Emollient Guidelines and Formulary
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Emollient Guidelines and Formulary
Approved by the Barking and Dagenham, Havering and Redbridge Area Prescribing sub-Committees July
2016. Review date July 2019
1
Page
Content
number
Formulary products 3
Leave on emollients 4
Prescribing guide:
Points to consider and types of emollients 5
Quantities of emollients to be prescribed 6
Prescribing in under 12s 7
Full emollient formulary with ingredients and costs 8
Patient information leaflet - Information about your
9-10
emollient
The Barking and Dagenham, Havering and Redbridge (BHR) CCGs and Barking, Havering and
Redbridge University Hospitals Trust (BHRuT) agreed these emollient guidelines and formulary at the
July 2016 BHR Area Prescribing sub-Committees. A special thank you to Newham CCG for giving
permission to adapt their emollient guideline and formulary. The original guideline was developed in
collaboration with Newham, Tower Hamlets and Waltham Forest CCG medicines management
teams, GPwSI Dermatology, Consultant Dermatologists and Specialist Dermatology nurses from
Barts Health.
2Emollient Formulary and Guidelines
FORMULARY PRODUCTS
See page 8 for the full formulary including product ingredients and costs
FORMULARY FIRST LINE: NON-FORMULARY:
SOAP SUBSTITUTE
Soap, liquid cleansers and perfumed Aqueous Cream (prescribed generically)
products should be avoided as is very Epi-max® (Please note: Formulary for Barts Health for
drying. Emollient soap substitutes do not Zero AQS® use as soap substitute where SLS content is
foam but are just as effective at cleaning the Aquamax® not an issue. Patients can be offered cost
skin as soap. Soap substitutes can either be Emulsifying ointment effective alternatives in primary care subject to
applied before bathing, showering or choice)
washing, or while in the water (1).
BATH EMOLLIENTS
USE EMOLLIENT PRODUCTS AS BATH
Bath emollients are restricted for use in EMOLLIENTS (EXCEPT CHILDREN) EMOLLIENT BATH PRODUCTS ARE NON-
children in formulary. Sufficient time (10- FORMULARY IN ADULTS (unless indicated
20 minutes) must be spent in the bath to Any emollient (except Liquid and white soft in exceptional clinical cases):
allow the emollient to be absorbed onto paraffin 50:50 ointment) can be dissolved in Zeroneum®
the skin (1). some hot water and added to the bath water as Dermalo® Bath Emollient
a bath additive (2). Cream emollient as a soap Dermol 600®
Bubble baths are extremely drying and substitute in the bath can also be used. Patients Balneum Plus® Bath Oil
potentially irritating to skin (1). A daily bath should use a non-slip matt. Refer to page 8 for Hydromol Bath & Shower Emollient
removes dirt and skin debris which could emollient formulary choices. Zerolatum®
cause infection. Bath emollients are
restricted for use in children in formulary.
ANTIMICROBIAL CONTAINING
Dermol 500 Lotion®- Use for short periods of time only when clinically indicated.
EMOLLIENTS
UREA CONTAINING EMOLLIENTS First Line
Balneum®- Can be used as a soap substitute when eczema is infected.
Avoid use for moisturising skin. May soothe Hydromol Intensive®
itching but does not prevent skin from Nutraplus®
drying. Aquadrate®
Second Line
Calmurid®- used by paediatric hospital dermatologists for ichthyosis. Not to be used in
eczema
Dermatonics® Once Heel Balm
3Emollient Formulary and Guidelines
LEAVE-ON EMOLLIENTS
Choosing emollient depends upon balancing the hydrating strength of very greasy emollients against the tolerability of watery emollients. Note that
the very watery emollients are generally reserved as soap substitutes. Patient choice is important. Please consider the following:
PARABENS
-Some patients can be sensitive to parabens and therefore, should be avoided e.g. Zerocream, QV cream, Cetraben, E45 (non-formulary)
EMOLLIENTS CONTAINING PARAFFIN
-Patients should be counselled on safe application.
-Paraffin-based products such as white soft paraffin or emulsifying ointment can ignite easily by the naked flame. This risk will be greater
when these preparations are applied to large areas of the body and when clothing or dressing becomes soaked with ointment (3).
