Understanding and Applying Emollients in Paediatric Eczema

Eczema is a common ailment that affects babies and children. As healthcare professionals in the UK, it’s crucial to understand the best practices for applying emollients to children with this condition. Emollients, which come in various forms such as creams, ointments, and soap substitutes, soothe and hydrate the skin, reducing symptoms and flare-ups.

Choosing the Right Emollient, The effectiveness of emollients can vary according to disease severity, body site, climate, container type, and patient or carer preferences. A 2022 study found no significant differences in the effectiveness of different emollient types (lotions, creams, ointments, and gels) in children with eczema. However, stinging was less common with ointments. The “best” emollient is the one that the individual prefers after a period of testing.

Application Tips for Carers and Patients

• Use a large amount: Emollients should be applied generously to ensure all affected areas are covered.
• Do not rub it in: Instead of rubbing the emollient into the skin, smooth it into the skin in the same direction the hair grows. This helps avoid blocking hair follicles.
• Apply after bathing: Emollients may be more effective when applied straight after a bath or shower. This is because they can help seal in the moisture that the skin has absorbed during bathing.
• Store appropriately: Try storing emollient creams (not ointments) in the fridge. The coolness can help soothe itchiness. If your child prefers warm emollients, store them in an airing cupboard.

Incorporating Emollients into Daily Life Emollients should be applied frequently throughout the day. To help with this, consider keeping separate packs of emollients at places the child spends a lot of time in.

Remember that while emollients alone can help reduce eczema symptoms and prevent flares, most people will also need to use anti-inflammatory treatments such as topical corticosteroids of an appropriate strength and duration.

How do emollients work? Emollients work by forming an oily layer over the outermost layer of skin. The oil traps water underneath, hydrating the skin and making it harder for irritants and bacteria to penetrate, inflame, or infect the skin. Emollients create an oily layer between the skin and the environment and helps seal in water. Both these actions strengthen the skin barrier, protecting the child from allergens, irritants, and bacteria. This reduces the risk of infection and eczema flares. They also cause you to itch less, also reducing your risk of infection and flares.

Types of emollients Emollients come in a variety of forms: lotions, creams, ointments, gels, sprays, and soap substitutes. There are over 120 emollient products that are approved for use by the NHS (listed on what is known as the ‘NHS Drug Tariff’). However, healthcare professionals are usually only allowed to prescribe a few different brands.

A 2022 study compared the effectiveness of four different emollient types (lotions, creams, ointments, and gels) in children with eczema and found no significant differences. But stinging as a side effect was less common in ointments.

Some emollients contain urea (a keratin softener and hydrating agent), for example Aquadrate ®, Balneum ® Plus, Calmurid ®, E45 ® Itch Relief Cream, Eucerin ® Intensive, Hydromol ® Intensive and ImuDERM®.

While many use the terms “emollient” and “moisturizer” interchangeably, they aren’t the same. The term “moisturizer” is a catch-all marketing term for lotions, creams or other solutions made to help moisten the skin. There’s no consensus about what the term means. Emollients have a specific method of action to soothe and soften your skin. Moisturizers may contain other types of compounds with different methods of action such as humectants and occlusives.

In conclusion, emollients play a crucial role in the management of eczema in children. They work by forming an oily layer over the skin, trapping water underneath, and strengthening the skin barrier. Emollients come in various forms and the best one is usually the one preferred by the individual after a period of testing. Application should be generous, smoothed into the skin rather than rubbed, and done frequently throughout the day. While emollients alone can help reduce eczema symptoms and prevent flares, most people will also need to use anti-inflammatory treatments such as topical corticosteroids of an appropriate strength and duration. Understanding these principles can significantly improve a child’s eczema symptoms and their quality of life.

For those interested in furthering their knowledge and understanding of childhood eczema, there is a comprehensive course available titled “Childhood Eczema: Diagnosis, Treatment, and Support” offered by PDUK. This course provides an in-depth exploration of the condition, its impact on children and families, and the most effective strategies for diagnosis, treatment, and support. You can find more information about the course [here].

References

1. National Eczema Society. (2021). Emollients. [www.nationaleczemasociety.org/emollients]
2. Santer, M., Rumsby, K., Ridd, M. J., Francis, N. A., Stuart, B., Chorozoglou, M., … & Little, P. (2020). Emollient bath additives for the treatment of childhood eczema (BATHE): multicentre pragmatic parallel group randomised controlled trial of clinical and cost effectiveness. BMJ, 361, k1332. [www.bmj.com/content/361/bmj.k1332]
3. National Institute for Health and Care Excellence. (2018). Atopic eczema in under 12s: diagnosis and management. [www.nice.org.uk/guidance/cg57]
4. National Health Service. (2018). Emollients. [www.nhs.uk/conditions/emollients]
5. National Institute for Health and Care Excellence. (2020). Eczema - atopic: Management. [www.nice.org.uk/guidance/ng125/chapter/Recommendations]
6. British Association of Dermatologists. (2020). Emollients and moisturisers for eczema. [www.bad.org.uk/shared/get-file.ashx?id=3403&itemtype=document]
7. National Eczema Association. (2021). Understanding the differences between emollients, moisturizers, humectants and occlusives. [www.nationaleczema.org/eczema/treatment/moisturizing]