Emollients (Part 1) - A quick guide to emollients

In today’s episode, your expert hosts, Dr George Moncrieff and Dr Roger Henderson dive into a critical topic for anyone with a dry skin condition – emollients.  

Emollients are essential for managing dry skin conditions because they help restore the skin's moisture barrier, preventing water loss and providing a protective, soothing layer that keeps the skin hydrated and comfortable. But, they must be used correctly and that’s where these episodes on emollients come in... 

In this first of three episodes on this topic, you’ll gain an understanding of what exactly an emollient is, as well as guidance on what emollients are available to you, whilst diving into which ingredients can add additional benefits for your skin.  

Other key points covered include:  

• What the difference is between a simple and a sophisticated emollient
• Which emollients you should use as a soap substitute and which ones are ideal as a leave-on moisturiser
• Important safety tips, such as avoiding open flames with paraffin-based creams

Join us for a straightforward, informative guide to managing dry skin with the power of emollients. 

Thank you to our kind sponsor AproDerm, who provide a range of emollients designed for the management of dry skin conditions, including eczema, psoriasis and ichthyosis.  

Everyone’s skin is unique and what works for one person, may not work for another. That’s why AproDerm has developed the AproDerm Emollient Starter Pack. This pack contains all four of their emollients varying in their formulation, consistency and hydration, giving you the choice to find a routine which suits you.   

Find out more here.  

IG: https://www.instagram.com/aproderm/  

FB: https://www.facebook.com/AproDerm   

We hope you find this podcast interesting and helpful. Please leave us a review or email [e-mail] with any feedback on this episode or suggestions on skin-related topics that you would like to hear about in future podcasts.  

The views expressed in this podcast are of Dr George Moncrieff and Dr Roger Henderson. Fontus Health has not influenced, participated, or been involved in the programme, materials, or delivery of educational content.  

Episode Transcript

(00:10):
Hello and welcome to this SkinDeep podcast, where we'll be
looking at skin-related issues andtreatments in, what I hope is, an
interesting and informative way.
I'm Dr Roger Henderson, andI'm a GP with a long-standing
interest in this area of health.
And I'm Dr George Moncrieff.
I was also a GP, though I retiredfrom my practice a few years ago.

(00:32):
I'm also the past chair of theDermatology Council for England.
In this one, we'll be looking atthe use of moisturisers in dry skin
and giving practical advice as tohow and when these should be used.

(00:54):
Now, I'm going to start with a simplequestion here, George, um, although you
might think it's not a simple question.
What exactly is a skin moisturiser?
Well, actually, as you say,it's not simple at all.
We use the words "moisturiser" and"emollient" almost interchangeably.
But, accurately, a moisturisercontains an occlusive agent.

(01:17):
Basically, something that repels water.
So it stops water from leaving the skin.
So it's what's calleda "hydrophobic layer".
And that's things like petrolatumor waxes or different sorts of fats.
So it's a fatty material.
And then it concludes the emollient.

(01:38):
And the emollient isessentially an astringent.
An example would be isopropyl myristate.
If you look at the ingredientson a moisturiser, you'll see it
often has isopropyl myristate,and this soothes and smooths.
It softens the skin and generallyrenders the product less tacky,

(01:58):
less sticky, less greasy.
Makes it more cosmetically acceptable.
All moisturisers are buffered tomaintain that mildly acidic acid
mantle on the surface of the skin.
So critical for our skin health.
So, unlike detergents, whichare alkaline, emollients and

(02:18):
moisturisers are mildly acidic.
And then, finally, many of these productscontain additional agents, which we
could go through if you like, but oftencontain natural moisturising factors,
like those small molecules I talked aboutlast time that draw water into the skin.
So they penetrate the skin cells,and then draw moisture to themselves.

(02:40):
So things like urea and aminoacids and glycerol are often used.
Lactic acid sometimes.
The list is quite large, though.
So I suppose, in a nutshell, theaim of moisturising emollients
is to hydrate the skin cells.
Keep those nice and plumped andhydrated, and prevent or reduce that

(03:03):
hydration disappearing out of the skin.
Otherwise, just try and keep it at thepH level that it should be, keep it as
hydrated as it can be and to stop theskin drying as quickly as it other...
as it otherwise might.
I mean, it's a little bit simplistic,but it's pretty much my view.
That's where we are.
Would you agree?
Absolutely.
In a nutshell, that'sexactly what they're about.

(03:25):
But they're also a very convenientvehicle for bringing other
ingredients onto the skin.
Helpful, useful ingredients,which we can talk about shortly.
So, having said all that, Roger,what are your basic views on
emollients in your practice?
Well, unfortunately, I'm going backso many years now to when I was
a medical student, and I suspectit's the same with you George.

