Using leave-on emollients (moisturisers)
People said they use emollients one or two times a day, but sometimes more. Usually this was in the morning (such as after a shower) and in the evening before bed. Some thought it was important to also use an emollient before putting on steroid creams. Some people like that there are no limits on how often they can moisturise. Lizzie and Sarah find that emollients soothe the skin. Anissa found it helped to put the cream in the fridge. Alice says she uses moisturiser “constantly” and Lizzie described it as “just part of your daily routine”. Some people put thin layers of their moisturisers on frequently, others preferred to put a thicker layer on and wait a bit longer for it to absorb.
Many people felt strongly that using emollients is an important part of looking after their skin and helped limit flare-ups. Yet, it can be time-consuming having to moisturise so much – Aisha says it’s “hard work having to do that all the time”. It sometimes left her feeling like she should always be moisturising and that even then it wouldn’t be enough. Some said it can feel like a lot of time and effort to put in, especially if they were unsure how much of a difference it made.
Dermatology nurses helped Cat understand how best to use emollients (moisturisers).
Dermatology nurses helped Cat understand how best to use emollients (moisturisers).
Age at interview: 24
Sex: Female
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So the nurses are quite good, they’ve obviously got a bit more time so they sort of talk to you if you’ve got any sort of worries or issues, but I wouldn’t say I've sort of overly sort of had like many in-depth conversations with them, but they're sort of quite good at just sort of giving you a bit more sort of information and sort of stuff that may be sort of dermatologists sort of look over, and GPs, so they're quite a good sort of knowledge hub.
What sort of things have nurses spoken to you about that GPs and dermatologists have skimmed over?
Some of it's just like technique, like techniques, like ways to sort of apply creams and things like that that you don’t really, you're like ‘well you put it on, how difficult can it be?’ [laughs] “Arr no, well if you do it like this and this and this, then it's actually sort of better” – things like that, that they don’t, like dermatologists don’t really have the time; well they probably wouldn’t think to sort of do or how like what's the best order to do stuff in, and things like that.
Could you say a bit more about what the nurses have said about techniques for applying creams?
Yeah so things like you follow like the hairline down, rather than up against, that was one of the key things. And like putting on the shower gel before you get in the shower, which I'd never thought to do [laughs] before, which I don’t always do cos I don’t have the time to sort of sit there for five minutes and do that. But yeah, so you sort of put it on and then it absorbs into your skin or something, and then you sort of get in and wash it off rather than just sort of putting it straight on and it coming straight off again. So things like that that I hadn’t really thought about.
Katie-Lauren has to plan ahead about showering because moisturising is so time-consuming.
Katie-Lauren has to plan ahead about showering because moisturising is so time-consuming.
Age at interview: 19
Sex: Female
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If on that day I’m having a shower, because I try not to shower a lot, because it hurts. If I’m having a shower I will put eczema cream on before I have a shower, sometimes during the shower and then after I shower, so it’s like I’m not actually washing the cream off. It’s really irritating.
I have to plan whether I can have a shower or whether I’ve got time to do all the creaming like before and after and during and if I’m going out somewhere, like if I’m going out on a Saturday then I will think about whether I should have a shower the night before and then just do cream in the morning or whether it’s going to be a long day and so I really should have a shower in the morning, so that I’m not sweaty all day and stuff like that. So it takes a lot of, a lot of planning. And if I’m just waking up and I’ve got a day off, if I am just in my room then I will be doing my eczema cream all day. I mean, it’s a good thing, but it’s also annoying, cos I will just keep scratching.
Forgetting to use an emollient could be a problem. Hazel said there have been times when she’s “let it slide” and Aisha said this missing moisturising just once can “wreak havoc”. Molly thought that getting into the routine was easier when she can see a flare-up but a “battle” to remember at other times. She found it supportive when friends reminded her to put on the creams. Remembering can be especially difficult when there’s a lot going on in your personal life. Sometimes people also felt they were missing out on doing fun things with their friends because they tried to stick to a routine with using eczema treatments.
The seasons can make a difference how emollients are used. In dry and cold weather, some people said they use more and thicker creams. Anissa and Molly also moisturise more often if they’ve been in contact with triggers such as washing detergent or damp in a house.
It can be tricky to put emollient on some parts of the body or when the eczema is very painful. Parents often helped younger children but it could be embarrassing having parents help when they got older.
Shams explains about the difficulties he has when putting treatments on his back, especially when eczema makes it difficult for him to move.
Shams explains about the difficulties he has when putting treatments on his back, especially when eczema makes it difficult for him to move.
