NEW INFO SKIN
Whilst the terms 'emollient' and 'moisturiser' are used interchangeably, by definiton, an emollient is an ingredient contained in a moisturiser. 17 Moisturisers are the first-line therapy during acute flares and as maintenance therapy during remission and can also be used with, when necessary, other treatments.16,17
Evidence has highlighted that moisturisers reduce the number of eczema flares by 60% and increase the average time to flare from 30 to 180 days.17
Moisturisers contain varying amounts of emollient which form an occlusive layer and soften the skin by offering a source of lipids
An essential element of eczema management is avoidance of trigger factors /irritants and using moisturisers at an early stage to restore skin barrier function.18
Pharmacy teams should suggest that patients avoid or minimise exposure to trigger factors/ irritants, such as wool fabrics and detergents, psychological stress, certain, inhalants and/ or contact allergens;1,18 keeping a diary may help patients identify triggers.
Patients should be advised that some soaps, shampoos, bubble baths, shower gels can dry out the skin and aggravate skin conditions. If patients experience this, they should consider using an emollient as a soap substitute.
When recommending, dispensing or selling paraffin-containing emollients, instruct parents not to smoke or go near naked flames: skin, clothing or fabric (eg bedding or bandages) that have been in contact with an emollient can rapidly ignite.22
Pharmacists should remind patients of the fire risk with all paraffin-containing emollients. A fire risk cannot be excluded with paraffin-free emollients. Although emollients are not flammable, they can increase the speed of ignition and intensity of the fire
The pharmacy team should ensure that children with eczema are offered a choice of unperfumed moisturisers to use every day for moisturising, washing and bathing.14
Moisturisers should be suited to the child's needs and preferences. Some children may need several moisturisers, such as a cream during the day and an ointment at night. Other children may find one moisturiser for all purposes. Choosing the right product for each patient may mean trying a variety of products and formulations.14,18,20,23
Leave-on moisturisers should be prescribed or sold in large quantities (250 g to 500 g weekly) for children younger than 12 years.14
Pharmacy teams should ensure that parents and carers are given the appropriate advice on managing eczema so they understand the practicalities of using moisturisers, including:11,18
- How to apply
- How often to apply
- How much to apply
- How long to apply
- How to use more than one product (e.g. different moisturisers or with other topical products).
HOW TO APPLY MOISTURISERS
|Product||Advise parents and carers:|
|Leave-on products||To apply directly to the skin|
|To gently smooth (not rub) the moisturiser into the skin in the direction of hair growth; this reduces the risk of hair follicles getting blocked|
|Soap substitutes (for hand-washing, showering or in the bath)||To mix about a teaspoon of moisturiser into the palm of their hand with a small amount of water then spread over damp or dry skin|
|To rinse and pat (do not rub) skin dry|
|Moisturisers do not foam like soap|
|To speak to their pharmacist if the skin stings and does not improve after rinsing; the pharmacist can suggest an alternative|
|With other medicines||
To wait at least 30 minutes after applying the emollient before using a steroid or another topical treatment to avoid diluting the latter and reducing spreading to unaffected skin.
- Apply moisturisers as often as needed to keep the skin well moisturised and in good condition (ideally, at least 3-4 times a day)20
- Regularly apply moisturiser to the hands and face, which are exposed to the elements20
- Apply moisturisers before activities that may irritate the skin (e.g. swimming) and protect babies' hands and cheeks before mealtimes20
- Apply moisturisers after washing hands, or taking a bath or showering; apply after patting skin dry20
- Ensure that moisturisers are available at nursery, pre-school or school.1