In the clinical management of atopic eczema, the most important treatment is not a medicated steroid but a high-quality moisturiser, known medically as an emollient. These products are essential because they provide a physical barrier that replaces the missing oils and proteins in eczema-prone skin. Without consistent moisturisation, the skin becomes dry, brittle, and highly susceptible to the allergens and irritants that cause flare-ups. In the UK, emollients are available in various forms, and finding the right one often depends on the severity of the dryness and the time of day it is being used.
What We’ll Discuss in This Article
- The difference between lotions, creams, and ointments.
- Key ingredients to look for in a medical-grade emollient.
- How to apply moisturisers effectively to maximise hydration.
- The role of emollients as soap substitutes.
- Ingredients to avoid in products for sensitive skin.
- Practical tips for maintaining a consistent skin care routine.
Understanding the types of emollients
Emollients are classified by their oil-to-water ratio. Choosing the right type is crucial for balancing comfort with effectiveness.
- Lotions: These have a high water content and are easy to spread over large, hairy areas of the body. While they feel light and non-greasy, they evaporate quickly and are often not moisturising enough for very dry eczema.
- Creams: These have a more balanced mix of oil and water. They are the most popular choice for daytime use because they absorb well into the skin without leaving a heavy residue.
- Ointments: These are very greasy and contain almost no water. They are the most effective at locking in moisture and are ideal for very dry, thickened, or cracked skin. Because they are oily, they are often used at night or under bandages.
Key ingredients for the skin barrier
When selecting a moisturiser, look for ingredients that actively support the structural integrity of the skin. NICE guidance recommends products that help the skin hold onto water.
- Humectants (e.g., Glycerin, Urea): these ingredients draw moisture from the air into the outer layer of the skin.
- Occlusives (e.g., Petrolatum, Paraffin): these create a waterproof seal on the surface of the skin to prevent moisture from escaping.
- Ceramides: these are natural lipids that help “glue” the skin cells together, repairing the barrier defect found in atopic eczema.
How to apply emollients effectively
The way you apply your moisturiser is just as important as the product you choose. To get the best results, follow these clinical tips:
- Apply Liberally and Frequently: You should use large amounts of emollient, typically 250g to 500g per week for an adult.
- The “Soak and Smear” Technique: Apply your moisturiser immediately after a lukewarm bath or shower while the skin is still slightly damp to lock in the most moisture.
- Use Downward Strokes: Smooth the emollient into the skin following the direction of hair growth. Avoid rubbing it in vigorously, as this can generate heat and trigger an itch.
- Do Not Double-Dip: If your emollient comes in a tub, use a clean spoon or spatula to remove the product to avoid contaminating the rest of the jar with bacteria.
Using emollients as soap substitutes
Standard soaps and shower gels contain detergents that strip the skin of its natural oils, which is a major trigger for eczema. One of the best ways to protect your skin is to use your emollient as a soap substitute. Simply rub the cream or a specialised wash onto your skin before rinsing it off with lukewarm water. It will clean the skin while leaving a protective oily film behind. Note that emollients can make the bath or shower very slippery, so using a non-slip mat is highly recommended.
What to avoid in a moisturiser
Not all moisturisers are safe for eczema. Many commercial products contain “hidden” irritants that can cause contact dermatitis or trigger a flare-up.
- Fragrances: These are the most common cause of allergic reactions in skin care.
- Sodium Lauryl Sulfate (SLS): This is a foaming agent found in many aqueous creams that can irritate and thin the skin.
- Preservatives (e.g., Parabens, MI): While necessary to prevent bacteria, some specific preservatives are known allergens.
- Alcohol: Some types of alcohol can be very drying to the skin surface.
Conclusion
The best moisturiser for eczema is one that you feel comfortable using several times a day. For most people in the UK, this involves a combination of a cream for the daytime and a thicker ointment for the evening. By choosing products with effective ingredients like ceramides and petrolatum, and avoiding fragrances and harsh detergents, you can significantly improve your skin’s barrier function. Consistency is key; applying your emollient even when your skin looks clear is the best way to prevent future flare-ups.
Can I use aqueous cream as a moisturiser?
The NHS no longer recommends aqueous cream as a leave-on moisturiser because it contains SLS, which can irritate the skin; it should only be used as a quick wash-off soap substitute.
How many times a day should I moisturise?
Most people with eczema should apply their emollient at least three to four times a day, or whenever the skin starts to feel dry or tight.
Can I use a moisturiser and a steroid cream together?
Yes, but you should wait about 20 to 30 minutes between applying each one so that the steroid isn’t diluted or blocked by the emollient.
Why does my moisturiser sting when I apply it?
Why does my moisturiser sting when I apply it? If your skin is very raw or broken, even a gentle cream can sting. In these cases, a greasy ointment is often more comfortable as it contains fewer preservatives.
Are expensive “luxury” creams better than NHS ones?
Not necessarily; many medical-grade emollients prescribed by GPs are highly effective and free from the fragrances often found in luxury brands.
Are expensive “luxury” creams better than NHS ones?
Not necessarily; many medical-grade emollients prescribed by GPs are highly effective and free from the fragrances often found in luxury brands.
Do I need to change my moisturiser in the winter?
Many people find they need to switch to a thicker, more protective ointment during the cold, dry winter months in the UK.
Authority Snapshot (E-E-A-T Block)
This article provides guidance on selecting and using emollients for the management of atopic eczema. It is written by the MyPatientAdvice Medical Writing/Research Team and reviewed by Dr. Rebecca Fernandez, a UK-trained physician with experience in dermatology and primary care. All recommendations are strictly aligned with the clinical standards for topical management provided by the NHS and NICE.
