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 Formulary Chapter 13: Skin - Full Chapter
Notes:

Review date: September 2018

Non-formulary drugs - any drug or formulation not listed in the formulary is deemed to be non-formulary.

Paediatrics - all drugs are deemed to have the same RAG status as they have for adults unless stated otherwise.

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13.02.01  Expand sub section  Emollients
 note 

Emollients soothe, smooth and hydrate the skin and are indicated for all dry or scaling disorders. Their effects are short-lived and they should be applied frequently even after improvement occurs. They are useful in dry and eczematous disorders, and to a lesser extent psoriasis. The choice of an appropriate emollient will depend on the severity of the condition, patient preference, and the site of application. Emollient preparations contained in the tubs should be removed with a clean spoon or spatula to reduce bacterial contamination of the emollient. Emollients should be applied in the direction of the hair growth to reduce the risk of folliculitis. Ointments may exacerbate acne and folliculitis. Some ingredients rarely cause sensitisation and this should be suspected if an eczematous reaction occurs. The use of aqueous cream as a leave-on emollient may increase the risk of skin reaction, particularly in eczema, see MHRA safety warning.

Paraffin-based skin emollients on dressings or clothing: fire risk Smoking or a naked flame could cause patients’ dressings or clothing to catch fire when being treated with paraffin-based emollient that is in contact with the dressing or clothing. The risk is greater when these preparations are applied to large areas of the body, and clothing or dressings become soaked with emollient. Advise patients not to: smoke; use naked flames (or be near people who are smoking or using naked flames); or go near anything that may cause a fire while emollients are in contact with their medical dressings or clothing.
MHRA safety warning
Emollients creams and ointments, paraffin-containing

Preparations such as aqueous cream and emulsifying ointment can be used as soap substitutes for hand washing and in the bath; the preparation is rubbed on the skin before rinsing off completely. The addition of a bath oil (section 13.2.1.1) may also be helpful.

Preparations containing an antibacterial (section 13.10) should be avoided unless infection is present or is a frequent complication.

Urea is a keratin softener and hydrating agent used in the treatment of dry, scaling conditions (including ichthyosis) and may be useful in elderly patients. It is occasionally used with other topical agents such as corticosteroids to enhance penetration of the skin.

For further information Atopic eczema in children: Management of atopic eczema in children from birth up to the age of 12years consult NICE CG 57

AproDerm®
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Formulary
Green

Emollient cream; 45 g tube; 450 g pump pack

Colloidal oat cream; 500mL pump pack

Medium

 
   
Aquamax®
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Formulary
Green

Cream; 100g tube; 500g tub

Medium

 
   
Aveeno®
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Formulary
Green
Lotion; 500 mL; Cream; 100ml, 300ml pump pack

For ACBS approved indication only: endogenous and exogenous eczema, xeroderma, ichthyosis, and senile pruritus (pruritus of the elderly) associated with dry skin.

Cream = Medium
Lotion = Light 
   
Cetraben®
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Formulary
Green

Ointment; 450 g tub

Very Greasy

 
   
Cetraben®
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Formulary
Green
Cream; 500 g pump pack

Medium
 
   
Diprobase®
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Formulary
Green

Cream; 500 g pump pack

Medium

Ointment; 500g tub

Greasy

 
   
DoubleBase®
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Formulary
Green

Gel; 500 g

Dayleave Gel; 100g; 500g pump pack

Greasy

 
   
E45®
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Formulary
Green
Lotion; 200 mL, 500 mL pump pack

Light
 
   
Emulsifying Ointment BP
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Formulary
Green
Ointment; 500 g tub

Very Greasy
 
   
Epimax®
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Formulary
Green
Cream 100 g tube, 500 g pump
(same as Aqueous Cream but SLS free. Use as emollient and soap substitute)

Light
 
   
Hydromol®
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Formulary
Green
Ointment only (not cream); 500 g, 1 kg tub

