Emollients: How can we use them?
Emollients are found in many skin and beauty applications, such as lipsticks, lotions, and a wide range of cosmetic products. People who use moisturizers and emollients for eczema or psoriasis should avoid perfumed products.
An emollient is a humectant, a lubricant, and an occluder. Occlusion puts a layer of oil on the skin's surface, slowing down water loss. A humectant enhances the surface of the skin's capacity to hold water. A lubricant reduces friction when anything rubs against the skin.
This triple function helps skin cells on the surface of the skin to repair.
Emollients can usually be applied as often as necessary.
Emollients can reduce symptoms of cracked and dry skin.
Emollients may be medicated or nonmedicated.
Nonmedicated topical moisturizers contain occlusive agents, emollients, and humectants.
Occlusive agents coat the skin, forming a physical barrier that prevents the loss of water. Petrolatum, waxes, oils, and silicones are examples. They can be uncomfortable on the skin, so they may be combined with an emollient.
Emollients offer an occlusive barrier and they smooth flaky skin cells, to make the skin look smoother. Some spread more easily than others. Esters and oils can be used.
Humectants include ingredients such as glycerin, urea and pyrrolidine carboxylic acid. They attract water from the atmosphere and from the lower layers of skin to moisturize the surface of the skin. They can feel sticky, so they will be combined with other elements.
The balance of these three elements will determine the type of moisturizer and its purpose.
Emollients also vary according to the ratio of oil, or lipid, to water. Lotions have a low lipid content, and but the lipid content of ointments. Emollients with high lipid contents are greasier and stickier. They also make the skin shinier.
Aloe vera gel has been found to help some people with mild to moderate psoriasis, but not all. The coating effect of the gel on the skin may provide benefits.
Some people are allergic to the ingredients in products, including aloe vera. To check for allergies, it is a good idea to apply some of the product to a dime-sized section of the arm, and wait 24 hours to see if there is any reaction, before applying it more widely.
For eczema and psoriasis
Moisturizers and emollients are recommended for people with eczema and psoriasis, at any age.
One study that looked at the feasibility of skin barrier treatment from birth concluded:
"The results of this trial demonstrate that emollient therapy from birth represents a feasible, safe, and effective approach for atopic dermatitis prevention. If confirmed in larger trials, emollient therapy from birth would be a simple and low-cost intervention that could reduce the global burden of allergic diseases."
People with eczema or psoriasis can find soap too drying to the skin. Many bar soaps, liquid soaps, and cleansers and perfume products can irritate the skin.
Emollient soaps substitutes do not foam but they clean the hands and skin. They can be applied before washing or in the water.
A range of emollients are available, and a doctor can recommend the best option for an individual's condition.
Aqueous creams or emulsifying ointments are good alternatives for hand and bath soaps, because they do not strip the skin of its surface layer, as most soaps do. Aqueous creams can be used instead of shaving foam.
Some aqueous creams may cause stinging. If this continues, a pharmacist or doctor will be able to suggest an alternative product.
Bubble baths can dry and irritate the skin, but bathing helps to remove skin and dirt that could contribute to infection. Emollient bath additives or bath oils added to bathwater can help prevent the loss of moisture from the skin.
They can make the bathtub slippery, so it is important to be careful when getting in and out of the bath. A non-stick mat might help.
Emollients can also be applied on a sponge either before or during a shower.
For children who are at risk of developing infected eczema, bath oils with an antiseptic may offer protection, but these should be used occasionally. The label will state the recommended amount that should be used. A high concentration may cause skin irritation.
Emollient creams and ointments are less greasy than ointments, but they might sting after the first application, especially if the skin is very dry. Symptoms normally settle down within a few days. If the stinging persists, see a qualified pharmacist or doctor. Some people experience persistent stinging because of the preservatives used or because of an allergic reaction.
The type of emollient to use will depend on how dry the skin is, and where the emollient will be applied.
Emollients can come in bottles, large pump dispensers, tubes, tubs, and jars. They are mainly sold over-the-counter, without a prescription, but some products need a prescription.
Patients with psoriasis or eczema have extremely dry skin, so they will need to apply emollients more frequently. They may benefit more from medicated emollients which help prevent flare-ups, inflammation, and infection.
These products may be more effective if applied after washing or bathing, when the skin most needs moisturizing.
Medicated emollients for psoriasis and eczema may contain corticosteroids, salicylic acid, vitamin D analogs, coal tar, tazarotene, anthralin, tacrolimus, and pimecrolimus.
These should be used with a doctor's recommendation, as some of them they may cause itching or irritation, and extensive steroid use can have serious side effects.
Tips for applying
For best results:
- Apply emollients and moisturizers after bathing, while the water is still trapped in the skin
- Use at least three times a day, or according to a doctor's instructions
- Apply gently, and follow the direction of hair growth
- Do not rub up and down as this can lead to itching, block hair follicles, and generate heat in the skin
- Continue to use the emollient after a flareup has cleared, to prevent it from returning
- Ask a doctor for advice about the best product for you and how to use it
- Use trial and error for a product that suits you
Used daily, nonmedicated products can help to keep mild to moderate cases of eczema at bay, and they can reduce the need for corticosteroid creams.
Nonmedicated moisturizers have not been found to be toxic, and most are safe during pregnancy and for pediatric use.