1. Emollients - what you need to know
Barbara Page
Dermatology Liaison Nurse Specialist
NHS Fife
November 2013

2. Skin facts and functions promoting healthy skin – skin integrity
emollient therapy
explore the variety of emollients

4. Skin Facts ……. the largest organ of the body weighs approx 2.5 kg
covers area approx 2 sq metres
contains over 1 million nerve endings
has ability to regenerate itself
cell renewal takes approx 28 days
two main layers - dermis & epidermis

5. Functions of the skin barrier temperature control sensory
vitamin D synthesis
communication & display

6. Promoting Healthy Skin……. the basics of skin care
emollients……
emollients…...

7. Healthy Skin Allergens Water Water Water Water Water Water Water Water
Normal healthy skin
Looking at the top layer of skin which is known as the epidermis or the “cell factory” of the skin where cells develop through a number of stages until they form the stratum corneum
From base to surface this takes around 28 days……..much slower as the skin ages. The skin cells produce natural lipids which hold the skin cells together.
If we can relate this simply to a brick wall ……… bricks are the cells ……..mortar, the natural lipids ……… surface is intact, like a smooth coping stone on top of the wall ……… what happens when the surface layer (stratum corneum/coping stone) is not intact ……… there is a loss of barrier function
Water
Water
Water
Water
Water
Water
Water
© 2001 Elliott/Cork/Cork 7 7

8. Loss of Skin Barrier Loss of water Loss of water Loss of water
Loss of fat
Loss of fat
Loss of skin barrier………. entry point for :
Allergens
Irritants
Infection
allergens/irritants/infection
into skin - skin reacts
© 2001 Elliott/Cork/Cork 8 8

9. Internal and External Factors
Cold
Trauma
Nutrition
Fluid intake
Sun
Central
Heating
Infestation
Heredity
Factors
Skin
General Health
Pollution
Infection
Stress
Hormone
Change
Drugs
Chemicals/
Allergens/
Irritants
Ageing
Lifestyle

10. Emollients play a vital role in the management of skin disease
definition and function
classification
when to apply
how to apply
which emollient

11. Rawlings A.V. et al., Dermatologic Therapy, Vol. 17, 2004, 49-56
Emollients
Emollients are oils that spread easily on the skin, providing partial occlusion that hydrate and improve the Stratum Corneum
Rawlings A.V. et al., Dermatologic Therapy, Vol. 17, 2004, 49-56

12. Emollient……definition and function
medical term for moisturiser
safe
simple
effective
steroid sparing
intrinsic anti-inflammatory action

13. Emollients also help to…………
replace water lost from the skin
lubricate the skin
reduce scaling
seal the Stratum Corneum

14. Classification of emollients….
Lotions / Gels
contain more water and less fat than creams
Creams
contain a mixture of water and fat
Ointments
contain very little water
Lotions and gels are very light and more suitable to apply to hairy areas eg scalp or chest of a male
Creams contain preservatives which contain potential sensitisers – refer to your emollient chart to identify if a problem occurs with emollient therapy
Ointments do not contain any preservatives – preferred treatment for very dry skin
A cream could be applied day time and a greasier ointment at night to give optimum therapy 14 14

15. Classification cont………………
Bath oils
clean and hydrate - trap water in skin
Soap substitutes
not astringent - not alkaline - do not dry out the skin

16. Emollients…..when to apply
as frequently and liberally as possible
ideally times per day
after bathing when the skin is still moist

17. Emollients….how to apply effectively
bathing
generously but gently
do not rub vigorously - may cause itching
or irritation
smooth emollient along arms, legs and
body following the natural hair growth

18. Emollient………the choice
paramount importance
cosmetic acceptability essential
compromise between efficiency and
cosmetic acceptability

19. Which emollient ? individual is……………. the one they prefer
The very best emollient for any
individual is…………….
the one they prefer

20. Emollient base……... Important point to remember………
use a cream base for moist/wet skin
use an ointment base for dry/cracked
skin

21. Quantities of emollient
For an adult with dry or compromised skin
bath additives 300mls per month
creams or ointments 2000gr per month

22. Emollient chart

23. Emollient chart

24. What not to use on the skin
Aqueous Cream
Emulsifying Ointment
Olive Oil

25. Useful web sites www.pcds.org.uk www.dermnetnz.com

26. Thank you
Questions ?