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Skin Moisturisers in Atopic Eczema

Introduction

Skin moisturisers (or emollients) are used for many types of skin problems. However they play a very important part in managing atopic eczema.

How do they work?

The smoothness and softness of the skin depends on the amount of water in the surface layer of the skin. This layer protects the rest of the skin from damage. In eczema, it is often broken, allowing moisture to escape and infections to enter through the skin. Emollients protect the outer layer of your skin by covering it with a protective film. This keeps the water in the skin where it is needed and also helps to keep infections and other harsh substances out. They may also help eczema by dampening down inflammation which may in turn reduce the need for steroid creams.

How often can they be used?

Ideally, emollients should be used at least twice daily. By all means, use them more often than this, especially on exposed areas of the skin such as the hand and face during the day time. Emollients should be applied to exposed areas of the skin before coming into contact with factors which might aggravate the eczema such as cold weather, swimming, wet/dusty activities at school/home such as painting or gardening. In babies, it is a good idea to protect the hands and cheeks with an emollient before mealtimes to prevent irritation from foods and drinks. It is a good idea to keep small pots/tubes of emollient at home, work and at school for regular use. A 500g tub may be needed each week.

A good time to apply emollients is after bathing when the skin has has cooled (5-10 mins) because this is when the water content of the skin is highest. Emollients are very safe and cannot be overused. Very occasionally, creams may sting the skin when first applied to very dry skin. This normally settles after a few days of treatment, but if it persists, please tell your doctor as it is possible that your child is reacting to a preservative used in cream preparations.

Which one do I use?

Choosing a suitable emollient is a very personal thing. The choice is very much up to you as long as you use it regularly. Grease-based emollients such as white soft paraffin/liquid paraffin in a 50/50 mixture or emulsifying ointment are the best in that they protect the skin for a long time. They usually give best results on a very dry skin. Some people find that creams may be more pleasant to apply, but they do contain a lot of water and it may be necessary to apply them more often than ointments. Examples of cream emollients are: aqueous cream, Diprobase, Unguentum Merck, E45 cream.

What about bath additives and soap substitutes?

Bath additives such as Oilatum, Balneum, Diprobath, and Emulsiderm may be helpful for the dry skin of eczema. These are liquids which can be poured into the bath and will help to prevent the loss of moisture from the skin. They can make the bath slippery, so always use a non slip mat. Bubble baths, gels and cosmetics are best avoided as they can irritate the skin. Harsh soaps are best avoided in eczema. Many emollients such as aqueous cream and emulsifying ointment can be used as a soap substitute. Apply them to wet skin and rinse off with water as you would normally do with an ordinary soap.

Key Points for Emollient Use

1 Emollients moisturise and soften the skin.

2 Emollients are a very important aspect of managing atopic eczema.

3 Emollients may prevent skin infections and will help to protect the skin from outside irritants such as cold, water and detergents.

4 Emollient are safe to use.

5 Emollients need to be used at least twice a day and not only applied when the skin looks bad.

6 As with other creams apply in the direction of the hair as it lies on the skin.

7 When using a bath oil, use a bath mat to prevent slipping.

8 Allow at least 1 hour before applying other treatments such as steroid creams to your eczema, or the emollient will just dilute their effect.

9 Always keep plenty of emollients at home, school and work. Get a refill from your doctor or chemist when your tub is a quarter full.

© Professor Hywel C Williams, Sister Sandra Lawton Staff Nurse Sue Newham Queen's Medical Centre, Nottingham, 1995