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 Formulary Chapter 13: Skin - Full Chapter
Notes:

Dermatology clinics at George Eliot Hospital are run by UHCW.

Therefore all dermatology outpatient prescriptions need to be in line with the UHCW formulary which consultants should be familiar with.

We will only issue prescriptions from our outpatient department if the prescription is for a specialist drug (SO,SI or SC) and those prescriptions that are deemed urgent for the patient to start immediately (ie the patients condition will deteriorate if they wait for a supply from the GP).

For any prescribers wishing to start an inpatient or an outpatient on an emollient please refer to the formulary below which has been taken from both the APC and UHCW Preferred Prescribing List (PPL).

 Details...
13.01  Management of skin conditions
 note 

When managing skin problems, it is extremely important to consider patient acceptability of a product to maximise patient compliance. There are a wide range of products available and patient acceptance of individual products is extremely variable. The vehicle that the active drug is presented in, is therefore arguably as important as the active drug. Patient preference should be taken into consideration and a combination of creams, ointments, lotions and gels may be required for management on different body sites.

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
Patients should be educated about the hygiene precautions required when removing products from pots (as opposed to tubes). Patients should be advised to decant from the pot onto a plate/bowl using a spoon or a spatula. Hands should not be put into the pot as this will lead to the introduction of contaminants. Pump dispensers promote good hygiene.

Extemporaneous Preparations
Only commercially available products should be prescribed, unless otherwise advised by the consultant dermatologist. Extemporaneous products are expensive and have limited stability. An extemporaneous product should only be prescribed when there is no equivalent product commercially available. Increasingly extemporaneous products are prepared by a specials manufacturer, the cost can and usually does exceed £100 for a cream and cost is applied irrespective of quantity ordered; it is the same whether 500g or 50g of a product is ordered. Specials all have a very short shelf life with a maximum expiry date of 28 days from the date of manufacture. An 'unlicensed medicine request form' and an 'unlicensed medicine risk assessment form' must be completed and submitted with all requests for extemporaneous products.


13.01.01  Vehicles
 note 

The vehicle affects the degree of hydration of the skin, has a mild anti-inflammatory effect and aids the penetration of the active drug.

Creams are emulsions of oil and water and are generally well absorbed into the skin. Typically used in the flexures and on more acute eruptions. They are more cosmetically acceptable than ointments, especially when applied to the face, as they are easier to apply, disappear into the skin more rapidly and are less greasy.

Ointments are more greasy and occlusive in nature, and are well suited to chronic, dry lesions.

Gels generally have high water content and are suitable for application to the face and scalp.

Lotions are liquid preparations. They cool and dry the skin by evaporation and may be preferred for hairy areas. Those with an aqueous base are used in weeping eruptions as an alcoholic base can sting if used on broken skin.

13.01.02  Suitable quantities for prescribing
 note 

The table below shows suitable quantities of dermatological preparations (excluding corticosteroids) to be prescribed for specific areas of the body based on twice daily application for 1 week.

 

 Ointments/Creams

 Lotions

 Face

 15-30g

100ml 

 Both hands

 25-50g

200ml

 Scalp

 50-100g

200ml 

 Both arms or both legs

 100-200g

200ml

 Trunk

 400g

500ml 

 Groins and genitalia

 15-25g

100ml

13.01.03  Excipients and sensitisation
 note 

Please refer to the BNF Chapter 13 for a list of excipients that are rarely associated with sensitisation.

13.02.01  Emollients to top
 note 

Emollients soothe, smooth and hydrate the skin and are indicated for all dry or scaling disorders. Effects are short lived and thus frequent application is advised. Emollients should be applied immediately after washing or bathing to maximise the effect of skin hydration. They are useful in dry and eczematous disorders, and to a lesser extent in psoriasis. The choice of an appropriate emollient will depend on the severity of the condtion, patient preference and the site of application. The least expensive emollient that is effective, cosmetically acceptable and that the patient is prepared to use regularly should be prescribed.
Generally, 'greasy' preparations provide the best emollient effect, however, for cosmetic reasons, patients may prefer a less oily preparation for daytime use or for use on an exposed area such as the face.
Emollients should be applied liberally and as frequently as possible, intensive use may reduce the need for topical steroids.
Careful explanation of how to use emollients, as well as how much to use may encourage compliance.

Fire hazard with paraffin-based emollients: Emulsifying ointment or 50% Liquid Paraffin and 50% White Soft Paraffin Ointment in contact with dressings and clothing is easily ignited by a naked flame. The risk is greater when these preparations are applied to large areas of the body, and clothing or dressings become soaked with the ointment. Patients should be told to keep away from fire or flames, and not to smoke when using these preparations. The risk of fire should be considered when using large quantities of any parafin based emollient.
Rapid Response Report - Fire hazard with paraffin-based skin products.

 

DO NOT supply 500g pots to the wards routinely where a smaller pot is available, check area to be treated.

