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Area Prescribing Committee
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 Formulary Chapter 13: Skin - Full Chapter
Notes:

Review date: September 2021

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

Off-label use: Drugs are included in the formulary for their licensed indications – where inclusion of off-label use is considered to be included in the formulary this is specifically stated in the formulary entry for the drug N.B. also see Paediatrics note below.

Paediatrics: Drugs are included in the formulary for paediatric use for their BNF for Children recommended indications (indicated by symbol View childrens BNF) which may be off-label, unless otherwise stated. All drugs are deemed to have the same RAG status as they have for adults unless stated otherwise.

NHS England Specialised Commissioning
Drugs carrying the NHS England logo are commissioned by them. Links to key documents, national programmes of care, and clinical reference groups are found below.

NHSE NHS England Specialised Commissioning: Key documents

NHSE NHS England Specialised Commissioning: National programmes of care and clinical reference groups





Chapter Links...
 Details...
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.

Fire Risk with paraffin-based skin emollients on dressings or clothing: 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. Patients’ clothing and bedding should be changed regularly – preferably daily – because 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

Pan Mersey APC (2019). PARAFFIN-BASED EMOLLIENTS: fire risk

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.

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

Emollient cream; 50 g tube; 500 g pump pack

Colloidal oat cream; 500mL pump pack: Paraffin-free (suitable for those on oxygen or smokers)

Medium

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

Cream; 100g tube; 500g tub

Medium

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

Ointment; 450 g tub

Very Greasy

 
   
Cetraben®
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream; 500 g pump pack

Medium
 
   
Diprobase®
View adult BNF View SPC online View childrens BNF
Formulary
Green

Cream; 500 g pump pack

Medium

Ointment; 500g tub

Greasy

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

Gel; 500 g

Dayleave Gel; 100g; 500g pump pack

Greasy

 
   
E45®
View adult BNF View SPC online View childrens BNF
Formulary
Green
Lotion; 200 mL, 500 mL pump pack

Light
 
   
Emulsifying Ointment BP
View adult BNF View SPC online View childrens BNF
Formulary
Green
Ointment; 500 g tub

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

Light
 
   
Hydromol®
View adult BNF View SPC online View childrens BNF
Formulary
Green
Ointment only (not cream); 500 g, 1 kg tub

Very Greasy
 
   
Oilatum®
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream; 150 g, 500 mL pump pack, 1.05 litre pump pack

Medium
 
   
White Soft Paraffin 50% / Liquid Paraffin 50%
View adult BNF View SPC online View childrens BNF
Formulary
Green
Ointment; 500 g tub

Very Greasy
 
   
Whitesoft paraffin
View adult BNF View SPC online View childrens BNF
Formulary
Green
Ointment; 500 g tub

Very Greasy
 
   
ZeroAQS®
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream; 500 g tub

Light
 
   
Zerobase®
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream; 500 g pump pack

Medium
 
   
Zerocream®
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream; 500 g pump pack

Medium
 
   
Zeroderm®
View adult BNF View SPC online View childrens BNF
Formulary
Green
Ointment; 500 g tub

Very Greasy
 
   
Zerodouble®
View adult BNF View SPC online View childrens BNF
Formulary
Green
Gel; 475g squeeze bottle

Greasy
 
   
Zeroguent®
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream; 500 g tub

Greasy
 
   
13.02.01  Expand sub section  Preparations containing urea
Balneum®
View adult BNF View SPC online View childrens BNF
First Choice
Green
Urea 5%, ceramide 0.1% Cream; 500 g

Medium
 
ImuDerm Emollient®
View adult BNF View SPC online View childrens BNF
First Choice
Green

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

Medium

 
Balneum Plus®
View adult BNF View SPC online View childrens BNF
Second Choice
Green
Urea 5%, lauromacrogols 3% Cream; 500 g pump pack

Medium
 
   
Flexitol 10% urea cream®
View adult BNF View SPC online View childrens BNF
Formulary
Green

Urea 10%, Cream; 500 g

Medium

 
   
Hydromol Intensive®
View adult BNF View SPC online View childrens BNF
Formulary
Green

Urea 10%; Cream; 30 g; 100 g

Medium

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

Urea 10%, Cream; 100 g

Medium

 
   
13.02.01  Expand sub section  With antimicrobials
Dermol®
View adult BNF View SPC online View childrens BNF
Formulary
Green

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

Medium

 
   
Dermol® 500
View adult BNF View SPC online View childrens BNF
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 and shower additives – Not recommended. No evidence of clinical benefit shown from including emollient bath additives in the standard management of eczema in children. The evidence is for leave-on emollients and soap substitutes only.

See Emollient bath additives for the treatment of childhood eczema. BMJ 2018;361:k1332

Aqueous Cream BP
View adult BNF View SPC online View childrens BNF
Formulary
Green

Cream 100g, 500 g (not recommended as an emollient as contains SLS)

Soap substitute only

 
   
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

Can be used as a soap substitute

 
   
 ....
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

Requires specialist assessment to enable patient selection.  Amber Recommended medicines must meet criteria: (1) Requires specialist assessment to enable patient selection (2) Following specialist assessment, the medicine is suitable for prescribing in Primary Care.  

Amber Initiated

Amber Initiated. Requires specialist initiation of prescribing. Prescribing to be continued by the specialist until stabilisation of the dose 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 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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