13.1 Dry and scaling skin disorders

13.1 Dry and scaling skin disorders

Emollient and Barrier Preparations

Metanium^® ointment

• Not to be used on broken skin

Sudocrem^® cream

• Not to be used on broken skin

Secura^®

Emollients

General guidance

• Both vehicle and active ingredients are important in the management of skin conditions
• The vehicle affects the degree of hydration of the skin, alters (increases or decreases) penetration of the active constituent and may have a mild anti-inflammatory effect
• Topical products may contain excipients to which some patients develop sensitisation, especially those with eczematous skin. It is important to check the excipient content of products before prescribing for such patients (excipients are listed in the BNF)

See Local BNSSG Emollient Guidelines:

BNSSG formulary emollient table

BNSSG first line emollients

BNSSG Position Statement on Silk Garments

Emollient Creams and Ointments

Please see the MHRA Drug Safety Update regarding the fire hazard with use of ALL emollients (not just paraffin containing). And the MHRA Guidance document on the safe use of emollients.

Clinicians are reminded that when prescribing emollients containing the ingredient cetostearyl-alcohol, patients should be advised to avoid contact with the eyes/eyelids, and wash hands after use. If the product does accidentally come in contact with eyes, rinse well with water and seek medical advice.

Emollient Creams and Ointments, Paraffin-containing

Lotion

E45^® lotion (TLS Green)

QV^® lotion (TLS Blue)

• Only for use if a lanolin free lotion is needed. Lighter formulation emollient suitable for application to hairy areas, skin folds, face or scalp

Cream

Epimax^® Original Cream (TLS Green)

Epimax ExCetra^® cream (TLS Green)

ZeroAQS^® cream (TLS Green)

Zerocream^® (TLS Green)

Aproderm^® emollient cream (TLS Blue)

• Second line to epimax emollients, only for use if a pump container is required for patients with limited dexterity

Gel

Epimax Isomol^® gel (TLS Green)

Aproderm^® gel (TLS Blue)

• Second line to epimax isomol, only for use if a pump container is required for patients with limited  dexterity

Doublebase Once gel (TLS Blue)

• Second line emollient option for chronic severe inflammatory hand conditions only where first line emollient options have not controlled disease.

Adex gel (TLS Blue)

• Second line emollient option for facial inflammatory conditions - eczema, psoriasis, perioral dermatitis, seborrhoeic dermatitis.
• For use in patients with facial inflammatory conditions where topical steroid sparing is required but topical calcineurin inhibitors are not tolerated/effective or reduced topical corticosteroid frequencies are giving flare and alternative options have not controlled disease only.

Ointment

White soft paraffin in liquid paraffin (50:50) (TLS Green)

Emulsifying ointment (TLS Green)

Epimax^®  ointment (TLS Green)

Epimax^® Paraffin-free ointment (TLS Green)

Cetraben^® ointment (TLS Blue)

• For use if other ointments not appropriate or acceptable and therefore optimal use is restricted

Spray

Emollin^® (TLS Blue)

• Specific indication only: For very painful / fragile skin where there is difficulty with ‘hands on’ application of creams / ointments only or where a spray allows self application negating the need for DN/HCP visits

Emollients containing Oatmeal

Epimax^® oatmeal cream (TLS Green)

AproDerm^® colloidal oat cream (Paraffin-free) (TLS Blue)

• Second line to epimax oatmeal, only for use if a pump container is required for patients with limited dexterity or if a paraffin-free cream emollient is required

Emollient Creams and Ointments, Antimicrobial-containing

• For patients requiring antimicrobial emollients. For short term, acute prescription only

Dermol^® cream (TLS Green)

Dermol^® 500 lotion (TLS Green)

Emollients, Urea-containing

Balneum^® Intensiv cream (TLS Green)

Ultraveen^® Itch Relief cream (TLS Blue)

• Only for use for very dry chronic inflammatory dermatological conditions with associated significant irritation/itch that has not been responsive to or tolerant of other formulary emollient options

Balneum^® Plus cream (TLS Green)

• For patients with generalised itch that have not responded well to other emollients

Hydromol^® Intensive cream (TLS Green)

Emollient Bath and Shower Products

Not recommended for use

Note: risk of slipping in bath

Bath and shower emollients offer no advantages over emollients. Patients can use any of their normal creams or ointment above as a soap substitute in the bath/shower; except 50:50 (since it may not lather well).

Bath and shower preparations for dry and pruritic skin conditions should not be routinely prescribed as per NHS England guidelines 

Specialists may use their clinical judgement to consider bath/shower emollients for specific patients e.g. non-compliance with regular emollients of more than one emollient/type or patients with painful skin conditions who cannot tolerate emollient creams/ointments. The reasons for prescribing need to be clearly documented.