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Emollients

Emollients (moisturisers) reduce water loss from the outer layer of your skin (epidermis) by covering it with a protective film. This keeps the water in the skin where it is needed and also helps to keep infections and other harsh substances out. You can use soap substitutes, bath oils and moisturising creams or ointments to soothe, smooth and hydrate the skin in the treatment of dry skin conditions such as eczema and psoriasis. Use emollients even when the skin feels better. This will help to prevent patches of inflammation and flare-ups. The dry skin is also more prone to infection.

A good routine to prevent and treat dryness is:

  • Use a soap substitute for cleansing all areas of the body. 
  •  Use a medicinal bath oil in the bathwater or as you shower. This will give your skin a general background oiling. 
  •  After a bath or shower it is best to dry by patting with a towel rather than by rubbing.
  • Apply an emollient (moisturiser) cream or ointment after washing, bathing or showering and between baths or showers, as often as necessary.

If you find that you can’t fit this into your daily routine, the most important thing you must do is use an emollient cream or ointment, especially after washing or bathing. Try small quantities of several until you find a product that you like. For example, you might choose a cream based emollient for the daytime and an ointment base for night time.

Emollients are available in tubes, tubs and larger pump dispensers that can be bought from your pharmacy or prescribed by your GP. Many people keep some emollient in small pots or tubes at home, work and at school for regular use. Your pharmacist may also be able to provide small labelled empty containers. Wash dry and rinse the container thoroughly before filling and refilling it. Keep it labelled or (if the label gets too greasy and keeps coming off) keep the container in a small, labelled plastic bag for reasons of identification and safety.

Soap substitutes Soap (including moisturising soaps, ordinary bubble baths or shower gels) can strip the skin of its surface layer of natural oils and aggravate the eczema. Use a soap substitute such as aqueous cream or emulsifying ointment, for hand washing and bathing. Aqueous cream also can be used as a substitute for shaving foam. Mix a small amount in the palm of the hand (about half to one teaspoonful at a time) with a little warm water and spread it over damp or dry skin. Rinse and pat dry, do not rub. There have been some reports of patients who have had a sensitivity reaction to aqueous cream when it has been used as an emollient cream. For this reason, it is recommended only as a soap substitute and not as a ‘leave on’ emollient. However, if after using aqueous cream, your skin stings and it does not settle down after rinsing, talk to your pharmacist (chemist) or doctor about an alternative soap substitute or phone NHS Direct 0845 4647.

Emollient bath additives Use these daily, added to a lukewarm bath to help prevent the loss of moisture from the skin. Bath additives can make the bath slippery, always use a non-slip mat and be careful when moving your child out of the bath, they may be slippery too. Some bath oils include an antiseptic and are used occasionally to help prevent infection in children prone to episodes of infected eczema. They haven’t been proven to be effective and should only be used occasionally. Bath additives containing coal tar are particularly helpful in the treatment of psoriasis , although some people do not like the smell. Never use more than the recommended amount of bath additive because too high a concentration may result in skin irritation, particularly with antiseptic bath oils.

Emollient creams and ointments (moisturisers) vary from being very greasy (ointment) to less greasy (cream). The aim is to find ones that you like and that are best suited to you or your child’s condition and lifestyle. Very occasionally, emollient creams may sting the skin when first applied to very dry skin. This normally settles after a few days of treatment, but if it persists it is possible that it is a reaction to a preservative in the cream preparation. If this happens, it is important that you talk to your pharmacist or doctor as soon as possible about alternative emollients so treatment is not interrupted.