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Notes for: Skin
Last edited [06/01/2023 11:35:01]

NHS Kernow emollient prescribing guideline September 2021 

NHS Kernow moisture associated skin damage pathway September 2021

Emollient Pathway 2022 

Fire risk with paraffin-containing products


Management of skin conditions
With skin disease it is extremely important to consider patient acceptability of a product to maximise patient compliance. There is a wide range of products available and patient acceptance of individual products is very variable.
Where a consultant or GP with specialist interest asks a GP to prescribe a non-formulary agent they should check that formulary agents have been tried and not tolerated by the patient

Greasy preparations (ointments) are often preferable to creams in most circumstances because:

  • They contain fewer skin sensitisers
  • They are more hydrating (i.e. water retaining)
  • There is better penetration of active ingredients

However, patient preference or activity may necessitate a combination of ointments and creams, for example, patients may prefer to apply creams during the day and use ointments at night, or different preparations on different parts of the body.

Application technique: It is important to educate patients with the correct application technique. Ointments and creams should be applied down the direction of hair growth. They should also be smeared on and not rubbed in.

Pot Hygiene: When supplying patients with pots of emollient, it is important to educate them about the hygiene required. Patients should be advised to decant from the pot onto plate/bowl etc. using a spoon or a spatula. Hands should not be put into the pot as this will lead to the introduction of foreign particles.

In many cases generic prescribing will be difficult because products contain a combination of active ingredients. In this chapter brand names are used for products which should not be prescribed generically.

Extemporaneous preparations: A product should only be extemporaneously prepared when there is no product with a marketing authorisation available. Depending on the formulation this may be done in a pharmacy, or by a specials manufacturer, usually depending on the formulation. Where a specials manufacturer prepares the product, additional charges will be incurred. The cost can, and usually does, exceed £100 for a cream. The cost is usually the same whether 500 g or 50 g of a product is ordered. Specials all have a very short shelf life with an expiry date of a maximum of 28 days from manufacture.

A range (but not all) of specials preferred by the British Association of Dermatologists has been approved for use within Cornwall mainly for prescribing by secondary care.



 

Cornwall Joint Formulary Recommended Choices     (...Top)
Displaying 21 Drugs

Key:
First Line Drugs First Line Drugs
Second Line Drugs Second Line Drugs
Specialist Initiated Drugs Specialist Initiated Drugs
Hospital Only Drugs Hospital Only Drugs
Discouraged Discouraged
No comment available No comment available
Antibiotics Antibiotics

