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 Formulary Chapter 13: Skin - Full Chapter
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13.02.01  Expand sub section  Emollients
 note 
   COMPLIANCE is the most important factor when prescribing emollients.

Choice of emollient should be a cost effective joint decision by between the prescriber and the patient. Prescribing should fit the individual and their lifestyle.

Any initiation product should be given in the smallest appropriate pack size to allow the product to be trialled.

This is to reduce waste should the chosen product not be suitable.

Emollients should not be prescribed for non-clinical, cosmetic purposes at NHS expense. Emollients for these purposes can be readily purchased from retail outlets.

  • DO: Apply emollients regularly as possible (At least twice a day, more frequently if very dry skin). Carry some with you when you are out and about. Keep fingernails short and smooth

 

  • DO NOT: Rub into the skin. Put fingers in a tub product. Smoke or be near flames or fire when using paraffin-based emollients (see below).

Product Advice:

Soap Substitutes -

  • Can be prescribed for individuals whose condition is worsened by traditional soap products.
  • Soap, liquid cleansers and perfumed products can be very drying.
  • Any cream emollient can be used as a soap substitute. They will not foam but are as effective as cleaning with soap
  • They can be applied before bathing/ showering or washing, or while in the water
  • As with other emollients these should be trialled in small quantities until a suitable product is established.

Paraffin based products – WARNING

 Gov.UK weblink: Paraffin Safety Information

 NPSA Paraffin Based Skin Products Fire Hazard Leaflet

  • Dressings and clothing that have contact with paraffin based emollients are known to easily ignite near a naked flame.
  • Patients should be advised of this and that they should keep away from fire or flames and not smoke when using them.
  • The risk tends to be associated with the use of large quantities of these products.
  • It is important to consider someone’s profession when selecting these items.

Please see IOW Emollient Prescribing Guidelines for further information

13.02.01  Expand sub section  Greasy / heavy leave on emollients
13.02.01  Expand sub section  Rich cream leave on emollients
13.02.01  Expand sub section  Gel leave on emollients
13.02.01  Expand sub section  Light and creamy leave on emollients to top
 note 
  • For mild to moderate dryness
  • May need more frequent application than thicker formulations
  • Good for everyday use

Aqueous Cream:  

This carries a higher risk of skin irritation, possibly due to the sodium lauryl sulphate (SLS) content.

This is particularly prevalent in children with eczema and older people.

Its use is no longer recommended as a leave on emollient or soap substitute. There are more cost effective and less irritant leave-on emollients and soap substitutes available.

Epimax ® Cream (Epimax Original Cream)
View adult BNF View SPC online View childrens BNF
First Choice
Green

See IOW Emollient formulary

First Line option for Light and Creamy leave on emollients

For mild to moderately dry skin

Good for everyday use

Can be used as soap substitute

 

 
Aquamax ® Cream
View adult BNF View SPC online View childrens BNF
First Choice
Green

See IOW Emollient formulary

First Line option for Light and Creamy leave on emollients

For mild to moderately dry skin

Good for everyday use

Thicker than Epimax

Can be used as soap substitute

 
Zerocream ®
View adult BNF View SPC online View childrens BNF
Second Choice
Green

See IOW Emollient formulary

First Line option for Light and Creamy leave on emollients

For mild to moderately dry skin

Good for everyday use

Can be used as soap substitute

Cost effective alternative to E45

 
   
ZeroAQS®
View adult BNF View SPC online View childrens BNF
Second Choice
Green

See IOW Emollient formulary

Second Line option for Light and Creamy leave on emollients

For mild to moderately dry skin

Good for everyday use

Can be used as soap substitute

Cost effective alternative to Aqueous Cream. Less sensitisers

 
   
13.02.01  Expand sub section  Colloidal Oat based Emollients
13.02.01  Expand sub section  Urea containing emollients
13.02.01  Expand sub section  Emollients with antimicrobials and anti-inflammatory properites
13.02.01.01  Expand sub section  Emollient bath and shower preparations
 note 
  • Bath oils are not recommended. Most Ointments except 50:50 can be dissolved in some hot water and added to the bath water
  • Avoid bubble baths as they can be irritant
  • Emollients can be used as soap substitutes. These are indications on the IOW Emollient Formulary by the bar of soap symbol.
  • Leave on emollients should be used as traditional soaps strip skin of natural oils and promote skin shedding
  • Encourage regular bathing. A daily bath removes dirt and skin debris which could cause infection.
  • Patients should use a non-slip bath mat.
  • Bath emollients are restricted to use in children only. Sufficient time (10-20mins) MUST be spent in the bath to allow the emollient to be absorbed.

Use in adults is not recommended unless there are exceptional clinical cases indicating use

 ....
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Green

Drugs that may be initiated, stabilised and maintained by primary, secondary or tertiary care Secondary and tertiary care prescribing may be continued by primary care. [this does not indicate first/second line choice]  

Green Hospital

Items used by the Hospital but would not normally be continued into primary care. Primary care prescribers can change to GREEN first or second.   

Green plus

Initiation of drugs by primary care following written advice from secondary/ tertiary care advice.  

Yellow

Drugs that may be continued in primary care following initiation and stabilisation in secondary/tertiary care  

Amber

Items requiring a shared care agreement. These items should be initiated and stabilised by secondary or tertiary care. The GP should only be asked to take over prescribing through a formal shared care agreement. Secondary care will be expected to continue prescribing until the agreement is made.  

Red

Hospital/ Trust ONLY. These are items the secondary and tertiary care are responsible for prescribing and will need to continue to prescribe for long term maintenance. These items will NOT be prescribed in primary care. But primary care should be informed the patient is receiving these items. This will include NHSE funded items requiring repatriation.  

GP - Black

Items covered by NHSE ‘Should not prescribe in primary care list’ – See CCG policy on Drugs of limited clinical value  

GP - Grey

Grey List: Items covered by NHSE ‘Should not prescribe in primary care list’ that are not to be routinely prescribed but may be suitable in a defined population – See CCG policy on Drugs of limited clinical value  

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