Fragrance-Free, Preservative-Free Emollient Prescription for Eczema
For eczema management, prescribe emulsifying ointment or white soft paraffin/liquid paraffin (50:50) as your fragrance-free, preservative-free emollient, applied liberally at least twice daily, most effectively immediately after bathing. 1, 2
Specific Prescription Examples
First-Line Option: Emulsifying Ointment
- Drug: Emulsifying Ointment
- Quantity: 500g tub
- Directions: Apply liberally to affected areas twice daily, preferably immediately after bathing. Use as often as needed for dry skin.
- Refills: 3-6 months supply (approximately 200-400g per week for moderate involvement)
Alternative Option: White Soft Paraffin/Liquid Paraffin
- Drug: White Soft Paraffin 50% / Liquid Paraffin 50% Ointment
- Quantity: 500g tub
- Directions: Apply liberally to affected areas at least twice daily, especially after bathing
- Refills: 3-6 months supply
Soap Substitute (Essential Component)
- Drug: Emulsifying Ointment OR Aqueous Cream
- Quantity: 500g
- Directions: Use as soap substitute for cleansing. Apply to wet skin, rinse off. Avoid traditional soaps and detergents.
- Refills: 3 months supply
Application Algorithm
Timing and Technique:
- Apply emollients within 3 minutes after a 10-15 minute lukewarm bath or shower 2
- Emollients work by providing a surface lipid film that retards evaporative water loss from the epidermis 1
- Frequency: Minimum twice daily; increase to 3-4 times daily for severe xerosis 2
Quantity Guidelines (per 2 weeks for adults): 3
- Face and neck: 15-30g
- Both hands: 15-30g
- Both arms: 30-60g
- Both legs: 100g
- Trunk: 100g
- Total weekly usage: 200-400g for moderate body surface involvement 1
Why These Specific Products
Ointments are preferred over creams/lotions because:
- Provide maximum occlusion and penetration 3
- Naturally preservative-free due to anhydrous formulation
- No fragrance additives
- Suitable for very dry skin and chronic eczema 2
Critical Pitfall to Avoid: Do NOT prescribe aqueous cream as a leave-on emollient—it contains sodium lauryl sulfate which is irritating. Use it ONLY as a soap substitute if needed 1. The evidence clearly distinguishes between dispersible creams for cleansing versus emollients for moisturizing.
Patient Education Points
- Demonstrate proper application at the visit—education regarding quantity and technique is essential 1
- Explain that adequate amounts must be prescribed and used liberally 1
- Most effective when applied after bathing to hydrate skin 1
- Continue daily even when eczema improves—this is maintenance therapy 2
- Use soap substitutes instead of traditional soaps which remove natural skin lipids 1
Evidence Strength
The recommendation for fragrance-free, preservative-free emollients is supported by multiple international guidelines 1, 2. While the 1995 BMJ guidelines are older, they represent consensus from the British Association of Dermatologists and remain foundational. The 2022 Taiwan guidelines 2 provide the most recent evidence supporting frequent application of fragrance-free emollients as integral to daily AD management regardless of severity, with specific emphasis on immediate post-bathing application.