• The choice of emollient should be determined by:
• The dryness of the skin.
• The type of skin to which the emollient is to be applied.
• The individual's preference, determined by the product's tolerability and convenience of use.
• Dryness of skin:
• Less to moderately dry skin is most acceptably treated with a cream.
• Moderately dry to very dry skin requires a higher intensity of treatment with an ointment to restore the skin to normal.
• Weeping dermatitis is best treated with a water-soluble cream, as ointments will tend to slide off, becoming unacceptably messy.
• The tolerability and convenience of a product can only be determined by a trial of treatment:
• Creams are generally better tolerated but will need to be applied more frequently and generously to have the same effect as a single application of ointment.
• The individual will need to balance the tolerability of a product against the convenience of its use and its effectiveness.
• More than one type of product may be required. Different products may be preferred at different times, depending on the intensity of treatment required and the area of skin to be treated (e.g. a cream may be preferable for application to the hands).

In depth

• The most common adverse effect of emollients is irritation caused by sensitivity of the skin to an ingredient in the emollient.
• Skin reactions are usually irritant rather than allergic. The skin shows an immediate and dose-dependent inflammatory response:
• If a skin reaction occurs, stop use of the product and use a different emollient. If the person has had previous skin reactions to emollients, it may be prudent to test a small quantity before widespread application.
• Ingredients commonly implicated in skin reactions to emollients include perfumes and preservatives.
• If sensitivity to emollients is a known problem, the chance of a further reaction is reduced by prescribing a cream with few added ingredients or prescribing an ointment (these do not require preservatives and generally have fewer excipients).
• If the person has reacted to several products, consider referral for patch testing to confirm or exclude contact allergy and to identify the responsible allergen(s).
• The occlusive effect of ointments can cause folliculitis:
• Advise the person to apply the ointment in the direction of hair growth.
• If folliculitis occurs, stop use of the ointment (consider switching to a cream) and use an antibiotic if necessary.
• Emollients can present physical hazards:
• Paraffin-containing products are highly flammable and should not be used near naked flames or whilst smoking.
• Bath emollients can pose a slip hazard.

In depth

• Advise the person to use the emollient liberally and frequently:
• The frequency of application will vary depending on the person's condition and circumstances, but for very dry skin, application of an emollient every 2–3 hours should be considered appropriate.
• To facilitate frequent application, the person should consider keeping separate packs of emollients at work or school.
• It may be more convenient to use better tolerated products (creams and lotions) during the day and ointments at night.
• Advise the person about the effective application of emollients. Emollients should be applied by smoothing them into the skin along the line of hair growth, rather than rubbing them in:
• Creams and lotions are better for red, inflamed areas of skin.
• Ointments are suitable for areas of dry skin that are not inflamed.
• Advise the person to wait several minutes after application of an emollient before applying a topical corticosteroid.

In depth