HEAVY EMOLLIENTS LIGHT EMOLLIENTS
Greasy Rich cream Opaque Gel Light or creamy
FIRST LINE
Emulsifying ointment Zeroderm® Zero AQS® Cream
Liquid and white soft paraffin 50:50 ointment Hydrous Zerodouble® Zerobase®
White Soft Paraffin (WSP) Ointment® Aquamax®
Second Line
Cetraben® Zerocream® (contains PARABENS)
Hydromol ointment®
Diprobase® QV cream®
Third Line
Aveeno ® - after trying Cetraben®
Doublebase®
(contains PARABENS)
COST EFFECTIVE OPTIONS
When initiating, cost should be taken into consideration alongside patient choice when selecting a product or changing products.
Equivalent cost
Emollient Cost (July 16 list price) Cost (July 16 list price) Saving
effective product
Aveeno £7.19 per 500g Cetraben £5.99 per 500g £1.20 per 500g
Aqueous cream (soap substitute only) £4.40 per 500g Zero AQS £3.29 per 500g £1.11 per 500g
Diprobase £6.32 per 500g Zerobase £5.26 per 500g £1.06 per 500g
Doublebase £5.83 per 500g Zerodouble £4.71 per 475g £0.83 per 475g
Epaderm (not on formulary) £6.53 per 500g £2.43 per 500g
Zeroderm £4.10 per 500g
Hydromol £4.89 per 500g £0.79 per 500g
4Emollient Formulary and Guidelines
PRESCRIBING GUIDE – CHOOSING THE BEST EMOLLIENT FOR YOUR PATIENT
INFORMATION
This is a document to help support prescribing and should not over-ride clinical judgement.
People can be allergic to, or react to, a variety of irritants any of which may cause contact dermatitis, but there are many known ingredients that are not
recommended for sensitive skin such as sodium lauryl sulphate, wool fat, lanolin and perfumes (1). Always ensure patients presenting with dry skin
conditions are aware of this fact and advise accordingly.
Product selection is based on:
- Severity and affected skin: understanding severity will govern product selection.
- Correct hydration potency: oily based products retain skin moisture and are better moisturisers. High water based products are more pleasant to
use but not as effective at retaining moisture. Patient’s skin type is important to consider: ‘fairer' skins often don't tolerate oily moisturisers whereas
those with pigmented skins need much heavier emollients.
- Patient preference: patient will not use a product if they think it does not work or not pleasant to apply, contributing to waste. Compliance is the
most important factor when prescribing emollients.
POINTS TO CONSIDER WHEN PRESCRIBING EMOLLIENTS TYPES OF EMOLLIENTS
There is no evidence from controlled trials to support the use of one Emollient is defined as a substance who main action is to occlude the skin
emollient over another, therefore selection is based on the known surface and to encourage build-up of water within the stratum corneum (2).
Generally the greasier an emollient is the more effective it is. All should be
physiological properties of emollients, patient acceptability, dryness of
applied frequently – at least twice per day.
the skin, area of skin involved and lowest acquisition cost (4).
Lotions
Patient lifestyle and preference - may prefer light moisturiser during
Needs reapplying frequently on very dry skin
day and greasy one at night.
Good for very mild dry skin and also for the face
Previous emollients - may have tried other moisturisers with little
More water spreads easily
benefit.
Creams
Cost - emollients vary greatly in price, therefore use the most cost Less greasy but more effective than mild emollients
effective. More cosmetically acceptable than oil based moisturisers
The greasier an emollient is the more effective it is at retaining Mixture of water and fat, well absorbed
hydration. Ointments
Leave-on emollients should be prescribed in large quantities (250- Oily preparation generally greasy and occlusive
500g weekly) for severe cases. This encourages improvement in No preservatives less likely to irritate skin than creams or lotions
eczema and decreases the amount of topical steroid needed. Refer to Useful for very dry and thickened skin, ideal under wet wraps
BNF section 13.1.2 for suitable quantities for prescribing (5).
Aqueous cream is no longer considered suitable as a leave-on emollient
or soap substitute for diagnosed dermatological conditions due to its
tendency to cause irritant reactions (6).
