If you have eczema then you’ve probably used Aqueous cream in the past; you may even still be using it as it’s still on the market as a moisturiser for dry skin conditions. Most doctors prescribed it as the first moisturiser to try if a patient displayed with signs of eczema; one of the main reasons being that it’s cheap! So, I was shocked to learn from Dr Adam Fox, Allergy specialist at Guys and St Thomas’s hospital in London that it’s actually bad for eczema. He gave a fascinating talk entitled “Hay fever and allergic rhinitis – state of the art solutions” at the Allergy and Gluten Free show in London last month, where he shared loads of useful new breakthroughs, but this one stuck in my mind.
Aqueous cream describes itself as: “Aqueous cream BP can be used as a moisturising cream suitable for use all over the body. It is also an ideal cream for the symptomatic relief of dry skin conditions. This non-perfumed emollient cream helps to soothe, soften and moisturise dry skin conditions such as eczema & dermatitis.”
However, acqeous cream is not quite what it seems. It has been found to actually make eczematous skin worse due to the harsh surfactants it contains.
A study, led by Tsang & Guy, at the University of Bath called, “Effect of Aqueous Cream BP on human stratum corneum in vivo”, investigated whether aqueous cream had a good of bad effect on the skin of people without atopic dermatitis.
The study was published in the British Journal of Dermatology in May 2011, where the article, “The effect of Aqueous cream BP on the skin barrier in volunteers with no previous history of atopic dermatitis” examines the results of the study with interesting conclusions.
Here is an abstract of the article, unfortunately you can’t read the whole thing without subscription to the journal.
Summary
Background:? The emollient Aqueous cream is frequently used for the treatment of atopic dermatitis (AD), yet it is associated with a high rate of adverse cutaneous reactions. It contains the harsh anionic surfactant sodium lauryl sulphate, a known negative environmental factor associated with the exacerbation of AD.
Objectives:? To investigate the effect of Aqueous cream on stratum corneum (SC) integrity and skin barrier function in volunteers with a predisposition to a defective skin barrier.
Methods:? Thirteen volunteers with a previous history of AD (no symptoms for 6 months) applied Aqueous cream BP twice daily to the volar side of one forearm for 4 weeks. The other forearm was left untreated as a control. Permeability barrier function and SC integrity were determined before and after treatment by measuring transepidermal water loss (TEWL) in conjunction with tape-stripping. For comparison thirteen volunteers with current AD were recruited for assessment, without treatment, of SC integrity and skin barrier function at unaffected sites.
Results:? Topical application of Aqueous cream resulted in significant elevation of baseline TEWL and a concomitant decrease in SC integrity. Measurements made after no treatment in volunteers with current AD, at unaffected sites, suggest that application of Aqueous cream negatively affects the skin barrier towards the damaged state associated with onset of flares of the disease.
Conclusion: Aqueous cream used as a leave-on emollient caused severe damage to the skin barrier in volunteers with a previous history of AD. Aqueous cream should not be used as a leave-on emollient in AD patients.
Basically, the results showed that even for people without any previous history of skin problems, acqueous cream thinned the skin, caused significant loss of moisture and damaged even the skin of the healthy participants of the study.
I was amazed to hear this, and to read on the internet more proof that it’s really bad for dry skin. 50% of people with eczema who try it say it irritates their skin so doctors should not be prescribing it anymore. It certainly made mine worse and I stopped using it years ago. If you are still using it and your skin isn’t great, question whether the aqueous cream might be the problem. Go back to your doctor and demand a different moisturiser to try and throw out the old tub straight away.
Apparently it’s not new news. The National Eczema Society had this to say on their website, “Why is Aqueous Cream bad for eczema?”
The Daily Mail ran an article entitled, The cure with a sting: Eczema cream meant to soothe ‘makes skin WORSE’ which puts the blame on the Sodium Lauryl Sulphate in the Aqueous cream. It also has some interesting comments from web readers who recommend Aveeno which does not contain any Sodium Lauryl Sulphate and is super moisturising; I know because I’ve tried this moisturiser on the recommendation of my sister.
Aqueous cream never worked for my skin, I persevered with it for years, but when my skin continued to be dry and I kept suffering from flare-ups my doctor changed my prescription to other moisturisers. I have now settled with Epaderm and Diprobase as my main moisturisers.
I would question whether the Sodium Lauryl Sulphate is the culprit here as I use Epaderm without any problems and on investigation, I discovered that it too contains Sodium Lauryl Sulphate. Just do a google search for the dangers of Sodium Lauryl Sulphate (SLS) and it doesn’t make pleasant bed time reading. Diprobase appears not to contain SLS but it does contain other ‘ium’ and ‘ate’ type ingredients which I don’t quite understand or identify as natural.
So should I still be using Epaderm? Or should I stop using that too? Even though it isn’t irritating me? Now I’ve looked into SLS on the internet I’m not sure I want to be using it anymore… Confused? How can our doctors, who are supposed to be experts in these matters be prescribing these products?
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I’ve been told to use aqueous cream many times for eczema and, whilst I can’t say it’s ever made mine worse, it’s been next to useless. I might as well not have used anything at all. Great article.
Thanks Jo! It’s cheap! That’s why they prescribe it. Obviously marketed well. Makes me really cross. It made my skin get worse and worse… There are loads now that are much better. Go back and demand a SLS free moisturiser! Might have do a blog about which brands from the shops are good. Usually they’re the expensive ones unfortuntalely!
This is so right Ruth.
My daughter had terrible ezcema for years and was prescribed Aqueous cream – I went back to the doctor as she used to cry when I applied it and the switched her to Epiderm. I did notice an improvement but I assumed that this was because her skin was changing as she got older – maybe not. Great information to share with us Ruth.
Thanks Lorraine. I know your daughter is very sensitive like me. I am even a bit allergic to the Aloe Forever living sun cream I think. The lady told me your daughter was the only other person who was! Ha Ha. Am amongst good company. Take note though that Epaderm also contains SLS. Check it out out on the internet and make sure you understand all the ingredients of everything you and she use on your skin, as well as what you eat. It all gets absorbed. I will be finding out all about SLS as this shocked me. More to follow…
Interesting blog Ruth. Don’t jump the gun on this. Make sure (as you appear to be planning to do) that your research is thorough and that you include peer-reviewed literature. Good luck!
Ken
Any cream can make eczema worse as they all contain preservatives which are sentitisers and can cause allergies. Thus always use a small amount of cream in one area for a day or two before applying more widely when you use any new cream. It is possible at any later date to become allergic to your cream so if suddenly it makes your skin worse this has happened and will probably always happen with that cream or a cream with similar ingredients.
Reaction to ointments is much rarer as they do not need preservatives if used up to the expirey date. Many people do not like them for obvious reasons of greasyness. Others use nothing else.
Aqueous cream is fine for those who do not react to it and have used it for years. It is cheap and the purveyors of more expensive creams try to get people to use their highly profitable creams instead.
Apply common sense as above.
Clearly those who react to Aqueous Cream are very vocal whilst the satisfied users remain quitely content.
I have no vested interests except comfortable patients.
Hi Colin. Apologies for not responding sooner. Are you doctor? I’ve been trying Shea butter recently. http://whatallergy.com/2012-03/shea-butter-for-sensitive-skin-and-eczema which, as just on ingredient, is amazing. I just worry about all these unnatural things we put on our skin, which absorbs 60% of what we put on it. Paraffin for instance. We don’t even use this to light lamps any more due to health concerns so why do we put it in creams and ointments for dry and sensitive skin? I know I’ve being controversial here and I also agree about the preservatives and stabilisers which can also cause irritation.