In addition to protecting against known triggers, non-medication approaches include:1

·       using cotton clothing and bedding

·       avoiding woollens and some synthetics

·       making sure rough seams or clothing labels do not scratch

·       using non-biological washing powder

·       keeping nails cut short

·       keeping room temperature comfortable, and cooler if heat triggers itching

·       avoiding extreme temperature changes.

Emollients are the mainstay of therapy at all levels of severity but products containing sodium lauryl sulfate (SLS) should be used with caution or even avoided. SLS, an ingredient in emulsifying wax, is considered the main culprit behind some children having skin reactions when aqueous cream is applied. Chlorocrescol, cetostearyl alcohol and parabens, may also contribute to dermatitis.16

Following an investigation in 2013, the medicines regulator, the MHRA advised: €Despite the potential irritant effects reported in the literature, in clinical practice aqueous cream used both as an emollient and a wash-off soap substitute has been useful in a substantial proportion of patients with atopic eczema.

€Some patients with eczematous conditions, particularly children, may develop adverse skin reactions if aqueous cream is used as a leave-on emollient, often within 20 minutes of application. These reactions are not generally serious. However, patients and their carers should be warned of this risk during an eczema treatment consultation, and if there is any skin irritation, patients should try an alternative SLS-free emollient.€

A further hazard with aqueous cream, as with any paraffin-based emollient if used in significant quantities, is the potential for it to cause dressings or clothing to become much more flammable.17