Taking care of dry, itchy or scaly skin
Taking care of dry, itchy or scaly skin
If you have a dry, itchy or scaly skin condition, such as eczema, psoriasis, varicose eczema or ichthyosis, your healthcare professional may suggest you use a moisturising treatment to sooth and hydrate your skin.
These treatments applied directly to the skin are called emollients. They cover the skin with a protective film to trap in moisture. They help prevent patches of inflammation and flare-ups of your skin condition.
Types of emollients
- Lotions are thin, spread easily and are not very moisturising so they are good for hairy or damaged areas of skin (such as weeping eczema – where pus is seeping out of damaged areas of skin).
- Sprays are absorbed quickly and are good for hard-to-reach areas and sore or infected skin that should not be touched.
- Creams are not very greasy and are absorbed quickly so they are good for daytime use.
- Ointments are greasy, thick and very moisturising and so are good for very dry, thickened skin and night-time use. Ointments are usually free of preservatives so are suitable for sensitive skin, but should not be used on weeping eczema.
- Leave-on products – there are lots of different types of leave-on emollients that can be put directly on the skin. Some create a protective barrier over the skin to lock in moisture. Some have added ingredients to reduce itching or prevent infection. Your healthcare professional will talk to you about which type of leave-on emollient will work best for your skin condition. You may have to try a few different emollients to find the best one for you or your child’s skin. Many of these leave-on products can also be used to wash with.
- Soap substitutes – everyday soaps, shampoos and shower gels usually dry out the skin and can make skin conditions like eczema worse. It’s recommended to use leave-on emollients as a soap substitute if you have dry or itchy skin. Emollient soap substitutes that are used instead of normal soap in the bath or shower are not usually available on the NHS.
How to get emollients
You can buy emollients from a pharmacy without a prescription. If the skin condition is severe, talk to a GP, nurse or health visitor, as you may need a stronger treatment.
If you or your children need to use an emollient regularly, it’s a good idea to keep some in small pots or tubes at home, school or work.
How to use emollient lotions, sprays, creams and ointments
Emollient lotions, sprays, creams and ointments should be applied directly to the skin. They should be smoothed, not rubbed, into the skin gently in the same direction that your hair grows. This helps prevent hair follicles getting blocked.
Emollients can be used to replace lost moisture whenever your skin feels dry or tight. They’re very safe and you cannot overuse them.
You may need to experiment with different emollients or try a combination. For example, you may decide to use a cream during the day and an ointment at night.
How to wash with emollients
Mix a small amount (around teaspoonful) of leave-on emollient or soap substitute in the palm of your hand with a little warm water and spread it over damp or dry skin.
Rinse and pat the skin dry, being careful not to rub it.
You can use leave-on emollients or soap substitutes for handwashing, showering or in the bath. They do not foam like normal soap but are just as effective at cleaning the skin.
If your skin stings after using an emollient wash product and does not settle after rinsing, ask a pharmacist to recommend a different product.
When to apply emollients
Emollients can be applied as often as you like to keep the skin well moisturised and in good condition. Ideally, this should be done at least three or four times a day.
It’s especially important to regularly apply an emollient to your hands and face, as they’re exposed to the elements more than any other part of your body.
Certain activities, such as gardening, can irritate the skin. It may help to apply an emollient before doing these.
It may help to apply an emollient before and after swimming. Leave enough time for it to be absorbed into your skin before you swim.
It’s a good idea to protect babies’ hands and cheeks with an emollient before mealtimes to stop them getting sore from food and drink.
Emollients are best applied after washing your hands, taking a bath or showering because this is when the skin most needs moisture.
The emollient should be applied as soon as you have patted your skin dry to make sure it’s properly absorbed.
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If you’re using a steroid cream or another treatment for your skin condition, wait 20 to 30 minutes between using an emollient and using the other treatment. Ask a doctor which one to use first.
This avoids diluting the effect of the treatment and spreading it to areas of skin that do not need it.
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Emollients can sometimes cause a skin reaction, such as:
- an overheating, burning sensation or stinging that does not settle after a few days of treatment – this is usually caused by a reaction to a certain ingredient in the emollient
- blocked or inflamed hair follicles (folliculitis) that may cause boils
- rashes on the face that can aggravate acne.
If you experience any of these symptoms, talk to a GP, nurse or pharmacist.
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Fire risk
Always keep emollients away from fire, flames and cigarettes when using all types of emollients (both paraffin-based and paraffin-free). Dressings, clothing and bedding that have been in contact with an emollient can easily catch fire. Washing fabrics at high temperatures may reduce the build-up of an emollient but does not remove it completely. Please read this fire safety information about the safe use of emollients.
Risk of infections
Use a clean spoon or spatula to remove emollients from a pot or tub. This reduces the risk of infections from contaminated pots.
Risk of slipping
Be careful not to slip when using emollients in a bath or shower, or on a tiled floor. Protect the floor with a non-slip mat, towel or sheet. Wear protective gloves, wash your bath or shower afterwards with hot water and washing-up liquid, then dry with a kitchen towel.
Skin irritation from aqueous cream
Aqueous cream is no longer recommended as an emollient. It contains an ingredient called sodium lauryl sulphate (SLS) which can cause skin irritation such as burning, stinging, itching and redness. Some people still find it helpful as a soap substitute.
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Topical steroids are used in the treatment of many skin conditions to reduce inflammation, speed up the healing of the skin, and help to make your skin less red, hot, itchy, and sore.
‘Topical’ means applied directly to the skin. ‘Steroids’ are synthetically made hormones.
Topical steroids are not a cure for your skin condition but should help bring your skin condition under control and are available as a cream, lotion, foam, gel, and shampoo.
Your health care professional will advise which topical steroid is appropriate.
How do I apply a topical steroid?
You may be given more than one topical steroid to treat different areas of the body. Make sure that you understand which topical steroid to use and where on your body to use it. If you are unsure, discuss with your pharmacist, consultant or nurse.
Follow the application instructions carefully and use for the required length of time.
Wash your hands before and after applying your topical steroid.
Leave a gap of 30 minutes between applying your topical steroid and your moisturiser. This is to avoid diluting the topical steroid with the moisturiser and potentially spreading it to areas that it is not needed.
Apply the steroid using the Fingertip Unit (FTU). FTU is the amount of topical steroid that just covers the end of an adult finger from the tip to the crease of the first joint.
One FTU is enough to cover an area the size of two adult hands with the fingers together.
The instructions can vary between patients depending on age and where on the body requires treatment, so please ask if you are unsure.
Are topical steroids safe to use?
Topical steroids are safe and effective when used as directed and in combination with good skincare management. Side effects can occur and are normally related to the potency of the topical steroid, where it is being used, the condition of the skin on which it is being used and the age of the person using the topical steroid.
Side effects can be reduced if you follow the application instructions carefully. Fear of side effects can cause your skin condition to be under-treated. Stopping treatment too soon or not using the topical steroid at all will be detrimental to the overall management of your skin condition.
Pregnant women should consult their doctor regarding the continued use of their usual topical steroid.
Allergy to the topical steroid can occur but is rare. Please inform your doctor if your skin condition gets worse whilst using the topical steroid.