OLIVE OIL AND OTHER NATURAL OILS IN NEONATAL SKIN
There is no evidence to support use of natural oils; olive oil has the potential to promote the development of and exacerbate existing, atopic dermatitis as it can
significantly damages the skin barrier. Olive oil for the treatment of dry skin and infant massage should be discouraged (4).
5Emollient Formulary and Guidelines
BATHS AND SHOWERS(1) Bath oils are not recommended ANTISEPTIC/ANTIMICOBIAL/UREA CONTAINING
Avoid bubble baths and soaps as they can be irritant. EMOLLIENTS
Use an emollient as a soap substitute e.g. ZeroAQS (all the
There is limited evidence to support use of antiseptic/antimicrobial containing
emollients, except for white soft paraffin alone, can be used in
emollients4 and routine use should be avoided. Their use should be restricted
this way) to recurrent infection for limited periods only.
Leave-on emollients should be used as soap substitutes for washing as
conventional soaps/wash products strip the skin of natural oils and cause In selected cases, where recurrent infection is a contributory factor to
shedding of skin cells. relapse, they can play an important role in stabilizing the patient’s
Encourage to bathe regularly condition.
Functions of the bath routine are to:
Clean the skin preventing infection by removing scales, crusts, dried Formulary first line choice: Dermol 500 Lotion® which can be used as a bath
blood and dirt from the skin. emollient.
Moisturise the skin and reduce discomfort caused by dry skin
Hydrates the skin making it more receptive to active topical therapy, e.g. Please note, do not prescribe bath additive Dermol 200 Shower Gel and
topical corticosteroids. Dermol 600 Bath emollient.
MANAGING THE INTERFACE BETWEEN PRIMARY AND SECONDARY CARE
If a non-formulary emollient is recommended by a hospital dermatologist during an admission, GPs can switch to a formulary emollient unless there are
exceptions due to clinical reasons which must be stated.
The hospital dermatologist will not routinely prescribe emollients in an out-patient setting, but may make recommendations to GPs to prescribe
emollients without specifying the product. Where non-formulary brands are stated GPs can switch to a formulary emollient unless there are exceptions
due to clinical reasons which must be stated.
When a patient is admitted to hospital, their current emollients will be used, unless there are compelling clinical reasons to change them which should
be stated in discharge summaries.
Patients admitted to hospital should be prescribed with their current emollients, except where an alternative is clinically indicated.
QUANTITIES OF EMOLLIENTS TO BE PRESCRIBED IN ADULTS
A trial of cost-effective emollients suitable for the patient should be prescribed in small packs initially for the patient to decide which is the most suitable for
them. A larger quantity then can be considered after this point. For emollient, general rule is 600g per week.
This table suggests suitable quantities to be prescribed for an adult for a minimum of twice daily application for one week. For children
approximately half this amount is suitable (5).
Area of application Creams and Ointments (Flare-up) Creams and Ointments Lotions (Flare-up) Lotions
Face 50-100g 15-30g 250ml 100ml
Both hands 100-200g 25-50g 500ml 200ml
Scalp 100-200g 50-100g 500ml 200ml
Both arms or both legs 300-500g 100-200g 500ml 200ml
Trunk 1000g 400g 1000ml 500ml
Groin and genitalia 50-100g 15-25g 250ml 100ml
Note: During a flare-up, patients should aim to apply the emollients every 2 hours where possible. All other times, emollients should be applied at least twice a
day but is dependent on the extent of dryness and may require more applications
6Emollient Formulary and Guidelines
PRESCRIBING IN CHILDREN UNDER 12 YEARS
Based on clinical experience of hospital dermatologists, greasy based emollients are preferable in children – these should be considered after engaging with
parents/carers.
When prescribing, consideration to suitable quantities should be based on clinical severity and need of patients:
Child with severe eczema can use 2 x 500g of emollient per month.
Leave-on emollients should be prescribed in large quantities (250-500g weekly) for severe cases. This encourages improvement in eczema and
decreases the amount of topical steroid needed.
Ensure adequate quantities for patient are prescribed in primary care, as experience from hospital dermatologist is that families do not use enough
emollients. 250g/week is sufficient for total body coverage of a child. GPs should prescribe up to 1000g/month if patient requests and compliance
should be checked.
