Emollients and moisturisers

There are 3 types or methods of application of emollients:

• leave-on emollients – these are left on your skin once applied
• soap substitutes  – used instead of soap and must be washed off your skin after a few minutes of application
• bath additives – also called bath emollients, which are added to bath water and are thought to leave a film of oil over the skin.

Leave-on emollients

There are a variety of leave-on emollients, which range from less greasy to very greasy. The choice of emollient is based on how dry your skin is and your preference. Emollient products may also need to be changed depending on the season, eg, if you experience drier skin during winter, you may benefit from temporarily using a more greasy emollient.

How to use leave-on emollients

• Apply at least 2 times per day, or more if possible; 3 or 4 times is beneficial, especially when your skin is very dry and cracking. 
• They may be used all over your body, including your face.
• Using emollients soon after a bath or shower can make them more effective. Apply after towel drying your skin. Do not rub your skin vigorously with a towel. Instead, gently pat your skin dry and apply the emollient.  
• Emollients are best applied by dotting the product onto your skin then spreading it using a downward stroking motion. It's not necessary to spread the product until it is all absorbed.
• If your cream is in a pot, use a spatula or spoon to get the cream out (this keeps the cream clean). 
• Apply cream or ointment in a downward direction or in the direction of hair growth to avoid blocking hair follicles.
• The quantity of leave-on emollient required will vary depending on your size and skin condition, and whether the emollient is also being used as a soap substitute.
• As a general guide, to treat your whole body, the recommended quantities used are 600 grams per week for an adult and 250–500 grams per week for a child.

Soap substitutes 

These are also called wash-off emollients. Regular soap can be irritating to dry, inflamed or sensitive skin so soap substitutes are a good alternative. Two common soap substitutes are aqueous cream and emulsifying ointment. 

• Some of them contain sodium lauryl sulfate (SLS) which can irritate skin if left on for prolonged periods. This is fine if in contact with your skin for a short time, but if it contains SLS, it must be washed off. There are some products that are SLS-free and these may be left on the skin as a moisturiser. 
• Soap substitutes should be gently rubbed onto your skin before rinsing off completely, or you can add them to bath water and soak in the bath for 10–20 minutes, then rinse them off.  
• Take care when using soap substitutes – these can make the floor or surface slippery and increase the risk of falls. If you are using them for a baby, take care when you are holding the baby in the bath.  
• Read more about aqueous cream and emulsifying ointment.

Bath additives

Bath additives (also called bath emollients) are bath oils or emulsifiers that are added to the bath water and are thought to leave a film of oil over your skin. When used for childhood eczema, a recent study found that bath additives are probably not effective and unlikely to lead to improvement in eczema. The authors advise to stop using bath emollients but to keep using leave-on emollients and soap substitutes. Read more about the study(external link).

Emollients are available in different formulations such as lotions, cream and ointments.

• Lotions have a higher water content than creams or ointment, and can evaporate faster. They need to be applied more often. They may not be suitable for eczema, where the skin needs to be kept hydrated at all times.
• Creams are better than lotions because they retain moisture for longer. They are preferred to ointments because they are absorbed faster into the skin. Some creams have additives such as glycerol and urea that attract and hold water. Creams are preferred to ointments if your skin is weeping or oozing. 
• Ointments form a covering layer that prevents evaporation of water from the skin. Ointments are greasier and thicker and may be less cosmetically acceptable, but are better at preventing evaporation. They are more difficult to wash off, with the exception of emulsifying ointment, which can be used as a soap substitute. Ointments may be more suitable than creams for people with more severe symptoms, such as dry, scaly areas of skin. They are not suitable if your skin is weeping or oozing.

There is no best emollient. The best type to use will depend on the dryness of your skin, the area of skin involved and what is comfortable and acceptable to you.

• You may need different emollients for different body areas, and some areas of skin may need treatment with different emollients during flare-ups. For example, creams can help to ease inflammation, as the evaporation of water cools the skin, whereas greasy ointments are more suitable for dry skin.
• More than one emollient may be required for use at different times of the day, and emollient products may also need to be changed depending on the season, eg, if you experience drier skin during winter, you may benefit from temporarily using a more greasy emollient.
• Try different products until you find one you like and will use throughout the day.
• If an emollient irritates your skin, try a different product. In very young children, watch for signs of discomfort or increased skin irritation when using a new emollient.

 If you are using emollients containing paraffin, take care because any dressings and clothing that has been in contact with a paraffin emollient could catch fire more easily. The risk is greater for emollients containing 50% or more paraffin. 

If you are using an emollient check the ingredients on the label or ask your doctor, nurse or pharmacist whether it has paraffin in it. Here are some tips to avoid the risk of burns:

• Paraffin-based emollients are not flammable on their own. But clothing, bedding or dressings covered in paraffin-based emollients are at risk of catching fire.
• Do not smoke, use naked flames (or be near people who are smoking or using naked flames) or go near anything that may cause a fire of clothing, bedding or medical dressings that have been in contact with paraffin-based emollients.
• Change clothing, bedding and medical dressings regularly, preferably daily, because paraffin-based emollients soak into fabric, build up and can become a fire hazard.
• People most at risk of burns are elderly smokers, with an even higher risk for those receiving home oxygen.