Fig 2.15 The Hows and Whys of Emollient Use THINLY
Emollients prevent water loss, rather than add water to the skin
GENTLY
Dry, and eczematous skin is brittle and fragile
QUICKLY
Application should be easy and not time consuming
FREQUENTLY
Emollients should prevent drying rather than treat dryness
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Plate 2.5 Aqueous cream. A tube should be kept by each sink so that it is easily available for use instead of soap. It should be very gently massaged on the skin before wetting the hands ...
Plate 2.6 rinsed off.
and then
moisturiser thickly. Prevention of water loss, and not heat loss, is the object of the exercise. The water that will moisturise the skin comes largely from the body fluids below rather than from the applied cream, and therefore the thinnest possible application is preferable. Not only will this be effective, but it will be more cosmetically acceptable if the emollient is opaque on application, it will become translucent more rapidly when only a small amount is used. The structural characteristics of both dry, and eczematous skin, including brittle fragility and lack of normal flexibility, dictate the relevance of gentle wiping on of a moisturiser, and argue strongly against the common advice that the emollient should be rubbed into the skin. Such rough treatment is known by many patients to be equivalent to scratching, and is sometimes indulged in for that reason alone. Not only is rubbing unnecessary, it is contraindicated it is a damaging process, and for some patients it provokes a significant itching reaction that then tempts an even more damaging scratching episode. The advice that topical applications should be accomplished quickly and without fuss aims similarly at avoiding unnecessary manipulation and therefore stimulation of the treated skin. It is useful to ask the patient at consultation to demonstrate how they apply their moisturiser. Almost invariably the cream is applied overvigorously and with much massage and rubbing. It can then be explained that this is inappropriate and counterproductive. The correct method can be easily demonstrated, and it will be seen immediately to be quicker and therefore easier. Frequent use, to achieve prevention rather than treatment of dry skin, becomes then a more feasible proposition.
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