Emollients should be easily available to use at nursery, pre-school or school3. A greasy emollient for use at home and a lighter cream at nursery, pre-school or
school can aid compliance and improvement.
UREA CONTAINING EMOLLIENTS SELF-CARE
These are well suited to the care of large areas of skin – even over long Patients with dry skin not related to a dermatological condition should be
periods – in patients with atopic eczema. It is recommended that such encouraged to buy an emollient of their choice from retail outlet.
emollients are used once or twice a day as an add-on therapy to their regular Self-care messages should be promoted for adults and children with a
emollient regimen as they can cause stinging. dermatological conditions:
- Increase emollient use when there is an exacerbation of the condition
In clinical practice, not all patients will tolerate urea-containing products which - Application of emollient should not be followed by immediate topical
are expensive, Urea containing emollients should not replace established steroid use – should allow time interval (12- 20 minutes)
emollients and be avoided for use in minor dry skin. - Adequate hydration is important for skin health
- Triggers should be identified and exposure minimised
Formulary first-line choice - Emollients should be applied correctly
Hydromol Intensive® - Apply liberally and frequently, even when skin condition has improved. It
Nutraplus® is important to use appropriate amounts to ensure adequate
Aquadrate® hydration/application.
- Olive oil has the potential to promote the development of and exacerbate
existing, atopic dermatitis as it can damages the skin barrier5.
UNLICENSED ‘SPECIALS’ PRODUCTS
Most prescribing aims to use licensed medicines whose safety and efficacy are assured. For many common dermatological conditions, the range of licensed
medicines is limited. Dermatology prescribing can lead to the use of unlicensed creams and ointments (known as ‘Specials’). This is of particular concern in
primary care where lack of effective price controls and a mechanism to ensure independent scrutiny of product quality has increased costs and concern about
standards.
To address these concerns and help to optimise quality of care, adherence to the revised British Association of Dermatologists (BAD) list of preferred Specials
(2014) is encouraged.
Reference
1. MeReC Bulletin. The use of emollients in dry skin conditions. Number 12, 1998, Vol. 9, pp. 45-48.
2. BDNG in association with Dermatological Nursing. Best Practice in Emollient Therapy: A statement for Healthcare Professionals. s.l. : Dermatological Nursing, December 2012.
3. Medicines and Healthcare products Regulatory Agency. Drug Safety Update Paraffin-based treatments: risk of fire hazard. s.l. : Medicines and Healthcare products Regulatory Agency, January
2008.
4. National Institute of Clinical Excellence (NICE). Clinical Knowledge Summaries Dermatitis- Contact. s.l. : NICE, March 2013.
5. Joint Formulary committee. British National Formulary. s.l. : BMJ Group and Pharmaceutical Press, 2015. Vol. 70.
6. Medicines and Healthcare products Regulatory Agency. Drug Safety Update Aqueous cream: may cause skin irritation. s.l. : Medicines and Healthcare products Regulatory Agency, March 2013.
7. Interventions to reduce Staphylococcus aureus in the management of atopic eczema. Birnie Andrew J., Bath-Hextall Fiona J., Ravenscroft Jane Catherine., Williams Hywel C. s.l. : John Wiley &
Sons, Ltd, 2008, Cochrane Database of Systematic Reviews, Vol. 3.
7INGREDIENTS OF FORMULARY PRODUCTS
Formulary Cost (July
Description Emollient Ingredients and additional information
position 16)
GREASY LEAVE- Emulsifying ointment First line £2.12 / 500g Emulsifying wax 30%, White Soft Paraffin 50%, Liquid Paraffin 20%.
