Does a heavy cream help eczema, or just feel nice?

A question came in about a thick, fragrance-free cream, and whether it does anything for eczema. Yes, in one specific way, and no in another.

Eczema is a barrier problem. The outer layer of skin stops holding water in and starts letting irritants through, which is why it goes dry, itchy and sore in the same place over and over. A thick cream works by sitting on top of that broken barrier: it slows the water leaving, and it puts something between your skin and whatever is in the air.

So yes, it genuinely helps, and it is the cheapest part of any eczema routine. What it isn't is a fix.

What to look for on the label. The one word that matters most is fragrance-free. Scented products are the single commonest thing that makes eczema worse. Note that unscented is not the same claim: unscented can still carry a masking fragrance.

• Thick ingredients, high on the list: petrolatum, glycerin, dimethicone, colloidal oatmeal, shea.
• Skip while flaring: fragrance, essential oils, and any botanicals that smell nice.
• Hypoallergenic and dermatologist tested are fine words, but nobody polices them. Fragrance-free is the claim you can check with your own eyes.

How to use it so it works. Within about three minutes of washing, while the skin is still damp, so it traps the water that is already there. A thick layer twice a day, and again after every hand wash in winter. Frequency beats price.

For winter hands specifically: a pair of washing-up gloves does more than any jar. Hot water and detergent strip oil faster than cream puts it back.

What it can't do. It doesn't switch off a flare. Red, raised, cracked, itchy and not settling is inflammation, and cream does not touch inflammation. For a mild patch the usual answer is a thin layer of over-the-counter hydrocortisone 1%, once or twice a day, for a week or two. The cream is the layer around that treatment, not a replacement for it.

If you're the one selling it, the honest sentence is: it's fragrance-free and I use it on my own hands in the winter. That's true and it's plenty. It cures eczema is not true, and shouldn't be said by anyone selling a cream.

What to say to a doctor. Both hands, worse in winter, cracking at the knuckles, the cream helps for a few hours and then it's back, worse after washing up. That sentence gets you further than a photograph.

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