Age at interview: 18
Sex: Male
Age at diagnosis: 7
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A worst place I've ever had was on my back sort of in-between my armpits and my back, and I'm trying to find…especially when I used to apply medication, when I'm trying to find the right area. I mean sometimes you end up applying medication on the normal part of your skin and you turn yourself in the mirror and see that…that place you're meant to apply hasn’t applied. And the other places would be sort of back of the knees, arms areas. Those are not painful to apply medication to but sometimes when eczema becomes really worse; my skin becomes sort of stiff and hard to move. During those times it's hard to sort of bend your arm and apply it to yourself. Well, you're just kind of stiff armed in a sense, you can't move.
Katie-Lauren’s boyfriend sometimes helps her moisturise.
Katie-Lauren’s boyfriend sometimes helps her moisturise.
Age at interview: 19
Sex: Female
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My boyfriend helps me a lot. I feel like sometimes when I do it, because it’s just so itchy, I rush it. And when he does it for me, he takes like, he puts a load of effort into it and it makes it feel better. I think just because he rubs over the part that’s itchy, it makes it less itchy as well, so it’s really helpful. And he always goes down, he never goes like that [rubs hands up and down over skin on arm] so if you go down, it stops the spread of infection or something like that.
It can be difficult to do things after applying emollient. Ele and Aadam have had to ask for help with activities, like opening jars, because their hands were slippery. People found it annoying having to wait until the emollient dries before putting on their clothes or getting into bed at night.
Alice doesn’t like wearing long sleeved tops because of the memory of clothes sticking to moisturisers on her arms.
Alice doesn’t like wearing long sleeved tops because of the memory of clothes sticking to moisturisers on her arms.
Age at interview: 22
Sex: Female
Age at diagnosis: 7
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I don’t like wearing long sleeves anyway just because of the residual memory of having itchiness there. But if I had my sleeves pulled down it would kind of get stuck to the inside and that would make it more itchy as well because then the fibres and stuff would get stuck to me and it’s just ergh. I tend to find it more of a problem on my upper body with the sticking to things, like if I’m wearing tights over the moisturiser or whatever – that’s okay, I can kind of deal with that but I’m not sure what it is, maybe it’s a psychological thing but having it stuck on the inside of my arms just makes me feel really horrible.
One thing that both Vicky and Himesh found worked well for shaving was to use either one of their emollients instead of a shaving gel product.
Taking creams to out and about with you
People said they had to take their emollients everywhere they go. This includes school or university classes and at work. Some thought it could be embarrassing being seen by others using prescribed creams, such as at work or in lectures, but that shop-bought moisturisers would be okay. George never took any creams into school and Shams put his emollients into another pot to disguise them. Anissa also put her creams into smaller pots because the tub of emollient was too big and heavy to carry about. Himesh’s dermatology doctors and nurses gave him smaller sample-size moisturisers to carry with him.
Abid felt more comfortable using a shop-bought moisturiser at work rather than a prescribed one.
Abid felt more comfortable using a shop-bought moisturiser at work rather than a prescribed one.
Age at interview: 24
Sex: Male
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I used to work at a desk job and had a small cream which was, which was branded and looked pretty okay but if you had like a huge tub of like hydrocortisone or some, some huge thing, people are gonna ask you questions and if you’re not comfortable with that then it might be worth, you know, just taking the ta-label off or just keeping it in your desk or whatever and just using a little at a time. It’s a shame that we have to do that but if you want to I guess have fewer conversations around that then yeah just, just slip it into your lifestyle a lot easier yeah.
Georgia has moisturiser ‘stations’ in the several of the places where she spends her time.
Georgia has moisturiser ‘stations’ in the several of the places where she spends her time.
Age at interview: 20
Sex: Female
Age at diagnosis: 4
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I’ve got, have little sort of stations round my room and round my house – so if I need it, it’s easy to reach. So if I wake up in the middle of the night and my face will be dry or itchy, I’ve got it down the side of my bed. And I’ve got it all in one place. And then I have bits and bobs in the bathroom. And I have creams at my friends’ houses. At my boyfriend’s mum, she knows to keep stuff like antihistamines and moisturisers for my skin. I always carry thick moisturisers, especially during winter, because it’s so, it cracks and it gets really dry. I’ve always got little bits and bobs in coats. I’ve [laughs] really got to keep my on it cos I have so many and I lose them all. But I always have to keep them with me. Because if I don’t have something as simple as like moisture there [points to upper lip] from the start of the day, it cracks and it swells and it gets really itchy and red.
