Ten years no eczema (living in healthy London smog). Winter, a move to the country, a few cats, a bit of hard water and some stress later and kaboom the eczema is back. Go to doctor. Doc says, “Get some emulsifying ointment, aqueous cream, oilatum and some hydrocortisone for that eyelid”. Use all four for a while. Eczema dies down by the summer and reappears in the winter. I manage it all along with lots of Aqueous cream.
Sodium lauryl sulfate
Having survived the winter, come April 2011 and the eczema flares up and is horrific. Itch all night – can’t sleep, itch all day – can’t work. Read National Eczema Society (NES) website FAQ on Aqueous cream. Aqueous cream thins the skin and increases water loss. Its got 1% Sodium lauryl sulfate (SLS aka Sodium dodecyl sulfate aka sodium laurilsulfate) and SLS is really bad stuff.
I kept telling my better half that Aqueous cream was great and safe. Its only got a few ingredients, its cheap, there’s no gimmicks or marketing behind it. Its just paraffin, as long as I don’t light my farts I’ll be fine.
Emollients not moisturisers
So what should I use? Read anything on eczema and they say – you gotta use emollients. None of these perfumed moisturisers, you want emollients. Yeah get some emollients.
WTF are emollients? Emollients are moisturisers (at least so says Wikipedia). But moisturisers are bad – you can’t use those. They’re perfumed, they’re bad.
Look at any moisturiser and its got 100 ingredients – and when chemists only get to use four ingredients (as with Aqueous cream) they still mess it up and put in a chemical (just 1%) that does explicity bad things, so what chance have you got with a 100? Aqueous cream is 30 years old, its been used by millions, it must be safe. Nope.
Just tell me one emollient. Aqueous cream is an Emollient. Oh… great.
So moisturisers are bad, Emollients are moisturisers and some Emollients are still bad.
I’m confused. I’ll ask again. WTF are Emollients?
Emollients for Dummies [June 2013]
Update Eventually I found a decent description of Emollients:
Those lovely chaps at the National Eczema Society, have a page on Emollients and actually print a pdf list for you that was last updated June 2013. I’m going to re-print it here in a slightly less buried and awkward format than they have it.
Lotions (light preparations)
- Dermal 500 (with anti-microbials)
- Eucerin lotion (3% and 10% urea)
- Vaseline Dermacare lotion
Creams (medium preparations)
- Aderma emollient cream (with oat milk)
- Aquadrate (10% urea)
- Avene Trixera Crème emollient
- Balneum (5% urea)
- Dermol cream (with anti-microbials)
- E45 Cream
- Epaderm Cream
- Eucerin (5% urea)
- Hewletts Cream (contains peanut oil)
Linola Gamma(removed in June 2013)
- Neutrogena dermatological cream
- Nutraplus (10% urea)
- Vaseline Dermacare
Ointments (oily preparations)
- 50/50 white soft paraffin/liquid
- Emulsifying ointment (related to Aqueous cream see below)
- Hydrous ointment (oily cream)
- Doublebase emollient
- Oilatum Gel emollient
- Aderma oat milk cleansing bar
- Avene cleansing bar
- Cetaphil wash
- Cetaphil cleansing bar
- Cetraben wash
- Doublebase Wash
- Dove Pure and Sensitive Bar (added June 2013)
- E45 wash
- Elave hand wash
- Emulsifying ointment (related to Aqueous cream see below)
- Eucerin Dry Skin Relief Wash (5% urea)
- Imuderm body/hand and face wash
- Oilatum soap bar
Pinetarsol gel(removed June 2013) Pinetarsol cleansing bar(removed June 2013)
- Aveeno Colloidal
- Aveeno (bath oil)
- Balneum Plus
- Cetraban bath oil
- Dermal 600 (with anti-microbials)
- Doublebase Bath
- E45 Bath
- Eucerin Bath Therapy
- Emulsiderm Emollient (with anti-microbials
- Hydromol Emollient
- Imuderm therapeutic bath oil
- Oilatum fragrance-free
- Oilatum Plus (with anti-microbials)
Pinetarsol bath oil(removed June 2013)
- QV Shower Products
- Dermal 200 (with anti-microbials)
- Doublebase Shower
- E45 shower
- Eucerin Shower Therapy
- Oilatum Shower
- Imuderm Shower
- Balneum Plus – anti-itch cream
- E45 – itch relief cream
- Emollin – emollient spray
Products for Children & Babies
Babies(removed June 2013) Infaderm bubble bath (baby bath) Infaderm body lotion Infaderm bath and body oil
- E45 Junior hand & body wash
- E45 Junior moisturising cream
- E45 Junior moisturising mousse
- E45 Junior shower mousse
- Oilatum Junior bath formula
- Oilatum Junior cream emollient
What I use
Interestingly I’m currently banned by my doctor from using anything (for a couple of weeks, until they can run tests to find what my current allergies are). I cheat slightly and take salt baths. Two cups of sea salt (about 300g) in a bath every day. Currently my skin is very dry but it doesn’t itch too much. And its the itching that knackers everything.
Ask your doctor to test you for allergies (patch test or blood test) – don’t leave until he sends you to a dermatologist. Its no good if you were tested years ago – things might have changed.
Update October 2014
My blood tests came back with cats as my number one allergen.
When my eczema was bad I tracked everything I took daily in a spreadsheet. I also included a subjective measure from 1-10 of how bad my eczema was – roughly based on what percentage (in 10s, 10%, 20%…) of my body was covered in eczema.
If you’re interested, I’ve published my Medical diary as a Google spreadsheet.
- For about two years I regularly used corticosteroids, a weaker one for my face and a stronger one for the rest of my body
- Once the skin was red only steroids did any good, so unfortunately I’ve still found nothing beyond steroids to get rid of serious eczema
- Once my eczema got slowly better, I switched to Elidel (it has similar properties to corticosteroids with less side-effects)
- I use Dexeryl (in the NES list) as my ‘non-cosmetic mosturiser’ aka Emollient 🙂
- It was one of the cheapest ones I could get hold of and does help with dry skin
- It didn’t help with the eczema if it was red, but does help preventing dry skin getting worse
- I have a weekly bath and shave using Dead Sea salt. Where as Atlantic Sea Salt showed no difference, Dead Sea salt definitely did (but not massively). WebMD does recommend this for psoriasis too
- I used antihistimines for a while e.g. Citrizine and Rupatall but I didn’t find that they made any difference
From the Wikipedia moisturiser article, I came across the cosmetics database which has an entire section on Eczema products (not they ever mention Emollients grrr). That might help when looking for products.
The BBC has an article on Aqueous cream citing the same study that the NES do.
There is a connected cream to this called Emulsifying ointment (its mentioned in the NES list above) , usually mentioned as the base from which Aqueous cream is made. This is a remarkably obtuse name (which I don’t understand why the ingredients of it don’t have to be explained). However Emulsifying ointment is also known as Emulsifying wax. According to the Emulsifying wax wikipedia article is usually made up with a ‘detergent’ sodium dodecyl sulfate i.e. Sodium lauryl sulfate).