What is the best over-the-counter (OTC) emollient for eczema?

Best Over-the-Counter Emollients for Eczema

The most effective over-the-counter emollient for eczema is a fragrance-free formulation containing urea and glycerol, which has been shown to significantly strengthen the skin barrier and provide superior protection against irritants compared to simple paraffin-based or glycerol-only emollients. 1, 2

Types of Emollients and Their Effectiveness

Different emollients have varying effects on skin barrier function:

• Urea-glycerol combinations: Provide superior skin barrier strengthening, increase natural moisturizing factor (NMF) levels, and protect against irritation 2
• Glycerol-containing emollients: Better than simple paraffin creams but not as effective as urea-glycerol combinations 2
• Simple paraffin-based emollients: Limited effectiveness for barrier repair despite being commonly prescribed; may actually reduce skin's natural moisturizing factors 2
• Ointments: Best for very dry skin and winter months due to occlusive properties 1
• Creams: Good balance between moisturization and cosmetic acceptability 1
• Lotions: Less moisturizing but preferred in hot, humid weather 1

Application Guidelines for Maximum Benefit

• Apply emollients liberally and frequently (3-8 times daily) 1
• Use even when skin appears normal to maintain barrier function 1
• Apply immediately after bathing while skin is still slightly damp to trap moisture 1
• For adults with eczema, approximately 600g/week may be needed for adequate coverage 2
• For children, emollient requirements can be estimated based on body surface area: approximately 130g/m²/week meets the needs of 95.8% of patients 3

Choosing the Right Emollient

When selecting an OTC emollient, consider:

1. Formulation effectiveness: Products with urea and glycerol have demonstrated superior barrier repair properties 2
2. Patient adherence: The most effective emollient is one that will be used consistently 1
3. Climate considerations: Ointments for dry/winter conditions, lighter formulations for humid/summer conditions 1
4. Potential allergens: Choose fragrance-free products to minimize risk of sensitization 1
5. Skin condition: More occlusive formulations for very dry skin 1

Cautions and Considerations

• Watch for signs of contact dermatitis, which may indicate sensitivity to emollient ingredients 1
• Deterioration in previously stable eczema may suggest development of contact allergy to the emollient 1
• Simple paraffin-based emollients, despite being widely prescribed, may not improve skin barrier function 2
• Emollients alone may not be sufficient for moderate to severe eczema; they should be part of a comprehensive treatment plan 4, 1

Evidence for Other Non-Medicated Topicals

• Tar preparations: Effective but may have compliance issues due to smell and staining 5
• Gamma-linoleic acid preparations, borage oil, evening primrose oil: Show efficacy in small studies 5
• MAS063DP cream (Atopiclair): Demonstrated effectiveness 5
• Chamomile and acidic hot spring water baths: May be effective but insufficient evidence 5
• Wet wrap dressings: Potentially effective but increase risk of skin infections 5
• Hamamelis distillate creams and aromatherapy massage: Ineffective 5

For optimal management of eczema, emollients should be used as part of a comprehensive approach that may include appropriate topical anti-inflammatory treatments for flares, trigger avoidance, and infection prevention strategies 4, 1.