The opportunity to use creams and feeling comfortable to do so varied in different settings. Himesh’s secondary school had a medical treatment room. He could leave his creams there and quickly put some more on during class breaks. Himesh also got extra time in exams so he could top up on the creams. Trying to quickly put on emollients in public/shared toilets between lectures is difficult, especially for eczema on areas usually hidden under clothes. Some jobs were seen as more suitable for using creams during the working day, such as those which are desk based. In contrast, waitressing and being on check-outs were tricky if you couldn’t fit moisturisers into uniform pockets or were always ‘customer facing’.
Anissa wasn’t allowed to put her creams on, or check they were rubbed in, at school. Things are different now she’s at university.
Anissa wasn’t allowed to put her creams on, or check they were rubbed in, at school. Things are different now she’s at university.
Age at interview: 20
Sex: Female
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Especially with the creams being so thick as well, you can’t just be like ‘mm [gestures rubbing], it’ll dissolve in’ or, you need to rub it in properly otherwise you’re gonna have massive white patches everywhere.
Yeah. Is that the same across like primary school, secondary school, sixth form or college?
Yeah. Yeah, if, you got, if you got a mirror out or anything or you tried to do anything – no you were definitely, well I was definitely, and I know like a few friends who were definitely belike, “Put that away.”
“You’re meant to be in class.”
Has that changed since you got to uni?
Because uni’s like, for me especially, is very split up. So I’ll have, the longest class I’ll have is three hours. And within the uni situation, I can leave the room without asking permission or anything like that. You can just leave and come back and no one bats an eyelid. No one thinks about it, because at school, at college, you have to ask permission to leave the room and I think that makes a massive difference because you can just, well you can’t be extra late. But you could be late. But while you’re in that class, if you’re on a, like, you can go back and forth. You could leave early if you wanted to.
Yeah.
There’s nothing telling you that you have to ask permission for anything.
Ele took a moisturiser into her school exams but found she couldn’t really use it.
Ele took a moisturiser into her school exams but found she couldn’t really use it.
Age at interview: 22
Sex: Female
Age at diagnosis: 2
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And then your skins really greasy and then the paper tends to sort of, because obviously writing left to right and moving down the page then you've got a streak of moisturiser just down the page [laughter] so trying to write over that is just sort of end up with massive gaps in texts and stuff just from, just skip to the other side of the moisturiser line. But yeh stuff like that and also taking moisturiser into exams was always a bit iffy just because, one you don’t really have time to sit and moisturise when you’re in an exam hall you’ve got an hour to write this essay, oh right yeh that’s fine just, just ignore me I’ll write it in a minute.
Some people were worried about taking their emollients with them if they went abroad. Having to plan ahead to take enough (but not too much) and packing them in luggage could be a stressful. A few people had lived abroad and had struggled to get similar emollients for managing their eczema.
George struggled without his emollients on a school trip.
George struggled without his emollients on a school trip.
Age at interview: 17
Sex: Male
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When it was bad last year for my GCSEs I would put it on pretty much every other day on my shoulders and my legs and arms but now cos I’ve just started the holidays for after my second set of exams it hasn’t been a problem recently. So I’d probably put it on maybe once every two weeks. And I went to Switzerland recently for a school trip and it was close to the, it was nearly the low 40s so it was really, really hot and it got quite bad so I had to- but I didn’t have any cream with me because I didn’t have it cos you’re not allowed to take more than 100mls so that was, that was really nasty and I couldn’t do anything there but I was only there for 3 days.
Downsides and side effects with emollients
Some people had side effects from emollients they’d used. Ele had a bad reaction to E45 and Gary remembers one cream which burnt when he put it on. Aisha and Shams both found that heavy emollients irritated their skins. Some side effects went away with time. Himesh noticed that often his skin would get red for a little while when he first used a new emollient.
Jessica and her dermatologist think her itchiness might now be an allergic reaction to a cream for vulval eczema.
Jessica and her dermatologist think her itchiness might now be an allergic reaction to a cream for vulval eczema.
Age at interview: 20
Sex: Female
Age at diagnosis: 20
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So I’ve been back and apparently I might be allergic to some of the like cream that she’s given me. So I’m having like a patch test in a few weeks to check that out, because when she, cos I went twice and the second time she’s like, when she examined me she’s like ‘well looks like your eczema’s actually gone, but you’re still itchy. So you’re probably gon-’ and then she was like ‘oh have you ever been allergic to like’ she gave me a few like things that I might’ve been allergic to and she was like one of them was like, ‘oh have you ever been allergic to like sort of like cheap jewellery’. And I was like, yeah and she gave me so- some sort of stats about people that are allergic to jewellery normally are quite allergic to some sorts of creams and things. So I’m having like a patch test in a few weeks, we’ll see how that goes. So the vulvar eczema thing is sort of still very much ongoing.
