Any one who reads this blog regularly will know that I am a rather atopic individual – having asthma, eczema and hayfever. These problems run in my family and I’ve now passed some of these traits onto my own children. A few years ago my son had quite a nasty flare up of eczema. His skin was incredibly dry and inflamed, and he wasn’t sleeping well due to the incessant itching. It was miserable for him – and for us – but fortunately once we’d found the correct creams to smear over him things settled down. The key to his improvement? Emollients, Emollients, Emollients!
Our skin is an amazing organ; it acts as a tough waterproof barrier for the rest of the body. In people with eczema the skin is less able to retain moisture. It becomes dry and tiny gaps can then form between the skin cells. This causes the top layer of the skin to stop being such an effective protective barrier, and the skin becomes cracked, irritated or inflamed.
This explains why in eczema the main treatment is to get as much moisture back into the skin as possible, reversing the dryness and restoring the barrier. The best way to do this is via emollients – and in mild eczema this is often the only treatment needed. Emollients differ from commercial moisturisers in that they don’t contain any perfume or other ‘extras’ e.g. anti-ageing ingredients.
1) Lotions: have a high water content. This makes them easy to spread over the skin, but less moisturising. They are best used on hairy areas.
2) Creams: have a higher fat content than lotions, so are more moisturising. They are usually oil based and good for use all over the body, without causing too much ‘shine’.
3) Ointments: ointments have the highest fat content. They are excellent moisturisers but are very greasy so usually not acceptable to people for day-to-day use. They are best used for more severe flare ups or before bed.
Here are my top tips for treating eczema with emollients:
- There are loads of different brands of emollient and it is often trial and error to see which suits you or your child best.
- Very occasionally emollients can irritate the skin – but don’t let this put you off using them. It is usually a very brief reaction caused by one of the preservatives in the cream and not a true allergy, so try a different brand instead.
- Use them! Emollients can be applied multiple times during the day, every day. Applying creams every 2-3 hours isn’t unusual for very dry skin. Most children should get through around 250g per week, and adults more.
- The skin loses more moisture overnight so using a greasier product may help keep the skin hydrated until morning.
- Don’t overly rub the cream into the skin as this will irritate it. Smooth the cream gently in the direction of the hair, until the skin is slightly tacky.
- When bathing avoid soaps and bubble baths, very hot water, vigorous rubbing with a towel or staying in longer than 15minutes. All of these things can aggravate the skin more.
- Some emollients can be used as soap substitutes. Don’t forget to use them in addition to your usual cream, not instead of.
- Emollient bath products can be very helpful in improving dryness and itching, as well as improving the effectiveness of other products.
- Leave around 30 minutes between applying emollients and any steroid creams. There is no evidence as to which way round is best to apply the various creams, but a gap between the two is advised.
- Don’t stop! Even when your skin is ‘good’ continue to use emollients regularly to reduce future flare-ups.
If you would like to read more about eczema and its treatments see the excellent eczema org website.
Have you experience in using emollient? Do you have any tips you’d like to share?! Keep watching this space, as I’ll be discussing the merits and common concerns of steroid creams in a later post.