Treatment options
Treatment options
Emollients (moisturisers) are the mainstay of eczema management. They form an oily layer over the skin, trapping water. A huge array is available over the counter and on prescription. But how do they differ?
- Many emollients are based on hard, soft or liquid paraffin, which are occlusive agents that form a protective barrier over the skin
- Colloidal oatmeal is often included for its anti-itch, moisturising, cleansing and protective properties
- Humectants, such as urea or glycerol are frequently included as they are hygroscopic, which means they draw water into the skin
- Antiseptics (e.g., benzalkonium chloride) are only really recommended if an infection is present or is a frequent problem for the individual
- Lanolin penetrates deep into the skin so is helpful for dry, cracked skin. It can cause allergies so is not suitable for everyone, although there are hypo-allergenic derivatives available
- Lauromacrogols have a local anaesthetic effect and can help soother the skin by reducing itching
- Ceramides may help restore oils in the skin barrier.
Note that aqueous cream is no longer recommended as a leave-on emollient as it may increase the risk of skin reactions.
Personal preference is key with treatment because the correct emollient for someone is the one they will use. This means that branded products are usually prescribed, rather than generic, and a person may need to try several products before settling on those that work best for them.
Note that some products may contain nut or soya oil so remember to check for any allergies.
Using emollients
While using emollient products may seem straightforward, there are various counselling tips that pharmacy staff can pass on to help customers get the most out of their treatments.
- Customers may prefer to apply ointments at night. Lotions contain more water than oil, so spread easily. Creams contain more oil but are less greasy than ointments
- Several products may be needed for different parts of the body or during flare-ups and periods of remission
- Bath additives and shower products are popular, but ointments can also be dissolved in hot water to make soap substitute
- Soap substitutes are substitutes for soap only, not for emollient application after cleansing
- If the emollient comes in a tub, a clean spoon or spatula should be used to scoop it out. This minimises the risk of contamination from fingers
- Emollients should be applied frequently and liberally, in the direction of hair growth. An adult with eczema should expect to get through a 500g tub a week. They may also want to purchase smaller tubes and/or pots that they can take with them to re-apply during the day
- Customers who use paraffin-based emollients should be warned about the easy ignition of clothing, bedding, dressings and other fabric that have dried residue of an emollient product on them and advised not to smoke or go near naked flames.