Most complaints about emollients were about how they smell and what they feel like:
- oily, greasy, slimy, sweaty – makes the skin shiny
- sticky, gooey, too thick
- smelly, stinky – like petrol, gas, “medicated”, like a "laboratory"
- dries too quickly or comes off with sweating so has to be reapplied
- messy – gets on clothes and bedsheets, picks up pet fur, gets in eyes and hair
- crusty and sharp when dried
- difficult to rub in – leaves a residue and rolls of cream on skin
- putting on creams “heats up” the skin which makes it itchier
Putting on emollients makes Himesh’s skin feel too warm and uncomfortable.
Putting on emollients makes Himesh’s skin feel too warm and uncomfortable.
Age at interview: 17
Sex: Male
Age at diagnosis: 10
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When I’m applying a cream I feel really like heated up so then obviously then I would have to wait until it soaks in and then put my clothes on and I remember when I used to do it about probably about two years ago, usually put it, no yeh two years ago, used to our it day and night when I wake up and like I would get heated up especially when it was school time I would have to put my cream on and then put my clothes on and I feel really uncomfortable especially when you have to wear a shirt, blazer, tie all day, so yeh I’d feel uncomfortable basically.
Abid talks about the texture and practicalities of some emollients he has tried for his eczema.
Abid talks about the texture and practicalities of some emollients he has tried for his eczema.
Age at interview: 24
Sex: Male
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I think there’s one which is quite common which is called Epaderm which is like I can’t, I’m trying to think of a, of a texture to, to give you a an idea of it but it’s almost like pâté almost and you're supposed to rub that in your skin and it’s, it’s not, it’s not really practical. And it’s not even from that point of view and like you have to be super conscious of this, so if you want it to, if you want to try to rub this in, this incredibly greasy thing, you’re not gonna feel comfortable putting clothes on after, so you need, let’s say you start your work at 9 ‘o’ clock which is a normal, normal time to work. I wake up and let’s say it’s a half an hour commute, normally you would wake about maybe 7 ‘o’ clock have a shower, have your breakfast and go to work kind of thing. In this situation you’ll have a shower and you, strangely saying you can’t put your clothes on after because you’ve just applied this, this so called cream.
And then you're there, kind of stuck in this kind of limbo, where you’re pretty much magnetic man which everything will stick to you.
Sarah found that some eczema creams blocked her pores, making her more prone to spots and ingrown hairs.
Sarah found that some eczema creams blocked her pores, making her more prone to spots and ingrown hairs.
Age at interview: 23
Sex: Female
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When the eczema’s bad I don’t really, I don’t get spots really when my eczema’s bad. And I just like moisturise everywhere. But then when it’s kind of like an average point you kind of like have to moisturise. And then obviously the bits where you’ve got eczema, you have to moisturise a lot. And then the bits where you’ve got spots, you’re like, ‘oh, I don’t really wanna put the moisturiser on there.’ So I end up like not moisturising my forehead at all and then putting like eczema cream like on my eyes and like the bottom of my face. And then where, wherever you don’t have eczema but you’ve used eczema cream, you get clogged pores, cos it really clogs and it builds up on your skin.
Young people said these downsides drew attention from other people and
made them feel self-conscious, including
at school and with
romantic partners.
Georgia worries that other people will smell her emollients.
Georgia worries that other people will smell her emollients.
Age at interview: 20
Sex: Female
Age at diagnosis: 4
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I always feel really stinky. I’ve been, I was using a product called Cetraben. And I had, I have Hydromol as an ointment and Hydromol… as a cream. And they stink. I just, it’s the paraffin I think that is so prevalent. So cos I can’t wear make-up or anything scented, I’d just be in public and just be like, “[sniffs] What’s that smell?” And then realise it was me. And like oh, it’s just horrible. Like if I’m sitting at home and I’m trying to be intimate with my boyfriend, I’ll think, “Oh my God, I stink. I don’t want to, I don’t want to be intimate with you because I smell and I think you might pick up on it.” [Laughs] So, yeah, being slimy and sticky all the time is really annoying as well. Cos I can’t touch things. I can’t, that’s mainly why I keep my hair up all the time, because I can’t touch my hair cos it gets greasy and sticky easily. And the same if I’m, say if I’m just doing that [itches eye], if I get it in my eyes, my eyes are all slimy. And I can’t touch my phone or pick up things if I’ve just put moisturiser on. I can’t do things so it’s a bit annoying in that aspect.
Himesh feels comfortable putting his creams on at home and leaving them around the house, but others like Katie-Lauren and Aman took the bottles back to their room when sharing bathrooms at university.
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