A practical solution to emollient selection....
Dry skin is regular problem encountered in podiatry clinics – particularly at this time of the year when the days get shorter and colder, winter itch (see my previous blog) becomes a common issue with our patients as the heating goes on. As podiatrists, we are regularly confronted with scenario, patients with dry and scaly patches on their legs and feet. The conversation then turns into a discussion about emollients – “do you use an emollient regularly on your feet?" If I had a pound for every time, I had used this phrase….
As practitioners, we are all aware of urea-based emollients that are on the market and many of us may sell these in our practices for the benefits it shows when applied to the feet (read my blog on urea here) but what about the rest of the body? Urea based creams are great for the dry skin on the feet but products containing higher percentages of urea may not be so suitable elsewhere on the body, on areas such as the face.
It is important to remember too, many emollient guidelines state [1, 2] that patient choice should be the overriding factor in choosing an appropriate emollient. After all, the most expensive emollient is the one that is never used but there is a dazzling array of products available to the patient (and practitioner) so which should they choose? Many patients may rely on their healthcare practitioners to advise them on the best products to use so perhaps it is pertinent to ensure they are aware of the ranges available, but is there any guiding evidence?
Probably the overriding factor in emollient selection is how it feels on the skin, in other words the vehicle or base of the product. A survey in the USA  of consumer choice in 147 leading emollient brands demonstrated that most popular vehicles were lotions [59%], followed by creams [13%] and ointments [2%]. This perhaps demonstrating that consumers prefer lighter formulations. This was mirrored in UK research of children where the study attempted to discover the Best Emollient in Eczema (BEE study). A total of 550 children under 12 years of age with eczema, were randomised to receive a lotion, gel, cream or ointment for 16 weeks. The results suggested there was no difference in the effectiveness of any one vehicle but the parents responded least favourably to the heavier ointments.
This finding challenges traditional dermatological thinking, as anecdotally advice has always been that heavier vehicles such as ointments are better for very dry skin conditions. This study perhaps confirms that if a product is acceptable to the patient, then it more likely gets used and therefore will be of benefit. What this study did not examine is the effect of specific ingredients within a particular formulation. That is another study....
With this in mind, I came across a product which can help patients make a choice with just one purchase or one prescription. The Aproderm® starter pack (Fontus Health Ltd, Birmingham, UK) is a box containing a set of 4 moisturisers – each with a different vehicle that the patient can try before deciding on which they prefer. The set of four consists of a colloidal oatmeal cream (100mls), an emollient cream (50g), ointment (50g) and an emollient gel (100g). The pack comes in a box with a booklet (and, unusually, a nail file). The products can be used on adults and children from birth, are not tested on animals and are vegan friendly. The best part about it is that it is available as a single NHS prescription available on FP10. If the patient pays prescription charges the pack retails at £11.99 from pharmacies or on Amazon UK. Once a product has been chosen larger quantities can be supplied or prescribed.
The product is available to Podiatrists through Canonbury.
Declaration: The author has received no financial compensation from the manufacturers or distributors for writing this blog.
1. Moncrieff, G., et al., Use of emollients in dry-skin conditions: consensus statement. Clin Exp Dermatol, 2013. 38(3): p. 231-8.
2. British Dermatological Nursing Group. Best practice in emollient therapy a statement for healthcare professionals (December 2012). 2012; Available from: https://bdng.org.uk/emollient/.
3. Xu, S., et al., Consumer Preferences, Product Characteristics, and Potentially Allergenic Ingredients in Best-selling Moisturizers. JAMA Dermatology, 2017. 153(11): p. 1099-1105.