ON EMOLLIENT Liquid and white soft paraffin
First line £4.57 / 500g White Soft Paraffin 50: Liquid Paraffin: 50
50:50 ointment
White Soft Paraffin (WSP) First line £3.23 / 500g White Soft Paraffin
Liquid Paraffin 40%, White Soft Paraffin 30%, Cetomacrogol
Hydromol ointment® Second line £4.89 / 500g Emulsifying. CONSIDER SWITCHING TO ZERODERM® (SIMILAR,
BUT NOT IDENTICAL)
RICH CREAM Liquid Paraffin 40%, White Soft Paraffin 30%, Cetearyl Alcohol
LEAVE-ON Zeroderm® First line £4.10 / 500g Consider switching Hydromol® and Epaderm® to Zeroderm®
EMOLLIENT (similar, but not identical)
Dried magnesium sulfate 0.5%, phenoxyethanol 1%, wool alcohols
Hydrous Ointment® First line £4.89 / 500g
ointment 50%
White soft paraffin 13.2% w/w, Light liquid paraffin 10.5% w/w
Cetraben® Second line £5.99 / 500g Contains humectant – glycerin. CONTAINS PARABENS. Available as
cream and ointment
White Soft Paraffin 15%, Liquid Paraffin 6%
Diprobase® Second line £6.32 / 500g CONSIDER SWITCHING TO ZEROBASE® (SIMILAR, BUT NOT
IDENTICAL)
OPAQUE GEL Isopropyl myristate 15%w/w, liquid paraffin 15%w/w.
LEAVE-ON Zerodouble® First line £4.71 / 475g Pack size is 475g. DO NOT prescribe 500g (5x100g is more expensive
EMOLLIENT than Doublebase)
Isopropyl myristate 15%w/w, liquid paraffin 15%w/w.
Doublebase® Third line £5.83 / 500g CONSIDER SWITCHING TO ZERODOUBLE®
LIGHT OR White Soft Paraffin 15%. Liquid Paraffin 6%
Zero AQS® Cream First line £3.29 / 500g
CREAMY LEAVE- Same ingredients as Aqueous cream but does not contain SLS.
ON EMOLLIENT Zerobase® First line £5.26 / 500g Liquid paraffin 11% w/w, White Soft Paraffin 10%
White soft paraffin 20%, liquid paraffin 8%
Aquamax® First line £3.99 / 500g CONSIDER INSTEAD OF AQUEOUS CREAM (SIMILAR, BUT NOT
IDENTICAL)
LIGHT OR Light Liquid Paraffin 12.6%, White Soft Paraffin 14.5%, Anhydrous
CREAMY LEAVE- ® Lanolin 1.0%
Zerocream Second line £4.08 / 500g
ON EMOLLIENT Similar formulation to E45 but not identical
CONTAINS PARABENS, LANOLIN
Aqua (water), paraffinum liquidum, glycerin, petrolatum, cetearyl
QV cream® Second line £5.92 / 500g alcohol, squalane, dimethicone, ceteth-20, stearic acid, laureth-3,
glyceryl stearate, methylparaben, dichlorobenzyl alcohol
Aveeno® Third line £7.19 / 500g Colloidal oatmeal in emollient base
SOAP ® First line
Zero AQS £3.29 / 500g White Soft Paraffin 15%. Liquid Paraffin 6%
SUBSTITUTE Aquamax® First line £3.99 / 500g Light Liquid Paraffin 8%, white soft paraffin 20%, phenoxyethanol 1%
Emulsifying ointment First line £2.12 / 500g Emulsifying wax 30%, White Soft Paraffin 50%, Liquid Paraffin 20%.
Purified Water Ph. Eur., White Soft Paraffin, Liquid Paraffin,
Epi-max® First line £2.49 / 500g
Polysorbate 60, Cetosteryl Alcohol, Phenoxyethanol
Non-formulary White Soft Paraffin 15%. Liquid Paraffin 6%
Aqueous cream (prescribed
in primary £4.40 / 500g CONTAINS: SLS CONSIDER SWITCHING TO ZERO AQS or EPI-
generically)
care. MAX (SIMILAR, BUT NOT IDENTICAL)
ANTIMICROBIAL
Benzalkonium Chloride 0.1% w/w; Chlorhexidine Dihydrochloride 0.1%
CONTAINING Dermol 500 Lotion® First line £6.04 / 500g
w/w; Liquid Paraffin 2.5% w/w; Isopropyl Myristate 2.5% w/w.
