Part of our complete guide to eczema and dermatitis in the UK.
Emollients for Eczema: Types, How to Use & What the Evidence Shows
A NICE-aligned UK guide to emollients for eczema — the different types, how to choose between them, correct application technique, the aqueous cream warning, paraffin fire safety, and when emollients alone are not enough.
▶ What are emollients?
Emollients are medical moisturisers that restore and maintain the skin barrier in eczema. NICE recommends using them at least twice daily to all affected skin, continuously — not just during flares. They come as ointments (most occlusive, best for dry skin), creams (most commonly used), and lotions (for scalp and hairy skin). The best emollient is the one the person will use consistently.
If there is one thing all eczema guidelines agree on, it is this: emollients are the cornerstone of treatment, and most people with eczema do not use enough of them, often enough. This guide covers the evidence, the different types, how to choose between them, and how to use them correctly. Emollients are the part of eczema management that requires the least medical oversight but produces the most consistent benefit when done properly.
Prescription Eczema Treatment Online
When emollients alone are not enough, Access Doctor’s GPhC-registered prescribers can assess your suitability for prescription treatment. GPhC pharmacy #9011198.
View Eczema Treatments →What Are Emollients and Why Do They Matter?
Emollients are moisturisers formulated for chronic dry skin conditions. Unlike cosmetic moisturisers, which primarily improve the feel and appearance of skin, medical emollients are designed to restore and maintain the skin barrier function that is fundamentally impaired in eczema.
In eczema, the filaggrin protein that holds skin cells together and retains moisture is deficient. The result is a leaky barrier that loses water rapidly (increased transepidermal water loss, TEWL) and allows allergens and irritants to penetrate. Emollients work by:
- Forming an occlusive film over the skin surface that reduces TEWL
- Hydrating the stratum corneum (outer skin layer), softening and reducing cracking
- Reducing skin irritability and decreasing the itch threshold
- Reducing flare frequency and severity when used consistently between flares
- Reducing topical steroid use — the better the barrier is maintained, the less steroid is needed during flares
NICE guidance is unambiguous: emollients should be used continuously, even when eczema appears well controlled. Stopping emollients when skin looks clear is one of the most common reasons for early relapse.
Types of Emollient: Which Is Best?
| Type | Consistency | Water content | Best for | Drawbacks |
|---|---|---|---|---|
| Ointment | Thick, greasy | None (oil-based) | Very dry, lichenified, scaly skin; overnight use; severe eczema | Greasy; may be less cosmetically acceptable; can cause folliculitis on hairy skin |
| Cream | Moderate | Medium (50% water) | Most eczema types; daytime use; inflamed or weeping skin | Contains preservatives which can occasionally cause sensitisation |
| Lotion | Light, runny | High (70–80% water) | Scalp, hairy skin, mild eczema, acute flares, hot climates | Least occlusive; may dry quickly; less effective for severe dryness |
| Gel | Light, cool | High | Acute, weeping eczema; provides cooling relief | Less protective barrier than cream or ointment |
The best emollient is the one the person will actually use. NICE explicitly states that personal preference is the most important factor in emollient selection — a less occlusive cream used consistently beats a better ointment used only occasionally. Offer choice and review if the patient is not using it regularly.
Leave-On Emollients
Leave-on emollients are applied directly to the skin and left to absorb. These form the backbone of eczema management. Examples include:
- Ointments: white soft paraffin 50:50 (highly occlusive, very cheap, very effective), Diprobase ointment, Epaderm ointment, Hydromol ointment
- Creams: Diprobase cream, Doublebase, Aveeno, Cetraben, E45, Zerobase, Zerocream
- Lotions: Aqueous cream BP (note: no longer recommended as a leave-on due to SLS content), E45 lotion
Aqueous cream BP is no longer recommended as a leave-on emollient. It contains sodium lauryl sulfate (SLS), a known skin irritant that can worsen eczema with repeated application. It remains acceptable as a soap substitute but should not be applied as a leave-on. This is a common point of confusion between older and current NICE guidance.
Emollient Soap Substitutes (Wash-Off)
Soap substitutes are used in place of soap and shower gel for washing. Soap strips the skin barrier and should be avoided entirely in eczema. Examples include:
- Dermol 500 lotion (also has antimicrobial properties — useful if secondary infection is a recurrent issue)
- Oilatum bath additive and shower gel
- Doublebase gel (can be used as wash-off or leave-on)
- Hydromol bath and shower emollient
The wash-off emollient is not a substitute for a leave-on emollient — both are needed. Wash-off removes surface debris and delivers some hydration; leave-on maintains the barrier throughout the day.