(03:48):
My sort of medical skin trainingwas "If it's dry, wet it.
If it's wet, dry it."
Fortunately, we've bothmoved on a bit from that.
But the bottom line, I suppose, of whatI've learned over all these years is
that you can have the best emollientsin the world, but it's only going to be
effective if it's used appropriately.
And I found that it's absolutely thecase that patient preference is the

(04:11):
key here in encouraging adherence.
There is no point in sort of tryingto hit a patient over the head with
a tub of emollient if they don'tunderstand why you want them to use it.
And in general, I've found thatemollient creams are more cosmetically
acceptable to people very often, andthey penetrate the skin nice and easily.

(04:33):
And although heavy emollientointments also can work really
well, a lot of people consider themtoo greasy for their everyday use.
Although many patients of mine, I suppose,are prepared to use them at bedtime.
I also have found over the yearsthat simple emollients should
always be used as soap substitutes.
Then the more sophisticated emollients- and I think we might touch on what

(04:56):
that actually means - being thechoice for leave-on treatments here.
Yeah, I absolutely agree with you there.
The soap substitutes aregoing down the drain.
So, really, what we want thereis something that's going to
regrease the skin rather thandegrease it, and something that's
going to maintain the surface pH.
And so that can be a very,very cheap emollient.

(05:17):
It doesn't matter which one you use.
I would go for something as cheapand cheerful as you can get, but
just using an emollient to wash withrather than soaps or detergents.
And on that point, it's really importantto remind patients that it will render
the shower tray or the bath dangerouslyslippery, so they may need to use a
bath mat inside the bath or somethinginside the shower to stop them falling.

(05:41):
The other thing, in fact, justto warn patients is that they
will actually clog up the drains.
So they may need to pour some boilingwater down the drain every week, just to
stop that grease from clogging things up.
So just a simple, practical tip there.
Yeah, that's something peopleforget is the mini fatberg, uh,
from [laughter] from using...
It's interesting about the safetyaspects, which you've got to think of.

(06:05):
Not only just the slipping over, butfrom my point of view, I always have to
try and remind myself about the use ofthe heavy, paraffin-based emollients.
Products such as white, soft paraffin;or white, soft paraffin and the
50% liquid paraffin or emulsifyingointments that have contact with
dressings or clothing, [these can beconsidered] as potential fire risks.

(06:25):
And there are some slightlychilling stats, I think, about
this, if I remember rightly.
Well, absolutely.
Yep.
All emollients are fatty based,and fat is flammable and,
certainly, paraffin is flammable.
Almost every singleemollient contains paraffin.
In fact, the only one that doesn'tis AproDerm® Colloidal Oat Cream.

(06:48):
But paraffin is particularly flammable,but all emollients are flammable.
And I believe the Medicines [and]Health[care Products] Regulatory
Authority, (the MHRA) have over50 cases of people who have died,
because they've caught fire.
They've put an emollient on, andthey've gone near to a naked flame.
So we have a medical legalresponsibility as doctors to
warn our patients about this.

(07:09):
Do not put an emollient onand then go close to a naked
flame, a fire or whatever.
Even smoking could causethings to catch fire.
A frightening figure is that, evenif you put an emollient on and then
go to bed with your pyjamas [on], andyou [then] wash those pyjamas, even
after they've been washed and dried,they're still massively more flammable

(07:29):
than pyjamas that have never beenexposed to that emollient at all.
So even washing pyjamas doesnot render them less flammable.
So very worrying facts there.
I think a lot of jaws will have hit theground with that, because as we've said,
you know, it is not generally recognised.
It's particularly a risk,in fact, with the ointments.

(07:49):
The ointments have a very highconcentration of paraffin and a
very low concentration of water.
So the tubs of ointments arethe ones that most worry me.
The creams have a higher water content,and so, naturally, are going to be less
flammable, but they are still flammable.
Well, I think this is a perfecttime to take the opportunity to
say a few words about our kindsponsor, AproDerm®, and their range

(08:12):
of emollients and barrier creams.
Now, as we know,everyone's skin is unique.
In my many years as a GP, it'soften been tricky to find an
emollient that immediately suitedone person and their one condition.
And we know it's not as simple asone condition, one type of emollient.
It's often the case of patients trying anemollient, and then going back and forth

(08:34):
with several prescriptions, several visitsto the practice, which is far from ideal.
But, fortunately, AproDerm® havedeveloped a genius solution to
simplify the whole process ofselecting the right emollient for you.
Their AproDerm® Emollient Starter Packcontains all four of their emollients
in one pack, each having a uniqueconsistency and level of hydration.

(08:56):
With just one prescription, you havethe opportunity to try each one and find
the one that works best for your skin.
This allows you to choose the one ormore that you prefer and that suits your
lifestyle, whilst saving money, time,and more importantly, [making] fewer
visits to the GP, pharmacist or nurse.
Sounds like the perfectanswer to me, as a GP.

(09:17):
And if you can't make it to yourhealthcare professional, it's available to
buy from your local pharmacy and Amazon.
I've been a big advocate of theAproDerm® range for a while now.
It's such a great range of products.
All are suitable from birth and freefrom common irritants and sensitisers.
Yeah, and I have to say I love them evenmore now and, actually, use them myself.

