Emollients for Baby Eczema: Cream, Ointment or Lotion?

If your baby has eczema, the first thing your GP or health visitor will probably recommend is an emollient. It's a word most parents have never used before, and the choice on the pharmacy shelf can be bewildering: creams, ointments, lotions, gels, "barrier" this and "repair" that.

Here's what an emollient actually is, how the different types compare, and how to use one so that it really works.

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The Short Answer

An emollient is a medical moisturiser: a non-perfumed cream, ointment, lotion or gel that softens the skin and helps repair its barrier. For baby eczema, the best emollient is a fragrance-free one that you can apply generously and consistently, at least twice a day, every day. A large UK trial in children found no difference in results between creams, ointments, lotions and gels, so choose the texture that suits your baby's skin and your routine.

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What Is an Emollient?

"Emollient" is the medical term for a moisturiser used to treat dry skin. Emollients work in two ways. They form a protective layer that slows down water loss from the skin, and many contain fats (lipids) that help repair the skin barrier itself.

In eczema, that barrier is weaker than it should be. Moisture escapes and irritants get in, which is why the skin becomes dry, red and itchy. Using an emollient every day, even when the skin looks clear, is the foundation of eczema care. NICE guidance is clear that emollients should always be used, not only during flare-ups.

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Emollient, Moisturiser or Barrier Cream?

These words overlap, and you'll see them used interchangeably:

• Emollient is the medical term for any moisturiser used to treat a dry skin condition. Everything below is a type of emollient.
• Moisturiser is the everyday word. A fragrance-free moisturiser designed for eczema-prone skin is an emollient.
• Barrier cream usually means a thicker product designed to sit on the skin and shield it. Some are fine on eczema. Others, such as many nappy creams, contain zinc oxide or lanolin and are made for the nappy area rather than daily use all over.

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Cream, Ointment, Lotion or Gel?

The main difference between emollients is how much oil they contain compared with water. The more oil, the greasier it feels and the longer it stays on the skin.

Ointments

Thick and greasy, with little or no water. They give the heaviest protective layer, so they suit very dry, thickened or cracked skin and are useful at night. The downside is the greasiness: they can feel hot and sticky and can mark clothes. Ointments should not be used on weeping eczema.

Creams

A mix of oil and water. They absorb more quickly and are less greasy, which makes them practical for daytime and for babies who will be dressed, picked up and cuddled straight afterwards. Most families find creams the easiest to use consistently.

Lotions

Mostly water, so they're light and easy to spread. But they are not very moisturising, and on their own they are rarely enough for a baby with eczema. A perfumed lotion sold for "everyday baby skin" is not an eczema emollient.

Gels

Light and non-greasy, somewhere between a lotion and a cream. Some families like them for daytime.

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Which Type Works Best? The Evidence

In 2022 the Best Emollients for Eczema (BEE) trial put this question to the test. Across 77 GP surgeries in England, 550 children aged six months to 12 years with eczema were given a lotion, a cream, a gel or an ointment. After 16 weeks there was no difference in eczema severity between the four groups.

The researchers concluded that the right emollient for a child is the one they like to use. That matches my experience exactly. The "best" emollient on paper does nothing if it sits on the shelf because it's too greasy to live with. One that gets used generously, two or three times a day, makes a real difference.

Many families end up using two: a cream during the day and something richer at bedtime or in the depths of winter.

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Paraffin-Based or Paraffin-Free?

Many traditional emollients, including most of those prescribed on the NHS, are based on paraffin. Paraffin works well as a protective layer, and these products are inexpensive and widely available. Some parents prefer a paraffin-free emollient made with plant oils and lipids, such as sunflower, shea, avocado and jojoba, which aim to replace the fats that eczema skin is short of as well as sealing moisture in.

Both approaches are reasonable. What matters more is that the emollient is fragrance-free and that you use plenty of it.

Emollients of every type soak into clothing, bedding and dressings and make them easier to set alight. This applies to paraffin-free products too. Keep anyone using them away from fire, naked flames and cigarettes.

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What to Look For

• Fragrance-free, including "natural" fragrances and essential oils
• Suitable from birth, if your baby is very young
• No sodium lauryl sulphate (SLS), a foaming agent that can damage the skin barrier. It's the reason aqueous cream is no longer recommended as a leave-on emollient.
• A pump or tube, or, if you use a tub, a clean spoon to scoop the cream out each time so fingers don't contaminate it
• A size that matches how much you need, which is more than you might think

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How Much and How Often

Babies and children with eczema need a lot of emollient. NICE guidance suggests children with atopic eczema may need 250g to 500g a week: the lower end for a small baby with a few patches, more for widespread eczema.

• At least twice a day, every day, including when the skin looks clear. NHS guidance suggests three or four times a day where you can.
• After every bath, within a few minutes, while the skin is still slightly damp
• Smooth it on, don't rub it in, in the direction of hair growth
• Wash with it too. A leave-on emollient can be used in place of soap, which dries the skin.

For more detail, see How Often Should You Moisturise Eczema-Prone Skin? and How to Bath a Baby With Eczema Without Making It Worse.

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Using an Emollient With Other Treatments

If your GP prescribes a steroid cream for flare-ups, keep using the emollient alongside it. They do different jobs. Leave a gap between the two so the emollient doesn't dilute the treatment. Here's which to apply first and how long to wait.

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When to See Your GP

• The eczema isn't improving despite an emollient every day
• Your baby's sleep or feeding is affected
• An emollient stings or seems to make the skin worse. Ask about an alternative: NICE says families should be offered a choice.

Get urgent advice from your GP or NHS 111 if the skin becomes blistered, crusty or weepy, has pus-filled spots, feels hot or painful, or if your baby has a high temperature or seems unwell.

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About Ovée

I developed the Ovée Baby & Child Moisturising Cream as a paraffin-free, fragrance-free emollient cream for daily use from birth, built around oat, sunflower, jojoba and avocado oils. It's one option among many. Prescription emollients cost less, and if one is working well for your baby there's no reason to change. If you'd like to try a paraffin-free cream, the 50ml size is a sensible place to start, and it's covered by our 30-Day Skin Promise.

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Dr. Tim Clayton is a Consultant Paediatric Dermatologist, President of the British Society for Paediatric and Adolescent Dermatology, and Co-Founder of Ovée Skin Health.