Which emollient is best?

There is no 'best emollient'. The type (or types) to use

EMOLLIENTS soft paraffin or liquid paraffin and are ideal for very dry or involved, and what is comfortable and acceptable to
thickened skin - normally applied at night, they do not you.
usually contain preservatives and are therefore less likely to
AND HOW TO USE THEM If you only have mild skin dryness and do not
cause skin reactions.
experience flare ups frequently a lotion/cream maybe
the best option.
Creams: Have a mixture of oil and water. Less greasy than
ointments, therefore easier to spread onto the skin. Must For moderate to severe dryness, a thicker cream or
be used frequently and liberally to prevent the skin from ointment would be ideal to use. Areas of weeping
drying out. Good for daytime application. eczema will usually be managed with a cream/lotion, as
ointments will tend to be very messy.
Lotions: Contains the most water and least oil, so are the
least effective in moisturising the skin. They usually contain How to apply emollient treatment?
preservatives (ingredients that help to protect the product Step 1: Wash your hands to remove invisible bacteria.
from bacteria/germs and increase its shelf life) which may
cause skin irritation. Lotions are useful for hairy areas such
What are emollients? as scalps and areas of weepy skin.
Emollient is simply the medical word for a moisturiser.
They help soothe the skin and provide relief from itching
Step 2: Do not put fingers into tubs to scoop out the
and dryness. Patients who do not have a diagnosed How often should emollient treatment be applied? emollient, as you may introduce bacteria into the
dermatological condition or risk to skin integrity
Emollients should be applied as frequently as possible. This emollient tub. To reduce the risk of infection, transfer
(breakdown of skin) should purchase emollients over
should be at least three times daily, and ideally applied four some emollient onto a clean plate using a clean dessert
the counter e.g. from pharmacies or health and beauty
to six times a day (every 3 hours). Emollient use should be spoon. If you have cream in a tub with a pump top, you
stores.
continued even when the skin condition has im- proved. can pump directly onto your hand.
Emollients can and should be applied at other times during
How do emollients work? the day e.g. in extreme weather in order to provide a barrier
An emollient replaces natural oils that help keep water in from the cold. Reviewing the need of your prescribed
the skin to prevent it becoming dry, cracked, and itchy. It emollient should be carried out by your GP annually.
also traps moisture in the skin and forms a protective oily
layer on the outer skin, which helps skin to repair and Step 3: Emollients should be applied to the skin in a
improve hydration. downward direction of hair growth and left in a thin
layer to soak in - this can take up to 10 minutes. Please
do not rub emollients in.
Types of emollients
Emollients can be used either as soap substitutes or as a
leave on emollient. There are many different types of
emollients and they can be classified according to how
they are used and how greasy they are.
How and when should topical steroids be used (if
and when prescribed)? The risk of bedding, clothing or dressings catching fire is Lifestyle
highest for people who smoke, because they use lighters or
Intensive use of emollients can reduce the need for A light moisturiser should be applied during the day and
matches. If you use naked flames or other potentially
topical corticosteroids (reduce skin inflammation). The a greasy one at night. The greasier the emollient, the
flammable heat sources, we strongly recommend that you
quantity and frequency of use of emollients should be far more effective at retaining hydration. You may wish to
take extra care and avoid using them near clothing, bed-
greater than that of other therapies given. If a topical use different types of emollients at different times of the
ding or dressings.
corticosteroid is required, emollients should ideally be day, on different areas of the body or when severity of
applied at least 15-30 minutes before or after the topical If you find that an emollient is making your skin sore and/ or your condition varies. For example, use a cream in the
corticosteroid. The skin should be moist, but not slippery, very itchy, you may be allergic to one of the ingredients and morning if dressing to go to work or school and an
when applying the steroid. you should discuss this with your doctor or nurse. If you are ointment in the evening when wearing pajamas.
having ultraviolet light treatment or radiotherapy, ask for
Bathing and washing specific guidance on emollient use, as instructions may Possible side effects from emollients
differ slightly. Emollients used for skin conditions tend to be bland and
Bathe regularly in tepid water only, this cleans and helps
prevent infection by removing scales, crusts, dried blood, non-perfumed. However, some creams contain
and dirt. Applying emollients after bathing increases skin How much emollient should be applied? preservatives, fragrances, and other additives.
hydration, as water is still trapped in the skin. Any The quantity of leave-on emollient required will vary de- Occasionally, some people become sensitised (allergic) to
emollient (except white soft paraffin) should be used as a pending on the size of the person, the severity of the skin an ingredient. If you suspect that you are sensitive to an
soap substitute, as normal soap tends to dry the skin. This condition, and whether the emollient is also being used as a emollient then speak to your doctor, nurse, or
can be applied prior to washing and directly after- wards soap substitute. As a general guide, if you needed to treat pharmacist for advice.
onto damp skin. They provide greater moisturising than the whole body, the recommended quantities used are 600g
bath emollients that don't have enough contact with the per week for an adult, and 250-500g per week for a child Washing clothing and bedding
skin. When drying, pat the skin dry to avoid damage to the under 12. It is recommended to wash clothing and bedding
skin. The use of bath emollients/ oils and shower
regularly at the highest temperature recommended by
products are not routinely recommended for the
The table below is a guide for suitable quantities needed the manufacturer. This might reduce the build-up of
majority of dermatological conditions. As an alternative,
for an adult for twice daily application for a month but can emollient on them but does not remove it completely
1-2 tablespoons of any ointment (except 50:50) can be
be adjusted depending on frequency of application. and the danger may remain.
dissolved in some hot water and added into the bath
water as a bath additive.' Area of body Creams or Lotions
ointments (g) (ml) References:
National Eczema Society Emollient factsheet Jun23 (eczema.org)
What precautions should be taken with Face 120g 500ml MHRA – Skin Creams Alert

emollients? Both hands 200g 500 ml Further information:

make the surface slippery so take extra care. Both arms or both legs 1000g 1000ml How to use emollients ‐ YouTube
Emollients | Eczema Treatment | Eczema.org
Emollients are not flammable in themselves, or when Trunk 1000g 1500ml
they are on the skin. But when bedding, clothing, and Groins and genitalia 100g 500ml Acknowledgements:
dressings containing dried emollient residue catch fire, North East London ICB, GSTT NHS Foundation Trust, and South East London
ICS. Images from St. John’s Institute of Dermatology GSTT.
they ignite and burn more quickly and intensely than
they would if they did not contain dried emollient Approved by: IMOC
residue. Approval date: October 2023
Review date: October 2025
Version 1.0