EMOLLIENTS
UREA Balneum® First line £9.97 / 500g Urea 5%, ceramide 0.1%
CONTAINING Hydromol Intensive ®
First line £4.37 / 100g Urea 5%
EMOLLIENTS
Nutraplus® First line £4.37 / 100g Urea 10%
Aquadrate® First line £4.37 / 100g Urea 10%
®
Calmurid Second line £33.40 / 500g Urea 10%, Lactic acid 5%
Dermatonics® Once Heel
Second line £9.50 / 200g Urea 25%. CONTAINS LANOLIN
Balm
All Emollient bath products are non-formulary in adults unless indicated in exceptional clinical cases
Any emollient (except Liquid and white soft paraffin 50:50 ointment) can be dissolved in some hot water and added to the bath water as a bath additive
8Types of emollients Soap substitutes: any emollient (except white soft
Information about There are many types and brands of emollients paraffin) can be used with water to cleanse the
ranging from runny lotions to thick ointments. The skin, as they do not remove natural oils in the skin.
your emollient difference between lotions, creams and ointments
is the proportion of lipid (oil) to water. The lipid
Soap is very drying for the skin and should be
avoided in people with dry skin conditions.
content is lowest in lotions, intermediate in Leave-on-emollient: these emollients are applied
creams, and highest in ointments. The higher the directly onto the skin and left on to soak in. they
lipid content, the greasier and stickier it feels, and are not washed off the skin (as with soap
the shinier it looks on the skin. As a general rule, substitutes). It keeps the skin well hydrated and
the higher the lipid content (the more greasy and supple.
thick the emollient), the better and longer it works.
You may need to try more than one emollient Bath additives/emollients: added to bath water:
before you find one that suits. Cleans skin by removing scales, crusts, and dirt.
Hydrates skins to make it more receptive to other
Lotions: more water, spreads easily, absorbs treatments. A tablespoon of any emollient can be
quickly, can be cooling, and is good for very mild dissolved in some hot water and added to the bath
What are emollients? dry skin. These contain the least oil and most water.
Emollient is the medical word for a moisturiser water so are the least effective in moisturising the
Emollients trap moisture in the skin and form a skin. They normally contain preservatives so may Urea containing emollients: well suited to the care
protective oily layer on the outer skin which helps cause skin irritation. Lotions are useful for hairy of large areas of the skin, over long periods,
skin repair and improves skin hydration. areas such as scalps and areas of weepy skin. patients with atopic eczema. It is recommended
Emollients replace natural oils that help keep that such emollients are used once or twice a day
water in the skin to prevent it becoming dry, Creams: mixture of water and fat, well absorbed, as an add-on therapy to their regular emollient
cracked, rough, scaly and itchy. Their use can less greasy, more cosmetically acceptable. These regimen as they can cause stinging.
prevent conditions like eczema ‘flaring up’. contain a mixture of oil and water and are less
greasy, and therefore easier to spread on the skin Which emollient is best?
Why use emollients? than ointments. They should be used often and There is no ‘best emollient’. The type (or types) to
Applying emollients regularly can be time applied liberally to prevent the skin from drying use depends on the dryness of the skin, the area
consuming but is worthwhile as it can prevent out. Creams usually come in a container with a of skin involved, and what is comfortable and
eczema and other dry skin conditions from flaring pump dispenser and are good for day-time acceptable to you.
up. It may mean that other treatments that could application.
cause side effects e.g. steroid creams may not be If you only have mild skin dryness and flare-ups
needed as much or even at all. It can be continued Ointments: oily preparation, more greasy and do not happen often, then a lotion or cream may
after skin condition has cleared. occlusive, usually preservative-free, more inert, be best. If you have moderate-to-severe dryness
less likely to irritate skin than creams/lotions, then a thicker cream or an ointment is ideal. For
How often to use? useful in very dry/thickened skin, and not areas of weeping eczema a cream or lotion is
Apply emollients whenever the skin feels dry and appropriate for weeping areas. They are usually usually best as ointments will tend to be very
as often as you need. This may be two to four made of white soft paraffin or liquid paraffin, and messy.
times a day or more. You may apply more are ideal for very dry or thickened skin and night-
frequently in adverse weather conditions. Your time application. They do not usually contain
doctor or nurse will be able to advise you on preservatives and are therefore less likely to
quantities to use per week which depends on how cause skin reactions.
extensive and severe your condition is.
