What is the best eczema cream?
I’ll let you in on a secret – creams are baffling for a lot of doctors; there are so many to choose from and unless you specialized in dermatology or have personal experience, it is difficult to understand the difference between each and every one. I often see patients bring in aqueous cream that they have been prescribed as a moisturizer – and yet it is a terrible moisturizer, and should only be used as a soap substitute to wash with! Luckily, I spent one year working with some of the best dermatologists at St John’s Institute of Dermatology (London) where I picked up invaluable knowledge that I will share on this blog.
As well as medical suggestions, the billion dollar cosmetic industry bombards consumers with different creams and lotions, so I am not surprised eczema sufferers don’t know which way to turn when it comes to creams.
Whether you are a hater of mineral oils and petroleum based products, the ultimate tip when it comes to picking a cream is that it needs to provide the cement (see my article what causes eczema?) that is lacking in eczema skin and seal in moisture. Petroleum based products (especially the ointments) are thick and good at providing this barrier, and they are usually inert (i.e. don’t contain potential allergens). I have no problems with commercial creams on the market if they work well to provide and seal in moisture – however, they may contain potential food allergens* (more on this below) and a lot are simply too watery to really provide a good barrier.
It’s hard to pick ‘the best’ because what works well for one may not work for another, but I will provide a guide for you here so you understand the fundamental differences. Emollients are basically divided into 3 categories:
Ointments are very thick Vaseline-like (i.e. semi-solid) moisturizers which are very good at sealing in moisture. For flare-ups, this is a good one to use. It is particularly good after a bath or shower where the skin has just been hydrated and the ointment can seal in that moisture. The downside is that it is thick and some people don’t want the shiny/oily look, and it can also rub off on clothing cos it doesn’t ‘sink-in’ to the skin. If you dislike the oily/shiny look then perhaps use the ointment when you are at home e.g. after a bath/shower in the evening, and a cream during the day when you need to go out. Examples of ointments: Aquaphor ointment, Hydromol ointment, QV ointment, Epaderm ointment.
Creams are basically diluted ointments – water or another liquid has been mixed into the ointment and so it is more runny, easier to apply/absorb and doesn’t leave a shiny appearance. However, due to the water content, it evaporates easier and does not have as much staying power as ointments. Therefore, you may need to re-apply more frequently. During flare-ups, it is probably best to switch to an ointment unless you can moisturize very frequently to keep the skin hydrated. It is also worth noting that many creams contain a preservative so if it ‘stings’, you may be reacting to the preservative in the cream. Examples of creams: Aveeno* Cream, Cetaphil cream, Eucerin cream, Cetraben cream, Hydromol cream, sebamed cream.
Lotions are the thinnest emollient and have the highest water content, they are runny and have the least staying power. It is useful for hot, humid weather where you want to avoid a sticky feeling. However, if your eczema flares up using only lotion, it may be because it is not moisturizing enough or staying on the skin for long enough. So either increase the frequency of moisturizing or switch to either a cream or ointment. Example: Aveeno* lotion, Exederm lotion, sebamed lotion.
Tip. You may have noticed that actually a lot of the ointments, creams, lotions have the same name but it is what follows the name that determines its consistency. e.g. there is Aveeno Cream and Lotion. So when you are choosing a product, the most important thing is to look at whether it’s an ointment, cream, or lotion rather than the brand names only.
And remember, in flare-ups, use thick moisturizers not lotions!
*As mentioned above, you may sensitize to allergens through your skin. So oat products such as Aveeno (and home-made oat baths) may theoretically be sensitizing the individual to oats through the skin (not a problem if your child is already eating and tolerating oats). If your child is not eating oats, but is bathing in it, there is a chance the immature immune system will SEE oats through broken eczema skin and become allergic. It is a theoretical risk and we don’t know for sure that sensitization comes from skin contact, but it may be something to bare in mind especially before weaning. Once your child is eating and can tolerate the various allergens it’s fine to use creams that contain them. Similarly, if you use any oils that have been bought off the shelf, check the ingredients as some may contain nut oils/seed oils which could potentially be sensitizing the body through the skin.