How to choose an effective emollient for eczema

When first-time patients visit the Allergy Clinic, they often bring shopping bags full of emollients that they have tried with varied success and frustration. These patients tend to be at their wits’ end, and rightfully so, because choosing an effective emollient can be extremely time-consuming, not to mention how expensive a trial and error approach can get.

There are three factors to understand before choosing an emollient for your skin. Eczema is a chronic condition that requires pro-active management and treatment – it cannot be cured. If you’re suffering from this condition, your approach needs to be one of controlling it instead of looking for a miracle cream.

1. The key to eczema control is using liberal amounts of emollient (moisturiser) consistently and not on an as-needed basis;
2. Find a product that suits your skin and your budget, taking into consideration that if you have extensive eczema, your emollient use should be in the order of 250g per week for children and 500g per week for adults;
3. Understand what you need from your emollient and the scientific support for your choice.

I will try not to make product recommendations in this blog post, but I will express my preferences to ingredients.

It might surprise you that many products claim efficacy, but very little evidence supports some claims.

Emollients vs moisturisers

The claims are based on what we know and understand to be the properties of particular ingredients in products. Although we talk about the moisturisers as emollients, emollients are critical components of moisturisers. To understand this, we must take a look at the three most important types of ingredients – emollients, occlusive agents and humectants:

• Emollients lubricate and soften the skin through ingredients like glycol, glyceryl stearate or soy sterols. They do not protect the skin against water loss, which is one of the main problems we face in eczema.
• Occlusive agents assist in preventing the loss of water through the surface of the skin. This happens thanks to ingredients like petrolatum, dimethicone, mineral oil.
• Humectants attract and hold water thanks to glycerol, lactic acid and urea. Unfortunately, urea can burn and irritate the skin.

So which emollient will work for you?

We always seek to find the most sustainable treatment for your unique circumstances. But my recommendations to my patients seeking emollients tend to be grounded in the following three points:

1. No Aqueous cream. Ever! It dries out the skin and should never be used;
2. I prefer to use a thick occlusive agent. Especially at night, petrolatum remains my occlusive agent of choice. This simple agent gives a lot of relief and ease of accessibility;
3. Using an emollient/humectant/occlusive that leaves residue during the day is often more acceptable and easier to use. Water is often one of the main ingredients in the easier to apply products. However, the softening and soothing effect is temporary. The more water in a product, the easier to apply, but the more likely you are going to need to reapply.

Natural products

Applying natural products might contain proteins that can make a child, or infant allergic and care should be taken if you opt to use the products.

There is conflicting evidence about the efficacy of Coconut Oil, with some evidence suggesting that it has a drying effect on the skin and should not be used.

There is some evidence that oatmeal can give some relief.

Allergic reactions

It is possible to develop allergic reactions to creams, and it can be a frustrating experience if this is the case. When our skins are very inflamed and irritated, it is possible that your emollient can burn your skin. It is often challenging to isolate the ingredient that causes it if you are using a combination product. This why it might be best to seek simple emollients with limited ingredients. Using a single ingredient product makes it easier to establish the culprit.

A final three thoughts.

1. The first line of treatment for eczema is emollients applied in liberal amounts.
2. Eczema is a chronic condition, and the treatment should be persistent and ongoing to prevent a see-saw effect.
3. There is no one-stop-shop to choose an emollient, but sanity needs to prevail when selecting one to treat and prevent flare-ups.

The purpose of this article is to raise awareness of allergies and the treatment options that are available for it. This article should by no means be used, or viewed, as a primary source for medical or other professional advice – please arrange for a personal consultation with your medical practitioner before taking any decisions that could affect the wellbeing of you or your loved ones. Read our medical disclaimer for more information.