Prescriptions issued in accordance with this advice and Suitable quantities for

13.1.2 Prescriptions issued in accordance with this advice and Suitable quantities for

endorsed ‘ACBS’ will normally not be investigated. See

prescribing

Appendix 7 for listing by clinical condition.

Suitable quantities of dermatological pre-

13.2.1 Emollients

parations to be prescribed for specific areas of the body

Emollients soothe, smooth and hydrate the skin and are indicated for all dry or scaling disorders. Their effects

Creams and Ointments

Lotions

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 in Both hands

Face 15–30 g

100 mL

psoriasis (section 13.5.2). Light emollients such as Scalp

25–50 g

200 mL

aqueous cream are suitable for many patients with Both arms or both legs

50–100 g

200 mL

dry skin but a wide range of more greasy preparations, Trunk

100–200 g

200 mL

including white soft paraffin, emulsifying ointment, Groins and genitalia

and liquid and white soft paraffin ointment, are avail- able; the severity of the condition, patient preference

These amounts are usually suitable for an adult for twice daily application for 1 week. The recommendations do

1. Purified versions of wool fat have reduced the problem

BNF 57

13.2.1 Emollients 617

and site of application will often guide the choice of Proprietary emollient preparations emollient; emollients should be applied in the direction

Aveeno c (J&J)

of hair growth. Ointments may exacerbate acne and Cream , colloidal oatmeal in emollient basis, net price folliculitis. Some ingredients rarely cause sensitisation

100 mL = £3.78, 300-mL pump pack = £6.80 (section 13.1.3) and this should be suspected if an

Excipients include benzyl alcohol, cetyl alcohol, isopropyl palmitate

eczematous reaction occurs. ACBS: For endogenous and exogenous eczema, xeroderma, ichthyosis, and senile pruritus (pruritus of the elderly) associated

Fire hazard with paraffin-based emollients

with dry skin

Emulsifying ointment or 50% Liquid Paraffin and Lotion , colloidal oatmeal in emollient basis, net price 50% White Soft Paraffin Ointment in contact with

400 mL = £6.42

dressings and clothing is easily ignited by a naked

Excipients include benzyl alcohol, cetyl alcohol, isopropyl palmitate ACBS: as for Aveeno

flame. The risk is greater when these preparations Cream are applied to large areas of the body, and clothing or

Cetraben c (Genus)

Patients should be told to keep away from fire or Emollient cream , white soft paraffin 13.2%, light liq- flames, and not to smoke when using these prepara-

dressings become soaked with the ointment.

uid paraffin 10.5%, net price 50-g pump pack = £1.17, tions. The risk of fire should be considered when

150-g pump pack = £2.88, 500-g pump pack = £5.61, using large quantities of any paraffin-based emoll-

1.05-kg pump pack = £11.11 ient.

Excipients include cetostearyl alcohol, hydroxybenzoates (parabens) For inflamed, damaged, dry or chapped skin including eczema

Preparations such as aqueous cream and emulsifying Dermamist ointment can be used as soap substitutes for hand c (Alliance) washing and in the bath; the preparation is rubbed on

Spray application , white soft paraffin 10% in a basis the skin before rinsing off completely. The addition of a

containing liquid paraffin, fractionated coconut oil, bath oil (section 13.2.1.1) may also be helpful.

net price 250-mL pressurised aerosol unit = £9.22 Excipients none as listed in section 13.1.3

Preparations containing an antibacterial (section 13.10) For dry skin conditions including eczema, ichthyosis, pruritus of should be avoided unless infection is present or is a

the elderly

frequent complication.

Note Flammable

Urea is a hydrating agent used in the treatment of dry, scaling conditions (including ichthyosis) and may be

Diprobase c (Schering-Plough) useful in elderly patients. It is occasionally used with

Cream , cetomacrogol 2.25%, cetostearyl alcohol other topical agents such as corticosteroids to enhance

7.2%, liquid paraffin 6%, white soft paraffin 15%, penetration of the skin.

water-miscible basis used for Diprosone c cream, net price 50 g = £1.34; 500-g pump pack = £6.76 Excipients include cetostearyl alcohol, chlorocresol For dry skin conditions

Non-proprietary emollient preparations Ointment , liquid paraffin 5%, white soft paraffin 95%,

Aqueous Cream, BP

basis used for Diprosone c ointment, net price 50 g =

Cream , emulsifying ointment 30%, 1 phenoxyethanol

1% in freshly boiled and cooled purified water, net

Excipients none as listed in section 13.1.3

price 500 g = £1.68

For dry skin conditions

Excipients include cetostearyl alcohol

1. The BP permits use of alternative antimicrobials provided Doublebase c (Dermal) their identity and concentration are stated on the label

