Emollients

Everything you
need to know
about but were
EXPLAINED
afraid to ask

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 Published by:
Wounds UK
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© Wounds UK, 2022

This document has been

developed by Wounds UK
and supported by
Hydromol.

Glossary

EMOLLIENT: A substance that hydrates and softens the

skin by slowing evaporation of water
Content reviewed by HUMECTANT: A substance that helps retain moisture by
Ayesha Marshall, Nurse drawing water into the skin
Consultant Tissue NATURAL MOISTURISING FACTOR (NMF): A mixture
Viability, South Tyneside of small compounds present in the the skin, derived from
and Sunderland NHS filaggrin, sweat constituents and triglyceride turnover.
Foundation Trust The NMF mixture consists of amino acids and amino acid
derivatives, lactic acid, sugars, urea, glycerol and a variety
The views expressed are of ions
those of the authors and
SKIN FRAGILITY: Skin that is easily damaged bruised or
do not necessarily reflect
torn, especially in older individuals or those who are very
those of Hydromol.
young or have comorbidities
SKIN INTEGRITY: Skin being whole, intact and undamaged
How to cite this SKIN TEAR: A wound that occurs when the layers of skin
document: separate or peel back, which are most common on the
Wounds UK (2022) Emollients arms or legs, and are often seen in those with fragile skin
Explained. Available to download (particularly older people)
from: www.wounds-uk.com XEROSIS: Dry skin

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What is an emollient?

Emollients help restore the barrier function of the integrity of the skin has typically become vulnerable
skin, reduce itching, and increase hydration levels and requires support (Moncrieff et al, 2015).
(Callagahan et al, 2018). Emollients should be used
in all patients with fragile or at-risk skin, to reduce How emollients work
the risk of skin damage and further complications Simple emollients work by ‘trapping’ moisture into
that may affect patient quality of life and add the skin and reducing water loss by evaporation
to clinician time and overall costs (Le Blanc et (Wounds UK, 2015). They are available as
al, 2018). moisturisers (creams, ointments and lotions), bath
oils, gels and soap substitutes (NICE, 2015).
In healthy individuals, the skin is strong and
resilient. However, as skin ages and becomes Some emollient products contain humectants,
thinner and more fragile, it becomes more which either mimic or comprise the same
susceptible to external and internal injury due to molecule as NMF. These emollients have been
ageing and altered physiology. The loss of natural shown to promote increased hydration, as the
moisturising factor (NMF) with age also means humectants have water-attracting properties and
that the skin becomes drier and less hydrated. encourage the active movement of water from
the dermis to the epidermis, as well as helping to
Once the skin becomes dry, it is more vulnerable hold water in the stratum corneum (Callaghan et
to splitting and cracking, exposing it to increased al, 2018).
water loss through trans-epidermal evaporation
and to bacterial invasion, further adding to the risk Using emollients has been found to preserve skin
of infection (Callagahan et al, 2018). By age 60, the integrity and reduce the risk of damage: a care

Fully developed adult skin Ageing older skin

• Dry skin
• Skin damage
Skin integrity

• Increased skin surface pH

Developing infant skin

- linked to an increase in skin

barrier breakdown
• Decreased skin integrity
• Reduced natural moisturising factor (NMF)
• Poorer water-holding capacity
• Abnormal levels of intercellular lipids

0 40 80
Age (years)
Figure 1. Changes in the epidermis as it ages (from Moncrieff et al, 2015)

EMOLLIENTS EXPLAINED | 3
 What is an emollient?  (continued)

home-based study that introduced twice-daily use 2018), which are wounds that may result from
of emollients as part of the residents’ daily routine blunt trauma, falls, poor handling, equipment
was found to decrease incidence of skin tears injury or the removal of dressings.
by 50%. Guidance states that emollients should
be used daily, particularly in those with fragile or They can occur anywhere but are often
aged skin, or those who have, or are at increased sustained on the arms, legs and hands (LeBlanc
risk of, a wound (Carville et al, 2014). and Baronski, 2011). Skin tears can be painful
and distressing, may increase the length of
Injuries in fragile skin hospital stays, can lead to increased health
Patients with aged and fragile skin are at increased costs and have an impact on quality of life
risk of wounds such as skin tears (LeBlanc et al, (Wounds International, 2018).

