Atopic dermatitis isn’t just dry skin. It’s a persistent, frustrating cycle: itch, scratch, rash, repeat. For millions, this isn’t a temporary annoyance-it’s a daily battle. The good news? The foundation of managing it doesn’t require pills or injections. It starts with something simple, but often misunderstood: emollient therapy.

What’s Really Going On With Your Skin?

Atopic dermatitis, often called eczema, isn’t caused by dirt or stress alone. It’s rooted in a broken skin barrier. Think of your skin like a brick wall. The bricks are skin cells, and the mortar is made of proteins like filaggrin. In people with atopic dermatitis, that mortar is cracked or missing. That’s why moisture escapes (called transepidermal water loss), and irritants, bacteria, and allergens slip in. Studies show people with AD lose 15-30 grams of water per square meter of skin per hour-more than triple the rate of healthy skin.

This isn’t just dryness. It’s inflammation. The immune system overreacts to these invaders, triggering redness, swelling, and that intense itch. And scratching? That makes the cracks wider, letting in more irritants, and the cycle spins faster. It’s not a matter of willpower-it’s biology.

What Makes Flares Worse?

You can’t control your genes, but you can control what touches your skin. Some triggers are obvious. Others sneak in quietly.

Cold, dry air is a major one. In Glasgow, winter humidity often drops below 40%. That alone increases flare risk by 37%. Heat is just as bad. Sweat, especially when it sits on skin for too long, becomes an irritant. Over 60% of people with AD report flares when temperatures climb above 27°C.

Then there are the everyday products. Sodium lauryl sulfate, found in many soaps and shampoos, can damage the skin barrier at concentrations as low as 0.5%. Fragrances-even those labeled "natural"-trigger flares in 15% of users. Preservatives like methylisothiazolinone cause contact dermatitis in nearly 6% of emollient users.

Even laundry detergent can be a culprit. Residue left on clothes, especially in hard water areas like Glasgow, can sit against skin for hours. Many people don’t realize their rash isn’t from the air-it’s from their own washing machine.

Why Emollients Are the First Line of Defense

Emollients aren’t just moisturizers. They’re skin repair tools. Their job is to replace the missing mortar in your skin’s wall.

There are three types of ingredients that do this:

• Occlusives (like petrolatum) seal moisture in. Petrolatum blocks water loss by 98%-more than any other single ingredient.
• Humectants (like glycerin) pull water into the skin. The sweet spot? 40-50% concentration. Too little, and it doesn’t help. Too much, and it can dry skin out.
• Emollients (like ceramides) fill in the gaps. Ceramides make up 50% of the skin’s natural barrier. In AD, levels drop by up to 70%. Replacing them isn’t optional-it’s essential.

The American Academy of Dermatology calls emollients the cornerstone of treatment. Why? Because they work without side effects. Unlike steroid creams, which can thin skin with long-term use, emollients have adverse events in only 2.3% of users.

How to Use Them Right (It’s Not Just Slathering)

Applying emollient the wrong way makes it useless. Applying it right can cut flares by over a third.

The key is timing and technique.

After a lukewarm bath (15-20 minutes), pat skin dry-not rub. Then, within three minutes, apply your emollient. That’s when your skin is still holding onto 50% more water. Miss that window, and you’re locking in dryness.

Use enough. Most people use too little. The AAD recommends 250-500 grams per week for adults. That’s about two full tubes of a standard 150g tube, twice a week. For kids, double that. A 2020 study found patients using over 100 grams per week had 43% fewer flares than those using less than 50 grams.

Apply in downward strokes, following hair growth. Rubbing in circles can irritate skin. Use two to three finger-lengths of product for each body section-arm, leg, chest, back.

Which Emollients Actually Work?

Not all products are equal. The market is flooded with options, but only a few deliver real results.

Petrolatum (Vaseline) is the gold standard for severe flares. It’s cheap, effective, and fragrance-free. Reddit users with eczema mention it in 63% of positive reviews.

For daily use, look for ceramide-containing products like CeraVe or Eucerin. CeraVe scored 68% satisfaction in a National Eczema Association survey-higher than Eucerin’s 52%. Both contain ceramides at the right concentration (0.5-3%), and both are free of fragrances and common irritants.

Avoid anything with alcohol, essential oils, or "natural" scents. Even lavender or chamomile can trigger flares. Check the ingredient list. If you see "parfum," skip it.

Preservatives matter too. Parabens cause reactions in 2-5% of users. Look for products labeled "preservative-free" or those using phenoxyethanol, which is better tolerated.

When Emollients Alone Aren’t Enough

Emollients are the base. But they’re not a cure-all.

For mild cases, they clear up symptoms in 30-40% of people. For moderate to severe, you need more. Topical steroids are still the go-to for flares. They reduce inflammation fast. But they’re not for daily use on thin skin-like the face or eyelids. That’s where topical calcineurin inhibitors like tacrolimus come in. They’re steroid-free and safe for sensitive areas.

For chronic, severe cases, newer biologics like dupilumab can reduce flares by 70-80%. But even these work best when paired with consistent emollient use. As Dr. Eric Simpson puts it: "Without consistent barrier repair, no other treatment can be fully effective."

The Hard Truth About Adherence

The biggest problem with emollient therapy? People stop using it.

In studies, only 35% of patients stick with it after six months. Why? Two reasons: texture and time.

Petrolatum feels greasy. Ceramide creams can be thick. Urea-based products leave a sticky residue. And applying twice a day, every day, takes effort. A 2022 survey found 67% of people say they skip applications because they’re "too busy." The solution? Make it easy.

Keep emollients where you’ll see them: next to the sink, in the bathroom, in your bag. Use pump bottles instead of tubs-they’re less messy. Apply while watching TV, after brushing your teeth, or right after your child’s bath. Turn it into a habit, not a chore.

What’s Next?

The field is evolving. In May 2023, the FDA approved the first emollient with sustained-release ceramides-Ceramella MD. It reduces water loss by 63% over 12 hours, compared to 38% for standard versions.

Researchers are now testing microbiome-targeted emollients-formulas designed to reduce Staphylococcus aureus, a bacteria that thrives on broken skin and worsens flares. Smart dispensers that track how much you use are in pilot testing at major hospitals.

But the core hasn’t changed. Your skin needs repair. Emollients are the most proven, safest, and most accessible way to do it.

Frequently Asked Questions