Emollients for Eczema: Which to Choose, How Much to Use and How to Apply Them
The everyday treatment that controls eczema: ointments vs creams vs lotions, soap substitutes, how much and how often, the fire risk, and when you need a steroid as well.
Part of our eczema and dermatitis guide.
Get urgent help first. Call 999 or go to A&E if you have swelling of the lips, face or tongue or difficulty breathing. Contact NHS 111 or your GP the same day if eczema suddenly gets much worse with clusters of painful blisters or punched-out sores and a fever (possible eczema herpeticum), or the skin becomes hot, swollen, weeping or crusted and you feel unwell. Online treatment isn’t suitable in these situations.
The short answer: emollients are medical moisturisers, and they’re the foundation of eczema treatment. Use them every day, even when your skin looks clear, at least twice a day and more during a flare. Use plenty: an adult with widespread eczema may need up to 500g a week. Use an emollient instead of soap too. The best one is the one you’ll actually use.
Adults only online, and not in pregnancy or breastfeeding. Access Doctor’s online eczema service is for adults aged 18 and over, and can’t supply treatment if you’re pregnant or breastfeeding: your GP or midwife can help. For children with eczema, a pharmacist or GP can advise on emollients and treatment.
What are emollients and why do they matter?
Emollients are moisturisers made for dry skin conditions. Unlike cosmetic moisturisers, which mainly improve how skin looks and feels, they’re designed to repair and protect the skin barrier, which doesn’t work properly in eczema.
Many people with eczema have less of a protein called filaggrin, which helps hold the outer skin layer together. The result is a leaky barrier that loses water quickly and lets irritants and allergens in. Emollients help by:
- Sealing in moisture with a thin film over the skin
- Softening the skin and reducing cracking
- Calming itch and making the skin less reactive
- Reducing how often flares happen and how bad they get
- Reducing how much steroid you need when you do flare
Keep going when your skin is clear. NICE advises using emollients all the time, not just during flares. Stopping once the skin looks better is one of the most common reasons eczema comes back.
Ointment, cream, lotion or gel: which is best?
| Type | What it’s like | Best for | Downsides |
|---|---|---|---|
| Ointment | Thick and greasy, with little or no water | Very dry, thickened or scaly skin; night-time; severe eczema | Greasy; can block hair follicles on hairy skin |
| Cream | A mix of oil and water | Most eczema; daytime use; red or weepy skin | Needs reapplying more often; contains preservatives, which occasionally irritate |
| Lotion | Thin, mostly water | Larger or hairy areas; mild dryness | Least protective; not enough for very dry skin |
| Gel | Light and cooling | People who dislike greasy products | Less protective than a cream or ointment |
The best emollient is the one you’ll actually use. NICE says personal preference matters most. A cream you use every day beats an ointment you can’t face. Many people use an ointment at night and a lighter cream in the day. If one stings or you don’t like it, try another.
Leave-on emollients
Leave-on emollients are applied to the skin and left to soak in. They’re the backbone of eczema care. Common examples sold in UK pharmacies include:
- Ointments: 50:50 white soft and liquid paraffin, Epaderm ointment, Hydromol ointment
- Creams: Diprobase, Doublebase, Cetraben, Zerobase, Aveeno, E45
- Gels: Doublebase gel
Don’t use aqueous cream as a moisturiser. It contains sodium lauryl sulfate (SLS), which can irritate the skin and make eczema worse when it’s left on. The MHRA says it can still be used as a soap substitute, washed off, but there are better options.
Soap substitutes
Soap, shower gel and bubble bath strip the skin’s natural oils. In eczema, use an emollient instead for all washing. Many leave-on emollients can be used this way: rub a little onto damp skin, then rinse and pat dry. Products made for washing include Dermol wash and Doublebase shower gel.
- Antiseptic emollients such as Dermol contain an antiseptic. They’re sometimes advised for eczema that keeps getting infected, but they’re not needed routinely.
- Bath additives (emollient you pour into the bath) aren’t routinely recommended. A large UK trial found they added no benefit for children who were already using leave-on emollients and a soap substitute.
A soap substitute doesn’t replace a leave-on emollient. You need both.
How to apply emollients correctly
1
Use plenty
Don’t be sparing. An adult with widespread eczema may need up to 500g a week. Most people use far less than they need. Apply enough to leave the skin with a thin, slightly shiny film.
2
Smooth it on in the direction of hair growth
Smooth it downwards on the arms and legs rather than rubbing it in hard. Rubbing against the hair can block follicles and cause spots.
3
At least twice a day, more during flares
Morning and night as a minimum, even when your skin looks good, and more often when it’s dry or flaring. Reapply after washing your hands or bathing.
4
Leave a gap before a steroid
If you’re using a steroid cream too, leave around 30 minutes between the emollient and the steroid, so one doesn’t dilute or spread the other. Don’t mix them in your hand.
5
Keep it clean
Use a pump dispenser, or take emollient out of a tub with a clean spoon or spatula, so bacteria from your hands don’t get into it. Don’t share your emollient.
Emollient fire risk
Emollients soaked into clothing, bedding or dressings make the fabric burn more easily. The MHRA warns this applies to both paraffin-based and paraffin-free emollients. Don’t smoke or go near naked flames, gas hobs or heaters while wearing fabric with emollient on it. Change and wash clothing and bedding often, though washing may not remove it all. People who smoke and use a lot of emollient, especially older people or those with limited mobility, are most at risk.