NameTariffBNF Sub Paragraph
Epimax original cream
500 g Pack of 1
£2.67PCT FORMULARY STATUS: First Line Drugs EmollientsView BNF Article on 'Epimax original cream'View SPC on 'Epimax original cream'View PIL on 'Epimax original cream'
Epimax isomol gel
15 % Isopropyl myristate / Liquid paraffin 15% gel 500 g Pack of 1
£3.08PCT FORMULARY STATUSFirst Line Drugs EmollientsView BNF Article on 'Epimax isomol gel'View SPC on 'Epimax isomol gel'View PIL on 'Epimax isomol gel'
Epimax excetra cream
500 g Pack of 1
£3.09PCT FORMULARY STATUS: First Line Drugs EmollientsView BNF Article on 'Epimax excetra cream 'View SPC on 'Epimax excetra cream 'View PIL on 'Epimax excetra cream '
Epimax ointment
500 g Pack of 1
£3.13PCT FORMULARY STATUS: First Line Drugs EmollientsView BNF Article on 'Epimax ointment'View SPC on 'Epimax ointment'View PIL on 'Epimax ointment'
Liquid and White Soft Paraffin Ointment
50 % / 50% ointment Pack of 500
£4.57PCT FORMULARY STATUS: First Line Drugs EmollientsView BNF Article on 'Liquid and White Soft Paraffin Ointment'View SPC on 'Liquid and White Soft Paraffin Ointment'View PIL on 'Liquid and White Soft Paraffin Ointment'
Emollient Bath Oil (Zerolatum)
500 ml unit Pack of 500
£4.79PCT FORMULARY STATUS: First Line Drugs Emollients
View BNF Article on 'Emollient Bath Oil'View SPC on 'Emollient Bath Oil'View PIL on 'Emollient Bath Oil'
Emulsifying Ointment
500 g Pack of 500
£4.82PCT FORMULARY STATUS: First Line Drugs EmollientsView BNF Article on 'Emulsifying Ointment'View SPC on 'Emulsifying Ointment'View PIL on 'Emulsifying Ointment'
Adex
100 gm gel Pack of 1
£2.69PCT FORMULARY STATUS: Second Line Drugs [Notes:] Adex gel is accepted onto the formulary as an option for patients only following poor response from other first / second line formulary choices EmollientsView BNF Article on 'Adex'View SPC on 'Adex'View PIL on 'Adex'
Adex gel is accepted onto the formulary as an option for patients only following poor response from other first / second line formulary choices
Emollient Cream (ZeroAQS)
500 g unit Pack of 500
£3.39PCT FORMULARY STATUS: Second Line Drugs EmollientsView BNF Article on 'Emollient Cream'View SPC on 'Emollient Cream'View PIL on 'Emollient Cream'
White Soft Paraffin
500 g unit Pack of 1
£4.03PCT FORMULARY STATUS: Second Line Drugs EmollientsView BNF Article on 'White Soft Paraffin'View SPC on 'White Soft Paraffin'View PIL on 'White Soft Paraffin'
Emollient Ointment (Zeroderm)
500 g ointment Pack of 500
£4.29PCT FORMULARY STATUS: Second Line Drugs EmollientsView BNF Article on 'Emollient Ointment'View SPC on 'Emollient Ointment'View PIL on 'Emollient Ointment'
Zerocream (Zerocream)
500 g unit Pack of 500
£4.30PCT FORMULARY STATUS: Second Line Drugs EmollientsView BNF Article on 'Zerocream'View SPC on 'Zerocream'View PIL on 'Zerocream'
Epimax
500 g Paraffin-Free Ointment Pack of 1
£4.99PCT FORMULARY STATUS: Second Line Drugs EmollientsView BNF Article on 'Epimax'View SPC on 'Epimax'View PIL on 'Epimax'
Emollient Ointment (Hydromol)
500 g Ointment Pack of 500
£5.40PCT FORMULARY STATUS: Second Line Drugs EmollientsView BNF Article on 'Emollient Ointment'View SPC on 'Emollient Ointment'View PIL on 'Emollient Ointment'
Liquid Paraffin Emollient Cream (Zerobase 11% Cream)
500 g unit Pack of 500
£5.58PCT FORMULARY STATUS: Second Line Drugs EmollientsView BNF Article on 'Liquid Paraffin Emollient Cream'View SPC on 'Liquid Paraffin Emollient Cream'View PIL on 'Liquid Paraffin Emollient Cream'
Hydrating Gel (Doublebase Gel)
500 g gel pump dispenser Pack of 1
£5.83PCT FORMULARY STATUS: Second Line Drugs EmollientsView BNF Article on 'Hydrating Gel'View SPC on 'Hydrating Gel'View PIL on 'Hydrating Gel'
Adex
500 gm gel Pack of 1
£5.99PCT FORMULARY STATUS: Second Line Drugs [Notes:] Adex gel is accepted onto the formulary as an option for patients only following poor response from other first / second line formulary choices EmollientsView BNF Article on 'Adex'View SPC on 'Adex'View PIL on 'Adex'
Adex gel is accepted onto the formulary as an option for patients only following poor response from other first / second line formulary choices
Dermol Preps
500 lotion Pack of 500
£6.04PCT FORMULARY STATUS: Second Line Drugs EmollientsView BNF Article on 'Dermol Preps'View SPC on 'Dermol Preps'View PIL on 'Dermol Preps'
Cream (Cetraben)
500 g pump Pack of 1
£6.29PCT FORMULARY STATUS: Second Line Drugs EmollientsView BNF Article on 'Cream'View SPC on 'Cream'View PIL on 'Cream'
Balneum Plus Cream
500 g pump pack Pack of 500
£14.99PCT FORMULARY STATUS: Second Line Drugs EmollientsView BNF Article on 'Balneum Plus Cream'View SPC on 'Balneum Plus Cream'View PIL on 'Balneum Plus Cream'
Diprobase Advanced Eczema cream
500 ml Pack of 1
£7.01PCT FORMULARY STATUS: Discouraged EmollientsView BNF Article on 'Diprobase Advanced Eczema cream'View SPC on 'Diprobase Advanced Eczema cream'View PIL on 'Diprobase Advanced Eczema cream'

 
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