(09:38):
So if you're affected by a dry skincondition and want to know which
emollients will be the best for you, thendo try the AproDerm® Emollient Starter
Pack, which, incidentally, also comeswith a handy self-care guide full of tips
on helping you manage your condition,including useful advice on applying
emollients, and potential triggers.

(09:58):
It really is a game changerfor the world of dermatology.
And, as George said earlier, it'savailable on prescription or to buy
from your local pharmacy or Amazon.
Now, I think I touched onsimple and sophisticated
emollients earlier on, George.
So when we talk about "Whatis a simple emollient or a
more sophisticated emollient?"
- what are we actually meaning?

(10:21):
Well, what I think of there is what thoseadditional ingredients are that they've
added to it to make it more sophisticated.
So sophisticated emollients usuallycontain high concentrations of
what are called "humectants".
These [are] small molecules thatdraw moisture to the cell, so they're

(10:41):
mimicking natural moisturising factors.
So things like urea, glycerol,lactic acids, and so on.
Others contain ceramides.
I mentioned in the first podcastthese fatty materials that form a
layer between these epidermocytesin that lipid lamellar bi-envelope.
That oily layer between thecells in the stratum corneum,

(11:03):
the top layer of the epidermis.
So ceramides are sometimes added, andour body naturally makes ceramides, but
some emollients contain these and aretrying to sort of support that oily layer.
Some contain nicotinamide.
Nicotinamide is vitamin B3, and,um, this is a very natural product.
But we know it has fabulousanti-inflammatory properties,

(11:26):
particularly in the skin.
[It's] Antimitotic; i.e.
stops cancer.
So we use it orally sometimesto help patients who are
getting recurrent skin cancers.
And it also supports and increases thenatural production of the skin barrier,
through promoting the production ofthese ceramides naturally in the skin.
So nicotinamide is a particularlyclever agent to add to an
emollient to make it sophisticated.

(11:48):
Some contain soothing agents thatare anti-itch, almost anaesthetic,
[coughs] things like lauromacrogols.
Some contain menthol, whichis cooling, and that can also
help to soothe [the] itch.
Others contain antiseptics, so ifsomeone's getting recurrent skin
infections, they could use anemollient with an antiseptic to

(12:10):
help to clear the abnormal bacteria.
And others contain probiotics, whichhelp to maintain and build up the
normal, healthy microbiome on the skin.
Then, finally, we've got somethat include really sophisticated
delivery mechanisms so that theemollient is released in a slow way.
So the emollient, you put it on oncea day, and it lasts for 24 hours.

(12:31):
So, for example, L'Oreal make one calledCeraVe, which isn't available on NHS
prescription, but it has a beautiful24-hour effect because it's gradually
releasing the emollient into the skinthrough this microvesicular technology.
Generally, the sophisticatedones have a longer duration.
So, you could actually...
some of them you can put onjust literally once a day,
which is fabulously convenient.
If you've got somebody, for example, ina nursing home, they might be undressed

(12:54):
once a day, they might have had...
be washed once a day and havetheir clothes off once a day.
Very easy to apply anemollient once a day.
If you've got somebody having togo into the home as a carer to look
after somebody, if they only needan emollient, and it'll give [a]
24-hour emollient effect by puttingit on once a day, it's worth using a
sophisticated one that might be slightlymore expensive, that achieves that.

(13:15):
Whereas if you used a cheaper onethat is more for [use as a] soap
substitute, it would only give [an]emollient effect for a couple of
hours and be nothing like as useful.
So, generally speaking, the sophisticatedones are more expensive, so I wouldn't
want to use those as soap substitutes.
But they're very much more convenientfor patients as the leave-on and
continue to moisturise the skin for...

(13:37):
we can demonstrate thatfor at least 24 hours.
But I think that might be an excellentarea for us to talk about in a
little bit more detail another time.
It's a huge area.
And interestingly, I waswatching TV last night.
There was an advert for a moisturisingcream or ointment, and heavily
sort of mentioning ceramides andthe vitamins and the long words.

(13:59):
I'm not sure exactly how peopleare au fait with them, but it was
a big selling point - the wholescientific, sophisticated moisturiser.
Trying to sort of hookpeople and get them in.
So it's obviously a growth area, um,in the world of creams and ointments.
In fact, one other ingredient I haven'tmentioned - and perhaps one of the
most important - is colloidal oat.

(14:21):
Colloidal oat has been usednow since biblical times on the
skin and has wonderful soothingproperties and anti-itch properties
and anti-inflammatory properties.
So there are a few emollients that containcolloidal oat, and that also extends its
emollient effect quite significantly.

(14:41):
So renders them very sophisticated, andthat's one of the emollients I like the

most (14:45):
those that contain colloidal oat.
I've found those working really well.
Although I do remember one patientwho was convinced that I was going to
be prescribing porridge to put on herskin, and I had to really explain it.
Well, it's a very jollygood idea actually, I think.
Putting some porridge onthe skin is good for it.
I hope everyone listening has foundthis, this little chat interesting.

(15:07):
So until next time, it's goodbye from me.
And it's goodbye from me; goodbye.