What is the best mosturiser for eczema?

This is a common question and the options can be overwhelming.

Firstly - what actually is a moisturiser? Moisturiers, also known as emollients, add moisture (hydration) to the skin. They typically contain emollients (oils, which smooth the skin), humectants (ingredients which bind water to the skin) and occlusives (ingredients which form a barrier and trap the moisture in the skin). The most basic moisturiser contains just paraffin and works by forming a thick protective layer. Most moisturisers have paraffin as the main ingredient. Dermatologists like paraffin, as it's bland - as it isn’t plant or animal based it’s unlikely to cause a skin allergy or reaction. The problem with paraffin is that it's very greasy, which many people find unpleasant. Water and emulsifiers (chemicals which help water mix into oils) are therefore added to make the paraffin into a lighter cream or lotion. Once water is added, there is a risk that microbes such as bacteria can grow in the bottle and contaminate the cream, so preservatives are also added.

There are 5 main types of moisturiser: ointments, creams, lotions, gels and sprays. Ointments contain no water and are the thickest and greasiest. Lotions are the thinnest and contain the most water. There are also specifically formulated moisturisers for the hands, (these feel thicker), the face (these are lighter to prevent blocked pores causing acne) and babies - but most of our Everyday Moisturisers can be used all over the body. 

We used to think that thicker and greasier ointment were best. The thinking was that thick ointments with a higher oil content form a thicker protective barrier on the skin’s surface and give better hydration. However, this has been debunked by a large study in 2022 called the BEE (Best Emollient for Eczema) study. In this study 520 children with eczema used one of the 4 different types of moisturiser (an ointment, a cream, a lotion or a gel) over 16 weeks. The study compared each moisturiser and looked specifically whether it improved eczema severity. Overall there was no difference in eczema severity, so the conclusion was that each person's preference is the most important factor. Whichever moisturiser you like and will regularly use is the best one for you. We offer a Moisturiser Trial Pack so you can buy a selection of small moisturisers to find the right one for you.

However, new data suggests that not all moisturisers are made equally. Studies looking specifically at skin hydration show some moisturisers are better than others. Cerave is a newer moisturiser which has good data showing it can improve skin hydration. It contains 3 essential ceramides (Ceramide NP, Ceramide AP, Ceramide EOP). These ceramides are natural lipids (oils), that help form the skin’s barrier. What makes Cerave different to other ceramide brands is the multi vesicular emulsion (MVE) technology. This is a patented delivery system that slowly releases the ceramides over 24 hours. There is a caveat that skin hydration (moisture) is different to skin inflammation (redness/itching). No moisturiser has been shown to be best in improving overall skin inflammation, which is what most people with eczema care about. 

Although there’s no specific ’best’ moisturiser for eczema there are certainly moisturisers to avoid. People with eczema have a weak skin barrier and are more vulnerable to irritation and allergies from ingredients. Fragrances (seen in the ingredients list as parfum, myroxylon pereirae, limonene, linalool amongst others) do not need to be in your moisturiser and can be harmful to eczema skin. Irritating detergents such as SLS (sodium laureth sulfate) are used in some older moisturisers (such as aqueous cream) and should also be avoided. Other ingredients, such as preservatives, can also cause allergies. People with sensitive skin should try to minimise the number of ingredients in their moisturisers. Less is more. Simple, bland, paraffin based moisturisers, such as fifty fifty ointment are safest. We have a collection of moisturisers with 6 ingredients or less to filter products with the least number of ingredients and the lowest risk of allergies. In babies we recommend avoiding plant based ingredients, such as oat based Aveeno. This is because there is a risk that plant based products that are put onto your skin, can induce a food allergy. This risk is reduced if you are regularly eating that plant.  

Some moisturisers also include extra ingredients. We've tried to group these together in a group called Medicated Moisturisers. These contain anti-inflammatory or anti-itch ingredients, such as nicotinamide, that can help reduce inflammation and potentially reduce the amount of steroid cream needed to treat your eczema. It should be emphasised that these are not a replacement for prescription therapies, such as steroid creams, but an adjunct. We particularly like Lipikar Baume, as this contains nicotinamide and Ophiopogon japonicus root extract as anti-inflammatory ingredients and aqua posae filiformis, which helps normalise the skin's microbiome (bacteria that lives on the skin). The caveat to these creams is that only small studies support their claims (these creams are classed as cosmetics - so they don't need to go through the same rigorous clinical trials to demonstrate their effectiveness as a Prescription Therapy). They are also more expensive (and not prescribed on the NHS) - so there is a risk you might not use enough moisturiser if this becomes your main moisturiser. We choosing an Everyday Moisturiser as your main moisturiser, and think about using a  Medicated Moisturiser such as  Lipikar Baume to complement your moisturiser alongside a Prescription Therapy. 

References:

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