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13.1 Dry and scaling skin disorders

First line drugs Second line drugs Specialist drugs Secondary care drugs

Traffic light status explained:

  • Green: Routine prescribing within licensed indication
  • Amber 1: specialist recommendation followed by GP initiation and continuation
  • Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
  • Amber 3: specialist initiation and stabilisation followed by GP continuation
  • Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
  • Red: Hospital or specialist prescribing only

 

Emollient and barrier preparations

These amounts are suitable for an average adult, when the emollient is applied TWICE A DAY. These recommendations are not suitable for steroid preparations.

Body site

Creams or ointments

Lotions

One week supply

One month supply

One week supply

One month supply

Face

15-30g

60-120g

100ml

400ml

Both hands

25-50g

100-200g

200ml

800ml

Scalp

50-100g

200-400g

200ml

800ml

Both arms or legs

100-200g

400-800g

200ml

800ml

Trunk

400g

1600g

500ml

2000ml

Groin & genitalia

15-25g

60-100g

100ml

400ml

 

Refer to the locally agreed Emollient Prescribing Guidance which has information on the following:

  • General advice on lotions, creams and ointments
  • The Hows and Whys of emollient use
  • Application technique
  • 'Pot' hygiene
  • When to consider prescribing

 

Note:

 

 

Emollients

Creams 

 

    Traffic light status         Paraffin Soya   bean oil Urea  Antimicrobial Lanolin/derivatives Parabens
 Preferred  Cetraben  Green YES          
Zerocream  Green YES       YES  
Zerobase  Green YES          
Zeroveen®  Green YES          
                 
Others       QV cream  Green YES         YES
Epaderm cream  Amber 1 YES          
Hydromol cream  Amber 1 YES         YES
Dermol cream  Amber 1 YES     YES 1,2    
*Flexitol 10% urea cream  Amber 1     YES   YES  
*Flexitol 25% urea heel balm  Amber 1     YES   YES  

 Antimicrobials

  • 1 = benzalkonium chloride; 2 = chlorhexidine

 

*Notes on Flexitol

  • It is recommended for patients classified as medium to high risk of diabetic foot disease
  • Flexitol 25% Urea Heel Balm is used initially once or twice daily for approximately 2 weeks
  • When the skin is repaired and restored then maintain with Flexitol 10% cream

 

Lotions  

    Traffic light status      Paraffin Soya   bean oil Urea  Antimicrobial Lanolin/derivatives Parabens
 Preferred Cetraben lotion  Green  YES          
 QV lotion  Green  YES          YES
                 
  Dermol lotion  Amber 1 YES     YES 1,2    

 

 

Rich Creams

    Traffic light status Paraffin Soya   bean oil Urea  Antimicrobial Lanolin/derivatives Parabens
Preferred Zeroguent Green YES YES        

 

Ointments

    Formulary designation Paraffin Soya   bean oil Urea  Antimicrobial Lanolin/derivatives Parabens
Preferred Emulsifying ointment  Green YES          
Cetraben Ointment  Green YES          
Zeroderm  Green YES          
WSP 50%:LP 50%  Green YES          
                 
Others QV intensive  Amber 2 YES          
Hydromol ointment  Amber 1 YES          
Epaderm ointment  Amber 1 YES          

 

 

Gels

    Traffic light status Paraffin Soya   bean oil Urea  Antimicrobial Lanolin/derivatives Parabens
Preferred Zerodouble Green YES          

 

Cleansers, Bath and Shower additives

    Traffic light status      Paraffin Soya   bean oil Urea  Antimicrobial Lanolin/dervatives Parabens
  Cetraben bath  Green YES          
Preferred ZeroAQS  Green YES          
Zerolatum  Green YES       YES  
Zeroneum  Green   YES        
QV bath oil  Green YES         YES
QV gentle wash  Green           YES
                 
Others Oilatum fragrance free shower gel  Amber 2 YES          
Aqueous cream  Amber 2 YES          
Hydromol bath and shower  Amber 1 YES          

Dermol 600 bath emollient;

Dermol 200 shower emollient

  Amber 1 YES     YES 1,3    

  Antimicrobials

  • 1 = benzalkonium chloride
  • 2 = chlorhexidine
  • 3 = sorbic acid

Notes: 

  • Emulsifying ointment and aqueous cream may be acceptable to many patients as a bath emollient.  These products are best whisked with hot water in a jug before adding to bath water.
  • Patients should be aware of the potential dangers of slipping in the bath if emollients are added - the use of a bath mat may reduce this risk. Parents may also wish to be cautious when removing children from the bath. 

 

Barrier Preparations

 

Click here for "Skin Care Guidelines for Prevention and Management of Moisture to the Skin"

 

 

Medi Derma-S  

  • Barrier cream 28g, 90g tube
  • Barrier Film 1ml foam applicator
  • Barrier Film 3ml foam applicator
  • Spray 30ml

 

Medi Derma-Pro  

  • Ointment, skin protectant 115g tube
  • Foam & spray incontinence cleanser, 119g

 

Metanium® 

  • ointment 

Notes: 

  • Should not be prescribed in Primary Care or at Discharge
  • Advise patient to purchase

 

Sudocrem® 

  • cream 

Notes: 

  • Should not be prescribed in Primary Care or at Discharge
  • Advise patient to purchase

 

 

  

 

 

Traffic light status explained:

  • Green: Routine prescribing within licensed indication
  • Amber 1: specialist recommendation followed by GP initiation and continuation
  • Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
  • Amber 3: specialist initiation and stabilisation followed by GP continuation
  • Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
  • Red: Hospital or specialist prescribing only

  

Return to Chapter: 13. Skin

Last updated by: Sheila Wood on 19-06-2019 12:18