What's the difference between ointments, creams and lotions?

Emollients are mainly made up of lipids (fats) and water. Some have a thicker consistency than others. This is influenced by the amount of lipids compared to other ingredients, and what kinds of lipids are used:

• Ointments: Ointments contain a lot of lipids and form a thick, long-lasting protective film on the skin. They are especially suitable for severe eczema or very dry skin.
• Creams: Creams have more water in them than ointments do. They are less gooey so they are easier and more pleasant to apply. They are absorbed faster and are less visible on the skin. And they don't leave marks on clothing or bedding as easily.
• Lotions: Lotions contain the most water of all the emollients. The water evaporates quickly, which tends to have a cooling and more dehydrating effect.

Some products also have water-binding substances in them, such as urea. Urea products can sometimes irritate the skin and cause mild burning, particularly in children and babies.

But if you feel a burning sensation after you have applied a skin care product, it may instead be caused by a flare-up of eczema that has not been treated enough, or not at all. Then it's a good idea to temporarily treat the skin with steroids or other medications.

Which products are most suitable in different situations?

There is no evidence that certain products are more effective than others from a medical point of view. But they vary widely in how they are used in everyday life. Depending on your needs and situation, various ointments, creams and lotions can be used. The main factors that play a role here are the time of year, the areas of skin that are affected and the current condition of your skin:

• On hot and humid summer days, it's often more pleasant to use products with more water in them because they are absorbed faster and don't clog the pores of your skin. In cold or dry winter air, thicker products are more suitable.
• Lotions and creams are more suitable for your face because they are less noticeable. Products that have more lipids (fats) in them are more suitable for your arms, legs, hands and feet. They also offer longer-lasting protection and you don't need to re-apply them as often.
• Lotions are especially recommended for areas of "weeping" skin (skin that is wet from oozing fluid). They are less suitable for very dry skin.

But a person's choice of skin care products is also a matter of personal preference.

How are skin products applied?

When applying these products, experts recommend

• using them at least twice a day and as needed,
• using generous amounts,
• applying them with clean hands and gentle stroking movements in the direction of any hair growth, to prevent inflammations from developing at the roots of the hairs.

If you are also treating your skin with a topical steroid, you should wait at least 15 minutes before applying any skin care products in order to avoid weakening its effect. It doesn't matter whether you apply the steroid or the skin care product first.

If you are taking a product from an unsealed jar or pot, it's better to use a clean spatula or spoon to keep it free of bacteria.

Are certain products better than others?

Many skin care products contain contact allergens (substances that some people are allergic to). It's a good idea for people with allergies to check the ingredients for any substances that they know will irritate their skin.

There's no proof that special or more expensive products are generally better. Ultimately, the most important thing is how comfortably you can use the product. Product descriptions like "unscented" or "tested by dermatologists" aren't always reliable and mostly used for marketing purposes. There are no agreed-upon standards for these terms. Claims about skin care products are less regulated than claims about medications are.

One study of over 150 different products showed that nearly half of all the products that were claimed to be unscented actually contained a scent or other allergens. What's more, over 90% of the products advertised as "recommended by dermatologists" contained a potential allergen.

What should you be careful about when taking a bath or shower?

When you take a bath, a lot of moisture enters your skin, and flaky skin and irritants on the surface of your skin are removed. So bathing is generally considered to be good for people with eczema.

People who have eczema are advised to do the following when taking a bath or shower:

• Use warm water (not too hot). Hot water can make the itching worse and irritate your skin.
• Don't bathe or shower for more than 5 to 10 minutes.
• When you're finished, apply an emollient lotion or cream to your skin. This prevents the absorbed moisture from evaporating. Using an emollient like this afterwards is especially important.

People are often advised to only use cleansing products that have a low pH, are free of irritants and unscented. But there's no good-quality research comparing the effects of different cleansing products.

Is it a good idea to use moisturizing bath additives?

Special bath additives are available for people who have eczema. These additives contain oils or other substances that are claimed to protect the skin and keep it supple. One large, high-quality study has shown that they don't have an added benefit when used together with the conventional basic skin care routine. Dermatological societies don't usually recommend using these bath additives regularly. This is also true for products that are supposed to make the water softer.

Can wet wraps help?

Wet wraps are usually only used to treat eczema if it is severe. Two pieces of bandage are cut to the right size. A rich moisturizing cream is then applied to the skin. Next, the first bandage is moistened with lukewarm water (excess water is wrung out) and placed on top of the cream. The second (dry) bandage is placed on top of the wet bandage, or wrapped around it.

These dressings relieve itching by keeping the skin moist and cool. They also protect the skin from damage caused by scratching. A lot of people find them pleasant and say they help them sleep better, for instance. But there are no good-quality studies on the benefits and drawbacks of using wet wraps like this.

Does special clothing help?

Rough fabrics like wool or coarse linen can irritate your skin. Finely woven clothes made from cotton or silk are usually a better choice for people with sensitive skin. And loose-fitting clothes are often more pleasant to wear than tight clothes.

Special clothing made from silver-coated fabric are available too. The idea is that these will prevent bacteria from growing on your skin, preventing flare-ups. But there's no proof that it has this effect.

One high-quality study involving 300 children and teenagers looked into clothing made from a special type of silk. Potential irritants had been removed from the clothing and it had an antimicrobial (anti-germ) coating. This silk clothing wasn't shown to have any advantages, though: The children and teenagers who wore it didn't have fewer eczema symptoms than the control group did. They also needed to use just as much medication.

Due to this lack of clear proof that special clothing helps, dermatological societies don't recommend that people with eczema wear it.

Sources

• Ridd MJ, Roberts A, Grindlay D et al. Which emollients are effective and acceptable for eczema in children? BMJ 2019; 367: l5882. [PubMed: 31649114]
• Santer M, Ridd MJ, Francis NA et al. Emollient bath additives for the treatment of childhood eczema (BATHE): multicentre pragmatic parallel group randomised controlled trial of clinical and cost effectiveness. BMJ 2018; 361: k1332. [PMC free article: PMC5930266] [PubMed: 29724749]
• Thomas KS, Bradshaw LE, Sach TH et al. Randomised controlled trial of silk therapeutic garments for the management of atopic eczema in children: the CLOTHES trial. Health Technol Assess 2017; 21(16): 1-260. [PMC free article: PMC5410632] [PubMed: 28409557]
• Van Zuuren EJ, Fedorowicz Z, Christensen R et al. Emollients and moisturisers for eczema. Cochrane Database Syst Rev 2017; (2): CD012119. [PMC free article: PMC6464068] [PubMed: 28166390]
• Xu S, Kwa M, Lohman ME et al. Consumer Preferences, Product Characteristics, and Potentially Allergenic Ingredients in Best-selling Moisturizers. JAMA Dermatol 2017; 153(11): 1099-1105. [PMC free article: PMC5710429] [PubMed: 28877310]

• IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

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