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