Is Aqueous Cream Really Good for Your Eczema?

Many people suffer from eczema globally and a lot of us understand the importance of using skin moisturizers to protect their skin and prevent flare ups. However, many cosmetic products such as aqueous cream (AQ cream) claim to help improve eczema. But is this really the case? This article will explore the matter of controversial problems relating to AQ cream and provide alternative products for treating eczema.

What is Aqueous Cream?

AQ cream is a moisturizing cream rich in emollients and suitable for patients with eczema. It is an emulsion of natural oil and water which can also be used as soap. It is fragrance-free and aims to hydrate dry and sensitive skin. 

AQ cream is a popular choice for many patients as it is cheap and easy to buy. It is known to be an “over the counter medicine”which can be obtained easily from nearby pharmaceutical shops at a reasonable price. 

Its major ingredients are paraffin, purified water, and sodium lauryl sulfate (SLS). Most of these ingredients work as natural emulsifiers and occlusives to reduce moisture loss in the skin. [1] However, recent research poses concern over side effects of using AQ cream. 

What is the problem with AQ cream?

Recent studies from dermatologists and scientists shows that the use of AQ cream can cause skin irritation and potential flare ups for eczema patients. 

The study used trans epidermal water loss (TEWL) to determine the permeability barrier function and the integrity of the outermost skin layer. TEWL refers to the amount of water evaporated to the environment through the skin surface. The higher the amount of water evaporated, the drier the skin becomes which may lead to worsening skin conditions. [2]

The permeability barrier function and integrity of the outermost skin layer are great indicators for eczema patients. The permeability function of skin indicates whether the skin can maintain solutes and prevent irritants from getting in. These two factors are indicators of eczema patients as we often have problems with flaky skin. [3]

The research indicated an increase in TEWL and decrease in outermost skin integrity after using AQ cream as a leave-on emollient on eczema patients. Applying AQ cream made their skin dryer with more water loss and a reduction in permeability barrier function. [2]

The disruption in permeability barrier function is closely correlated with the onset and severity of eczema. It may lead to an increased penetration of irritants and allergens which can potentially trigger eczema flare ups. It may also cause an increased infection of harmful bacteria. 

How does Sodium Lauryl Sulfate Trigger Eczema?

AQ cream contains Sodium Lauryl Sulfate (SLS) which is a surfactant commonly found in skin care and beauty products. Its function is to trap oil-based dirt on skin which can then be removed by water. It is important for cleaning and foaming properties in cosmetics. 

As AQ cream can also be used as body soap for bathing, the SLS functions as a cleansing agent to generate foam and wash away the dirt. This allows patients to rub off dirt effectively. [4]

Although SLS is a relatively safe chemical, it is recently said to be a culprit of triggering eczema flare ups. SLS is the reason for TEWL elevation and skin irritation. 

As SLS weakens the skin barrier, it may cause potential eczema flare ups. SLS can increase the pH of the outermost skin, disrupt the lipid synthesis on the outermost skin layer and disrupt the skin's structural protection. This allows an increased chance of inflammations and flare ups. 

A Pharmacist’s perspective on SLS – by Keshia Kung

I believe that SLS is common in a lot of cosmetic products such as soap and shampoo, and the cause of irritation of these cosmetic products is rare as they are washed off quickly. I also think that using AQ cream for showers is fine as there is no evidence of it causing adverse effects. However, it may be a different story when applying to skin.

The MHRA reported that some patients may develop irritations and allergy reactions when AQ cream is used as a leave on emollient. [5] But I believe that the patient is unlikely to have adverse skin reactions if there are no negative effects seen after a period of time. 

On the other hand, when the patient faces adverse effects when using AQ cream, they stop using it and consult the doctor immediately. The patient can also request for a SLS-free moisturizing cream or one from a different brand. 

In addition, it is important to study the list of ingredients carefully and avoid SLS products as it may cause skin irritations.

