Emollients soothe, smooth and hydrate the skin and are indicated for all dry or scaling disorders. Their effects are short-lived and they should be applied frequently even after improvement occurs. They are useful in dry and eczematous disorders, and to a lesser extent psoriasis. The choice of an appropriate emollient will depend on the severity of the condition, patient preference, and the site of application. Emollient preparations contained in the tubs should be removed with a clean spoon or spatula to reduce bacterial contamination of the emollient. Emollients should be applied in the direction of the hair growth to reduce the risk of folliculitis. Ointments may exacerbate acne and folliculitis. Some ingredients rarely cause sensitisation and this should be suspected if an eczematous reaction occurs. The use of aqueous cream as a leave-on emollient may increase the risk of skin reaction, particularly in eczema, see MHRA safety warning.
Risk of severe and fatal burns with paraffin-containing and paraffin-free emollients: Warnings about the risk of severe and fatal burns are being extended to all paraffin-based emollients regardless of paraffin concentration. Data suggest there is also a risk for paraffin-free emollients. Advise patients who use these products not to smoke or go near naked flames, and warn about the easy ignition of clothing, bedding, dressings, and other fabric that have dried residue of an emollient product on them.
MHRA (2018). Emollients: new information about risk of severe and fatal burns with paraffin-containing and paraffin-free emollients.
Emollients creams and ointments, paraffin-containing
Pan Mersey APC (2020). EMOLLIENTS: fire risk
Preparations such as aqueous cream and emulsifying ointment can be used as soap substitutes for hand washing and in the bath; the preparation is rubbed on the skin before rinsing off completely.
Preparations containing an antibacterial (section 13.10) should be avoided unless infection is present or is a frequent complication.
Urea is a keratin softener and hydrating agent used in the treatment of dry, scaling conditions (including ichthyosis) and may be useful in elderly patients. It is occasionally used with other topical agents such as corticosteroids to enhance penetration of the skin.
For further information Atopic eczema in children: Management of atopic eczema in children from birth up to the age of 12years consult NICE CG 57