Eczema is a chronic skin condition characterized by inflammation and a compromised skin barrier. This defect causes the skin to lose moisture easily, leading to dryness, itching, and heightened sensitivity to irritants. Applying a moisturizer, or emollient, is a foundational component of managing eczema. Emollients help repair the weakened barrier by sealing in water and protecting the skin. Consistent use reduces water loss, which decreases the frequency and severity of eczema flare-ups.
Understanding Emollient Options
The term “lotion” is often used interchangeably with “moisturizer,” but for eczema management, it is important to distinguish between the three main categories of emollients: lotions, creams, and ointments. These products differ primarily in their oil-to-water ratio, which dictates their effectiveness. Generally, the thicker the emollient, the more oil it contains and the better it is at locking moisture into the skin.
Ointments
Ointments possess the highest oil content, sometimes nearly 100% oil, such as petroleum jelly, with little or no water. This high oil concentration makes them the most effective occlusives, creating a physical barrier to prevent water evaporation. Ointments are highly recommended for severely dry, cracked skin and are often applied at night due to their greasy texture.
Creams
Creams are a balanced mixture of oil and water, offering a middle ground between ointments and lotions. They are thick, spreadable, and less greasy than ointments, making them suitable for moderate eczema and daytime use. Creams function as both emollients, softening the skin, and occlusives, providing a moderate seal.
Lotions
Lotions contain the least amount of oil and the highest proportion of water, often including alcohol to aid evaporation. They are the least effective choice for eczema because they do not provide a strong occlusive barrier. The alcohol content in many lotions can also sting or cause further dryness on compromised skin.
All emollients may contain humectants, such as glycerin or hyaluronic acid, which attract water into the top layer of the skin. For eczema, combining a humectant with a strong occlusive agent is ideal. Thicker creams and ointments are preferred because their high oil content offers superior occlusive properties compared to thinner lotions.
Optimizing Application Techniques
Selecting the right emollient is crucial, but application technique significantly influences its effectiveness. The most recommended method is the “soak and seal” technique. This involves bathing in lukewarm water for five to ten minutes to hydrate the skin, then gently patting the skin dry, leaving it slightly damp.
The moisturizer must be applied liberally to the entire body within three minutes of exiting the bath or shower. This small window is crucial for trapping the water the skin absorbed before it evaporates. If a topical prescription medication is used, apply it to affected areas first, and then apply the moisturizer over the rest of the body.
Moisturizer should be applied at least twice daily, regardless of bathing, to maintain continuous barrier protection. When applying, use a generous amount and gently massage it into the skin in a downward motion, following the direction of hair growth. Applying against the hair can irritate the hair follicles, potentially leading to folliculitis. Storing moisturizer in the refrigerator can provide an immediate cooling sensation for managing intense itch or a flare-up.
Common Eczema Irritants in Moisturizers
While moisturizers are intended to soothe the skin, many products contain ingredients that can trigger or worsen eczema symptoms. The most common irritant is fragrance, often listed as “parfum” or “natural essential oils.” Fragrances contain chemical compounds that are known allergens, which can cause contact dermatitis and intensify itching.
Alcohols are another frequent offender, particularly drying alcohols like ethanol found in lighter lotions. These alcohols accelerate evaporation, stripping the skin of its natural oils and compromising the barrier. Conversely, fatty alcohols like cetyl or stearyl alcohol are generally safe and act as thickeners.
Other problematic ingredients include artificial dyes, coloring agents, and certain preservatives, such as parabens and formaldehyde-releasing agents. Lanolin, a strong occlusive derived from sheep’s wool, can also cause allergic reactions in some people with eczema. To minimize the risk of a reaction, seek products labeled “fragrance-free” and “hypoallergenic,” and always perform a patch test before using a new product widely.