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Eczema and Emollients

The Use of Emollients in the Treatment and Management of Eczema

Nov 24, 2008 Emma Brodrick

The aim of this article is to describe the varying types of emollients used in the treatment of eczema and how they work.

Simple emollients are the mainstay in the treatment of eczema and are prescibed as bath additives, soap substitutes and skin moisturisers. All of which are used to soothe, smooth and rehydrate to enhance absorption of active treatment on the skin. They have a mild inflammatory effect and can reduce the overall amount and potency of the topical corticosteriods used (Holden et al 2002).

There are numerous formulations from aqueous based lotions, creams and greasy ointments and pastes. Which ones used depends on the stage of the eczema i.e. acute, subacute and chronic.

The drier the skin the greasier the emollient needed, for example chronic dry eczema will require an ointment for a greater therapeutic effect as it is more occlusive, preventing water loss as well as hydrating the skin. It is also longer lasting and requires only 2-3 applications per day.

Creams and lotions are water based, short acting and require frequent applications, 4-6 times daily.

Enhanced Emollients

Some emollients contain substances that further enhance their effect on the skin. These effects include attracting water to the outer layer of the skin encouraging water to remain in this outer layer. This provides a surface barrier to water loss, reduces scale and reduces itching. These ingredients are ceramides, glycerol, urea and lactic acid and although they are natural moisturising factors in the skin the addition of them in emollients serves to further rehydrate and prevent water loss. Lauromacrogols are additives which have an antipuritic effect or in other words help reduce the sensation of itch (Yosipowitch 2004).

Emollient Creams

These are oil in water emulsions and have a two stage mode of action (Peters 1999).

Water is lost from the mixture by evaporation and absorption into the skin. This cools the skin and alleviates itching.
The cream cracks as a result of water loss from mixture and the mechanical stress of application. This releases oil onto the surface of the skin which seals it and prevents any further water evaporating from the skin's surface.

Contraindications with Emollients

All emollient products can be bought over the counter and all are generally safe to use; however, it is worth noting that a sensitivity may be developed to the different ingredients used in their manufacture, for example lanolin (hydrous wool fat) and preservatives.

An adverse reaction should be suspected if the eczema fails to clear up or if an outbreak occurs in an area that was clear but where an application was applied.

References

Holden C, English J, Hoare C et al (2002) Advised best practice for the use of emollients in eczema and other dry skin conditions. Journal of Dermatologocal Treatment. 13, 3, 103-106.

Peters J (1999) Eczema. Primary Health Care. 9,7, 29-37.

Yosipovitch G (2004) Dry skin and impairments of barrier function associated with itch:new insights. International Journal of Cosmetic Science. 26.1,1-7

The copyright of the article Eczema and Emollients in General Medicine is owned by Emma Brodrick. Permission to republish Eczema and Emollients in print or online must be granted by the author in writing.