Topical treatments for skin conditions
What are topical treatments and emollients?
A topical treatment is anything that is used directly on the skin. One of the main types of topical treatment are emollients. Emollients are moisturising products used to treat conditions such as eczema, dermatitis and psoriasis. They come in 3 main forms: creams, ointments and lotions. They vary in how thick and greasy they are, and depending on your condition and lifestyle, you may prefer one type over another. Ointments tend to be greasier but more effective at moisturising so you may want to use these at night, rather than during the day.
The most important thing is finding the best emollient for you that you can use regularly to reduce flare ups in your condition. Some of most common reasons why emollients are perceived not to work are that the patient has not used a sufficient quantity, not used it regularly enough, or not used it for long enough.
We have a specific list of emollients that are recommended and this will guide our choice for prescriptions.
For information on use of emollients in specific conditions, please see the following links:
How to apply emollients to maximise effectiveness
When you are first trying a new product, start with a small patch of skin to ensure you tolerate it before using on a larger surface area.
When applying an emollient, use smooth strokes in the direction of hair growth and remember to wash your hands first. Try not to rub the cream or ointment into the skin as this can cause irritation and potentially worsen the skin condition. If your emollient came in a tub use a clean spoon or spatula. This reduces the chance of you rubbing, and also avoids the risk of you accidentally introducing bacteria into the tub from your fingers (or anyone else’s fingers).
For a video demonstration, please use this link provided by Guys and St Thomas NHS Foundation Trust in association with the British Association of Dermatologists and St Johns Institute of Dermatology:
What should I use as soap?
A recent study in 2018 showed that the use of bath additives in addition to leave-on emollients provided no significant benefit compared to just using the leave-on emollients only. The study looked at eczema severity over 1 year, including the number of flare ups, quality of life and adverse effects. For this reason, the NHS no longer recommends prescribing bath additives. Instead, the majority of leave-on emollients can be used as a soap substitute. When you use an emollient as a soap substitute it will not foam but you can be sure that it is just as effective at cleaning the skin as soap. Soap substitutes can either be applied before bathing, showering or washing, or while in the water. They are not effective if you squirt them into the water.
Please note, if you choose to buy a bath additive, they can make skin and surfaces very slippery which might may lead to accidents in the shower/bath.
Are antimicrobial emollients better as a soap substitute?
The use of antimicrobial-containing emollients (such as Dermol) should be avoided unless infection is present or is a frequent complication. In these situations, usage should be limited to a short period of time (up to a month). Some people find their skin becomes sensitised to these products if they are used for long periods.
When my skin flares up, how should I apply my steroid cream/ointment?
Topical steroids come in different strengths and are usually applied once or twice a day for up to 7-14 days. Different steroids can be applied to different areas of the body – for instance very strong steroids should NOT be applied to the face so it is important you follow the directions of your GP or pharmacist. To prevent side effects from the steroids it is important to take treatment breaks; don’t use the products for longer than the prescribed course. Please call to speak to the pharmacist or GP if you have any issues.
If you are also applying an emollient along with a steroid cream, the recommendation is to leave 20-30 minutes after applying your emollient FIRST before applying the steroid cream/ointment. This ensures the steroid is not diluted by the emollient. For information on how much steroid cream you should use, here is a helpful guide on something called “fingertip units”
And the British Association of Dermatologists has produced the following information on topical steroids:
Potential side effects of long-term topical steroid cream use
If topical steroid creams and ointments are used as prescribed, there are usually no side effects. However, if they are used for prolonged periods they can cause the following side effects:
· Thinning of the skin
· Permanent stretch marks (striae)
· Skin discolouration
· Thin spidery blood vessels (called telangiectasias)
· Worsen other skin conditions like acne, rosacea and perioral dermatitis
Paraffin is the active ingredient in most emollient products. The amount of paraffin varies from product to product so the safest approach is to minimise fire risk with all paraffin containing emollients, regardless of paraffin concentration. Fire risk relates both to storage, but also when you are applying the cream and soon after until is absorbed. Keep away from all flames and cigarettes. Also, dressings, clothing and bedding can absorb emollient and ignite so change dressings and wash clothing and bed linen regularly. Paraffin can cause severe burns if ignited which need urgent treatment. Please share this warning with any carers that help you. Further safety information is available in this leaflet produced by Medicines & Healthcare products Regulatory Agency in conjunction with National Fire Chiefs Council:
And from the London Fire Brigade:
Please note that many moisturising creams available in supermarkets/pharmacies also contain paraffin so this advice is not restricted to prescribed products
Following all of this advice will help you get the most out of the products that we recommend for your circumstances.