Intended for healthcare professionals

Practice Uncertainties

Which emollients are effective and acceptable for eczema in children?

BMJ 2019; 367 doi: (Published 24 October 2019) Cite this as: BMJ 2019;367:l5882
  1. Matthew J Ridd, GP and reader in primary healthcare1,
  2. Amanda Roberts, patient and carer2,
  3. Douglas Grindlay, information specialist3,
  4. Hywel C Williams, professor of dermato-epidemiology3
  1. 1Population Health Sciences, University of Bristol, Bristol BS8 2PS, UK
  2. 2Nottingham Eczema Support Group for Carers of Children with Eczema, Nottingham, UK
  3. 3Centre of Evidence Based Dermatology, University of Nottingham, UK
  1. Correspondence to: M J Ridd m.ridd{at}

What you need to know

  • Although emollients alone can help reduce the symptoms of eczema and prevent flares, most people will need to use anti-inflammatory treatments such as topical corticosteroids of an appropriate strength and duration as well

  • Effectiveness and acceptability of emollients varies according to disease severity, body site, climate, container, and patient or carer preferences and beliefs

  • Based on current evidence, the “best” emollient is the one that the individual prefers after a period of testing

Atopic eczema or dermatitis, commonly referred to as eczema, is characterised by dry, itchy skin. Although mainly a childhood condition, this disease commonly persists into or develops in adulthood.1 Patients are advised to use “leave-on” emollients or moisturisers, applied directly to the skin which add or help retain moisture.23 While evidence of their clinical effectiveness is limited, their use is ingrained in clinical practice and guidelines.2

Many different emollients can be prescribed or bought over the counter. Most are formulated as lotions, creams, gels, or ointments (see infographic). There is little evidence to recommend one type of emollient over another. Healthcare professional recommendation is the main source of advice when choosing a prescribed emollient.4 Preferences of the patient or carer are critical and may be influenced by the characteristics of the emollient, patient, and environment.5 The National Institute for Health and Care Excellence (NICE) recommends patients try different emollients in the clinic before choosing.2 This approach is not practical in most primary care settings, and even in specialist clinics the range of emollients available to try can be arbitrary and influenced by pharmaceutical companies and local formularies.

Older, cheaper emollients may be as effective as newer, more expensive ones,6 and the advantages of products that claim “dermatologically tested,” “fragrance-free,” and “hypoallergenic” are dubious.7 Through a process of trial …

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