Emollient therapy is the foundation of dry skin and eczema management, and NICE guidelines recommend using emollients as soap substitutes for washing as well as leave-on moisturisers. Yet the range of emollient bath additives, shower gels and wash products on pharmacy shelves can be bewildering for patients — and for pharmacy teams asked to recommend between them.
Why emollient washing matters
Standard soaps, shower gels and bubble baths contain surfactants that strip the skin's lipid barrier, worsening transepidermal water loss. According to NICE CKS guidance on atopic eczema, soap and detergent avoidance is one of the first-line recommendations for all patients.
Emollient wash products work in two ways: they clean without stripping natural oils (many contain mild surfactants at lower concentrations than standard soaps), and they deposit a thin lipid film on the skin surface during washing, which helps retain moisture.
Bath additives: soak formulations
These are added to bathwater and are particularly useful for children and for adults with widespread dry skin or eczema.
| Product | Key ingredients | Antimicrobial? | Notes |
|---|---|---|---|
| Oilatum Bath Formula | Light liquid paraffin 63.4% | No | Well-established, widely prescribed. Add 1-3 capfuls to bath. Makes bath slippery — advise non-slip mat. |
| Oilatum Junior Bath | Light liquid paraffin 63.4% | No | Same formulation as adult. Fragrance-free. |
| Balneum Bath Oil | Soya oil 84.75% | No | Alternative for patients who prefer a non-paraffin base. Less greasy residue. |
| Balneum Plus Bath Oil | Soya oil 82.95%, lauromacrogols 15% | Mild antiseptic | Contains lauromacrogols which have mild antipruitic and antiseptic properties. Useful in infected eczema. |
| Dermol 600 Bath Emollient | Liquid paraffin 25%, isopropyl myristate 25% | Yes (benzalkonium chloride 0.5%, chlorhexidine 0.5%) | First-line choice when antimicrobial action is needed (e.g. recurrent infected eczema). |
| Aveeno Bath Oil | Colloidal oatmeal | No | Suitable for sensitive skin. Oatmeal has mild anti-inflammatory properties. |
| QV Bath Oil | Light liquid paraffin 85.09% | No | High paraffin concentration. Australian origin, increasingly available in UK pharmacies. |
Bath additive counselling points
According to BNF guidance, bath additives should be used in addition to, not instead of, leave-on emollients. The bath or shower deposits a thin film that supplements the main moisturiser.
Safety warning: Paraffin-based bath additives make baths and shower trays extremely slippery. Pharmacists should advise using a non-slip bath mat and, for elderly or mobility-impaired patients, consider whether a shower formulation might be safer.
For children, NICE CG57 recommends adding the emollient to running water rather than directly onto the child's skin, and bathing for 10–20 minutes in lukewarm (not hot) water.
Shower and wash products
For patients who shower rather than bathe — the majority of adults — wash products and soap substitutes are the practical choice.
| Product | Key ingredients | Antimicrobial? | Notes |
|---|---|---|---|
| Dermol 500 Lotion | Liquid paraffin 2.5%, isopropyl myristate 2.5% | Yes (BAK 0.1%, chlorhexidine 0.1%) | Dual-purpose: use as soap substitute in the shower AND as a leave-on moisturiser. Very cost-effective. |
| Dermol Wash Cutaneous Emulsion | Liquid paraffin 2.5%, isopropyl myristate 2.5% | Yes (BAK 0.1%, chlorhexidine 0.1%) | Same antimicrobial formula as Dermol 500, in a wash-off format. |
| Cetraben Bath Additive | Light liquid paraffin 82.8% | No | Can be used as both bath additive and shower emollient. |
| Aqueous cream BP | Emulsifying ointment in water | No | Traditional soap substitute. Note: now recommended ONLY as a wash product, not as a leave-on moisturiser, following evidence of skin irritation with leave-on use. |
| Emulsifying ointment BP | Emulsifying wax, white soft paraffin, liquid paraffin | No | Add a walnut-sized amount to a sponge and use as soap substitute. Very cost-effective but heavy texture not popular with all patients. |
Choosing between products
When antimicrobial properties are needed
Patients with atopic eczema who experience recurrent skin infections (impetiginised eczema) benefit from antimicrobial emollient wash products. Dermol products (containing benzalkonium chloride and chlorhexidine) are the standard choice, according to NICE CKS. These reduce Staphylococcus aureus colonisation on the skin, which drives the itch-scratch-infection cycle.
When a paraffin-free option is preferred
Some patients prefer to avoid paraffin-based products due to the fire risk warning (MHRA 2016 safety alert: paraffin-based emollients can soak into fabric and become a fire hazard in contact with a naked flame). Soya-based alternatives (Balneum) or colloidal oatmeal products (Aveeno) are suitable alternatives for washing, though the fire risk applies primarily to leave-on products that soak into clothing and bedding.
For babies and infants
Plain water is recommended for newborns in the first weeks of life. When an emollient wash is introduced, fragrance-free, simple formulations such as Oilatum Junior or Aveeno Baby are appropriate. NICE CG57 specifically recommends against using aqueous cream as a leave-on moisturiser in children.
The fire risk counselling obligation
Pharmacists have a duty to counsel patients about the MHRA paraffin fire risk. All products containing more than 50% paraffin should carry a warning. Advise patients not to smoke or go near naked flames while wearing clothing or using bedding that may have been in contact with paraffin-based emollients, and to wash clothing and bedding regularly.
Finding pharmacy skin care advice
Community pharmacists can recommend and supply emollient products without a prescription. Many are available OTC as well as on NHS prescription. Use PharmSee's pharmacy finder to locate a pharmacy near you for skin care advice.
Sources: BNF Emollient and Barrier Preparations, NICE CKS Atopic Eczema, NICE CG57.