Refer to Highland Formulary: skin

• Emollients are an important part of the treatment of all inflammatory dermatoses. They soothe inflamed skin, give the necessary lubrication to protect against further damage from external agents and help reduce transdermal water loss. They should continue to be applied even when the skin appears to return to normal, as it will still be unstable and easily irritated for several months after the inflammation subsides.
• It is particularly important to use emollients regularly, repeatedly and in adequate quantities in dry skin conditions such as atopic dermatitis and on dry, older skin, to reduce scaling, itching and protect against environmental irritants.
• Many emollients can be directly applied and used in the bath/shower. It is helpful for patients to be shown how to do this properly by trained staff.
• Some emollients contain an antiseptic (eg Emulsiderm^®). These may be especially useful where the inflammatory condition is at risk of secondary infection, eg when the skin is broken by scratching.
• Emollients can be applied at any time of the day but are particularly helpful after a bath or shower; many can also be used as a soap substitute for cleansing.
• There are many types of emollient available. The cheaper ones are often as effective as the more expensive however it is helpful to give patients a range of emollients to find which suits their skin best, as choice of preparation will vary from person to person. Some patients like to use a cream or gel (non-sticky) during the daytime, and an ointment at night.
• Aqueous cream is not recommended as an emollient because it commonly irritates. It was not designed to be left on the skin.
• The best emollient to use is that which suits the patient.
• When applying topical steroids and emollients allow one to dry in before applying the other.
• MHRA alert: new information about risk of severe and fatal burns with paraffin-containing and paraffin-free emollients.

  Warnings about the risk of severe and fatal burns are being extended to all paraffin-based emollients regardless of paraffin concentration. Data suggest there is also a risk for paraffin-free emollients. Advise patients who use these products not to smoke or go near naked flames, and warn about the easy ignition of clothing, bedding, dressings, and other fabric that have dried residue of an emollient product on them.