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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 7 Drugs

    First Line Drugs First Line Drugs
    Second Line Drugs Second Line Drugs
    Specialist Initiated Drugs Specialist Initiated Drugs
    Hospital Only Drugs Hospital Only Drugs
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    Antibiotics Antibiotics

    NameTariffBNF Sub Paragraph
    Ostomy skin protectives (Zerolon)
    28 gm barrier cream Pack of 1
    £2.33PCT FORMULARY STATUSFirst Line Drugs Barrier PreparationsView BNF Article on 'Ostomy skin protectives'View SPC on 'Ostomy skin protectives'View PIL on 'Ostomy skin protectives'
    Dimeticone Lotion (Hedrin Lotion)
    4 % lotion Pack of 50
    £3.28PCT FORMULARY STATUS: First Line Drugs Barrier Preparations
    View BNF Article on 'Dimeticone Lotion'View SPC on 'Dimeticone Lotion'View PIL on 'Dimeticone Lotion'
    Dimeticone + Benzalkonium (Conotrane cream)
    500 g Pack of 500
    £3.51PCT FORMULARY STATUS: First Line Drugs Barrier PreparationsView BNF Article on 'Dimeticone + Benzalkonium'View SPC on 'Dimeticone + Benzalkonium'View PIL on 'Dimeticone + Benzalkonium'
    Ostomy skin protectives (Zerolon)
    92 gm barrier cream Pack of 1
    £5.06PCT FORMULARY STATUSFirst Line Drugs Barrier PreparationsView BNF Article on 'Ostomy skin protectives'View SPC on 'Ostomy skin protectives'View PIL on 'Ostomy skin protectives'
    Zinc & Castor Oil Ointment
    500 g unit Pack of 500
    £5.15PCT FORMULARY STATUS: First Line Drugs [Notes:] contains peanut oil Barrier PreparationsView BNF Article on 'Zinc & Castor Oil Ointment'View SPC on 'Zinc & Castor Oil Ointment'View PIL on 'Zinc & Castor Oil Ointment'
    contains peanut oil
    Titanium Barrier Ointment (Metanium)
    30 g Unit Pack of 30
    £2.24PCT FORMULARY STATUS: Second Line Drugs Barrier PreparationsView BNF Article on 'Titanium Barrier Ointment'View SPC on 'Titanium Barrier Ointment'View PIL on 'Titanium Barrier Ointment'
    Drapolene Cream
    100 g tube Pack of 100
    £2.81PCT FORMULARY STATUS: Second Line Drugs Barrier PreparationsView BNF Article on 'Drapolene Cream'View SPC on 'Drapolene Cream'View PIL on 'Drapolene Cream'

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