Psoriasis topical treatments: leave-on emollients (moisturisers)

Leave-on emollients (moisturisers) were used by lots of the people we spoke to. Lisa says she’s been using them since she was a young child. Many people had tried different emollients, including those which were medicated, available on prescription and shop-bought/over-the-counter. Emollients range from lighter creams to more greasy ointments and the choice of emollient is up to people’s preferences. Unlike eczema where people often have dry skin all over, dry skin with psoriasis tends to be in particular areas. Abbie didn’t find E45 helped but other types made her skin less itchy. Some people had also used cosmetic moisturisers and ‘natural remedy’ creams – like Manuka honey cream. Most said they preferred unscented moisturisers.

Steven likes being able to try different emollients (moisturisers) to see which work for him.

Age at interview 22

Gender Male

Age at diagnosis 14

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So a friend of mine raves over the Aveeno cream, which is like oat-y. And I remembered like when I first started, in fact it’s just come back to me, when I first started that oats were a thing and someone was like, Put oats in tights and like put them, wrap them round. And I was like, Really? I did it, it didn’t help. And this friend raved over the Aveeno cream. She was like, Oh, I’ll bring it when I see you, you can try it. I was like, This is bloody awful, like, y’know. It’s not doing it for me. And funnily, at the hospital last week I got given a load of little like test pots. And I think if you can get hold of them, it’s really good. Our, my dermatology department are fantastic. They’ll let you, photo therapy nurses will let you just, they’ve got a cupboard and it’s like, Help yourself to the cupboard. Try what you like. And that’s quite good, cos you can then try something. As it happened, a pot of the Aveeno stuff came in. It was a little one, came in this thing. And I actually quite liked it on my hands. And I was like, Okay, well maybe we won’t use it on all of me, but as a hand thing we’ll bear it in mind.

I think also, for me, a lot of it is what comes in like a handy sized packet that you can hide somewhere. Got one in the car.

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Russell talks about the types of moisturisers which work best for his skin.

Age at interview 20

Gender Male

Age at diagnosis 19

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I think some of the kind of scented ones tend to work less or kind of the high street brands ones tend to work less you need the kind of like the heavier, more medical, homeopathic ones like the kind of the because I was prescribed a I think it’s like a water based moisturiser for along with the steroid cream kind of like aqueous cream you can buy over the countered very similar to that, I think maybe just one step kind of more serious [laughs] or more heavier than that yeh but those ones seemed to work best, the high street ones or the ones that are sort of I don’t know fancy, flowery or whatever tend to work less but I’ve no idea why, but I think the other ones tend to be a bit more kind of, pack more of a punch.

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Using emollients was often an everyday part of people’s treatment routine. This was usual after showering and before going to sleep. Russell keeps a moisturiser on his desk at home to top-up during the day. He also puts on moisturiser after washing his hands or washing-up. Steven sometimes moisturises in the bathroom at work and keeps a spare ’emergency’ moisturiser in his car. Abbie says carrying emollients when out or going away is a pain.

Many people said moisturising helped keep their psoriasis ‘under control’. Emollients were enough for Sofia’s skin when she was younger but she needed steroid creams when it became worse. Russell hopes moisturising will prevent another flare-up. Lucy can ‘definitely see the difference’ if she doesn’t moisturise every day. Ella says her emollient helps her psoriasis and makes her ‘normal skin nice and smooth’. A few people said they didn’t use moisturisers much. Jack has a prescribed emollient but doesn’t use it often because he says his skin isn’t very dry. Simon finds steroid creams are enough to keep his skin moisturised without emollients. Adam doesn’t use moisturiser often but feels he should do more.

Louie fits emollients into his routine and finds using them helps his skin.

