titration with emollients
Making eczema a part of everyday life, not the life of everyday
Your Skin – What Happens and Why
With eczema your skins protective barrier becomes damaged and allows water (which is normally retained within this protective barrier) to become lost increasing the dryness of the skin. The damaged skin allows antigens/irritants to enter further damaging the skin and cells causing higher inflammation and ‘itch’ causing the sufferer to scratch. The more scratching, the more damage. The greater the damage the greater the breakdown to the skin barrier and more possibility of infection. This process, of ‘The Itch, Scratch Cycle’ is now well under way and the skin barrier function will be in need of repair with emollients to re-hydrate the skin.
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Emollients are the main foundation for treatment of eczema and work in a number of different ways; an emollient provides an oily film over the skins surface such as a bath oils/additives, an occludant forms a barrier film over the skin and can penetrate into the upper layers of the stratum corneum thus restoring the epidermal barrier, and humectant creams absorb water from their environment (the product) and promote water retention, they act like biological sponges. Primarily all forms of emollient add moisture to the skin and help to form/repair the protective barrier over the damaged skin. Emollient ointments act in a similar way to emollient creams by occluding and protecting the skin and retaining water but they are thicker and more intensive.
The most difficult part of any emollient programme is to get the user/patient to use enough emollient to support the skin into recovery. Generally, the reason for under use of emollients is due to a lack of understanding on ‘HOW’ to use emollients or being given a wide enough choice of the different types of emollients that are available to patients.
The recommended amount of emollient to use for eczema patients is listed below:
Recommended emollient use is:
- 250 – 500g per week for children
- 500g = 1 large pump dispenser of cream
- 4 x 500g per 4 weeks (of cream alone) other emollients are necessary to achieve healthy skin.
Understanding how to use your emollients in-line with your skins needs - Emollient Titration
Eczema is a skin condition which will vary in severity by person to person and also from day to day. Your skin will act and feel different in the morning, throughout the day and by the end of the day. During the night your skin will also be repairing itself, you are (generally) inactive and not exposing yourself to any external weather conditions or substances so it is an ideal time to increase the weight of your emollient and give your skin the extra moisture that it needs ready for the next day.
Understanding how to use your emollients will enable you to choose the best emollient for your skin at each point of the day/night and depending on ‘How’ your skin feels.
QV have introduced a ‘grading system’ to help you decide how heavy an emollient you feel your skin needs, and this grading system can be applied to most emollient ranges. For example QV Lotion is a light lotion that is great when your skin is feeling dry (but not sore or cracking), or for covering large body areas or for men who do not want the feel of a heavy emollient. QV Lotion has therefore been given a grading of (2), as opposed to QV Intensive Ointment, a much richer and more nourishing product which has a grading of (4) and is generally used when your skin is at its most dry and in flare and makes an ideal night-time treatment or when you are happy to apply a heavier weight product. Being able to step up and down the ‘Titration Ladder’ puts YOU in control of YOUR eczema program, and when you understand how Titration works this can be a very powerful way of managing YOUR treatment and YOUR eczema whilst supporting the recommendations of using the 500g per week of emollient. Titration means to move up and down the emollients available to YOU by grade (1 being the lightest weight) so YOU can decide which emollient to use, when and how they will work for you within YOUR daily lifestyle.
Using your emollients to fit in with your lifestyle
Understanding how to use emollients to meet the needs of your skin and to start to use your emollients to fit in with YOUR lifestyle will not only help you to achieve the right amount of emollient you need to keep your eczema under control, but also keep your eczema as a part of YOUR daily life NOT your life. This will be particularly useful when choosing an emollient for daytime use when using underneath delicate clothing or for use underneath make-up. For example an adult suffering with moderate eczema may choose to use QV cream (grade 3), rather than QV Ointment for daytime use (grade 4) first thing in the morning on the affected area but use QV lotion on their face (grade 2) in particular if they are using make-up (QV Lotion is lighter than QV Cream and would allow make-up application to be more easily applied than a heavier cream). This would also apply for teenagers.
Bathing with a bath additive such as QV Bath Oil (grade 1) will provide even and all over body coverage. This is a great way to cleanse and provide your skin with a base emollient without needing to use any further soaps or surfactants to your bath. It is the base layer for your skin and prepares your skin ready for your choice of emollient; it’s also a great way of keeping your normal bath time routine for yourself or for your children before bedtime. QV Bath Oil is perfectly safe for the whole family, it is non-slippy and there is no need to bath siblings separately. Pre bedtime is the best time for a heavier emollient such as QV Intensive Ointment (grade 4); it is SLS (sodium lauryl sulphate) free which gently glides onto the skin providing an occlusive layer of protective ointment to nourish the skin whilst you sleep. QV Intensive Ointment is the most concentrated product within the QV range but is still gentle enough to provide outstanding moisturisation for skin of all ages from neo-natal to elderly skin.
Children of school age would also benefit from using an emollient such as QV cream (grade 3) first thing in the morning as it moisturises deep into the skin and provides a protective layer over the skin to prevent additional moisture loss. A handy 100g pack size is also available for use in school bags for additional lunchtime applications.
QV Gentle Wash has been formulated for shower use and also for those who do still like to use a product that has some foaming action. Unlike many products on the market QV Gentle Wash does not contain any SLS (sodium lauryl sulphate), a commonly used surfactant that acts as a detergent in many toiletries (a common problem for people who suffer from eczema as it is directly associated with skin barrier breakdown).
QV Gentle Wash contains Glycerol at 15%, which acts as moisturiser retaining water in the skin cells and helps to support the skins own moisturising function. For people who suffer from eczema, showering and constant washing of hands will present a problem which is why QV Gentle Wash is a key product to have in your home.
QV Emollient Chart – A suggested Chart to Aid Emollient Product Choice
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Managing your Skin with QV – More than an emollient
QV Emollient Extra’s – There is soooo much more
- QV Bath Oil – can also be used directly on the skin to cleanse the skin or as eye make-up remover
- QV Gentle Wash – can be used diluted in warm water to wash babies skin instead of using wet-wipes
- QV Lotion – can be used as a face cleanser
- QV Cream (a humectant cream) – a great post shave moisturiser for men and women
- QV Intensive Ointment – a great shave ointment for men and women
To find out more about the QV range and to purchase online follow this link
Information written and supplied by Crawford Healthcare Ltd.
Last Reviewed: 3 February 2012
Next Review Date: 19 March 2012
