Published: March 2012

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Aqueous Cream - Moisturiser or Irritant?

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Prescriber Update 33(1): 4
March 2012

Aqueous cream is the most widely prescribed emollient for the treatment of dry skin conditions and is often the first line of treatment for patients with eczema¹. However, recent studies suggest that the use of aqueous cream can damage the skin barrier when used as a leave-on emollient^1-3.

Aqueous cream BP first appeared in the British Pharmacopoeia in 1958 and the formulation has remained unchanged since then. One of its ingredients, sodium lauryl sulphate, is an emulsifier and known skin irritant. Although the product was originally intended to be a wash product, it is now generally prescribed and used as both a soap substitute and leave-on emollient¹.

Users of aqueous cream have reported high rates of skin irritation, prompting the National Institute for Health and Clinical Excellence (NICE) in the United Kingdom to remove it from their guideline on the management of eczema in 2007.

Eczema arises from a combination of genetic and environmental factors leading to the breakdown of the skin barrier. Soap and surfactants, such as sodium lauryl sulphate, have been identified as negative environmental factors and their use is not recommended in patients with eczema.

New research, published in the British Journal of Dermatology, shows that aqueous cream induces skin irritation². The study compared parameters of skin barrier function between skin treated with aqueous cream as a leave-on emollient and untreated skin. Treated areas showed a decrease in the size and maturity of keratinocytes, causing the skin’s protective structure to be compromised. Treated skin also showed increased transepidermal water loss, reflecting impaired barrier function.

In patients with a history of atopic dermatitis aqueous cream appeared to cause a greater amount of skin barrier damage and subjective irritation was common³.

These papers highlight the importance of not using products containing sodium lauryl sulphate, such as aqueous cream, as leave-on emollients as they may act to exacerbate skin damage rather than support skin barrier function.

References

1. Tang M, Guy RH. 2010. Effect of Aqueous Cream BP on human stratum corneum in vivo. British Journal of Dermatology, 163(5): 954-958
2. Mohammed D, Matts PJ, Hadgraft J, et al. 2011. Influence of Aqueous Cream BP on corneocyte size, maturity, skin protease activity, protein content and transepidermal water loss. British Journal of Dermatology, 164(6): 1304-1310
3. Danby SG, Al-Enezi T, Sultan A, et al. 2011. The effect of aqueous cream BP on the skin barrier in volunteers with a previous history of atopic dermatitis. British Journal of Dermatology, 165(2): 329-334