Emollients

Emollients are moisturising treatments applied directly to the skin to reduce water loss and cover it with a protective film.

They are often used to help manage dry or scaly skin conditions such as eczema and psoriasis.

Types of emollients

Emollients are available as:

• moisturising creams, ointments, lotions and sprays
• bath oils and shower products
• soap substitutes

They are available in tubes, tubs and larger pump dispensers, and can either be bought over the counter from your pharmacy or be prescribed by your GP, nurse or health visitor.

If you or your children need to use an emollient regularly, it's a good idea to keep some in small pots or tubes at home, school or work.

Leave-on products

There are a variety of emollients that can be applied to the skin to help with specific problems. For example:

• occlusive emollient creams and ointments – these create a film over the skin to prevent water evaporating
• humectant-containing emollients – these contain additives such as urea glycerol, popylene glycol and lactic acid to attract and hold water in the top layer of skin
• antipruritic emollients – these contain ingredients to help treat itching
• antiseptic emollients – these contain ingredients to prevent infection

The best emollient is the one that suits your skin condition. You should be given the opportunity to try a variety of emollients.

Soap substitutes (emollient wash products)

The everyday use of soaps, shampoos and shower gels can remove the surface layer of natural oils on your skin. This can make your skin dry and further aggravate long-term skin conditions such as eczema.

Soap substitutes are one type of emollient that can be used instead of soap for handwashing and bathing. Although soap substitutes do not produce foam like normal soap, they are just as effective at cleaning the skin.

Many of these leave-on products can also be used as a wash product.

How they help

Emollients work by:

• helping skin retain water
• moisturising dry skin
• easing itching
• reducing scaling
• softening cracks
• protecting the skin
• helping other creams and ointments to be absorbed into the skin

How to use them

Soap substitutes (emollient wash products)

Mix a small amount of soap substitute in the palm of your hand (about half to one teaspoonful) with a little warm water, and spread it over damp or dry skin. Rinse and pat the skin dry, but do not rub.

If you are using a soap substitute as well as other treatments, apply the soap substitute first. Allow 30 minutes after using a soap substitute before applying the other treatments.

The soap substitute can be rubbed into the skin and showered or washed off in the bath.

Although aqueous cream is often prescribed, it should not be used. There are better emollients available, as some people may have a reaction to aqueous cream used as an emollient. It also has a high water content, making it less effective than other products as a leave-on emollient.

However, if your skin stings after using the emollient wash products and does not settle down after rinsing, speak to your GP or pharmacist about an alternative soap substitute.

Bath additives

Emollient bath additives can be added to lukewarm bath water to help prevent the loss of moisture from your skin. They can make surfaces slippery, so always use a non-slip mat and be careful when getting yourself or your child out of the bath.

Some bath oils contain an antiseptic, which can help prevent infection. But these products should only be used occasionally, unless the infection is recurrent or widespread.

Never use more than the recommended amount of bath additive. It may cause skin irritation if the concentration is too high, particularly when used with antiseptic bath oils.

Creams and ointments

Emollient creams are less greasy than emollient ointments. They are easy to spread, absorb easily into the skin and are good for use during the daytime. They can also be used on weeping eczema.

Emollient ointments are most suitable for very dry, thick skin and are not suitable for use on weeping eczema. Find one that is best suited to your or your child's skin.

Occasionally, emollient creams may sting when they are first applied to very dry skin. This usually settles down after a few days of treatment.

If it persists, it may be caused by a reaction to a preservative in the cream. If this occurs, talk to your GP or pharmacist about possible alternative emollients, such as an emollient ointment.

Emollients can be used to replace lost moisture whenever your skin feels dry or tight. They are very safe and you can't overuse them because they don't get absorbed through your skin into your body.

You may need to try a variety of different emollients before you find one that is best suited to you or your child. For example, you may decide to use a cream-based emollient during the day and an ointment base at night.

When to apply them

Emollients can be applied as often as recommended by the manufacturer to keep the skin well moisturised and in good condition. 

It's especially important to regularly apply an emollient to your hands and face because they are exposed to the elements more than any other part of your body.

Certain activities, such as swimming or gardening, can irritate the skin, so it may help to apply an emollient beforehand. 

For babies, it is a good idea to protect their hands and cheeks with an emollient before meal times to stop them getting sore from food and drinks.

Emollients are best applied after washing your hands, taking a bath or showering because this is when the skin is moist. The emollient should ideally be applied to the skin at least three or four times a day.

Whether you are prone to dry skin or not, it's a good idea to use an emollient cream or ointment after washing or bathing because this is when your skin is most in need of moisture. The emollient should be applied as soon as you have patted your skin dry to ensure it is properly absorbed.

Possible reactions to emollients

Possible reactions to emollients can include:

• irritant reactions – such as an overheating, burning sensation or stinging, usually caused by a reaction to a certain ingredient contained in the cream or lotion
• folliculitis – some emollients can occasionally cause hair follicles to become blocked and inflamed (folliculitis) and cause boils
• facial rashes – some facial emollients may cause rashes on the face that can aggravate acne

If you experience painful stinging that continues, try a different emollient or speak to your local pharmacist for advice.

You may be able to help prevent folliculitis by applying emollients gently and in the same direction your hair grows.

Safety advice when using emollients

• if you are using paraffin-based emollients, keep away from fire, flames and cigarettes – dressings and clothing soaked with the ointment can be easily ignited
• if you keep your emollients in a pot or tub, use a clean spoon or spatula to remove the product – this reduces the risk of infections from contaminated pots
• take care when using emollients in a bath, shower or on a tiled floor as there's a risk of slipping – protect the floor with a towel or sheet, wash your bath or shower afterwards with hot water and washing up liquid, then dry with a kitchen towel
• avoid using aqueous cream – recent evidence has shown it can cause burning, stinging, itching and redness, especially in children with atopic eczema

Read more information about the safety of aqueous cream on the Medicines and Healthcare Products Regulatory Agency (MHRA) website.

Treating skin conditions

It's important to use emollients even when your skin condition is not flaring up and to make sure you don't run out.

After applying emollients, allow 30 minutes before using topical corticosteroids or other treatments applied to the skin. This avoids diluting their effect, spreading them to areas that don't need treating, and increasing the risk of side effects on normal skin.

Emollients are commonly used to treat dry skin conditions such as:

• eczema – a long-term skin condition that causes the skin to become reddened, dry, itchy and cracked (read more about treating eczema)
• psoriasis – a long-term skin condition that causes red, flaky patches of skin covered with silvery scales (read more about treating psoriasis)
• ichthyosis – a long-term condition that results in persistently thick, dry, "fish-scale" skin

If you have a dry skin condition such as eczema, psoriasis or ichthyosis, use a medicated emollient, even when your skin feels better, to help prevent patches of inflammation and flare-ups. This is because dry skin is more prone to infection.