When emollients aren’t enough
Emollients prevent flares, but they don’t settle an active flare on their own. If your skin becomes red, inflamed and itchy despite using emollients properly, the next step is a steroid cream or ointment for a short course, matched to how bad the eczema is and where it is:
- Mild flares: a mild steroid such as hydrocortisone, which a pharmacy can sell for adults and children aged 10 and over (not on the face or genitals).
- Moderate flares: a moderate steroid such as Eumovate.
- Severe flares on the body: a potent steroid such as Betnovate or Elocon.
Keep using your emollient throughout. For more on the potent options, see what Betnovate is used for and how Elocon works. For which strength suits which area, see our steroid cream strengths guide. If your eczema is weeping, crusted or you feel unwell, it may be infected: see how to spot infected eczema and our guide to steroid and antibiotic creams.
Emollients not keeping your eczema under control?
Our GPhC-registered pharmacist independent prescribers can assess your eczema online and, if suitable, prescribe a steroid of the right strength for the area. Adults 18 and over. Dispensed from our UK pharmacy. Approved before 3pm, Monday to Friday? Dispatched the same day, by Royal Mail Tracked 48, Tracked 24 or Special Delivery guaranteed by 1pm next working day: you choose.
Start Eczema Consultation →UK safety and reporting side effects
Most emollients can be bought from a pharmacy or supermarket, and a pharmacist can help you choose one. Steroid creams stronger than hydrocortisone are prescription-only medicines; before one is prescribed, a GPhC-registered pharmacist independent prescriber reviews your consultation. Always read the leaflet that comes with your emollient, including the fire safety warning.
If you think you’ve had a side effect or reaction to a medicine or emollient, tell your pharmacist or doctor. You can also report it to the MHRA through the Yellow Card scheme, which helps keep medicines safe for everyone.
Our private online service is for adults aged 18 and over. For a child with eczema, speak to a pharmacist or your GP.
Eczema treatments from Access Doctor
We don’t sell emollients online, but when emollients alone aren’t enough, our prescribers can supply steroid creams and ointments across the strength ladder following an online consultation, matched to the area and severity of your eczema.
Mild
Hydrocortisone 1% Cream and Ointment
The first step for mild flares.
View product →Moderate · Rx
Eumovate Ointment
For flares that hydrocortisone hasn’t settled.
View product →Potent · Rx
Betnovate Cream
For severe flares on the body, arms and legs. Not for the face.
View product →Potent · Rx
Elocon Cream
A once-daily potent steroid. Not for the face.
View product →Frequently Asked Questions
What are emollients?
Emollients are medical moisturisers for dry skin conditions such as eczema. They form a film over the skin that seals in moisture, soften and soothe the skin, and reduce how often eczema flares. They come as ointments, creams, lotions and gels, and some can also be used instead of soap.
Do emollients actually work for eczema?
Yes. Emollients are the foundation of eczema treatment, and NICE recommends using them at every stage, all the time, not just during flares. Used regularly, they reduce how often eczema flares and how much steroid you need.
What is the difference between emollient cream and ointment?
A cream is a mix of oil and water, so it’s lighter, rubs in easily and suits daytime use and red or weepy skin. An ointment has little or no water, so it’s greasier but seals in moisture best, which makes it better for very dry, thickened or scaly skin and for night-time.
How often should I apply emollient for eczema?
At least twice a day to all dry skin, even when your eczema looks well controlled, and more often during a flare. You can’t really use too much. An adult with widespread eczema may need up to 500g a week. Reapply after washing your hands or bathing.
Should I apply emollient before or after topical steroids?
Either order is fine, but leave a gap of around 30 minutes between them so one doesn’t dilute or spread the other. Many people apply the emollient first, wait, then apply the steroid to the affected areas only. Never mix the two in your hand.
Are emollients safe for children?
Yes. Emollients are safe for children of all ages, including babies. Fragrance-free products are best. A pharmacist or GP can help you choose one for your child. Access Doctor’s online service treats adults only.
Can emollient wash substitutes replace soap?
Yes, and in eczema they should. Soap strips the skin’s natural oils. Washing with an emollient instead cleans the skin without drying it out. Many leave-on emollients can be used this way, and there are washes made for it, such as Dermol wash or Doublebase shower gel.
Can I use aqueous cream for eczema?
Not as a moisturiser. Aqueous cream contains sodium lauryl sulfate, which can irritate the skin and make eczema worse when left on. The MHRA says it can be used as a soap substitute and washed off, but most people do better with a proper emollient.
Are emollients a fire risk?
Yes, when they soak into clothing, bedding or dressings, which then burn more easily. The MHRA says this applies to paraffin-free emollients as well as paraffin-based ones. Don’t smoke or go near naked flames, and change and wash fabric often.
References
- NICE Clinical Knowledge Summaries. Eczema – atopic: emollients. cks.nice.org.uk
- NICE. Atopic eczema in under 12s: diagnosis and management (CG57). nice.org.uk
- MHRA. Emollients: new information about risk of severe and fatal burns with paraffin-containing and paraffin-free emollients. Drug Safety Update, December 2018. gov.uk
- MHRA. Aqueous cream: may cause skin irritation, particularly in children with eczema. Drug Safety Update, March 2013. gov.uk
- Santer M et al. Emollient bath additives for the treatment of childhood eczema (BATHE). BMJ. 2018;361:k1332.
Medical disclaimer: This article is for information only and isn’t medical advice. Always follow the instructions that come with your emollient, including the fire safety warning. Steroid creams stronger than hydrocortisone need a clinical consultation before they can be supplied. In a medical emergency, call 999.