I wrote this article because quite a number of patients have requested an opinion on the world of topical creams out there — these are patients relatively new to eczema and other dermatoses like psoriasis or TSW. Then there are those patients who have shared with me what worked for them. I have tried to put a list of what is out there commercially, and hopefully by reading this article and other related articles, they will get a good head start in using and deciding on what works best for them or their child.
Let’s get to know the classic petrochemical product first. Emulsifying Ointment BP has received somewhat good feedback despite being in-your-face synthetic.
It has been used to good effect for cracks, especially those in the webbings as well as joints on the hands and fingers, for example in the photo below, by a patient in the chronic dry phase of Red Skin Syndrome.
As for its sidekick, the Aqueous Cream BP, I hear less about it from clients. Aqueous Cream BP has had bad press for being in the market despite a research paper concluding in 2010 that “application of Aqueous Cream BP, containing ∼1% SLS, reduced the SC thickness of healthy skin and increased its permeability to water loss.”
Many patients are scouring the market for the best product for them or their kids. The products they look for are slightly more ‘sophisticated’, for lack of a better word. They include baseline products like Cetaphil, QV, Physiogel and Eucerine; oat-based products like Dermaveen, Aveeno, A Derma and Robertson’s; and finally, what I classify as the Dump-It-On products (which dump on additional natural ingredients), like Sebamed, Atopiclair, Propaira and Derma-E.
They also end up using more ‘natural’ ointments/cream, but we will talk more about that in another article.
The Baseline: Cetaphil, QV, Physiogel and Eucerin
These products contain more ingredients for humectant and emollient function and are one up on Aqueous BP. The most common and affordable creams would be QV or Cetaphil.
QV cream is prides itself on its squalene content. Squalene makes up about 10% of our sebum, a mix of lipids coming from our sebaceous glands. The function of sebum includes, amongst others things, providing lipid protective function as well as help in riding the skin of free radicals.
Cetaphil cream prides itself on its ceramide content. Skin ceramides make up about 40% of the lipids in the extracellular ‘cement holding together the barrier that is the stratum corneum (outermost layer of skin). Ceramides are also a component of Elizabeth Arden’s Gold Eye capsules.
Cetaphil has an enhanced product a.k.a Restorderm, which can also be purchased online. Its selling point is the “patented ceramide and filaggrin technology”.
There is some research (e.g. this french one) that show how ceramides and other skin lipids do reduce transepidermal water loss and improve barrier repair after damage. And this paper concludes that ceramides are crucial to barrier function for childhood atopic dermatitis.
And there is Physiogel, which has creams and lotions, but also a cream catered uniquely to those with eczema, Physiogel AI.
Physiogel boasts of containing Squalene just like QV does. And it adds on a natural ingredient of olive oil, which also contains squalene. Olive oil has historically been used for skin maintenance as well as a carrier oil in a balm or salve.
Eucerin is another one that is similar. Its main call to fame for the cream is “pH5”, which means “more acidic”, which means better for supporting barrier function.
Note that Eucerin’s expanded product range includes a cream containing oatmeal (read up more on oats below), ceramides and licochalcone. You can get it online.
Adding Oats: Dermaveen, Robertson’s, Aveeno, A-Derma
Oats have about 10% lipid content and these provide humectant and emollient qualities a compromised skin barrier requires. More than that, it is rich in beta-glucans, which have strong anti-inflammatory function and also assist in deposition of collagen in the skin. These products reviewed below were probably inspired by the humble oatmeal bath prescribed by naturopaths, but they take it to the cream/ointment level.
Dermaveen is a cream like QV or Eucerin, but it contains colloidal oatmeal, which is simply oats that you grind up and throw into a body of water – voila a colloidal bath. Here, you have ground-up oats in a cream with ingredients that provide humectant and emollient support.
Aveeno cream is named after avena sativa, the botanic name for the common oat. Many patients have ‘recommended’ Aveeno to me, so that I can share its goodness with other patients.
As if to one-up on Aveeno, we have A-Derma cream, a range of products based on the Rhealba Oat (extracted) as well as another proprietary substance, Filaxerine. Filaxerine is a basically a combination filaggrin (the deficient protein in barrier-compromised ezcemateous skin) and omega-6 fatty acids. The hope is that filaggrin which is slathered on will then crosslink amongst the keratin layer in the epidermis to strengthen skin barrier.
Again, i have only heard good things about A-Derma, so do consider this product is you are looking for topical solutions. It has worked wonders for one of my patients with weepy wounds and intense heat under the skin.
Robertson’s Skin Repair is an ointment made in Australia. Robertson’s provides the colloidal oat component as well as cod liver oil, which is rich in omega-3 fatty acids, EPA and DHA. All these would help moisturize and repair the skin barrier. Note that this is a very natural product compared to the other three mentioned before. It is not good or bad, because different people respond differently and have their sensory (how their skin feels in response) preferences. Note too that this is an ointment, so it is heavier on the oils, and hence provides a thicker feel when compared to creams, and is often preferred when the skin is very dry.
Dump-It-On Natural: Sebamed, Propaira, Atopiclair, Derma E
Sebamed moisturizing cream with a low pH5.5 that adds in vitamin E as an antioxidant. As with most other products we are featuring here, it sings the hypo-allergenic motto, and so frees itself of certain ingredients.
Propaira provides an Extra Calming Lotion (note: thin texture) for eczematous skin. Apart from the usual chemical ingredients for humectant and emollient function, it adds on grapeseed extract.
Atopiclair moves further along the ‘natural ingredients’ path, including shea butter to moisturize with hyaluronic acid, while throwing in antioxidants like grapeseed extract and vitamins C and E. Like Aveeno, it is a cream, which is of lighter texture than an ointment.
Derma E Psorzema is a cream highly recommend by one client who has experimented with many ways of managing her Topical Steroid Withdrawal topically. Psorzema combines the two dermatoses Psoriasis and Eczema. This cream is big on natural ingredients and includes an armory of herbs European and Eastern, e.g. Neem, Burduck, Coptis, Barberry, Bearberry. It also contains the ‘skin vitamins’ A and E as well as expensive jojoba oil.
Apicare 30% Manuka is a recent recommendation by a friend whose child presented with mild eczema in the flexures. The cream worked well for him, so it is also on this list.
Choice of ointment/cream/lotion often depends most on symptomatic relief. It is of upmost importance that the topical application feels right on you, whatever the product boasts of. Yes, we would like a maximum of anti-inflammation and skin protecting qualities, but it also has to ‘feel good’, so that the itch factor is reduced somewhat, or the pain from cracks is alleviated. Some people respond better to thicker occulent ointments (e.g. petroleum-based or even thicker oils), because thinner creams/lotion leave the skin feeling ‘dry’.
Note too that you can be using different products on different parts of your body. e.g. thick ointment on cracked fingers and toes and a lighter cream on the rest of the body. Also, some creams that worked before may not work now. Other creams that disagreed a year ago may actually work when your skin is drier.