Very Greasy
 
   
Oilatum®
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Formulary
Green
Cream; 150 g, 500 mL pump pack, 1.05 litre pump pack

Medium
 
   
White Soft Paraffin 50% / Liquid Paraffin 50%
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Formulary
Green
Ointment; 500 g tub

Very Greasy
 
   
Whitesoft paraffin
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Formulary
Green
Ointment; 500 g tub

Very Greasy
 
   
ZeroAQS®
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Formulary
Green
Cream; 500 g tub

Light
 
   
Zerobase®
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Formulary
Green
Cream; 500 g pump pack

Medium
 
   
Zerocream®
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Formulary
Green
Cream; 500 g pump pack

Medium
 
   
Zeroderm®
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Formulary
Green
Ointment; 500 g tub

Very Greasy
 
   
Zerodouble®
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Formulary
Green
Gel; 475g squeeze bottle

Greasy
 
   
Zeroguent®
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Formulary
Green
Cream; 500 g tub

Greasy
 
   
13.02.01  Expand sub section  Preparations containing urea
Balneum®
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First Choice
Green
Urea 5%, ceramide 0.1% Cream; 500 g

Medium
 
Nutraplus®
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First Choice
Green
Urea 10%, Cream; 500 g

Medium
 
Balneum Plus®
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Second Choice
Green
Urea 5%, lauromacrogols 3% Cream; 500 g pump pack

Medium
 
   
Calmurid®
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Second Choice
Green
Urea 10%, lactic acid 5% Cream; 100 g, 500 g

Medium
 
   
Hydromol Intensive®
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Formulary
Green

Urea 10%; Cream; 30 g; 100 g

Medium

 
   
ImuDerm®
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Formulary
Green

Urea 5%, glycerol 5%, Cream; 500 g pump

Medium

 
   
13.02.01  Expand sub section  With antimicrobials
Dermol®
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Formulary
Green

Cream; 500 g pump pack (used as emollient and soap substitute)

Medium

 
   
Dermol® 500
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Formulary
Green

Lotion; 500 mL pump pack (used as emollient and soap substitute)

Light

 
   
13.02.01.01  Expand sub section  Emollient bath and shower preparations
 note 

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. In dry skin conditions soap should be avoided (see section 13.2.1 for soap substitutes). The quantities of bath additives recommended for adults are suitable for an adult-size bath. Proportionately less should be used for a child-size bath or a washbasin; recommended bath additive quantities for children reflect this.
These preparations make skin and surfaces slippery—particular care is needed when bathing

Hydromol®
View adult BNF View SPC online View childrens BNF
First Choice
Green
Bath and shower emollient; 350 mL, 500 mL, 1 litre
 
Zerolatum®
View adult BNF View SPC online View childrens BNF
First Choice
Green
Emollient medicinal bath oil; 500 mL 
Zeroneum®
View adult BNF View SPC online View childrens BNF
First Choice
Green
Bath oil; 500 mL 
Aqueous Cream BP
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Second Choice
Green
Cream 100g, 500 g (not recommended as an emollient as contains SLS)

Soap substitute only
 
   
Balneum®
View adult BNF View SPC online View childrens BNF
Second Choice
Green
Bath oil; 500 mL, 1 litre 
   
Oilatum®
View adult BNF View SPC online View childrens BNF
Second Choice
Green
Emollient bath additive; 250 mL, 500 mL

Junior emollient bath additive (fragrance free); 250 mL, 600 mL

 
   
Cetraben®
View adult BNF View SPC online View childrens BNF
Formulary
Green

Emollient bath additive 500mL

 
   
13.02.01.01  Expand sub section  With antimicrobials to top
Dermol® 200
View adult BNF View SPC online View childrens BNF
Formulary
Green

Shower emollient; 200 mL

 
   
Dermol® 600
View adult BNF View SPC online View childrens BNF
Formulary
Green

Bath additive; 600 mL

 
   
Emulsiderm®
View adult BNF View SPC online View childrens BNF
Formulary
Green
Liquid emulsion; 300 mL (with 15ml measure), 1L (with 30ml measure)
To add 7–30 mL/bath or rub into dry skin until absorbed. 
   
