Complete Emollient Therapy or CET involves the frequent and liberal application of emollient moisturisers to the skin, and the replacement of wash products with emollient equivalents.3,11
Simple emollients leave an occlusive oil-based layer on the skin, which helps to prevent the loss of water from the stratum corneum.3
Other emollients contain a humectant such as sodium pyrrolidone carboxylate (NaPCA).12,13 Humectants have a hygroscopic action, which draws water into the stratum corneum and holds it there, and are usually combined with an occlusive layer to then preserve this moisture.3,12
Urea also acts as a humectant.12 A component of the skin's natural moisturising factor (NMF), urea augments the effects of simple emollients. Urea has been found to decrease trans-epidermal water loss (TEWL) in normal to dry skin (i.e. in patients who do not have a defective skin barrier), and also to reduce skin sensitivity to irritation induced by sodium-lauryl-sulphate (SLS).14
In "Skin barrier breakdown: a renaissance in emollient therapy" (2009), it is advised:3
"In order to produce the optimum repair of the skin barrier in atopic eczema a complete emollient therapy regimen should be used. This consists of a leave-on emollient cream or ointment and emollient bath, shower and wash products. It is essential to use sufficient quantities of emollients in order for them to be effective: 250-500 grams of an emollient cream per week in a child."
Another key facet of Complete Emollient Therapy is cosmetic acceptability and patient choice, ensuring that the prescribed emollient products are suitable for the patient and their ability to apply them.15 Ointments tend to be greasy and may be more appropriate for use at night, for example,15 or children may not have access to emollients during the school day.
It may be advisable to have samples of different brands and formulations, so that patients can test and reject unacceptable products before going through the expense and process of prescription.16
Complete Emollient Therapy is a long-term skin treatment, and can be maintained for as long as required. Patients should be encouraged to continue with emollient therapy even if their skin condition appears to be under control, as emollients play a role in helping to prevent dry skin, and sudden cessation of treatment may lead to a relapse of symptoms.
The Hydromol range includes a number of emollient-based products for the management of dry skin conditions.