13.2.1 Emollients

(Click here for creams)

(Click here for other formulations including urea and antimicrobial)

Ointments

ChoiceDrugDosage
Formulary choicesHydromol® ointment (emulsifying wax 25.5%, yellow soft paraffin 32%, liquid paraffin 42.5%)Dose:
Apply into the skin as often as required
or
Epaderm® ointment (emulsifying wax 30%, yellow soft paraffin 30%, liquid paraffin 40%)Dose:
Apply into the skin as often as required
or
Cetraben ointment (35% white soft paraffin, 45% light liquid paraffin)Dose:
Apply into the skin as often as required
or
Diprobase® ointment (white soft paraffin 95%, liquid paraffin 5%Dose:
Apply into the skin as often as required

Creams

ChoiceDrugDosage
Formulary choicesOilatum® cream (light liquid paraffin 6%, white soft paraffin 15%)
Dose:
Apply into the skin as often as required
or
Aproderm® Colloidal Oat cream (paraffin free)Dose:
Apply into the skin as often as required
or
Cetraben® emollient cream (white soft paraffin 13.2%, light liquid paraffin 10.5%)Dose:
Apply into the skin as often as required
or
Diprobase® cream (cetromacrogol 2.25%, cetostearyl alcohol 7.2%, liquid paraffin 6%, white soft paraffin 15%)Dose:
Apply into the skin as often as required
or
Ultrabase® cream (liquid paraffin 10% and white soft paraffin 10%)Dose:
Apply into the skin as often as required
or
Epaderm® cream (yellow soft paraffin 15%, liquid paraffin 10%, emulsifying wax 5%)Dose:
Apply into the skin as often as required

Prescribing Notes

  • CAUTION – there is a fire hazard associated with emollients. The risk is greater when they are applied to large areas of the body and clothing or dressings become soaked with the emollient. Following new information, warnings about the risk of severe and fatal burns are being extended to all emollients regardless of paraffin concentration. Advise patients who use these products not to smoke or go near naked flames and warn about the easy ignition of clothing, bedding, dressings and other fabric that have dried residue of an emollient product on them. Resources available to support safe prescribing use include MHRA Drug Safety Update Dec 2018 and MHRA Safe Use of Emollient Guidance July 2020.
  • A paraffin-free emollient may be required in certain circumstances e.g. patients using medical oxygen therapy. Aproderm® Colloidal Oat cream is a cost effective option where a paraffin-free emollient is necessary.
  • There is no evidence that any one emollient is better than another but there is wide inter-patient variability in response to treatments. The emollients of choice are therefore the least expensive ones that are effective which the patient finds acceptable and is prepared to use.
  • Ointments should be used for dry skin and chronic eczema. Creams should be used for acute inflammatory eczema.
  • Emollients should be applied as liberally and frequently as possible. They are best applied when the skin is moist but they can, and should, be applied at other times as well. Ideally emollients should be applied every 4 hours or at least 3-4 times daily.
  • Emollients should be applied in the direction of hair growth.
  • Continual treatment with complete emollient therapy (combinations of cream, ointment and emollient soap substitute) will help provide maximal effect.
  • With the exception of white soft paraffin 50%/liquid paraffin 50%, emollients may be used as soap substitutes by firstly wetting the skin, washing with the cream or ointment, then rinsing off
  • Products that come in pump-dispensers may be more suitable for long-term use in order to reduce the risk of microbial contamination. For emollients that come in tubs, a clean spoon should be used to remove required amount of emollient from the tub.
  • Emollients should be prescribed in large quantities. The recommended quantities used in eczema being 600g/week for an adult and 250g/week for a child. More information on recommended quantities can be found here.

Other formulations

ChoiceDrugDosage
1st choiceMyriBase® gel (isopropyl myristate 15%, liquid paraffin 15%)Dose:
Apply into the skin as often as required
2nd choiceDoublebase dayleve gel (isopropyl myristate 15%, liquid paraffin 15%)Dose:
Apply to the affected areas morning and night
Or
Emollin® spray (liquid paraffin 50%, white soft paraffin 50%)Dose:
Apply into the skin as often as required

Urea containing formulations

ChoiceDrugDosage
1st choiceBalneum® cream (urea 5%, ceramide 0.1%)Dose:
For dry skin conditions, apply twice daily
or
Flexitol 10% urea creamDose:
Apply sparingly and rub into area twice a day
or
Flexitol 25% urea heel balmDose:
Apply to area twice a day
or
Eucerin® Intensive Lotion (urea 10%)Dose:
Apply sparingly and rub into area twice a day

Prescribing Notes

  • Products containing urea should not be used unless simple emollients have been tried unsuccessfully.
  • Urea products are particularly useful in patients with particularly dry skin, hyperkeratotic scaling and ichthyotic conditions.
  • Urea may cause stinging and irritation for some people.

Emollients containing antimicrobials

ChoiceDrugDosage
1st choiceDermol® lotion
(benzalkonium chloride 0.1%, chlorhexidine dihydrochloride 0.1%, isopropyl myristate 2.5%, liquid paraffin 2.5%)
Dose:
Apply into the skin as often as required
Or
Dermol® Cream (benzalkonium chloride 0.1%, chlorhexidine dihydrochloride 0.1%, isopropyl myristate 10%, liquid paraffin 10%)Dose:
Apply into the skin as often as required

Prescribing Notes

Preparations containing an antimicrobial should be avoided unless infection is present or is a frequent complication. Topical antiseptics or antibiotics should not be used for more than 2 weeks due to increased risk of sensitisation and bacterial resistance.