Pharmacists are on the front line of eczema treatment. Today, Jean Robinson look at the role emollients play in soothing the skin condition.
Treatment and the pharmacist’s role
There is clear guidance available nationally on how to treat eczema.
A core component of the treatment of eczema is the use of emollients and for many children the use of topical corticosteroids (TCS).
Poor adherence to treatments can be due to lack of knowledge and understanding about medications and side effects, how and when and how much treatment to use, over complicated skin care regimes and the use of complementary and alternative medicines.
Guidance emphasises the importance of professionals spending time on the education of parents and carers with verbal and written instructions alongside practical demonstrations of how to apply treatments.
Pharmacists are on the frontline and are often the first healthcare professional seen by parents through the Pharmacy First scheme. They can influence children’s care for the better and it is essential they are able to give balanced, consistent and accurate advice.
Emollients remain a vital and often underestimated part of the treatment of all eczema. The terms emollient and moisturiser are often used interchangeably.
Emollients soften while moisturisers add moisture and work to increase the hydration of the stratum corneum by occluding the skin’s surface so that water is not lost from the stratum corneum.
Emollients are available as bath oils, soap substitutes and leave on emollients or moisturisers.
Children and their parents and carers should be involved in the choice of moisturisers but this must be done in conjunction with education so they are able to make informed choices.
In 2007, it was questioned whether the cost of prescribing bath emollients was justified.
It is suggested first line therapy for eczema must include the intensive use of emollients including soaps and oils, and it is accepted that plain water has a drying effect on the skin, which is clearly counterproductive so the addition of oil is indicated.
Bathing and cleansing the skin is an integral part of the emollient regime and daily baths or showers of no more than 20 minutes with added emollients will help hydrate the skin.
The Softened Water Eczema Trial (SWET) study found no significant benefit from the use of water softeners.
Leave on emollients or moisturisers
These are available in lotion, cream or ointment formulations.
Ointments are occlusive and greasy and more effective for very dry fissured skin but some families will find these cosmetically unacceptable and will prefer to use cream formulations.
Come back tomorrow for the third instalment of our weekly feature where we look at the use of aqueous cream and olive oil.