Emollients

Overview

Emollients are moisturising treatments. They are rubbed onto the skin to add water, soften rough patches and form a protective film that stops moisture escaping. You may hear them called moisturisers, creams, ointments, lotions or soap substitutes. They are the everyday, first-line treatment for dry skin conditions such as eczema and psoriasis, and many people use them simply because their skin feels dry and tight.

Very common. Dry, itchy skin is one of the most frequent reasons people visit a pharmacist or GP, and emollients are among the most widely used skin products worldwide. Eczema alone affects around one in five children and many adults.

Anyone can use emollients. They are especially helpful for people with eczema, psoriasis, ichthyosis (a condition where skin is scaly and dry), contact dermatitis, and for anyone whose skin dries out with age, cold weather, frequent handwashing or harsh soaps. Babies and children often need them, and older adults commonly use them because skin becomes drier with age.

Symptoms

Common symptoms

• Skin that feels dry, tight or rough to the touch
• Flaking, scaling or a 'cracked' look, especially on hands, elbows, knees and shins
• Itching, which may be worse at night or after a bath or shower
• Small cracks that sting, particularly on hands and feet
• Skin that looks dull or reddish and feels sore after washing
• Chapping or chafing in skin folds and on the face

Symptoms in children

• Dry, itchy patches on the cheeks, scalp, elbows, knees or behind the knees
• Restlessness and broken sleep because of itching
• Scratching that leaves red marks or small grazes
• Fussiness or crying during nappy changes or bath time if skin is sore

Symptoms in older adults

• Thinning, papery skin that dries out quickly and bruises easily
• Dryness on the lower legs, forearms and back that is hard to reach to moisturise
• Itching that disturbs sleep or makes skin feel 'crawling'
• Dryness made worse by central heating, long hot baths, or medicines that dry the skin

Causes

Main causes

• A weakened skin barrier — skin loses water too easily and lets irritants in, which is the underlying pattern in eczema
• Cold, windy weather and low humidity indoors from heating or air conditioning
• Frequent washing, long hot baths or showers, and swimming in chlorinated pools
• Harsh soaps, shower gels, detergents and fragranced products that strip natural oils
• Ageing — skin produces less oil and holds less water over time
• Underlying skin conditions such as eczema, psoriasis, ichthyosis or contact dermatitis
• Some medicines and medical treatments can dry the skin as a side effect; your doctor or pharmacist can tell you if this applies to you

Risk factors

• A personal or family history of eczema, asthma or hay fever
• Working in a job with frequent handwashing or contact with water, soap or chemicals
• Living in a cold or dry climate, or spending a lot of time in heated rooms
• Being an older adult, or being a baby or young child
• Having diabetes, thyroid problems or other long-term conditions that can affect the skin
• Using lots of fragranced or highly perfumed skincare products

When to see a doctor

See a doctor urgently if:

• Skin that suddenly becomes hot, swollen, very painful or leaks pus
• A fast-spreading rash with fever, or blisters and sores in eczema
• Signs of a severe allergic reaction (see the emergency section) — call emergency services rather than waiting
• Severe itching with no rash at all, together with weight loss, night sweats or feeling generally unwell

Book a routine appointment if:

• Dry, itchy skin that is not settling despite regular emollient use for a few weeks
• You are unsure which type of emollient suits your skin, or yours stings or feels greasy
• The itch is disturbing sleep or affecting school, work or mood
• You need a larger supply, or your usual product has been discontinued
• You have a long-term skin condition and want to review your routine

Diagnosis

There is no test for needing emollients. A pharmacist or doctor will usually look at your skin, ask about itching, sleep, washing habits, products you use and any family history, and then suggest a type of emollient to try. The most useful 'test' is how your skin responds over a few weeks of regular use.

Tests that may be done

• Usually none — the diagnosis is made by looking at the skin and taking a history
• Patch testing may be suggested if a contact allergy to a product or ingredient is suspected
• Skin swabs if infection is suspected
• Blood tests only if another underlying condition is being considered

What to expect at your appointment

Expect a practical conversation rather than a procedure. Your clinician or pharmacist will likely ask how often you can realistically moisturise, whether you prefer a light cream or a thicker ointment, and whether bathing products need changing too. You may be given a small supply to try before committing to a larger amount.

Treatment

Emollients are the backbone of treatment for dry skin. They come as lotions (light and watery), creams (in between), ointments (thick and greasy, and usually the most effective at holding in water) and gels, plus bath additives and soap substitutes. The aim is to apply enough, often enough, to keep skin comfortable all day — most people need several applications daily, and much more during a flare-up.

