Considerations that will effect how patients use emollients

Encouraging patients to concord with treatment is a key role for nurses; the concept of concordance is examined in some depth in Helping patients make the most of their treatment. With regards to emollient use, one of the key considerations is the usability of the product. The Skin Care Campaign reminds us that patients have to ‘wear’ topical products and this is of course true for emollients. Products that suit one person will not suit another and so choice is key to successful selection and subsequent use. ‘Psychorheology’ is the name given to the study of the response an individual has to the application of a topical product (Marks, 2001).

In practical terms, the best way to get patients to use emollients is to provide them with a number of samples that they can go away and try before getting large quantities prescribed. To make this a reality, a team approach with the pharmacy department or advisor within the workplace is essential. Consideration needs to be given to workplace policies on getting free samples from the pharmaceutical industry and on giving non-prescribed items to patients. Having emollient formularies within a workplace helps in the process of establishing the emollients which can be given out as samples.

Patient choice of emollient might be affected by something related to the product, the environment or themselves. Each of these are considered in turn.

The product
A common concern for patients is the consistency of the product, how greasy it is and how it smoothes onto the skin. This is not as simple as saying people do not like greasy products and do like creamy ones, because this is simply not the case. The product needs to be easy to apply to the skin and not to sting. Although most pharmaceutical products have no fragrance added to them, some do have a slight aroma. Indeed, it is probably because there is no fragrance to ‘mask’ the smells of the ingredients that people complain. Smell is a very personal issue. So, if someone does not like the smell of a product (even if it does not appear to have a smell) it is important that another product is tried. The physical presentation of a product may also have a bearing, e.g. a pump dispenser may be much easier than having to scoop a product out of a pot.

The environment
One of the major environmental factors that can impact on and individual’s choice of emollient is the ambient temperature. Thick greasy emollients can also act as insulators and in hot weather may be too uncomfortable to use. It is also true that when the atmosphere is dry, the skin is more likely to become dry as there is less natural moisture in the air. Windy conditions can have a similar effect. Thus in hot conditions a lighter cream might be preferred whereas in cold, dry, windy conditions an ointment might be more suitable.

The person
The condition of an individual’s skin will impact on the type of emollient that they may feel able to use. If the skin is very dry, a greasy ointment may feel most comfortable; if it is only moderately dry, a cream might be more appropriate. What a person does on a day-today basis will also make a difference; someone who is at work in smart clothing is unlikely to want to put on greasy emollients prior to getting dressed, but the same person may well be willing to use the greasier products under their pyjamas before going to bed. A greasy product may be fine on the feet where it can be covered up with socks and shoes, but totally unbearable on the face.

To get the most out of emollients, health care professionals need to engage in a conversation with their patients ascertaining as much information on the above as possible. It is not as straightforward as thinking ‘very dry skin, needs very greasy emollients’. Therapeutically this may be the best decision to make, but in reality, if a patient does not like the product, it will stay in the pot where it has no therapeutic benefit at all!