products available range from lotions to creams, gels and ointments. These are on a continuum, in which the water content decreases. The greasier the preparation the more effective it will be, so your choice depends on how dry your skin is, but also on acceptability. Use of greasy products, at the ointment side of the scale, may be limited during the day as they appear shiny on the surface and stick to clothing. They are more difficult to apply as they are thick. They are also impractical for hair bearing skin such as the scalp. A less oily preparation could be better for daytime use, for larger areas or on visible areas such as the face.

Creams and lotions contain water and also contain preservatives, a potential cause of irritation.

When is the best time of day to apply emollient?

Emollients can be used as often as required. When the skin feels dry, you can re-apply. This is especially important after washing, as the water itself, as well as any detergents (soap, shower gel or shampoo) dry the skin. You can use emollient as a soap substitute and use oil in the bath to negate this drying effect.

How much should I be using?

This will vary according to the dryness of your skin and the preparation used. As a rough guide, you may need 500gm per week – this would cover trunk and limbs twice daily for an average sized adult.

Which do I apply first, emollient or steroid?

When eczema flares-up, a topical steroid (ointment or cream applied to the skin) is often prescribed to calm the inflammation. Your skin will improve more quickly, if you apply emollients too. If you apply the steroid first, rubbing on emollient after could spread it from where it had been applied. If you put the steroid on immediately after the emollient it cannot be absorbed. If you wait for 15 minutes, it will be more effective.

My skin feels dry after I wash – why?

Water dries the skin and it's best to have shorter baths or showers. Heat can aggravate dry skin, so try warm or cool water. Foaming cleaning preparations contain soap or detergent, which strip natural oils from the skin, leaving it even drier. Avoiding soap and switching to an emollient wash moisturises rather than dries the skin.

Washing with soap substitute feels different to normal soap and can take time to get used to. Some patients are attracted to anti microbial preparations, however any emollient can be used as a soap substitute. After your wash, use a soft towel and pat dry rather than rub.

Are there any side effects of emollients?

Emollients rarely have side effects; they are designed to sooth inflamed skin. However they can cause irritation – redness and itch, and even contact dermatitis where eczema is caused by allergy to an ingredient. Ingredients more likely to irritate skin, such as perfumes and colours, are not used in these prescription items. Some people react to the water content, preservatives or antimicrobials in lotions and creams.

Slippery baths have caused falls and even hip fractures, please be careful.

Occasionally folliculitis (inflammation of hair follicles) can occur as a result of emollients blocking follicles. To reduce this, apply moisturiser in direction of hair growth.

Emollient preparations, dispensed in tubs, should be removed with a clean spoon or washed finger to reduce bacterial contamination. Pumps prevent this potential problem.

Paraffin based emollients are flammable and therefore pose a potential hazard for smokers.

How can I prevent a flare up?

Avoid irritants and apply emollients. You may recognise triggers. Common irritants are soap, household cleansers, detergents, aftershave lotions, and solvents. Don't use these or wear gloves. Avoid itchy clothing e.g. wool. The weather may also affect the skin, especially cold or dry conditions. In some people stress or exercise – possibly salty sweat, worsen skin. The sun helps the skin especially in psoriasis, in others it can trigger eczema. Diet is more likely to play a role in children. If you notice a certain foods affect your skin, it would be best to avoid them. In psoriasis alcohol is the only recognised dietary trigger.

What should I do in a flare up?

Avoid triggers, apply emollient and apply any active treatments you have been prescribed e.g. steroids. If this is not helping, or if you are red all over and feeling unwell and cold, see your doctor.

Help, I can't sleep at night, I wake scratching

Itching can be an extremely unpleasant sensation that disturbs sleep and can cause low mood. Applying emollients will sooth your skin, but you should see your doctor too, to make sure that there isn't a treatable cause. Your doctor will look at your skin for signs of skin disease, and may do blood tests to identify diseases which cause itching. Some medications can cause itch as a side effect, and if you take any, they would be considered too. It is not always possible to make a diagnosis. A lot of itchy skin does not have an identifiable cause. Skin dryness certainly contributes to itchiness. The advice is: not to scratch and keep finger nails short, keep cool and avoid over clothing, hot baths, shorten water (bath/shower) contact time and avoid soaps/alcohol cleansers/wet wipes. Your doctor may prescribe creams to further sooth or numb the skin, or tablets to help with sleep.

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