Using Emollients for Psoriasis

Substances used to trap moisture on dry, scaly plaques

An emollient is a natural or manufactured substance used to hydrate and protect the skin. Emollients work by not only adding moisture to the skin but preventing moisture from evaporating. Used for everyday skin care, emollients are also a cornerstone of treatment for psoriasis and other skin conditions.

Although it may take some experimentation to find the emollient that's right for you, there are some insights and tips that can help guide your search.

emollients for psoriasis
Illustration by Cindy Chung, Verywell

Psoriatic Skin Needs Hydration

The outermost part of your skin is composed of a layer of dead skin cells called the stratum corneum. It forms a barrier that protects the underlying tissue from infection, dehydration, and other sources of stress.

With psoriasis, the stratum corneum cannot protect the skin in the way that it should. This is because the disease causes the hyperproduction of skin cells, which pushes them to the surface faster than they can be shed. This not only disrupts the stratum corneum, allowing moisture to escape, but leads to the formation of dry, red, flaky patches called plaques.

Psoriatic plaques can often be intensely itchy and, if scratched, begin to bleed. The resulting trauma can even stimulate the production of new plaques (a phenomenon referred to as the Koebner’s response).

How Emollients Work

Emollients can help mitigate the symptoms of psoriasis by forming an occlusive (airtight and watertight) barrier atop the stratum corneum. This is achieved by adding oily compounds, known as lipids, to as the moisturizer base. By doing so, water molecules become trapped on the skin and are less able to evaporate. The higher the lipid content, the higher the emollient effect.

In addition to infusing moisture into the skin, emollients help plump the cells in the stratum corneum known as corneocytes. Doing so has a knock-on effect by:

  • Reducing skin scaling and flaking
  • Softening skin cracks
  • Alleviating irritation
  • Calming itch
  • Preventing scratching and bleeding
  • Relieving inflammation
  • Improving the skin’s barrier function
  • Avoiding secondary infections
  • Promoting healing
  • Reducing the risk of flares

Unlike the sun protection factor (SPF) rating used for sunscreen, there is no standard measurement used to rate the effectiveness of an emollient for consumers. With that being, emollients are generally evaluated on their ability to extend the time by which water naturally evaporates from the skin, known as the transepidermal water loss (TEWL).

Under normal circumstances, TEWL occurs at a rate of 4 to 8 grams per square meter per hour (g/m2/h). A layer of 5% petrolatum can increase the rate by 50% to 75% over several hours, according to a 2016 study in the Indian Journal of Dermatology. Other emollients may offer greater or lesser effect.

Types and Formulations

By definition, an emollient is a substance used to moisturize and soften skin, while a moisturizer is a finished product that contains an emollient. In practice, however, the terms are often used interchangeably.

There are many different types of emollients to choose from. The one that is right for you depends on both your skin condition and personal preferences.

Common emollients to look for include:

  • Petrolatum (white soft paraffin)
  • Mineral oil
  • Castor oil
  • Cocoa butter
  • Vegetable oils
  • Isopropyl palmitate
  • Liquid paraffin
  • Polyethylene glycols
  • Shea butter
  • Silicone oils
  • Stearic acid
  • Stearyl alcohol

There is not a lot of scientific data as to which emollients are best for psoriasis. For mild to moderate psoriasis, products made with petrolatum are often very useful. Petrolatum long-lasting and less likely to irritate the skin; the same applies to mineral oil and waxes (like lanolin and cetyl alcohol). In contrast, vegetable-oil-based emollients can oxidize and promote inflammation.

Of all the emollient options, silicone derivatives tend to be the least greasy.

Formulations to consider include:

  • Creams
  • Ointments
  • Lotions
  • Gels
  • Bath oil
  • Sprays
  • Soap substitutes

Generally speaking, products that are thicker and richer provide better moisture retention. However, some may be so rich that they leave the skin greasy. If you use a cream or ointment, you may want to use it at night and choose a lighter lotion for the daytime.

Other Product Ingredients

In addition to emollients, there are other substances used in the manufacturing of certain moisturizers. These include humectants such as alpha hydroxy acids, propylene glycol, and aloe vera gel. Rather than trapping water molecules, humectants bond to water molecules and draw them to the stratum corneum.

Another ingredient popularly marketed in skin care products is ceramide. This is waxy lipid found naturally in the stratum corneum that mixes with cholesterol and saturated fatty acids to maintain hydration and prevent infection. While marketed on its own as a special ingredient, ceramide is actually one of several substances used to create an emollient in certain moisturizers.

Application

Dermatologists generally recommend applying an emollient-rich moisturizer one to three times daily if you have psoriasis. For mild psoriasis, apply enough so that it rubs in smoothly and is absorbed in 10 to 15 seconds. If absorbed too quickly, the product is likely too thin.

For moderate to severe psoriasis, find a thicker moisturizer that takes 15 to 20 seconds to rub in. For facial psoriasis, it is best to use a thicker option at night and a lighter one during the day.

You may need to apply the moisturizer more frequently if you are exercising, sweating, or swimming. If outdoors, apply a layer of moisturizer to your skin before sunscreen. The same applies if certain topical medications irritate or dry your skin.

If using a moisturizer to treat foot psoriasis, change your socks every time you moisturize. If you don't, moisture can build up, creating a hotbed for a fungal infection.

Don’t stop using a moisturizer once your skin improves. By keeping the skin supple, it is less likely to incur stress that can trigger an acute flare.

Side Effects

Generally speaking, the emollients used is commercially available moisturizers are safe for use in adults, children, and pregnant women. Problems, if any, tend to be caused by other ingredients, such as solvents, preservatives, fragrances, or additives like vitamin E and essential oils. Some of these may cause an allergic reaction or irritate the skin.

Symptoms may include rash, skin redness, itching, and burning. An over-the-counter hydrocortisone cream can usually help relieve these. If symptoms persist, call your doctor. A systemic allergy or anaphylaxis is extremely rare.

Extra-rich moisturizers intended for the body should not be used on the face. Doing so may block the pores and cause blackheads or acne. If you need a richer moisturizer for your face, ask your dermatologist for advice.

A Word From Verywell

Almost everyone with psoriasis can benefit from using some sort of emollient product, including people with mild, moderate, and severe symptoms. Emollients can help protect the skin, promote healing, and reduce the recurrence of symptoms. Remember, though, that emollients are rarely used in isolation when treating psoriasis. While they can help ease dryness and itching, they do not treat the underlying inflammation in the way medications do.

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