Oilatum Plus®
View adult BNF View SPC online View childrens BNF
Formulary
Green
Bath additive; 500 mL 
   
 ....
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

Green

Medicines considered suitable for non-specialist prescribing in primary or secondary care.  

Amber Recommended

Amber Recommended  

Amber Initiated

Amber Initiated. Requires specialist initiation of prescribing. Prescribing to be continued by the specialist until stabilisation of the dose and the patient’s condition is achieved and the patient has been reviewed. Amber Initiated medicines must meet criteria: (1) Requires specialist assessment to enable patient selection (2) Medicine is suitable for on-going prescribing in Primary Care (3) Requires short to medium term specialist prescribing and monitoring of efficacy or toxicity until the patient’s dose and condition is stable   

Amber Retained

Amber Patient Retained. Requires specialist initiation of prescribing. Prescribing to be continued by specialist until stabilisation of the dose and the patient’s condition is achieved and the patient had been reviewed. Patient remains under the care of specialist (ie not discharged) as occasional specialist input may be required. Amber Patient Retained medicines must meet criteria: (1)Requires specialist assessment to enable patient selection (2)Medicine is suitable for on-going prescribing in Primary Care (3) Requires short to medium term specialist prescribing and monitoring of efficacy or toxicity until the patient’s dose and condition is stable (4) May require occasional specialist input indefinitely and therefore the patient should not be discharged from specialist care   

Amber

Medicines recommended or initiated by specialists in primary or secondary care. Non-specialist prescribing in primary care may follow according the RAG criteria. In process of being superceded by Amber Recommended, Amber Initiated and Amber Patient Retained.  

Purple

Shared Care. Medicines are considered suitable for Primary Care prescribing and/or management, following specialist initiation of therapy, with on-going communication between the Primary Care prescriber and specialist, within the framework of a Shared Care Agreement. Medicines designated as requiring Shared Care require on-going input from both Specialist and Primary Care clinicians and patients should not be discharged from Specialist care. Where prescribing and monitoring are required under shared care, it is implicit that the responsibility for both of these tasks rests with the prescriber. A Shared Care Agreement will always be available for Shared Care medicines and this document will include a Shared Care Agreement pro-forma which will be completed by all involved clinicians. This pro-forma will record agreement to take on defined aspects of care e.g. monitoring and/or on-going prescribing for the individual patients. A policy detailing clinician responsibilities in Shared Care Agreements must be referred to in all cases of Shared Care. All drugs to be included in this category must meet Shared Care criteria 1 to 3: SC1 Requires specialist assessment to enable patient selection and also initiation, stabilisation and review of treatment and the patient`s condition. SC2 Prescribing and/or management of the drug in Primary Care with specialist support and input, within the framework of the Shared Care Agreement is safe and convenient and that there is an appropriate mechanism for individual patient access in Primary Care. SC3 Requires specific long-term monitoring (blood test or other measurement) for adverse effects and / or efficacy of the drug to be completed in Primary Care, and requires on-going specialist support for the dose changes or management of adverse effects. Monitoring is required on a regular basis (typically four times a year). Implicit in any shared care agreement is the understanding that participation is at the discretion of the Primary Care prescriber subject to their clinical confidence.   

Red

Primary care prescribing of these medicines is NOT recommended. These treatments should be initiated by specialists only; ongoing prescribing is retained within secondary care.   

Black

Not recommended for use. Deviation from the policy may be considered on an individual basis where exceptional circumstances exist.   

Grey

Not recommended for use at this time. Deviation from the policy may be considered on an individual basis where exceptional circumstances exist. Further guidance will be issued when more information or evidence is made available.  

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