13.2.1 Emollients

Emollients provide itch relief, reduce shedding of skin scales, reduce eczema flares and allow dry, cracked thickened skin to return to normal. Their effects are short-lived and they should be applied frequently even after improvement occurs.

There is little evidence to guide the prescribing of emollients; in most cases when changing therapy there is no more sensible guide to the next product to try other than by cost.

Many of these products are cheap to buy and are readily available, along with advice, from pharmacies. Some self-care medicines are available in shops and supermarkets. Please click here for further information and a patient leaflet

Offer a choice of unperfumed emollients for everyday moisturising, washing and bathing. It is important to use a product which suits the patient and is effective for them. Offer alternatives if one emollient causes irritation or is not acceptable. Many patients benefit from a greasier ointment-like preparation at night or on very dry areas such as limbs, and a lighter cream for the daytime or on areas such as the face.

Emollients should be:

  • used more often and in larger amounts than other treatments
  • used on the whole body even when atopic eczema is clear
  • used while using other treatments
  • used instead of soaps and detergent-based wash products
  • easily available to use at nursery, school or work.

Adults would normally require at least 250g of emollients per week and children 125g.

Fire hazard with paraffin-based emollients: Emulsifying ointment or 50% Liquid Paraffin and 50% White Soft Paraffin Ointment in contact with dressings and clothing is easily ignited by a naked flame. The risk is greater when these preparations are applied to large areas of the body, and clothing or dressings become soaked with the ointment. Patients should be told to keep away from fire or flames, and not to smoke when using these preparations. The fire risk should be considered when using large quantities of any paraffin based emollients.

Creams and gels are often lighter and less greasy, and require multiple applications to sustain an emollient response.

Lotions are cooling, quick to apply but take a little longer to dry. Useful for hair-bearing areas prone to folliculitis.

Ointments are heavier and more greasy, but more effective than creams and require less applications per day.

Bath and shower preparations

Evidence to support the routine use of bath additives in the management of eczema is lacking. These products may be considered in individuals that cannot apply emollients easily or are having insufficient moisturising response, particularly young children.

Soap substitutes, aqueous cream or emulsifying ointment are safer than bath oils as they are less likely to make the bath slippery compared with bath oils. These products are best whisked with hot water in a jug before adding to bath water.

Patients should be aware of the potential dangers of slipping in the bath if emollients are added - the use of a bath mat may reduce this risk. Parents may also wish to be cautious when removing children from the bath.

Soap substitutes are necessary in inflammatory skin disease.

Non-proprietary emollient preparations

Reminder: Fire hazard with paraffin-based emollients (see notes above)

Emulsifying ointment
  • Ointment (£3.83 = 500g)

Proprietary emollient preparations

Reminder: Fire hazard with paraffin-based emollients (see notes above)
ZeroCream®
  • Cream (£4.08 = 500g)
Zeroderm®
  • Ointment (£4.10 = 500g)
Hydromol®
  • Ointment (£4.96 = 500g)
Zerobase®
  • Cream (£5.26 = 500g)
Oilatum®
  • Cream (£5.28 = 500g)
E45®
  • Cream (£5.99 = 500g)
  • Lotion (£4.59 = 500ml)
Doublebase®
  • Gel (£5.83 = 500g)
  • Dayleve® Gel (£6.29 = 500g)

Notes

  1. Doublebase Dayleve® Gel may be applied twice daily
Diprobase®
  • Cream (£6.32 = 500g)
Cetraben®
  • Cream (£5.99 = 500g)
  • Ointment (£5.39 = 450g)
Zeroguent®
  • Cream (£6.99 = 500g)
Zeroveen®
  • Cream (£5.89 = 500g)

Preparations containing urea

Reminder: Fire hazard with paraffin-based emollients (see notes above)


These products are not indicated for routine use as much more expensive but may be useful for very dry conditions such as ichthyoses and for keratosis pilaris.

For the management of pruritus see 13.3 Topical local anaesthetics and antipruritics.

Balneum®
  • Cream (£9.97 = 500g) (contains urea 5%)
Balneum® Plus
  • Cream (£14.99 = 500g) (contains urea 5% and lauromacrogols 3%)

Notes

  1. Contains soya oil and is therefore contraindicated in patients with peanut allergy.
Calmurid®
  • Cream (£33.40 = 500g) (contains urea 10%)

Notes

  1. Contains lactic acid; may irritate initially. Use sparingly
Dermatonics Once Heel Balm®
  • Cream 75ml (£3.60) (contains urea 25%)

Indication

  • For the daily treatment of diabetic patients at high risk of foot ulcers where there is drying skin combined with callous with or without fissures (splits) foot ulcers.

Notes

  1. Only when recommended by Podiatry, Tissue Viability of or members of the multidisciplinary foot team
  2. Not all patients with diabetes will require this product, however around 30% of this group suffer from neuropathy which reduces sensations in the feet. A high proportion of these patients will suffer a reduction in the quantity of sweat produced and the resultant development of anhydrosis leading to drying and cracking of the skin and callus formation
  3. Should not be applied between the toes or directly to open wounds
  4. For patients with diabetes who have neuropathy where the skin is very dry with callus, continuous use would be recommended. For diabetic patients with hydrated heels with little or no drying skin with no callus, a standard emollient should be used.

With antimicrobials

Reminder: Fire hazard with paraffin-based emollients (see notes above)

Use only when skin is infected or if infection is a frequent complication; not for prolonged use.

Dermol® 500
  • Lotion (£6.04 = 500g)
Dermol®
  • Cream (£6.63 = 500g)

13.2.1.1 Emollient bath and shower preparations

Reminder: Fire hazard with paraffin-based emollients (see notes above)
ZeroAQS®
  • Cream (£3.29 = 500g)
Aqueous cream
  • Cream (£3.99 = 500g)

Notes

  1. Non-allergic cutaneous reactions to aqueous cream in children with atopic eczema are very common and should only be used as a soap substitute rather than a "leave on" emollient.
  2. The British Dermatology Nursing Group and the Skin Care Campaign have asked GPs not to prescribe or recommend aqueous cream because:
    1. It is made by different manufacturers and is not a consistent product; this can cause problems with patient sensitivities and intolerances.
    2. It usually contains several preservatives, which are known sensitisers.
Zerodouble®
  • Gel (£4.90 = 500g)
Hydromol®
  • Bath and shower (£4.46 = 500ml)
Aveeno®
  • Bath oil (£4.49 = 250ml) (£9.98 = 500ml)
Oilatum®
  • Emollient bath additive (contains fragrance) (£4.57 = 500ml)
Zeroneum®
  • Bath oil (£4.48 = 500ml)
Balneum® Plus Oil
  • Bath oil (£6.66 = 500ml)

 

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