Environmental factors Physiological lipids

a. normal
outer
epidermis
Stratum
corneum
Urea Ceramides

Environmental factors
Water loss Physiological lipids

Stratum
b. aged corneum
outer
epidermis

Decreased urea Decreased ceramides

Inflammation due to
unprotected skin

Figure 2. The physiology of the normal outer epidermis (a) and aged outer epidermis (b), adapted from
Moncrieff et al, 2015

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The importance of preventing skin damage

The ageing population means the incidence of specialist dressings, this should include products
skin tears is increasing. However, skin tears are to cleanse and moisturise the skin (LeBlanc et al,
often preventable wounds that create avoidable 2018). Complete emollient therapy (CET) is a way
costs (LeBlanc et al, 2018). Prevention should of keeping skin properly moisturised at all times by
be the main aim when assessing, planning and using a combination of emollient products liberally
implementing care for skin damage, including and frequently. It should be seen as a vital part of
skin tears. skin care in patients with aged or fragile skin. The
use of emollients can be incorporated into a care
Emollient therapy and skin care bundle to aid with moisture management. Using
When skin tears occur, it is vital that the wound emollients instead of soap for cleansing can help
care products chosen will optimise healing and not protect and hydrate vulnerable skin at risk from
increase the risk of further skin damage. As well as pressure damage (Callaghan et al, 2018).

Skin damage prevention checklist (adapted from LeBlanc et al, 2018)

Risk factor Action
Skin ■ Inspect the skin and investigate previous history of skin tears
■ Assess risk of accidental trauma if the patient has dry, fragile, vulnerable skin
■ Manage dry skin and use an emollient to rehydrate
■ Implement an individualised skin care plan using a skin-friendly cleanser and warm water
■ Prevent skin trauma from adhesives, dressings and tapes; use a medical adhesive remover if
necessary
■ Consider medications that may directly affect the skin (e.g. topical and systemic steroids)
■ Be aware of increased risk due to extremes of age
■ Discuss use of protective clothing
■ Avoid sharp fingernails or jewellery in patient contact
Mobility ■ Encourage active involvement/exercises if physical function is impaired
■ Avoid friction and shearing and use good manual handling techniques as per local guidelines
■ Conduct a falls risk assessment
■ Ensure that sensible/comfortable shoes are worn
■ Apply clothing and compression garments carefully
■ Ensure a safe environment — adequate lighting, removing obstacles
■ Use padding for equipment and furniture
■ Assess potential skin damage from pets
General ■ Educate patient and carers on skin tear risk and prevention
heath ■ Actively involve the patient/carer in care decisions where appropriate
■ Optimise nutrition and hydration, referring to dietician if necessary
■ Refer to appropriate specialist if impaired sensory perception is problematic (i.e. diabetes)
■ Consider possible effects of medications and polypharmacy on the patient’s skin

EMOLLIENTS EXPLAINED | 5
 Introducing Hydromol

Hydromol is a range of emollients, which the surrounding skin from further damage
includes different products for indications or breakdown.
including dry skin, eczema and psoriasis. The
Hydromol range includes: Emollient creams can be used as a good soap
■ Hydromol Cream (containing sodium substitute, and bath emollient can be used
pyrrolidone carboxylate [PCA]) instead of traditional bubble bath. Hydromol
■ Hydromol Ointment Ointment is the number-one prescribed
■ Hydromol Bath & Shower Emollient ointment in the UK (NHSBSA, 2022) and
■ Hydromol Intensive (containing urea). provides an ideal option for use in wound care,
to preserve the skin and reduce the risk of
Why choose Hydromol damage, particularly in patients with vulnerable
The full Hydromol range can be used to skin who are at risk of developing a hard-to-
provide CET to individuals with vulnerable or heal wound (Wounds UK, 2022).
at-risk skin.
Additionally, Hydromol Ointment is available
Hydromol emollients can improve overall in a tube, helping to reduce the risk of infection
skin integrity and reduce the risk of damage compared to tubs (NHS, 2020). Hydromol
in dry skin, and in skin conditions such as Cream contains the added benefit of a
eczema (Wounds UK, 2022). Emollient use humectant for dual-action moisturisation in
can reduce the risk of damage at dressing patients with very dry skin. The humectant
change if the individual has a wound requiring sodium PCA hydrates the skin by attracting
adhesive dressing products and can be used water form the dermis to the epidermis and
as part of a care plan to reduce the risk of trapping water in the stratum corneum, which
occurrence in individuals at risk of recurring leg helps to moisturise the skin from the inside
ulcers (Wounds UK, 2022). They also protect (Callaghan et al, 2018).

