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Emollients soften skin and moisturisers add moisture. They are used to correct dryness and scaling of the skin and are an effective treatment for mild irritant contact dermatitis.
Dry skin results from lack of water in the stratum corneum. Water loss from the skin is increased by low humidity, wind, increasing age, diuretics, hypothyroidism and loss of sebum. Sebum is removed by washing with hot water and soap, detergents and solvents. Scaly skin arises from partial detachment of groups of corneocytes from the skin surface and is especially prominent in eczema, psoriasis and ichthyosis.
To correct dry skin, reduce bathing, use a non-soap cleanser and apply a moisturiser or emollient.
Occlusive emollients consist of oils of non-human origin (wool-fat, mineral oil etc.), either in pure form or mixed with varying amounts of water through the action of an emulsifier to form a lotion or cream. A large variety are available, reflecting that there is no ‘right’ moisturiser for all patients; the most suitable one often having to be found by trial and error.
The choice of occlusive emollient depends upon the area of the body and the degree of dryness and scaling of the skin. Lotions are used for the scalp and other hairy areas and for mild dryness on the face, trunk and limbs. Creams are suitable for moderate dry skin. Ointments are recommended for very dry scaly areas, but many patients find them too greasy. Sorbolene cream is a good all-round moderate-strength moisturiser that suits many patients because it is non-greasy, cheap and available in bulk with or without prescription. Typically, 250g (or ml) to 1Kg (1l) are needed and liberal and regular usage is to be encouraged.
Humectant / keratolytics are particularly important in management of the ichthyoses (inherited or acquired scaly disorders of the skin) but urea and lactic acid preparations often sting if applied to scratched, fissured or dermatitic skin.
Adverse reactions to emollients include:
Find out which emollients are fully funded on prescription. Discuss indications for their use.
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