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Topical Tip #1: Apply emollient sparingly!

publication date: Apr 12, 2011
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author/source: DrB
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Those who swim long distances in cold water cover themselves with grease to keep warm

This is not a good idea when applying a moisturiser to eczema. Then the purpose of the moisturiser, or emollient, is to provide insulation against water loss - otherwise the skin dries too quickly. A very thin layer of grease on the surface of the skin slows down water loss, which occurs normally all the time through healthy skin, but occurs too quickly through  inflamed and damaged skin. This slowing down of water loss keeps the skin hydrated: the moisturiser does not add significant water to the skin from the outside. 
          
           E
Also passing out through skin is heat. With eczema the deeper skin is hot - inflammation - and if the emollient is applied too thickly heat is trapped in the skin. A thin layer of moisturiser allows the skin to cool, but remain hydrated - just right!
              
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Interested? Read more in

Chapter Two
"Conventional Treatment"

Atopic Skin Disease
A Manual for Practitioners

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The best results with moisturisers, or emollients, in the treatment of eczema are obtained by applying the cream or ointment thinly. Thick applications trap heat in the skin: thin applications allow the heat out, but keep the water in.

PRINCIPLE: Optimal topical treatment gives best results

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5 Comments Posted Leave a comment

jean sheehan (albany)
very good article, however, my daughter does apply cream lightly but several times a day yet her skin is still extremely dry and inflammed..any ideas on this.
Christopher Bridgett (London)
Thank you for your comment.

On general principles - I cannot give a specific response - it is important to remember that inflammation dries the skin, and emollients are not anti-inflammatory. When there is active eczema an anti-inflammatory cream is needed also - usually a topical steroid.

DrB
martina king (clonee)
VERY GOOD ARTICLE BUT I DO EVERYTHING IT SAYS IN THAT ARTICLE, BUT MY SON OF 5, SKIN IS STILL EXTREMELY DRY AND FLAKES . I USE OINTMENTS AND CREAMS. ANY ADVISE WOULD HELP.
Hannah Smith (Carmarthen)
As a dermatology Specialist Nurse, i suggest that patients depending on age/size aim to use at least 500g of emollient a week, applied in a downwards motion to avoid complications such as infection of the hair follicles(folliculitis).

But i think it is important to find an emollient that suits each individual as the best moisturisers is one that a person likes and will use. If people will not tolerate an ointment, then i suggest a cream as less greasy alternative throughout the day and a greasier emollient at night.

This is just the practice I adopt as i cannot give direct advice to individuals, as not seen in person.

In children creams can sometimes sting on application more than an ointment.
Christopher Bridgett (London)
Getting the frequency of the application of moisturiser right is also important, and altering the frequency depending on need - aim to prevent the skin drying rather than treat dry skin!
But also if there is acute eczema ensure anti-inflammatory cream is used too, and if the eczema is chronic, add habit reversal! Hence The Combined Approach...
DrB
 

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