Improving skin condition

Dry skin can cause dermatitis and also aggravate certain types of pre-existing dermatitis—advise patients with dermatitis to frequently use emollients to improve the skin condition. Emollient choice depends on:

  • how dry the skin is—use more greasy emollients for drier skin
  • climate—use less greasy emollients in hot, humid weather
  • adverse effects—some emollients can sting (eg lotions, sorbolene cream in a pump dispenser)
  • preservatives and fragrances in the product—can cause contact allergy in some patients
  • cost—simple inexpensive preparations are as effective as expensive or compounded preparations
  • patient preference—patients may need to try several preparations.
See Emollient types and properties for emollient types and properties.
Table 1. Emollient types and properties

Printable PDF

Type

Examples and properties [NB1]

Emollient bases

light, nongreasy

lotions—not usually moisturising enough for atopic skin, and often sting

slightly greasy

bland moisturisers (eg aqueous cream)—preparation can be varied by adding liquid paraffin or white soft paraffin

moderately greasy

glycerine 10% in sorbolene cream—formulations in a tub or tube are more moisturising and less likely to sting than formulations in a pump pack

very greasy

bland barrier preparations (eg liquid paraffin, white soft paraffin)

liquid paraffin 50% mixed with white soft paraffin 50%—rarely stings, and spreads easily

emulsifying ointment—rarely stings, but more difficult to spread

Active ingredient–enriched moisturisers

urea creams (with or without lactic acid)

useful for very dry skin or coexisting ichthyosis vulgaris, but often sting when skin has active inflammation

containing ceramides

useful for conditions associated with skin barrier dysfunction (eg atopic dermatitis, rosacea, periorificial dermatitis)

containing niacinamide

have hydrating, anti-inflammatory and anti-ageing properties; useful for conditions such as rosacea

containing panthenol (pro-vitamin B5)

used as a skin repair balm (eg for fissures, hand dermatitis with painful broken skin requiring wound healing)

Note: NB1: Some emollients are subsidised by the Pharmaceutical Benefits Scheme (PBS), but they must be prescribed by a clinician and compounded by the pharmacy.
Note: Daily bathing is not harmful if soap and bubble bath are avoided, and an emollient is applied liberally immediately afterwards.

Daily bathing is not harmful if soap and bubble bath are avoided, and an emollient is applied liberally immediately afterwards. Advise the patient to use:

  • soap substitutes (eg aqueous cream, soap-free bars, soap-free wash)
  • dispersible oils when bathing if the skin is very dry
    • if showering, spray the oil onto wet skin immediately after the shower
    • if having a bath, add the oil to the bathwater.

Avoid bath oils containing fragrances and benzalkonium chloride because they can cause contact allergy or irritant dermatitis. Warn patients that bath oils can make bathtubs and showers slippery, and increase the risk of falls.

Food-related products (eg oatmeal, goat milk) are used by some patients. These products should be used with caution in patients with skin barrier dysfunction (eg atopic dermatitis) because of the low risk of developing food allergies from sensitisation to food allergens through the skin.