Notes for: SkinLast 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.
Notes for: Preparations For EczemaLast edited [10/07/2012 09:36:50]
Treatment of eczema
Emollients and soap substitutes:
Emollients are very important in the treatment of eczema as the skin is usually dry and lacks the natural oily protective barrier. They also soften and smooth the skin and improve itching that may be present. They must be used frequently, at least twice daily, on all areas of the skin even where there is no visible sign of eczema.
Topical steroids:
Steroids are useful where there is an inflammatory component to the disease and to reduce itching. The strength and type of steroid prescribed depends on the age of the patient, the site affected, the severity of the eczema and whether or not infection is present. The use of the least potent steroid to control symptoms is advised.
Topical immuno-modulators:
Tacrolimus and pimecrolimus are NOT recommended for mild atopic eczema or as first-line treatment. Refer to NICE guidance, and section 13.5.3.
Anti-histamine treatment:
The use of oral antihistamines is very effective in the treatment of itching associated with eczema. Itching is generally worse in the warmth of the bed and can often interfere with sleep. Sedating antihistamines are therefore useful in this situation.
Treatment of infection:
Once the skin is broken, it is common to get an infection on top of the eczema. This often affects the legs, wrists, hands and face, makes the patient feel unwell and limits movement. Infection with Staphylococcus aureus is the commonest cause of an acute flare up of atopic eczema and should be treated accordingly, eg flucloxacillin, erythromycin. It is also helpful to use products containing antiseptics, such as Dermol®.
Other treatments:
Applying a dry tubular bandage over topical treatments or using a wet or paste bandage on severe eczema can be helpful when proving difficult to control. Seek advice from dermatology specialist nurses.
Last edited [10/07/2012 09:40:54]Last edited [02/08/2013 13:00:07]
Once an accurate diagnosis of atopic eczema has been made, the key aspects of management are keeping the skin hydrated (regular and frequent applications of a moisturiser), and the use of the least potent topical steroid that will control symptoms. The potency of the steroid should be reduced as the condition improves, and periodically steroid treatment should be withdrawn when able. The use of oral antihistamines requires sedating antihistamines to be prescribed, preferably at night time. Wet wraps (in conjunction with Tubifast®), occlusive dressings, zinc bandages (eg Steripaste®), or Zipzoc® may also be utilised.