(Click here for creams)
(Click here for other formulations including urea and antimicrobial)
Ointments
| Choice | Drug | Dosage |
|---|---|---|
| Formulary choices | Hydromol® 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 |
Creams
| Choice | Drug | Dosage |
|---|---|---|
| Formulary choices | Oilatum® 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® eczema 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 | ||
| Epaderm® cream (yellow soft paraffin 15%, liquid paraffin 10%, emulsifying wax 5%) | Dose: Apply into the skin as often as required | |
| * Note: Caution on fire hazard applies to paraffin free emollients also - see Cautions below. | ||
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 whether they contain paraffin or not. 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 use include MHRA Drug Safety Update Dec 2018 and MHRA Safe Use of Emollient Guidance July 2020.
- 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
| Choice | Drug | Dosage |
|---|---|---|
| 1st choice | MyriBase® gel (isopropyl myristate 15%, liquid paraffin 15%) | Dose: Apply into the skin as often as required |
| 2nd choice | Doublebase 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
| Choice | Drug | Dosage |
|---|---|---|
| 1st choice | Balneum® cream (urea 5%, ceramide 0.1%) | Dose: For dry skin conditions, apply twice daily |
| or | ||
| Flexitol 10% urea cream | Dose: Apply sparingly and rub into area twice a day | |
| or | ||
| Flexitol 25% urea heel balm | Dose: Apply to 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
| Choice | Drug | Dosage |
|---|---|---|
| 1st choice | Dermol® 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.