Emollients for Adults with Eczema

How emollients work?

To understand how emollients can help reduce the symptoms of eczema, let’s look at what happens in the skin.

In skin where there is no eczema or dryness, the surface of the skin, which is called the skin barrier, is intact. This means that there are no breaks in the skin’s surface.  The surface of the skin acts as a barrier to prevent bacteria, allergens or irritants getting through.

The cells of the skin bind together, like a well cemented brick wall with no gaps, and there is no excess loss of moisture from the skin.

In skin with eczema, the skin is dry and the skin barrier is weakened or broken. This weakened or broken skin barrier is like an old crumbling brick wall with gaps. This means that moisture can escape and bacteria, allergens and irritants can travel deeper into the skin layers, causing inflammation and itch, and increasing the risk of infection and allergic sensitisation.

Emollient therapy

Why is emollient therapy important in the management of eczema?  

Regular emollient therapy is essential to try to restore the broken skin barrier.  Emollients work to provide a protective layer to the skin.

This protective layer helps to seal in moisture and prevent bacteria, irritants and allergens penetrating the skin.

When applied regularly, emollient therapy helps to reduce dry flaky skin, soothe redness and reduce the itch. Maintaining a regular skin care regime is essential for the management of eczema. It is important to continue to apply an emollient, even when the skin looks good.

Types of Emollients

Emollients are available in lots of different preparations, including ointments, creams, gels and lotions.

Ointments

Ointments are oil based and tend to be very greasy and thick. They are very good for people with lots of allergies as they don’t contain any perfume, preservatives or parabens that can irritate the skin. Ointments leave a protective layer on the skin to seal in moisture and are very good for dry cracked skin.

Creams

Cream based emollients tend to feel lighter on the skin than ointments. If you have very dry skin, cream based emollients may need to be applied more frequently than ointments.   You may find that you are more comfortable using a cream based emollient during the day and using a thicker oil based emollient at night.

Gels

Gels are not as greasy as ointment based emollients, but feel thicker, and tend to last longer on the skin than cream. Like creams, they are cosmetically acceptable for use during the day.

Lotions

Lotions are very light emollients and very high in water content.  They are very quickly absorbed by the skin and are great for dry skin in areas of the body where hair grows, including the scalp, chest, arms and legs.

Soap Substitutes

Soap substitutes are designed to cleanse the skin and do not contain perfume or other irritants that can aggravate dry eczema skin.  Emollient shower gels and bath oils are also available to protect and preserve the skin barrier.  Often, you will find that your regular emollient can also be used as a soap substitute, to help cleanse the skin as well as moisturise.

Regular shower gels and bath products may contain perfume or ingredients that are likely to irritate the skin.

Emollient therapy should be a complete therapy and used for washing, bathing and showering, as well as to moisturise.

When the skin is dry and cracked, applying emollient can sometimes cause the skin to sting a bit. This is a normal sensation and this stinging will ease with regular applications.

Often when applying emollient to the skin, the skin can look redder than before especially after bathing. This is due to the capillaries in the skin opening up, also known as dilating, to help the emollient absorption into the skins surface. This is normal and will settle within 30 to 60 minutes after application.

Ingredients commonly found in emollients

Leave on humectants are ingredients in emollients designed to help the skin retain moisture – they are called Urea or ceramide.

Lauromacrogols are called anti pruritic, which means these ingredients help to reduce itch.

Antimicrobials are designed to help reduce the natural bacteria we carry on the skin.

Parabens and preservatives are added to water based emollients, such as creams and lotions, to help them last longer and prevent bacterial infection       

Most emollients are paraffin based and when they soak into fabrics, such as clothing and bandage dressings, become flammable. After applying emollients to yourself or your child always avoid open flames, including wood burning stoves or gas fires, cookers and matches.  

Applying emollients

Emollients should be applied to the skin gently. Do not rub in vigorously and allow any excess emollient to soak in naturally.

Apply the emollient using gentle downwards strokes following the direction of the hair growth. This is important to prevent clogging up the hair follicles with emollient, which can cause a bacterial infection called folliculitis.

The drier the skin is, the more often you will need to apply your emollient. If you find that you need to apply your cream or gel based emollient several times a day, consider switching to more greasy ointment based emollient for longer lasting protection.

You can apply your emollient before using other products to prevent further drying of the skin. It is usually recommended to leave 15-30 mins to allow your emollient to soak in before applying any other products on top.

You may need to experiment with different emollients to find one that is right for you.  It may be that you need to use a cream or gel based emollient during the day, and a more greasy emollient at night. Experimenting will help you find the emollient therapy that suits you best.

For more information on our services, visit www.allergyuk.org or call our Helpline on 01322 619898. 

The production of this video has been made possible by Eli Lilly and Sanofi.