9How to apply emollients? and an ointment in the evening when wearing
Step 1: Wash your hands pyjamas. Most emollients (except white soft How much leave-on emollient should I apply?
Step 2: Do not put fingers into tubs to scoop out paraffin alone) can be used as a soap substitute The quantity of leave-on emollient required will
the ointment as you may introduce bacteria into as well vary depending on the size of the person, the
the ointment. To reduce the risk of infection, severity of the skin condition, and whether the
transfer some emollient onto a clean plate using a Skin irritation emollient is also being used as a soap substitute.
clean desert spoon. If you have a cream in a tub People may react to a variety of irritants which As a general guide, if you needed to treat the
with a pump top, you can pump directly onto your may cause contact dermatitis, but there are many whole body, the recommended quantities used
hand. known ingredients that are NOT are 600 g per week for an adult, and 250-500g per
Step 3: Emollients should be applied to the skin in RECOMMENDED for sensitive skin such as week for a child.
a downward direction of hair growth and left in a sodium lauryl sulphate, wool fat, lanolin,
thin layer to soak in – this may take 10 minutes. perfumes. Triggers should be identified and Are there any possible side-effects from
Please do not rub emollients in. exposure minimised. Olive oil has the potential to emollients?
promote the development of and exacerbate Emollients used for skin conditions tend to be
Shorter, smooth nails help to reduce likelihood of existing, atopic dermatitis as it can damage the bland and non-perfumed. However, some creams
trauma to the skin. Topical products (e.g. steroid skin barrier. contain preservatives, fragrances and other
cream) should be applied to well-moisturised skin, additives. Occasionally, some people become
can be applied at different times of the day. Using emollients and topical steroids together sensitised (allergic) to an ingredient. If you
Applying an emollient on top of a topical steroid Topical steroids are very different to emollients, suspect that you are sensitive to an emollient then
results in dilution and spread to areas of the body and should be used and applied in a different way. speak to your doctor, nurse or pharmacist for
where it is not needed. When using the two treatments, apply the advice.
emollient first. Wait 20- 30 minutes after applying
Bathing and washing an emollient before applying a topical Washing up clothes for children
Bathe regularly in tepid water only, this cleans and corticosteroid. That is, the emollient should be
helps prevent infection by removing scales, allowed to absorb before a topical steroid is It is advisable to put the washing machine on 60
crusts, dried blood and dirt. Use an emollient as a applied (the skin should be moist or slightly tacky, degrees. This ensures pipes are kept free of
soap substitute (most emollients can be used in but not slippery, when applying the steroid). grease as well as clothes thoroughly washed to
this way) and should be applied prior to washing prevent any local irritation.
and directly afterwards onto damp skin. They What precautions should I take with
provide greater moisturising than bath emollients emollients? Acknowledgements
that don’t have enough contact with the skin. Paraffin-based emollients are flammable so take
Musgrove Park Hospital. Emollients (Moisturisers)
When drying do not rub with a towel but pat the care near any open flames or potential causes of Rotherham Clinical Commissioning Group. Emollient
skin dry to avoid damage to the skin. ignition, such as cigarettes. Ointments and education information leaflet.
creams used in the bath and shower can make the Guy’s and St. Thomas NHS Foundation Trust. St. John’s
surface slippery so take extra care. If you find an Institute of Dermatology. Emollients and how to use them.
Lifestyle
Buckinghamshire Healthcare NHS Trust. Department of
Light moisturiser during day and greasy one at emollient is making your skin sore and/or very
Dermatology, Allergy, and Skin Surgery. Patient Information
night. Greasier the emollient, more effective at itchy, you may be allergic to one of the ingredients – Emollients and Moisturisers
retaining hydration. You may wish to use different and you should discuss this with your doctor, NHS Newham, Tower Hamlets, and Waltham Forest Clinical
types of emollients at different times of the day, on pharmacist or nurse. If you are having ultraviolet Commissioning Groups
different areas of the body or when severity of light treatment or radiotherapy, ask for specific Barts Health NHS Trust
your condition varies. For example, use a cream guidance on emollient use as instructions may
in the morning if dressing to go to work or school differ slightly.
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