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13.2. EMOLLIENT AND BARRIER PREPARATIONS

13.2 Emollient and Barrier Preparations

13.2 Emollient and barrier preparations

 Patient concordance and compliance with prescribed dermatology treatments is largely dependent on the cosmetic acceptability 
 of the preparations concerned.  The dermatology section of the formulary contains a full range of suitable products to meet the
 needs of the vast majority of patients.
 Fragrances are a major cause of skin sensitization, and as a general principle, products containing fragrance should not be
 prescribed. Patients insisting on using fragranced products should be advised to purchase their own supply. 
 
 NEW CAMPAIGN FROM MHRA 'SKIN CREAMS DRIED ON FABRIC CAN LEAD TO FIRE DEATHS' JULY 2020
 A new campaign to raise awareness of the fire risk and the precautions that need to be taken by users of skin creams has been 
 launched  <click here to view>
 
 Patient information leaflets and posters to download are available here
 
 Paraffin-based containing and paraffin-free emollients -  Risk of severe fatal burns

 See latest MHRA resources:
  1. https://www.gov.uk/drug-safety-update/emollients-new-information-about-risk-of-severe-and-fatal-burns-with-paraffin-containing-and-paraffin-free-emollients
  2. https://www.gov.uk/drug-safety-update/emollients-and-risk-of-severe-and-fatal-burns-new-resources-available

13.2.1 Emollients

Emollient Prescribing Guidelines 
Emollient Guidelines for Dry Skin
Emollients Patient Information Leaflet
Eczema Guidelines

Emollients are used to hydrate the skin. Their effects are short lived and they should be applied frequently. To be effective, adequate quantities of emollients should be prescribed. 

Suitable quantities to prescribe: see Emollient Prescribing Guidelines
These recommended amounts are for twice daily application for an adult. To keep the skin well hydrated, leave-on emollients should be applied in adequate amounts to sufficiently cover dry and inflamed areas. 500g = 1 tub or pump dispenser. Quantities required will vary with the size of the patient, the severity and extent of skin dryness. For children approximately half this amount is suitable.
         
 Body site  Creams or Ointments    Lotions   
   One week supply  One month supply   One week supply   One month supply 
 Face  15 - 30g   60 -120g   100ml   400ml 
 Both hands  25 - 50g  100 - 200g  200ml   800ml
 Scalp  50 -100g  200 - 400g   200ml  800ml
 Both arms and legs  100 - 200g  400 -800g  200ml  800ml
 Trunk  400g  1600g  500ml  2000ml
 Groin and genitalia  15 -25g  60 -100g  100ml   400ml 


 NEW CAMPAIGN FROM MHRA 'SKIN CREAMS DRIED ON FABRIC CAN LEAD TO FIRE DEATHS' JULY 2020
 A new campaign to raise awareness of the fire risk and the precautions that need to be taken by users of skin creams has been 
 launched  <click here to view>
 
Light emollients
GREEN       Zerocream®  50g, 500g [E45® equivalent] 
GREEN      ExoCream® 50g, 500g pump [E45® equivalent] 
GREEN      Epimax® ExCetra cream 100g, 500g [previously ExCetra® Cream] [equivalent toCetraben® cream] 
 
Medium emollients 
GREEN      Colloidal Oatmeal Creams* (equivalent to Aveeno® Cream) 
                   [brands include: Miclaro® Oatmeal Cream,300ml: Aproderm® Oatmeal Cream, 500ml: 
                   Epimax® Oatmeal Cream, 500g flexidispenser]
GREEN      Epimax® Original Cream 100g, 500g [previously Epimax Cream, equivalent to Diprobase® cream] 
GREEN      Aproderm® emollient cream 500g pump dispenser, Aproderm gel 500g pump dispenser
GREEN      Epimax® isomol gel £, Zero® Double gel 100g ££, 500g [equivalent to Doublebase® gel££]
GREEN      Aveeno® cream 100ml, 500ml (consider trial with a colloidal oatmeal cream* before Aveeno cream)
GREEN      Epimax™  paraffin-free ointment**
(All the above products (except Zero®double gel) can be added to the bath).
 ** This product is especially suitable for use in:
                  >  Elderly patients requiring large amount of ointment
                  >  Use under wet wrapping
                  >  Patients requiring ointment for night use
                  >  Patient using Medical Oxygen Therapy
                  >  Patients who smoke
 
Heavy emollients - effective but not as cosmetically acceptable. 
GREEN      Zeroderm® ointment  125g, 500g [equivalent to Hydromol® & Epaderm® ointment] 
GREEN      Epimax® ointment 125g, 500g [equivalent to Hydromol® & Epaderm® ointment]
GREEN      Cetraben® ointment  125g, 450g
AMBER     Hydromol® ointment 125g, 500g
AMBER     Epaderm® ointment (Consider using Hydromol - same formula, but less expensive) 125g, 500g
AMBER     Liquid paraffin 50% / white soft paraffin 50%  
 
Containing urea 
GREEN      Urea 25% Heel Balm (Flexitol® Heel Balm) - specific use only for diabetic patients
GREEN      Urea 10% cream (Flexitol® Cream)
 
With antimicrobial        
Appropriate for use if there are recurrent problems with infection. 
GREEN      Dermol® cream 
GREEN      Dermol 500® lotion 
 
Soap substitutes  
All emollients, with the exceptions of Zerodouble® gel and WSP/LP (50:50), may be used as soap substitutes.  Aqueous cream is 
not recommended because it may cause stinging in a a high proportion of patients. Advise patients not to dip hands into tubs of 
emollients and to always clean scoop.

13.2.1.1 Emollient bath additive
BLACK     Not to be prescribed in Primary Care
       

13.2.2 Barrier preparations

Click here to access table of preparations and indications:       
First line: 
GREEN      Metanium® ointment   
GREEN      Sudocrem® cream  
GREEN      Zinc and castor oil ointment    
 
Moisture Lesion Management    
 Management of Moisture Associated Skin Damage
 Management of Moisture Lesions and Incontinence Associated Dermatitis
Moderate skin damage and in skin folds 
GREEN      Medihoney® Barrier Cream 50g, 20 x 2g sachet  
 
Mild to moderate skin damage
GREEN      Medi derma-S barrier cream [pea size amount, twice daily]
GREEN      Medi derma S barrier film [per-wounds/stomas/fistula]
 
Moderate and severe skin damage - second line use,  following specialist advice
GREEN      Medi derma-Pro Spray Cleanser
GREEN      Medi derma-Pro protectant ointment
 Please note: Medi Derma Pro is intended as a short term 1 month treatment. Patients should be reviewed before any repeat 
                       prescribing
 
Liquid faecal incontinence, Severe skin damage that is not responding after 6 weeks
AMBER     Cavilon Advanced - specialist product to be used only on advice of tissue viability nurses only* 
                  see product advice sheet for use

Dressing Request and  Exception Form*