Gel , isopropyl myristate 15%, liquid paraffin 15%, net price 100 g = £2.77, 500 g = £6.09 Excipients none as listed in section 13.1.3

Emulsifying Ointment, BP

For dry chapped or itchy skin conditions Ointment , emulsifying wax 30%, white soft paraffin

Emollient shower gel , isopropyl myristate 15%, liquid

Skin

50%, liquid paraffin 20%, net price 500 g = £2.10 Excipients include cetostearyl alcohol

paraffin 15%, net price 200 g = £5.45 Excipients none as listed in section 13.1.3 For dry and chapped skin conditions

Hydrous Ointment, BP

Ointment , (oily cream), dried magnesium sulphate

E45 c (Crookes)

0.5%, phenoxyethanol 1%, wool alcohols ointment Cream , light liquid paraffin 12.6%, white soft paraffin 50%, in freshly boiled and cooled purified water, net

14.5%, hypoallergenic anhydrous wool fat (hypoal- price 500 g = £2.12

lergenic lanolin) 1% in self-emulsifying monostearin, net price 50 g = £1.40, 125 g = £2.55, 350 g = £4.46, 500-g pump pack = £6.20

Liquid and White Soft Paraffin Ointment, NPF

Excipients include cetyl alcohol, hydroxybenzoates (parabens)

Ointment , liquid paraffin 50%, white soft paraffin

For dry skin conditions

50%, net price 500 g = £3.94 Emollient Wash Cream , soap substitute, zinc oxide 5% in an emollient basis, net price 250-mL pump pack

Paraffin, White Soft, BP

= £3.19 Excipients none as listed in section 13.1.3

White petroleum jelly, net price 100 g = 48p ACBS: for endogenous and exogenous eczema, xeroderma, ichthyosis and senile pruritus (pruritus of the elderly) associated with dry skin

Paraffin, Yellow Soft, BP

Lotion , light liquid paraffin 4%, cetomacrogol, white Yellow petroleum jelly, net price 100 g = 34p

soft paraffin 10%, hypoallergenic anhydrous wool fat

13.2.1 Emollients BNF 57 (hypoallergenic lanolin) 1% in glyceryl monostearate,

Wash , glycerol 10%, net price 200 mL = £2.50 net price 200 mL = £2.40, 500-mL pump pack = £4.50

Excipients include hydroxybenzoates (parabens) Excipients include isopropyl palmitate, hydroxybenzoates (parabens),

For dry skin conditions including eczema, psoriasis, ichthyosis, benzyl alcohol

and pruritus, use as soap substitute ACBS: for symptomatic relief of dry skin conditions, such as those

associated with atopic eczema and contact dermatitis Ultrabase c (Valeant) Emollin c (C D Medical)

Cream , water-miscible, containing liquid paraffin and Spray white soft paraffin, net price 50 g = 89p, 500-g pump , liquid paraffin 50%, white soft paraffin 50% in

pack = £6.44

Excipients none as listed in section 13.1.3 include fragrance, hydroxybenzoates (parabens), disodium edetate, stearyl alcohol For dry skin conditions

aerosol basis, net price 240 mL = £5.98

Excipients

For dry skin conditions Epaderm c (Medlock)

Unguentum M c (Almirall) Ointment , emulsifying wax 30%, yellow soft paraffin

Cream , containing saturated neutral oil, liquid par- 30%, liquid paraffin 40%, net price 125 g = £3.62,

affin, white soft paraffin, net price 50 g = £1.41, 100 g 500 g = £6.14, 1 kg = £11.44 Excipients include cetostearyl alcohol

= £2.78, 200-mL pump pack = £5.50, 500 g = £8.48 Excipients include cetostearyl alcohol, polysorbate 40, propylene gly-

For use as an emollient or soap substitute

col, sorbic acid

c Hewletts For dry skin conditions and nappy rash (Kestrel) Cream , hydrous wool fat 4%, zinc oxide 8%, arachis

Zerobase c (Zeroderma) (peanut) oil, oleic acid, white soft paraffin, net price

Cream , liquid paraffin 11%, net price 500-g pump

35 g = £1.43, 400 g = £6.69

pack = £5.99

Excipients include fragrance Excipients include cetostearyl alcohol, chlorocresol For nursing hygiene and care of skin, and chapped hands

