Emollients are the most frequently dispensed dermatological products in England. According to NHSBSA prescribing data, NHS spending on emollients exceeds £100 million annually — yet selecting the right product for a given patient remains one of the most common pharmacy counter queries.
Dry skin (xerosis) affects an estimated 20–30% of the UK population at any time, with prevalence highest among older adults, young children with atopic tendencies and anyone with chronic skin conditions such as eczema or psoriasis.
Understanding emollient types
Emollients work by forming a protective barrier on the skin surface, trapping moisture and reducing transepidermal water loss. The key distinction is between formulation types, which differ in their oil-to-water ratio:
| Formulation | Oil content | Best for | Examples |
|---|---|---|---|
| Lotions | Low (~20%) | Mild dryness, large body areas, hairy skin | E45 Lotion, Cetraben Lotion |
| Creams | Medium (~50%) | Moderate dryness, daytime use, face | Diprobase Cream, Epaderm Cream, Zerobase |
| Ointments | High (~80%) | Severe dryness, night-time use, flare management | Epaderm Ointment, Hydromol Ointment, 50:50 white soft paraffin/liquid paraffin |
| Gels | Variable | Preference-driven, lighter feel | Doublebase Gel, AproDerm Gel |
The general principle: the drier the skin, the greasier the emollient should be. Ointments are more effective than creams for severe xerosis and eczema flares, but patient adherence often drops because of the greasy feel. A cream or gel that the patient will actually use is better than an ointment left in the bathroom cabinet.
Condition-specific selection
Eczema (atopic dermatitis)
NICE guidelines recommend emollients as the foundation of eczema management, used liberally and frequently — at least twice daily and after bathing, regardless of flare status. Key points for pharmacy advice:
- Prescribe or recommend the most emollient-rich product the patient will tolerate
- Apply in the direction of hair growth to reduce folliculitis risk
- Leave a 20–30 minute gap between emollient and topical corticosteroid application
- Soap substitutes (emollient wash products) should replace all soap, shower gel and bubble bath
For children with eczema, the NHS recommends 250–500g of emollient per week. Many parents significantly under-apply — pharmacists can demonstrate appropriate quantities using the fingertip unit concept.
Psoriasis
Emollients in psoriasis serve a different role: softening scale to improve penetration of active treatments (coal tar, vitamin D analogues, corticosteroids). Thicker preparations — ointments and heavy creams — are preferred. Emollients containing urea (5–10%) can be particularly effective at descaling thick plaques.
General dry skin in older adults
Age-related xerosis is driven by reduced sebum production, thinner epidermis and environmental factors. Pharmacists should recommend:
- Emollient-based soap substitutes (avoid all conventional soaps and detergents)
- A cream or ointment applied within 3 minutes of bathing while skin is damp
- Attention to lower legs, which are most frequently affected
Ingredients to watch
Sodium lauryl sulfate (SLS)
Aqueous cream BP — historically one of the most commonly prescribed emollients — contains SLS as an emulsifier. Evidence published over the past decade shows SLS can thin the skin barrier and worsen eczema when used as a leave-on emollient. The NHS now advises against using aqueous cream as a leave-on moisturiser, though it remains acceptable as a soap substitute for short-contact wash use.
Urea
Emollients containing 5–10% urea (e.g. Eucerin, E45 Itch Relief Cream, Balneum) are keratolytic — they break down dry, flaky skin. They are useful for stubborn xerosis and psoriatic scale but can sting on broken skin. Advise patients to test on a small area first.
Paraffin-based products: fire safety
Emollients containing paraffin (both white soft paraffin and liquid paraffin) are flammable when absorbed into fabrics. The MHRA has issued safety warnings following fatal incidents. Pharmacists should advise patients to:
- Keep away from naked flames, cigarettes and candles
- Change bedding and clothing regularly, as paraffin residue builds up in fabric
- Not smoke while wearing paraffin-impregnated clothing or dressings
This fire-safety warning applies to most ointment-based emollients and some creams.
Practical pharmacy advice
- Quantity: most adults need 500g per week for whole-body application; children need 250g
- Application frequency: minimum twice daily, ideally after every wash
- Pumps and tubs: recommend pump dispensers over tubs where possible to reduce contamination risk
- Trial and error: no single emollient suits everyone — encourage patients to try alternatives if the first choice feels wrong
- Prescribability: all standard emollients are available on NHS prescription, which saves patients money for regular long-term use
Community pharmacies are the most accessible point of emollient advice and supply in England. With over 13,147 registered branches tracked by PharmSee's pharmacy finder, patients can access professional skincare guidance without a GP appointment.
Sources
- NICE, Eczema — atopic: management (NG169, updated 2024)
- NICE, Psoriasis: assessment and management (CG153)
- MHRA Drug Safety Update, Emollients and risk of fire (2020)
- NHSBSA prescribing data, emollient expenditure (2024/25)
- PharmSee pharmacy register data, April 2026