Age at interview 16

Gender Male

Age at diagnosis 13

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Well at the moment because I’m between treatments, I’ve finished with all the creams and all the different steroids and stuff like that. And at the moment I just use moisturiser just to keep my skin nice and smooth and not dry and it doesn’t let the psoriasis crust up as much and that is something I’d advise to anyone with psoriasis: do moisturise because it is really helpful. Find a moisturiser that’s good for you and that makes your skin feel nice and use that cos without it, it does inflame the psoriasis slightly and with me at the moment I get up, I moisturise in the morning say about, about quarter past seven then I chill in my room for about- until about half seven then I can get ready for the next half an hour before I go to school, doing obviously getting ready, washing, stuff like that. Well, I usually wash before I put cream on cos obviously that’s the normal order. And then when I get in, I usually- when I get in from school I usually like take off my school uniform, I moisturise then and then get into something a bit more comfortable like a vest and probably some boxer shorts or some shorts and just chill around the house for a bit and, yeah, that’s-. And then before I got to bed I usually have a bath and then moisturise again and then so I’m fresh for the morning and I don’t have to have, sometimes I don’t have to have a bath in the morning, I can just have a wash or a quick shower.

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Some people found emollients soothed their skin and helped stop itchiness. This provided ‘symptom relief’ for Carys while waiting to start phototherapy. Ella and Louie said moisturising reduced skin flaking. Lucy’s dermatologist recommended using emollient for shaving her legs. Some people liked thick emollients, but others found these could add to itchiness. Abbie says it’s difficult not to pick at the skin on her ears when she’s put moisturiser on it because it’s ‘thick and horrible’.

Many difficulties with using emollients are covered in the overview section on topical treatments. This includes the time taken to apply and wait for emollients to dry. Another big issue for many was feeling sticky or oily. Carys felt ‘covered’ in ‘grease’ and the emollients got on her clothes, which led to ‘a never ending circle of washing’. Emollients make Adam and Zara feel ‘sweaty’. Abbie’s skin feels oily when she moisturises after showering with soap substitutes. Many people put on emollients before going to sleep but disliked pyjamas and bedding sticking to the skin.

Moisturising her face helps Ella’s psoriasis but can be tricky with acne.

Age at interview 16

Gender Female

Age at diagnosis 3

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The creams can be quite greasy. I do have one which is like more of a like a creamy texture rather than my other ones which are sort of more like gel like so they’re translucent, but they can be really greasy which is like when I’m trying to moisturise my face as well, for my acne I’ve had some trouble with that because obviously it’s not the best to have greasy like-, have grease, like as soon as I moisturise my face I have to put the gels on so it can be really greasy which-. And it can get into my hair as well, especially when putting it around my face, which isn’t a problem but it’s like if I’ve washed my hair and then put my creams on and then my hair is greasy, and it’s just like little things like that which are quite cosmetic but, so that they don’t really like have any like medical issues or anything, but it can be quite annoying for me like with my, yeah, appearance.

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Carys struggled to fit in using emollients with shift work as a nurse.

Age at interview 23

Gender Female

Age at diagnosis 22

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So, at home I had the Oilatum and I had Doublebase cream which although it made me feel really oily, it did help. So when I mentioned this when I was having my phototherapy sessions, they gave me little sample bottles of Dermol, which I could use as a soap replacement and as a moisturiser while I was on the ward. So it meant I was able to keep topping up with moisturisers throughout the day, even at work. Cos, you know, cos I work 12 hours and the environment’s, the heating’s always on or, you know, it’s not a very good probably, it’s not a good environment for your skin, really. I would sometimes go 12 hours without putting anything on my plaques, which probably didn’t help but you know, it couldn’t be helped either. Like I had to work, so those little bottles at least meant that my hands and my arms were kept from getting any worse, because of the continual hand washing.

It was more just the time that it took and with me being a shift worker, having to add that into my day when I worked 12 hours was quite difficult because it would-, sometimes like I’d have to soak in the Oilatum and then put my creams on and all this and it would take upwards of an hour. And when you’ve worked 12 hours it’s the last thing on your mind. You just wanna go to bed, but when you’re covered like that and you can’t sleep with it, cos it’s irritating you, you have to do it. But I was lucky I didn’t react to any creams or anything.

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