For dry skin conditions Hydromol c (Alliance)

Cream , sodium pidolate 2.5%, liquid paraffin 13.8%, Preparations containing urea c

net price 50 g = £2.04, 100 g = £3.80, 500 g = £12.60 Aquadrate (Alliance)

Cream , urea 10%, net price 30 g = £1.37, 100 g = £3.64 For dry skin conditions

Excipients include cetyl alcohol, hydroxybenzoates (parabens)

Excipients none as listed in section 13.1.3

Dose Ointment for dry, scaling and itching skin, apply thinly and rub into , yellow soft paraffin 30%, emulsifying wax

area when required

30%, liquid paraffin 40%, net price 125 g = £2.79, 500 g = £4.74

Balneum c Plus (Almirall)

Excipients include cetostearyl alcohol

Cream , urea 5%, lauromacrogols 3%, net price 100 g For use as an emollient, bath additive, or soap substitute

= £3.29, 175-g pump pack = £8.33, 500-g pump pack Linola c Gamma (Linderma)

, evening primrose oil 20%, net price 50 g = Excipients Cream include benzyl alcohol, polysorbates Dose for dry, scaling and itching skin, apply twice daily £2.83, 250 g = £8.20 Excipients include beeswax, hydroxybenzoates (parabens), propylene

Calmurid glycol c (Galderma) Cautions epilepsy (but hazard unlikely with topical preparations)

Cream , urea 10%, lactic acid 5%, net price 100 g = For dry skin conditions

£7.36, 500-g pump pack = £28.37 Excipients none as listed in section 13.1.3

Lipobase c (Astellas) Dose for dry, scaling and itching skin, apply a thick layer for 3–5

Cream , fatty cream basis used for Locoid Lipocream c ,

minutes, massage into area, and remove excess, usually twice daily. Use half-strength cream for 1 week if stinging occurs

Excipients include cetostearyl alcohol, hydroxybenzoates (parabens) Can be diluted with aqueous cream (life of diluted cream 14

net price 50 g = £2.08

Note

Skin

days)

For dry skin conditions, also for use during treatment with topical corticosteroid and as diluent for Locoid Lipocream

E45 c Itch Relief Cream (Crookes)

Cream , urea 5%, macrogol lauryl ether 3%, net price Cream , light liquid paraffin 6%, white soft paraffin

13 Oilatum c (Stiefel)

50 g = £2.55, 100 g = £3.47, 500-g pump pack = £17.09 Excipients 15%, net price 40 g = £1.79, 150 g = £3.38, 500-mL include benzyl alcohol, polysorbates Dose for dry, scaling, and itching skin, apply twice a day pump pack = £6.35, 1.05-litre pump pack = £14.67;

Oilatum c Junior 150 g = £3.38, 350 mL = £4.65, Eucerin c Intensive (Beiersdorf) 500 mL = £6.35, 1.05-litre pump pack = £14.67

Cream , urea 10%, net price 100 mL = £7.59

Excipients include benzyl alcohol, cetostearyl alcohol Excipients include benzyl alcohol, isopropyl palmitate, wool fat For dry skin conditions

Dose for dry skin conditions including eczema, ichthyosis, xer- Shower emollient (gel), light liquid paraffin 70%, net

oderma, hyperkeratosis, apply thinly and rub into area twice daily price 150 g = £5.15

Lotion , urea 10%, net price 250 mL = £7.93

Excipients include fragrance Excipients include benzyl alcohol, isopropyl palmitate For dry skin conditions including dermatitis

Dose for dry skin conditions including eczema, ichthyosis, xer- oderma, hyperkeratosis, apply sparingly and rub into area twice

QV c (Crawford)

daily

Cream , glycerol 10%, light liquid paraffin 10%, white soft paraffin 5%, net price 100 g = £1.95, 500 g = £5.60

Nutraplus c (Galderma)

Excipients include hydroxybenzoates (parabens), propylene glycol pruritus

Excipients include cetostearyl alcohol, hydroxybenzoates (parabens)

Cream , urea 10%, net price 100 g = £4.37 For dry skin conditions including eczema, psoriasis, ichthyosis,

Dose for dry, scaling and itching skin, apply 2–3 times daily Lotion , white soft paraffin 5%, net price 250 mL =

£3.00 With antimicrobials

Excipients include cetostearyl alcohol, hydroxybenzoates (parabens)

Dermol c (Dermal)

