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SLS in Eczema — SCE Dermatology MCQ

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HardInflammatory DermatosesSLS in EczemaSCE Dermatology

A patient with atopic eczema uses aqueous cream as a leave-on moisturiser and reports immediate stinging followed by worsening erythema. The formulation contains sodium lauryl sulfate. What is the best next step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Stop it as a leave-on emollient and substitute a suitable sodium-lauryl-sulfate-free preparation

Explanation lettering: D = shown as B · B = shown as D

A is correct. Sodium lauryl sulfate is a detergent surfactant that can irritate eczematous skin, increase transepidermal water loss and disrupt the stratum-corneum barrier, particularly when aqueous cream is left on the skin. The product should be stopped as a leave-on emollient and replaced with a tolerable SLS-free formulation selected with the patient. Stinging is not evidence of efficacy, bacterial infection requires clinical evidence rather than automatic antibiotics, dilution does not convert SLS into a humectant, and prior corticosteroid cannot guarantee protection from irritancy. Some aqueous-cream formulations may be used as soap substitutes if tolerated, but the adverse leave-on response here is decisive.

Reference: MHRA aqueous cream safety update: https://www.gov.uk/drug-safety-update/aqueous-cream-may-cause-skin-irritation