Appropriate emollient products used correctly can:

• Restore and maintain suppleness and pliability
• Have a corticosteroid-sparing effect
• Improve cosmetic appearance.

Emollients are used to restore the integrity of the epidermal barrier. An emollient forms a thin, oily layer over the skin that prevents loss of water from damaged/diseased areas. The water trapped in the stratum corneum passes into the corneocytes, which swell and close up intercellular gaps.

In addition, emollients, especially those formulated with ceramides, can penetrate deep into the stratum corneum and restore the barrier effects of the deficient lipids.

Humectant-containing emollients attract additional water into a patient’s skin from the dermis. Commonly used humectants include urea, glycerine and sodium pyrrolidone carboxylate.

Emollients should be prescribed in sufficient quantities to allow for frequent, regular applications. Details are provided in the British National Formulary.

Some dermatologists recommend allowing patients to find the emollients that they like the best – smell and feel can be important, especially to children. Simple occlusive emollients are short-lasting and need to be applied frequently – typically three to four times a day. Humectant- containing emollients last longer and may only need twice-daily application. When advising patients on which emollients to try, it is important to ensure that they have at least one of each type and not just three or four simple occlusive emollients.

Emollient wash products should be used in preference to soaps and detergents (e.g. shower gel). Some emollient creams and lotions (oil-in-water formulations) can be used for washing. For young children, sometimes one product can be used for both leave-on moisturising and washing.

Reflection exercise

How would you deal with the mother of a young child with severe eczema who tells you that she is reluctant to use topical corticosteroids on her child’s skin because she has read that they can cause severe and lasting skin damage?

How could you explain the treatment and build her confidence in it?