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Notes for: Skin
Last edited [16/11/2021 14:55:40]


NHS Kernow emollient prescribing guideline September 2021

NHS Kernow moisture associated skin damage pathway September 2021

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 (ie 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 & IoS mainly for prescribing by secondary care. The website also lists various clinical guidelines.



     

    Cornwall Joint Formulary Recommended Choices     (...Top)
    Displaying 22 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
    Emollient Ointment (Diprobase)
    50 g tube Pack of 50
    £1.28PCT FORMULARY STATUS: First Line Drugs [Notes:] To be prescribed only if recommended by Dermatology EmollientsView BNF Article on 'Emollient Ointment'View SPC on 'Emollient Ointment'View PIL on 'Emollient Ointment'
    To be prescribed only if recommended by Dermatology
    Epimax original cream
    500 gm Pack of 500
    £2.49PCT 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 gm Pack of 500
    £2.92PCT 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 gram Pack of 500
    £2.95PCT 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
    £2.99PCT 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
    £3.29PCT 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'
    Zerocream (Zerocream)
    500 g unit Pack of 500
    £4.08PCT FORMULARY STATUS: Second Line Drugs EmollientsView BNF Article on 'Zerocream'View SPC on 'Zerocream'View PIL on 'Zerocream'
    Emollient Ointment (Zeroderm)
    500 g ointment Pack of 500
    £4.10PCT FORMULARY STATUS: Second Line Drugs EmollientsView BNF Article on 'Emollient Ointment'View SPC on 'Emollient Ointment'View PIL on 'Emollient Ointment'
    Emollient Ointment (Hydromol)
    500 g Ointment Pack of 500
    £4.96PCT FORMULARY STATUS: Second Line Drugs EmollientsView BNF Article on 'Emollient Ointment'View SPC on 'Emollient Ointment'View PIL on 'Emollient Ointment'
    Epimax
    500 gm Paraffin-Free Ointment Pack of 500
    £4.99PCT FORMULARY STATUS: Second Line Drugs EmollientsView BNF Article on 'Epimax'View SPC on 'Epimax'View PIL on 'Epimax'
    Liquid Paraffin Emollient Cream (Zerobase Cream)
    500 g unit Pack of 500
    £5.26PCT 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 500
    £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
    Cream (Cetraben)
    500 g pump Pack of 1
    £5.99PCT FORMULARY STATUS: Second Line Drugs EmollientsView BNF Article on 'Cream'View SPC on 'Cream'View PIL on 'Cream'
    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'
    Balneum cream
    5 % cream Pack of 500
    £9.97PCT FORMULARY STATUS: Second Line Drugs EmollientsView BNF Article on 'Balneum cream'View SPC on 'Balneum cream'View PIL on 'Balneum 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'

     
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