Self-care at home

• Apply emollient at least twice a day, and ideally 3–4 times, including after washing and before bed
• Smooth it on in the direction of hair growth rather than rubbing it in vigorously — this reduces irritation
• Use it on damp skin straight after a bath or shower to lock in water
• Use a soap substitute instead of ordinary soap or shower gel, and avoid bubble baths and fragranced products
• Keep baths and showers short and lukewarm rather than long and hot
• Apply plenty — an adult with widespread dry skin may need around 500g a week; ask your pharmacist for guidance on amounts
• Use a clean spoon or pump dispenser to take cream out of a tub so it stays free of germs
• If you use a paraffin-containing product, avoid naked flames and smoking, wash clothing and bedding regularly, and don't sit too close to a fire or heater
• Patch-test a new product on a small area first if your skin is sensitive
• Keep a simple diary of what you use and when symptoms flare, to help spot triggers

Medical treatments

Emollients themselves are the main treatment, and there are many types available over the counter and on prescription — your pharmacist can help you choose one that suits your skin and lifestyle. If the skin condition behind the dryness is inflamed, a clinician may also recommend additional treatments applied to the skin or taken by mouth; these are chosen individually and are not the same for everyone. Always follow the instructions given to you and check with a pharmacist before combining products.

When is surgery considered?

Surgery is not used to treat dry skin or to apply emollients.

Living with this condition

The key to living with dry skin is making moisturising automatic — like brushing your teeth. Keep a tube or tub by the sink, in your bag and by the bed. Put emollient on before getting dressed and again at night. Many people find it easiest to treat it as part of a bath-time routine, especially for children.

Lifestyle tips

• Choose soft, breathable cotton clothing next to the skin and avoid wool and rough synthetic fabrics
• Use non-biological, unperfumed washing powder and skip fabric conditioner
• Keep rooms at a comfortable humidity — a bowl of water near a radiator or a humidifier can help in winter
• Wear gloves for washing up, cleaning and gardening, and for cold weather
• Rinse skin well after swimming and apply emollient afterwards
• Keep fingernails short to reduce damage from scratching
• Manage stress where you can — stress is a well-known trigger for skin flare-ups

Diet and exercise

No special diet is needed for dry skin unless you have a confirmed food allergy, which should be assessed by a healthcare professional rather than guessed. Drinking normal amounts of water is sensible but does not 'cure' dry skin — emollients do that job. Exercise is encouraged; just shower soon afterwards, keep it lukewarm, use a soap substitute and reapply emollient. Chlorinated pools can be drying, so rinse well and moisturise after swimming.

Mental health and emotional wellbeing

Itchy, visible skin problems can be genuinely wearing. Broken sleep, self-consciousness and constant itching can affect mood, confidence and relationships, and that is a real part of the condition, not something to dismiss. If low mood, anxiety or exhaustion is building up, tell your doctor — support is available. If you ever feel you cannot cope or have thoughts of harming yourself, contact your local crisis support service or your local emergency number straight away; you deserve help quickly.

Prevention

Dry skin cannot always be prevented, especially if you have a condition like eczema, but it can usually be kept under very good control. Moisturising every day even when skin feels fine is the single most effective way to reduce flares, along with avoiding harsh soaps, hot water and fragranced products.

Vaccines

There are no vaccines for dry skin conditions. It is still important to keep up with routine vaccinations recommended for your age and health, and to check with your clinician whether any skin treatment affects this.

Screening programmes

No screening programme exists for dry skin. Do check your own skin regularly, though: see a doctor about any mole or skin patch that changes, itches persistently, bleeds or does not heal, and about longstanding cracks or sores that are not improving.

Complications

If left untreated

• Cracked skin that stings and becomes painful, especially on hands and feet
• Skin infection — cracked skin lets bacteria in, leading to weeping, crusting and sometimes a fever
• Thicker, leathery skin from long-term scratching
• Poor sleep and daytime tiredness from itching
• Flare-ups that become more frequent and harder to settle
• Reduced confidence and lower mood when skin is very visible
• With paraffin-based products, an increased fire risk if fabric soaked in emollient meets a naked flame or heat source

Long-term outlook

Very good. For most people, a simple routine of frequent emollient, gentle washing and avoiding irritants keeps skin comfortable and reduces flares within a few weeks. Some people need to keep moisturising long term, and that is entirely manageable. If one product does not suit you, another usually will — it can take a little trial and error, and your pharmacist is there to help you find the right fit. Seek advice early rather than struggling on alone.

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