6 | WOUNDS UK 2022 SUPPLEMENT

Remember, using emollients can help protect Self-care checklist (from LeBlanc et al,
and cleanse the skin, preserve skin integrity and 2018)
reduce the risk of wounds such as skin tears.
■ Have I been given an individualised skin
care plan?
Practical tips for using emollients such as ■ Am I using an emollient every day?
Hydromol: ■ Am I eating sensibly and drinking enough
■ Apply Hydromol as often as possible, at least water?
3–4 times a day (or twice daily for Hydromol ■ Am I keeping as active and mobile as
Intensive) possible?
■ Apply liberally to the affected area ■ Am I wearing clothing to protect my skin
■ Always use bath emollient when bathing. Air (e.g. long sleeves, shin guards or tubular
or pat dry (do not rub) and liberally apply the bandages)?
cream/ointment ■ Has my environment been made as safe
as possible (e.g. adequate lighting, no
■ Although Hydromol Bath & Shower Emollient
obstacles and using padding on furniture if
leaves less residue on surfaces than other required)?
leading products (data on file), always take ■ Am I wearing sensible/comfortable shoes to
care when getting in and out of the shower avoid falls?
or bath
■ Even when skin starts to improve, do not stop store in a cool place before applying (however,
using emollient therapy — skin problems can it should not be heated or chilled)
occur again quickly ■ Apply the cream/ointment in the direction of
■ Take some of your emollient with you hair growth to avid blocking hair follicles
wherever you go, and don’t wait until you run ■ Take care with naked flames after applying
out to get some more any emollient product; it is important to be
■ If you prefer the cream/ointment warmer or aware of the risk of fire and how to minimise
cooler, you can either warm it in your hands or this (CQC, 2022).

References
Beeckman D, Campbell KE, LeBlanc K (2020) Best practice LeBlanc K, Campbell K, Beeckman D (2018) Best practice
recommendations for holistic strategies to promote and maintain skin recommendations for the prevention and management of skin tears in
integrity. Wounds International aged skin. Wounds International
Callaghan R, Cowdell F, Danby S et al (2018) Best Practice Statement: Moncrieff G, Van Onselen J, Young T (2015) The role of emollients in
Maintaining skin integrity. Wounds UK maintaining skin integrity. Wounds UK 11(1): 68–74
Care Quality Commission (2022) Fire risk from use of emollient creams. NHS (2020) Emollients. Available at: https://www.nhs.uk/conditions/
Available at: https://www.cqc.org.uk/guidance-providers/learning- emollients/ (accessed 03.08.2022)
safety-incidents/issue-3-fire-risk-use-emollient-creams (accessed NHS Business Services Authority (2022) Prescription cost analysis (PCA)
26.07.2022) date. January 2022
Carville K, Leslie G, Osseiran-Moisson R et al (2014) The effectiveness of a National Institute for Health and Clinical Excellence (2015) Tacrolimus and
twice daily skin-moisturising regimen for reducing the incidence of skin pimecrolimus for atopic eczema (TA82) Quick reference guide. Available
tears. Int Wound J 11(4): 446–53 at: http://www.nice.org.uk/guidance/ta82 (accessed 21.07.2022)
Data on file. Mass residue experiment, University of Edinburgh, School of Wounds UK (2015) All Wales Guidance for the prevention and
Physics management of skin tears. Available at: www.welshwoundnetwork.org/
LeBlanc K, Baranski S, Christensen D et al (2016) The art of dressing files/8314/4403/4358/content_11623.pdf (accessed 21.07.2022)
selection: a consensus statement on skin tears and best practice. Adv Skin Wounds UK (2022) Emollients Made Easy. Wounds UK
Wound Care 29(1): 32–46

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