If you have just been told by your doctor or health care provider that your little one has eczema, the first thing you are likely to be prescribed is an emollient. There are a huge range of emollients available – both prescription and over the counter. It can be a minefield as (in our experience) there is only a 50:50 chance that any given cream will actually work, and if it does work it may be seasonal or time-limited. For parents with eczema children, it is the ultimate quest for the holy grail and we know how frustrating it can be, so we hope in writing this we make your own search a little easier!
So what IS an emollient and why has my child just been prescribed it for their eczema?
Emollients are medical moisturisers – they are unperfumed and do not have any anti-ageing properties. They are the first line of therapy for all dry skin conditions and using them as part of a daily routine can soothe, moisturise and protect the skin helping to reduce eczema flares.
As we know, dry skin is itchy skin. Emollients soothe skin and relieve the itch by forming an oily layer over the skin surface which traps water beneath it. When the skin’s barrier function is restored in this way, irritants, allergens and bacteria have a much harder time penetrating it.
There are lots of different types of emollient – these can be classified by application/use.
Leave on emollients
The leave-on emollients are available as lotions, creams, gels, sprays and ointments to be applied directly to the skin.
Lotions contain more water and less fat than creams – the high water content means that they need to contain preservatives which, very occasionally, can cause sensitivity.
They spread easily and are cooling but do not effectively moisturise very dry skin as they are not thick enough to repair the skin barrier.
Useful for hairy areas, weeping eczema or fast absorption in a hurry.
Creams contain fat and water and are light and cool on the skin.
Easy to spread over sore weeping skin and non greasy which makes them easy for daytime use.
Also need to contain preservatives.
Need to be applied liberally and frequently (every 3-4 hours) to repair the skin barrier and prevent further dryness.
Humectant creams contain natural moisturisers like urea and glycerine and need applying less frequently (every 6-8 hours).
Hydrating gels are relatively light and non-greasy, despite having quite a high oil content. Again they should be applied every 3-4 hours unless they contain humectants, in which case it’s every 6-8 hours.
Sprays are particularly useful for treating hard to reach areas.
There are 2 types: Dermamist (10% white soft paraffin) and Emollin (50% white soft paraffin and 50% liquid paraffin which evaporates on application to the skin)
Ointments are often stiff and greasy but are very effective and holding water in the skin and repairing the skin barrier.
Useful for very dry, thickened areas and ideal under wrap wraps or ScratchSleeves at night time.
Ointments should not be used on weeping eczema.
Please note that you must not put your fingers into pots of leave-on emollients as there is a risk of contamination and spreading infection. Opt for pump dispensers or use a teaspoon to decant ointment or cream from a tub into another clean container before applying to the skin.
Some emollients may contain the following added ingredients.
- Anti-itch – lauromacrogols is an local anaethestic which helps to relieve itch (found in E45 itch relief cream)
Makes a big difference to comfort and sleep in our experience!
- Humectants – propylene glycol, lactic acid, urea and glycerol – draw water into the epidermis from the dermis (skin layer below).
Urea softens the skin and enables the emollient to penetrate deeper but stings for a couple of minutes after application and therefore may not be popular with younger children.
- Antimicrobials – found in some leave-on creams, lotions and assorted wash products. An agent that destroys bacteria and inhibits their growth. May cause sensitivity if used for a long time.
- Ceramides can help to re-establish the balance of fats necessary for the skin barrier to function effectively.
- Oatmeal has anti-itch properties. See our post here on bath additives.
Washing with emollients
It’s essential to remove dirt and skin debris from eczema-prone skin to avoid infection.
A daily bath or shower is recommended using an emollient for washing as plain water will dry out the skin.
Water should be tepid as heat can aggravate the itch. If the water stings it’s a good tip to put the emollient on before getting into the bath and then gently wash it off.
Ordinary wash products should be avoided as they are alkaline and contain detergents and fragrances which can potentially dry and irritate sensitive skin.
Soap substitutes are essential – you can either use one designed specifically for washing or you can use your usual leave-on emollient. It takes a while to get used to using a soap substitute as they don’t foam but they are still very effective at removing dirt and bacteria (just like a make up remover in fact!)
Bath and shower oils and additives hydrate the skin and coat it with a film of oil to trap moisture. There isn’t any solid evidence that they particularly help with eczema and may be more hazardous that they are worth – they make the bath or shower very slippery for the next person and should only be used if you find them useful.
PLEASE BE AWARE that emollients make surfaces extremely slippery, including your child!
We have put some top tips for using them with small children at the end of this article!!!
Choosing an emollient
- The best emollient is one your child can get on with and will therefore use or accept you using on them.
- Test new products on a small patch of unaffected skin and wait 48 hours before putting it over eczema sore skin.
- Some people find a lighter emollient during the day and warmer months is preferable, whilst a greasier one is better in the winter or at night.
Tips for applying emollients
It can be time-consuming and tedious to apply emollients, however, they really are the cornerstone of treating eczema. Here are some tips to help:
Use your emollient frequently. Every few hours is ideal but twice a day is an absolute minimum. To give you some idea, you should be using 250g a week of emollient on your eczema child.
Pat skin dry with a soft towel and re-apply emollient every time you wash your child or they wash their hands.
Apply gently in the direction of hair growth – do not rub vigorously and this can block hair follicles, trigger itching and overheat the skin.
If you dot blobs of emollient on all areas of the body you won’t miss any spots.
Keep using your emollient alongside any other treatments that your doctor prescribes. Do not stop, just use them in conjunction.
A thick layer of greasy emollient before swimming forms a protective barrier. Remember your little one will be extra slippery!!
Continue use of emollients even when eczema isn’t flaring.
Apply emollient to all skin, not just areas affected by eczema.
Be aware that emollients are not flammable in themselves or on your child’s skin, but bedding, clothing and dressings with dried emollients on are more like to ignite and burn quickly.
Some emollient tips from ScratchSleeves
Here are just a few little tips about applying emollients learned over the years from personal experience with love from our itchy family to yours.
- Put emollients on your baby or child on a change mat on the floor. Changing tables are hazardous with slippery wriggling mini people!!
- Keep lots of muslins to hand – for wiping up spills, smears and your hands!!!
- Make sure your hands are clean and dry before picking your child up out of the bath or shower – ideal is to have your hands under their arms and your thumbs looped over their shoulders
- Have a clear area waiting to put them when you lift them out – the less time this takes to reach the better!
- Keeping lighter emollients in the fridge provides some relief for hot and itchy little bodies.
Finally, we believe that many of these emollients are broadly similar in formulation. On this basis, you can probably narrow down what will or won’t work for you based on these similarities. For example, Eucerin, Aveeno and Aproderm are all wheatgerm based, so if one of them doesn’t work for you the likelihood is the others won’t either. The emollient ingredient groupings we have come up with are listed below.
Diprobase, Cetraban, Aquamol, Hydromol
Aveeno, Aproderm, Eucerin
My Trusty Skincare, Cetaphil, Restoraderm
Skin Salve, Forever, Suvex Soothe
On a final note, the National Eczema Society put together a factsheet on emollients which contains a very useful table breaking down the weight and properties of all the common emollients.