Aquamax Cream
(White soft paraffin 20%, liquid paraffin 8%)
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Formulary
  • £/500g
  • Alternative to aqueous cream, can be used as a wash
 
   
Aveeno Cream
(Colloidal oatmeal)
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Formulary
  • £/100mL & ££/500mL
  • For dermatology outpatients only as per ACBS criteria
 
   
Balneum Cream
(Urea 5%)
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Formulary
  • ££/500g
  • Contains urea
  • Dermatology only
 
   
Balneum Plus Cream
(Lauromacrogols 3%, urea 5%)
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Formulary
  • £/100g & ££/500g
  • Contains urea
  • Dermatology only
 
   
Cetraben Cream
(13.2% white soft paraffin, 10.5% light liquid paraffin & 4.5% glycerin)
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Formulary
  • ££/500g
  • Dermatology advised only
 
   
Cetraben Lotion
(5% white soft paraffin, 4% light liquid paraffin & 3% glycerin)
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Formulary
  • £/500mL
  • May be used as an alternative to Aveeno Cream and Lotion
 
   
Cetraben Ointment
(35% white soft paraffin, 45% light liquid paraffin)
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Formulary
  • £/450g
  • Dermatology advised only
 
   
Dermol 500 Lotion
(liquid paraffin 2.5%, isopropyl myristate 2.5%, benzalkonium chlor. 0.1%, chlorhexidine hydrochlor. 0.1%)
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Formulary
  • ££/500mL
  • Contains antimicrobial, should only be used short term for infected/active eczema
  • Can be used as a wash (use Aquamax where long term wash required)
  • Dermatology only
 
   
Dermol Cream
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Formulary
  • £/100g & ££/500g
  • Contains antimicrobial, should only be used short term for infected/active eczema
  • Dermatology only
 
   
Doublebase gel
(isopropyl myristate 15%, liquid paraffin 15% (low paraffin content))
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Formulary
  • £/100g & ££/500g
  • Dermatology only
 
   
E45 Cream
(white soft paraffin 14.5%, hypoallergenic anhydrous lanolin 1%, light liquid paraffin 12.6%)
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Formulary
  • £/100g & ££/500g
 
   
Emulsifying Ointment BP
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Formulary
  • £/500g
 
   
Epimax Cream
(liquid paraffin 6%, white soft paraffin 15%)
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Formulary
  • £/500g
  • Alternative to diprobase and oilatum cream
 
   
Epimax Ointment
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Formulary
  • £/500g
 
   
ExCetra cream
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Formulary
  • £/500g
  • Similar to Cetraben cream but less expensive
 
   
Hydromol Intensive 10%
(urea 10%)
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Formulary
  • £/100g
  • Contains urea
  • Alternative to Calmurid
  • Dermatology only
 
   
Hydromol Ointment
(yellow soft paraffin 32%, emulsifying wax 25.5%, liquid paraffin 42.5%)
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Formulary
  • £/500g
 
   
ImuDERM Urea Emollient
(urea 5% & glycerin 5%)
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Formulary
  • ££/500g
  • Contains urea
 
   
Liquid and White Soft Paraffin Ointment
(white soft paraffin 50%, liquid paraffin 50%)
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Formulary
  • ££/500g
 
   
Menthoderm
(Menthol in aqueous cream 1%)
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Formulary
  • ££/500g
 
   
QV cream
(glycerol 10%, light liquid paraffin 10%, white soft paraffin 5%)
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Formulary
  • ££/500g
  • Dermatology advised only
 
   
QV Intensive Ointment
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Formulary
  • ££/450g
  • Dermatology advised only
 
   
Yellow soft paraffin
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Formulary
  • £/15g
 
   
13.02.01.01  Emollient bath and shower preparations
 note 

In dry skin conditions soap should be avoided. Emollient bath additives should be added to bath water; hydration can be improved by soaking in the bath for 10-20 minutes. Some bath emollients can be applied to wet skin undiluted and rinsed off.
Aqueous cream used as a soap substitute may also suffice as a bath additive. It is best whisked in a jug of hot water before adding it to the bath water.
The preparations make skin and surfaces slippery - particular care is needed when bathing. The use of anti-slip bath mats/handles especially for the young and elderly should be encouraged.

 

GPs can be asked to prescribe bath additives/wash - DO NOT prescribe from outpatients unless really urgent. Patients may be asked to purchase these products in the community.

Aquamax Wash
(white soft paraffin 20%, liquid paraffin 8%)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
  • £/250g
  • Aquamax cream can also be used as a soap substitute
  • Dermatology only
 
   
Hydromol bath and shower
(light liquid paraffin 37.8%, isopropyl myristate 13%)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
  • £/500mL
 
   
QV Gentle Wash
(Glycerol 15%)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
  • £/500mL
  • Dermatology only
 
   
 ....
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
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
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

Red SO

SPECIALIST ONLY - These drugs are deemed to be not appropriate for prescribing by GPs. Specialists should not ask GPs to prescribe these drugs.   

Green SI

SPECIALIST INITIATED - These drugs must be initiated, i.e. the first dose prescribed, by the specialist and then may be continued when appropriate by the patients GP following communication from the specialist.   

Green SA

SPECIALIST ADVISED Specialists may simply advise a patients GP to initiate these drugs themselves after they have made an initial assessment.   

Amber SC

SHARED CARE - Responsibility for prescribing may be transferred from secondary to primary care with the agreement of an individual GP and when agreed shared care arrangements have been established. The specialist MUST stabilize the patient before asking for care to be transferred. Only specialists should initiate these drugs. Prescribing should be transferred to GPs according to an Shared Care Agreement [SCA]   

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