The most effective way to moisturise eczema is to apply a generous layer of ceramide-containing cream or ointment to slightly damp skin straight after bathing, at least twice a day, in the quantities the guidelines actually name. Most people already moisturise regularly and still get limited benefit, because the amount, the timing and the spacing around other treatments are wrong. Quantity is usually the largest of the three gaps.
What an emollient is doing to the skin
Emollients do three separate jobs, and most products do more than one.
Occlusion is the first. Petrolatum, liquid and soft paraffin, and dimethicone form a film on the surface that slows transepidermal water loss, the constant outward leak of water through the stratum corneum. It is a physical seal, not a repair.
Humectancy is the second. Glycerin, urea and lactic acid pull water into the outer layers. With no seal over it, a humectant-heavy lotion can draw water upwards and lose it to the air.
The third job is replacing the lipids the skin barrier is short of. Ceramides make up roughly half the lipid matrix between corneocytes, alongside cholesterol and free fatty acids. Ceramide NP, AP and EOP on an ingredient list are the ones to look for. This is the only one of the three jobs that addresses the structural defect rather than compensating for it.
How much to use
The quantities in the guidance are much larger than most people apply. NICE tells prescribers to issue 250 g to 500 g of leave-on emollient weekly for a child with atopic eczema, applied to the whole body, both while the eczema is clear and while other treatments are in use (NICE CG57, Atopic eczema in under 12s). For adults, a 2023 review in Deutsches Ärzteblatt International puts the floor at 250 g a week, and the National Eczema Society recommends at least 500 g a week when a large area of the body is affected.
The arithmetic makes those figures easier to judge. At two applications a day, 250 g to 500 g a week is roughly 18 g to 36 g each time, so a 500 g tub covers between one and two weeks of whole-body use. A tub lasting a month means about a quarter of the recommended amount. For smaller areas, the British Association of Dermatologists defines the fingertip unit as the strip squeezed onto an adult fingertip to the first crease, enough for two hands with the fingers together, about 0.5 g (Wollenberg et al, 2023).
On frequency, the NHS says at least twice a day on its atopic eczema treatment page and at least three or four times a day on its emollients page. Both say to keep going once the skin looks clear, because the barrier defect outlasts the visible inflammation.
Timing: damp skin, straight out of the bath
The NHS says emollients are best applied after washing, bathing or showering, as soon as the skin has been patted dry. The National Eczema Society says the same: pat dry, then reapply immediately. The National Eczema Association puts a number on the window, advising a thick layer within three minutes of bathing, on skin left slightly damp.
Bathing raises the water content of the stratum corneum for a short period, and an occlusive layer applied while that water is still there traps it. Wait until the skin is dry and you are sealing a dry surface, which gives you the film without the hydration underneath. Water temperature and cleanser choice are covered in the bath and shower routine.
Wet wrap therapy extends the same principle, holding emollient against damp skin under a damp layer and a dry layer for hours, usually overnight during a severe flare.
Ointment, cream or lotion
The NHS describes the three formats by what they suit. Lotions spread easily and suit hairy or damaged areas. Creams are less greasy and suit daytime use. Ointments are greasy and thick, and suit very dry, thickened skin and night-time use. Oil content is what separates them, and it tracks how well each seals.
In practice that gives a simple split: ointment overnight and on lichenified patches, cream during the day under clothes, lotion for the scalp margin and other hairy skin. One formulation note from the NHS: ointments are usually free of preservatives, which is why they often suit skin that reacts to creams. The water and lipid percentages behind those labels, and what they mean for stinging and for the pack you buy, are set out in choosing an emollient.
Fitting emollient around a topical steroid
Where a topical steroid is also in use, the guidance is about separating the two rather than fixing an order. The NHS and the British Association of Dermatologists both advise 20 to 30 minutes between an emollient and another topical treatment, to avoid diluting it. The National Eczema Society gives the fuller reason: dilution reduces the steroid's strength and spreads it onto skin that does not need it.
NICE is looser on both points, recommending one product at a time with several minutes between them, and leaving the order to the person applying them.
Applying it, and what to do when it stings
Smooth emollient on in the direction of hair growth rather than rubbing up and down. The British Association of Dermatologists gives the reason as clogging and irritation of the hair follicles, and the National Eczema Society adds that rubbing triggers itch and builds heat in the skin.
Keep fingers out of the tub. The NHS advice is to use a spoon or pump dispenser instead, and not to share emollients, because repeated finger contact contaminates the pot. With a pump, avoid touching the nozzle.
Stinging has two common explanations. Broken or excoriated skin stings on contact with almost anything. On intact skin, the British Association of Dermatologists points at the preservatives, which sting more when the skin is already sore and itchy. A product that stings consistently on unbroken skin is worth swapping for a preservative-free ointment.
One safety point: emollients make fabric more flammable, and the MHRA states that this applies to all of them, whether they contain paraffin or not (MHRA, Drug Safety Update, 26 August 2020). Bedding, clothing and dressings that have absorbed emollient catch fire more easily, and the risk persists once the emollient has dried.
References
- NHS, Atopic eczema: treatment, reviewed 6 September 2024, https://www.nhs.uk/conditions/atopic-eczema/treatment/
- NHS, Emollients, reviewed 24 October 2023, https://www.nhs.uk/conditions/emollients/
- British Association of Dermatologists, Emollient use in skin conditions, January 2023, https://www.bad.org.uk/pils/emollient-use-in-skin-conditions
- British Association of Dermatologists, Topical corticosteroids, https://www.bad.org.uk/pils/topical-corticosteroids
- NICE, Atopic eczema in under 12s: diagnosis and management (CG57), https://www.ncbi.nlm.nih.gov/books/NBK571009/
- Wollenberg A, et al, Atopic Dermatitis in Children and Adults: Diagnosis and Treatment, Deutsches Ärzteblatt International, 2023, https://pmc.ncbi.nlm.nih.gov/articles/PMC10277810/
- National Eczema Society, Emollients, https://www.eczema.org.uk/information-and-advice/treatments-for-eczema/emollients/
- National Eczema Association, Moisturizing, https://nationaleczema.org/eczema/treatment/moisturizing/
- MHRA, Emollients and risk of severe and fatal burns: new resources available, Drug Safety Update, published 26 August 2020, updated 20 May 2021, https://www.gov.uk/drug-safety-update/emollients-and-risk-of-severe-and-fatal-burns-new-resources-available