What is emollient therapy?

Emollient therapy describes the application of moisturisers which are used to make the skin less scaly and dry. Often the words emollient and moisturiser are used interchangeably.

Should I use emollients?

The majority of people find the use of emollients helpful when treating their psoriasis. The reasons for this are:

(1) They make the skin feel less dry and more comfortable
(2) They make the skin feel less scaly and remove the dead dry skin scales
(3) They soothe the skin, making the skin feel less itchy
(4) They lubricate the skin and help prevent painful cracking
(5) It seems to make the other treatments you use more effective. Topical treatments applied after using emollients are often more effective, as you are applying the 'active' treatments to well moisturised skin rather than a layer of dry, dead skin cells.

So what are emollients?

There are three key elements to emollient therapy.

1. The first element is using a bath oil in the bath. There are many different ones on the market that you can buy but you can also get them on prescription from your GP. If you shower rather than bath you can buy emollient shower gels. An emollient bath is soothing and can help reduce dry skin and itching
2. The second element is using a soap substitute. Soap tends to dry the skin and if your skin is very dry it is best to avoid using it. Soap substitutes such as aqueous cream are very helpful. Many moisturisers can also be used as soap substitutes
3. The third element is applying a moisturising cream or ointment. Ointments tend to be greasier and therefore more effective, but are not always cosmetically acceptable. They take up to an hour to soak in and can stain clothing. Creams are more cosmetically acceptable and effective for the majority of people. They soak in within 10 to 15 minutes and do not stain clothing. These can be bought over the counter or are available on prescription. If your skin is not very dry at all, you can try using lotions which are in effect liquid creams- they tend to be the least effective but the easiest to use.

What sort of emollient?

There are hundreds of different emollients to choose from. Those produced by pharmaceutical companies are generally most effective and these are the ones that are available on prescription. What is most important is that you find one that you like to use and that seems to work for you.

When should I use emollients?

Ideally you should use bath oils and soap substitutes when ever you bath or shower. You can apply as much cream or ointment moisturiser as often as you like. Twice a day is the ideal minimum but it will depend on how dry your skin is. The best time to apply your cream or ointment moisturiser is when you have had a bath or shower and your skin is still warm.

Once you have applied it allow it to sink in for 10-15 minutes and then apply the "active" treatment which your doctor may have prescribed you. Carry out this procedure in the morning and evening (although you don't need to bath twice daily). Please note that the "active" treatment that your doctor has prescribed may only need to be applied once a day- read the instructions carefully.

How do I apply emollients?

When using emollients in the bath (bath oils) read the instructions as they will tell you the correct amount to use, please note they do make the bath slippery. All other elements of emollient therapy you can use as much as you need. Do not be afraid of using too much. When you apply the cream or ointment stroke it gently into the skin rather than rubbing vigorously. Also apply in a downward motion that follows the line of the hairs.

What is the difference between emollient therapy and "active" treatment?

Emollients by themselves will not clear your psoriasis, but they will make you skin feel more comfortable. It may be that by using them you make the "active" treatment more effective. "Active" treatments will help to clear your psoriasis if used properly. They are usually (but not always) available only on prescription. "Active" treatments include: calcipotriol, dithranol, steroids, tacalcitol, tar and tazarotene.

Which emollient to use on scalps?

Psoriasis can affect the scalp. Coconut oil is a very effective emollient treatment for the scalp. Coconut oil is a greasy preparation and is best applied overnight. You may need to ask a relative or friend to help you apply the coconut oil. You will need to part your hair and apply generously by rubbing into the scalp, your hair will be greasy from the oil, so to protect your bedding use an old pillow and pillowcase and you could consider sleeping in a shower cap. The next morning simply wash your hair with a tar shampoo.