How to Apply Emollients Correctly
1
Apply liberally
Do not be sparing. NICE recommends 250–500g per week for an adult with widespread eczema. Most people use far less than this. Apply enough to leave a thin visible film on the skin surface.
2
Apply in the direction of hair growth
Smooth the emollient onto the skin following the direction of hair follicles (downwards on limbs). Rubbing against the grain can cause folliculitis, particularly with ointments on hairy areas.
3
Apply before topical steroids
Apply emollient first. Allow 30 minutes for absorption, then apply any prescribed topical steroid. This sequence allows both to work optimally without diluting the active ingredient.
4
Apply at least twice daily
Morning and evening as a minimum, even when skin looks well controlled. More frequently during flares. Reapply after handwashing or bathing.
5
Continue between flares
Do not stop when the eczema clears. Continued twice-daily emollient use between flares is what prevents the next flare — this is where most eczema management breaks down.
Emollient Fire Risk Warning
Paraffin-based emollients (including 50:50 white soft paraffin and many common ointments) are a significant fire hazard. When these emollients soak into clothing, bedding, or bandages, they make the fabric much more flammable. Keep away from naked flames, gas hobs, and lit cigarettes. Wash bedding and clothing regularly. This risk applies to both leave-on and wash-off paraffin-based preparations. The MHRA has issued guidance on this risk — check the product information leaflet for your specific emollient.
When Emollients Are Not Enough
Emollients reduce flare frequency and severity but do not replace anti-inflammatory treatment during active flares. If consistent twice-daily emollient use is not maintaining control — particularly if you are having frequent flares requiring repeated steroid courses — speak to your prescriber. The next step in the NICE management ladder is a topical corticosteroid matched to your eczema grade and the affected site.
For the full steroid potency comparison, see: Steroid cream strengths UK: the complete potency ladder.
Get Prescription Eczema Treatment
When emollients are not enough, Access Doctor’s GPhC-registered prescribers can assess your suitability for prescription treatment. Betnovate, Dermovate and prescription emollients available. GPhC pharmacy #9011198.
View Eczema Treatments →Frequently Asked Questions
What are emollients?
Emollients are moisturisers used in the treatment of dry skin conditions including eczema. They work by forming a barrier on the skin surface that reduces water loss (transepidermal water loss, TEWL), softens and soothes the skin, and reduces the frequency and severity of eczema flares. They come in several forms — creams, ointments, lotions, and gels — each suited to different skin types and preferences.
Do emollients actually work for eczema?
Yes. Emollients are the most evidence-based intervention for eczema management. NICE guidelines recommend emollients as the foundation of treatment at every step of the eczema management ladder, used continuously — not just during flares. Consistent daily use reduces the frequency and severity of flares and the amount of topical steroid needed.
What is the difference between emollient cream and ointment?
Emollient creams are water-based (typically 50:50 or similar water-to-oil ratio) — lighter, easier to apply, and better tolerated in warmer conditions or on inflamed skin. Ointments are oil-based and occlusive — no water content — providing the strongest barrier function and best for very dry, lichenified, or scaly skin. Ointments are greasier but penetrate thick skin more effectively.
How often should I apply emollient for eczema?
NICE guidance recommends applying emollients at least twice daily to all affected skin, even when the eczema appears well controlled or in remission. During a flare, more frequent application (3–4 times daily or more) is appropriate. There is no maximum frequency — emollients cannot be overapplied.
Should I apply emollient before or after topical steroids?
Apply emollient first, allow it to absorb for around 30 minutes, then apply the topical steroid. This allows each product to work optimally without diluting the active ingredient. Never mix emollient and steroid together in your hand before applying.
Are emollients safe for children?
Yes. Emollients are safe for children of all ages including infants and babies. Fragrance-free preparations are preferred for children, whose skin is more sensitive. Several emollients are specifically formulated for paediatric eczema.
Can emollient wash substitutes replace soap?
Yes — and they should, in eczema. Soap disrupts the skin barrier and removes natural oils. Emollient soap substitutes (such as Dermol 500, Doublebase, or Oilatum) cleanse the skin without stripping it. Using a soap substitute for every wash is one of the most impactful practical changes for people with eczema.
References
- NICE. Eczema — atopic: CKS. 2024. cks.nice.org.uk
- NICE. Atopic eczema in under 12s (CG57). Updated 2023. nice.org.uk
- MHRA. Emollients: new information about risk of severe and fatal burns with paraffin-containing and paraffin-free emollients. 2018.
- Nankervis H et al. What gets under your skin? A systematic review of treatments for atopic eczema. Cochrane Database Syst Rev. 2016.
Medical disclaimer: This article is for informational purposes only. Always consult a qualified healthcare professional. Prescription treatments require a clinical consultation. In a medical emergency, call 999.