What can be used as an alternative?

Cetaphil is a well known brand for soothing eczema related symptoms. It has been recommended by US dermatologists for over 70 years and is an experienced brand in making skin care products.

Physiogel products are ranked top 1 in Korea and are the most commonly prescribed medical products in Hong Kong Hospitals. As Korea is famous for having high quality cosmetic products and Hong Kong has high medical standards, Physiogel is proven to be effective in treating eczema.

1. Physiogel Hypoallergenic Calming Relief A.I. Cream

Figure 3: A picture showing the Physiogel Hypoallergenic Calming Relief A.I. Cream

Physiogel Hypoallergenic Calming Relief A.I. Cream, Physiogel in short, is a cream used to soothe and moisturize sensitive skin which helps to reduce rash irritations for a long period of time. It has a watery texture which aims to give an instant relief on the skin by quick absorption. It can also strengthen and repair skin moisture barrier.

It contains ingredients such as shea butter and squalene which can effectively promote healing of skin and prevent water evaporation. It is beneficial for flaky skin and improves the skin protection barrier.

‍

2. Cetaphil Moisturizing cream

Figure 4. A picture showing the Cetaphil Moisturizing Cream

Cetaphil Moisturizing cream is a hydration-intensive cream with strong humectants and emollients. It can effectively prevent moisture loss and increase water binding to the skin. It has a slightly thick texture to ensure  long-lasting skin hydration. 

It is formulated with their unique hydration blend of vitamin B3, B5 and glycerin to enhance  skin moisturization for sensitive skin. It is also dermatologically tested to improve eczema skin conditions. 

Personal Experience with the Alternatives

As an individual with eczema, I personally prefer Cetaphil Moisturizing cream over Physiogel as it has a longer moisturizing effect. Although the texture is greasier than Physiogel, it is a better emollient and occlusive as I still feel moisturized after a night’s sleep. 

Also, Cetaphil Moisturizing cream is less irritable than Physiogel. When my condition is bad, I always have wounds and painful flare ups on my body. I normally opted to put moisturizing cream to relieve the symptom as it is better than steroids. Applying Cetaphil moisturizing cream felt better as there were no stings and painful irritations when compared to Physiogel. 

Applying Physiogel would be great when there are no wounds, and the skin is not super dry. Physiogel is more convenient as it can be absorbed quickly and feel less greasy. It is suitable for those who prefer a thinner moisturizer. It is also suitable for treating mild skin flare ups. 

In conclusion, AQ cream is a thick moisturizing cream that could be used for bathing but not as a leave-on ointment. It contains SLS which may cause skin irritations and water loss. It is best to avoid cosmetics with SLS and choose other alternatives such as Physiogel Hypoallergenic Calming Relief A.I. Cream and Cetaphil Moisturizing Cream according to the needs. 

‍Disclaimer: The preference on alternatives are based on personal experiences only. Impacts and reviews may differ in different individuals.‍

References

1. Ltd, T.R. Aqueous Cream BP. 2019  [cited 2022 17 Jun]; Available from: https://www.medicines.org.uk/emc/product/4820/smpc#gref.
2. Danby, S., et al., The effect of aqueous cream BP on the skin barrier in volunteers with a previous history of atopic dermatitis. British Journal of Dermatology, 2011. 165(2): p. 329-334.
3. Gilliam, A.E. and M.L. Williams, Chapter 4 - Skin of the Premature Infant, in Neonatal Dermatology (Second Edition), L.F. Eichenfield, I.J. Frieden, and N.B. Esterly, Editors. 2008, W.B. Saunders: Edinburgh. p. 45-57.
4. Scaefer, A. What is Sodium Lauryl Sulfate (SLS)? 2019; Available from: https://www.healthline.com/health/beauty-skin-care/what-is-sodium-lauryl-sulfate.
5. MRHA, Aqueous cream: may cause skin irritation. 2014.