Emollient Therapy

Emollient Therapy

emollient-therapy

Emollients (also known as moisturisers) are very important for promoting and maintaining healthy skin and for managing dry, itchy, flaky, and cracked skin. Emollients can be either water- or oil-based products that trap natural moisture in the skin and simply soften, smooth and rehydrate dry skin and can help to decrease the unpleasant sensations associated with itching. Emollients come in different formulations including cleansing products and leave-on products and are generally, considered effective and safe.

 

What are emollients?

The word “emollient” simply refers to a material/substance (can be both a particular type of moisturiser but also a term for moisturiser in general) that softens, moisturises and smooths the skin, both to the touch and to the eye. Emollients should only contain appropriate ingredients to minimise the risk of sensitisation or irritation. They usually have the effect of reducing the clinical signs of skin’s dryness, such as roughness and scaling, and improving sensations of itching. Emollients can be applied to the skin in a number of ways and they come in many different formulations. These include wash products such as cleansers and bath oils or leave-on topical products. Each topical preparation, namely ointments, creams, lotions and gels, are designed for use in slightly different circumstances (Table 1).

Table 1: Uses, advantages and disadvantages of different topical emollient preparations.

Topical emollient preparation Suitable application sites Advantages Disadvantages
Ointment Suitable for very sensitive skin and scaling skin conditions Very hydrating, useful for inflamed areas Greasy, likely to easily stain, can be less cosmetically acceptable
Cream Can be used in skin folds and also suitable for other areas of the body Easily spreads on skin, useful for sensitive skin, less oily/greasy than ointment, cosmetcially acceptable Ideally requires application several times a day, it may contain preservatives that may give rise to sensitivity reactions
Lotion Can be used in skin folds, hairy areas of the body and also suitable for other areas of the body Less oily/greasy than ointment and cream, very hydrating, quickly dries on the skin,cosmetically acceptable Requires frequent application due to faster water evaporation
Gel Most suitable for hairy areas as well as the face and scalp Highly oily but less oily/greasy than ointment, spreads easily and cools the skin Sticky, less cosmetically acceptable

 

What is emollient therapy and what are the benefits?

Emollient therapy is a way of keeping skin properly moisturised at all times by using a combination of emollients liberally and frequently. An emollient therapy regime helps to support the skin's natural barrier, keeping moisture in and irritants and allergens out. Replacing the use of fragrant soaps with emollient-based cleansers and bath oils and regularly applying lots of emollient ointments, creams or lotions helps to keep skin soft and supple.

Emollient therapy basically works by creating an oily layer on the surface (epidermis = skin’s outer layer) of the skin to form a barrier which slows water loss from the skin and also helps in the repair of the mortar that keeps all the skin cells together, arranging them in an orderly and tightly packed manner. Emollients are, therefore, able to help repair the skin's natural barrier that is damaged in dry skin conditions including eczema, xerosis, and psoriasis and can also improve itching (pruritus) sensations.

 

Who is emollient therapy designed for?

Emollient therapy is designed for anyone at any age, who needs it. While it is a recommended first-line/basic treatment option for eczema, emollient therapy can be used for any conditions where dry skin and/or itch are common symptoms.

 

Choosing the right emollient

There are no specific rules on what is the best and right type of emollient Nevertheless, since patients effectively “wear” an emollient in much the same way as cosmetics, consideration should be given to their preferences, which will be mainly influenced by the nature and severity of their skin condition and affected body areas/parts as well as the nature of patients’ work and/or social activities.

The right emollient is one which the patient prefers, keeping in mind that it should be: cosmetically elegant and acceptable, moisturising to sensitive and dry skin (e.g., allergen-free, non-sensitising, no added fragrance, colour or soap and will not block pores), offered at an affordable price, long lasting and absorbed rapidly providing immediate skin hydration. It is important to always try new emollients on a small area of unaffected skin first, to test for a reaction and once you have chosen your emollient, you should use it frequently to have maximum benefit.

Another factor to consider is the severity of the skin condition and dryness. In general terms, very dry skin will benefit from an ointment and even cream whereas mild to moderate dry skin can be managed with a lotion or cream. In reality, patients often require more than one emollient product; a less greasy, cosmetically-acceptable product (lotion or cream) for use during the day and a heavier (or greasier) product (cream, ointment or gel) (Table 1) for night time use.

 

Are there any safety concerns with emollient therapy?

Emollients are generally thought to be safe, with limited and minimal adverse effects. The most commonly reported adverse reaction is stinging or discomfort on application, generally related to one or more of the constituents of the emollient. This is usually transient and could often be considered a normal response to an application of emollient rather than an adverse effect. Patients who have skin conditions, such as eczema, have a tendency to experience irritant responses. However, discomfort on application may represent a true irritancy to the substance or, on very rare occasions, an allergy.

 

Key points:

  • Emollients are the mainstay of treatment for dry and itchy skin.
  • It is important to ensure that skin is properly moisturised at all times by using a combination of emollients liberally, frequently and continuously. Moisturise, moisturise, moisturise...
  • At the same time, emollients soften and smooth dry skin and soothe and relieve the itch, by producing an oily layer over the skin’s surface which traps water beneath it.
  • Emollient therapy is not just about the choice of the right products but understanding how
  • and when to use them properly and appropriately.

 

References

1. GM Supporting healthcare professionals in 50+ medicine. Use of emollients in dry skin conditions [Internet]. Available from: https://www.gmjournal.co.uk/use-of-emollients-in-dry-skin-conditions.

2. Loden M. The skin barrier and use of moisturizers in atopic dermatitis. Clin Dermatol. 2003; 21:145-157.

3. Cork MJ. The importance of skin barrier function. J Dermatol Treat. 1997; 8:s7-13.

4. Holden C, English J, Hoare C, Jordan A, Kownacki S, Turnbull R, Staughton RC. Advised best practice for the use of emollients in eczema and other dry skin conditions. J Dermatol Treat. 2002; 13(3):103-106.

5. National Eczema Society. Emollients [Internet]. Available from: https://eczema.org/information-and-advice/treatments-for-eczema/emollients/.

6. Hydromol. Complete emollient therapy [Internet]. Available from: https://www.hydromol.co.uk/complete-emollient-therapy.html.

7. Tollefson MM, Bruckner AL. Section on Dermatology. Atopic dermatitis: skin-directed management. Pediatrics. 2014; 134(6):e1735-44.

8. Kraft JN, Lynde CW. Moisturizers: what they are and a practical approach to product selection. Skin Therapy Lett. 2005; 10:1-8.

9. Spada F, Barnes TM, Greive KA. Skin hydration is significantly increased by a cream formulated to mimic the skin's own natural moisturizing systems. Clin Cosmet Investig Dermatol. 2018; 11:491-497.

10. Marks R. How to measure the effects of emollients. J Dermatol Treat. 1997; 8:s15-18

11. Ersser S, Maguire S, Nicol N, Penzer R, Peters J. Best Practice in Emollient Therapy: A Statement for Healthcare Professionals. Dermatology UK Ltd, 2007. Aberdeen.