For dry skin conditions including eczema, psoriasis, ichthyosis, Cream , benzalkonium chloride 0.1%, chlorhexidine pruritus

hydrochloride 0.1%, isopropyl myristate 10%, liquid

BNF 57

13.2.1 Emollients 619

paraffin 10%, net price 100-g tube = £3.22, 500-g

Cetraben c (Genus)

pump pack = £7.45 Excipients

Emollient bath additive , light liquid paraffin 82.8%,

include cetostearyl alcohol Dose

net price 500 mL = £5.25 for dry and pruritic skin conditions including eczema and dermatitis, apply to skin or use as soap substitute

Dose for dry skin conditions, including eczema, add 1–2 capfuls/ bath ( CHILD ½–1 capful) or apply to wet skin and rinse

Dermol c 500 Lotion , benzalkonium chloride 0.1%, Dermalo chlorhexidine hydrochloride 0.1%, liquid paraffin c (Dermal) 2.5%, isopropyl myristate 2.5%, net price 500-mL

Bath emollient , acetylated wool alcohols 5%, liquid pump pack = £6.31

paraffin 65%, net price 500 mL = £3.60

Excipients include cetostearyl alcohol Excipients none as listed in section 13.1.3 Dose for dry and pruritic skin conditions including eczema and

Dose for dermatitis, dry skin conditions including ichthyosis and dermatitis, apply to skin or use as soap substitute

pruritus of the elderly; add 15–20 mL/bath ( INFANT and CHILD 5– Dermol 10 mL) or apply to wet skin and rinse c 200 Shower Emollient , benzalkonium

chloride 0.1%, chlorhexidine hydrochloride 0.1%, Diprobath c (Schering-Plough) liquid paraffin 2.5%, isopropyl myristate 2.5%, net

Bath additive , isopropyl myristate 39%, light liquid price 200 mL = £3.71 Excipients include cetostearyl alcohol

Excipients paraffin 46%, net price 500 mL = £6.97 none as listed in section 13.1.3 Dose for dry and pruritic skin conditions including eczema and

Dose for dry skin conditions including dermatitis and eczema; dermatitis, apply to skin or use as soap substitute

add 25–50 mL/bath ( INFANT 10 mL); do not use undiluted Doublebase c (Dermal)

Emollient bath additive , liquid paraffin 65%, net

13.2.1.1 Emollient bath additives

price 500 mL = £5.70 Excipients include cetostearyl alcohol

Emollient bath additives should be added to bath water; Dose for dry skin conditions including dermatitis, ichthyosis, and hydration can be improved by soaking in the bath for

pruritus of the elderly; add 15–20 mL/bath, ( INFANT and CHILD 5– 10–20 minutes. Some bath emollients can be applied to

10 mL)

wet skin undiluted and rinsed off. In dry skin conditions

E45 c (Crookes)

soap should be avoided (see section 13.2.1 for soap Emollient bath oil , cetyl dimeticone 5%, liquid par- substitutes). The quantities of bath additives recom-

affin 91%, net price 250 mL = £3.19, 500 mL = £5.11 mended for adults are suitable for an adult-size bath.

Excipients none as listed in section 13.1.3

Proportionately less should be used for a child-size bath Dose ACBS: for endogenous and exogenous eczema, xeroderma, or a washbasin; recommended bath additive quantities

ichthyosis, and senile pruritus (pruritus of the elderly) associated for children reflect this.

with dry skin; add 15 mL/bath ( CHILD 5–10 mL) or apply to wet skin and rinse

These preparations make skin and surfaces slip- Hydromol c (Alliance) pery—particular care is needed when bathing

Bath and Shower Emollient , isopropyl myristate 13%, light liquid paraffin 37.8%, net price 350 mL =

Alpha Keri Bath c (Novartis Consumer Health) £3.80, 500 mL = £5.14, 1 litre = £9.00 Bath oil , liquid paraffin 91.7%, oil-soluble fraction of

Excipients none as listed in section 13.1.3

wool fat 3%, net price 240 mL = £3.45, 480 mL = £6.43 Dose for dry skin conditions including eczema, ichthyosis and Excipients include fragrance

pruritus of the elderly; add 1–3 capfuls/bath ( INFANT ½–2 capfuls) Dose for dry skin conditions including ichthyosis and pruritus of

or apply to wet skin and rinse the elderly, add 10–20 mL/bath ( INFANT

Imuderm and rinse c (Goldshield) Aveeno c

5 mL) or apply to wet skin

Bath oil , almond oil 30%, light liquid paraffin 69.6%, (J&J)

net price 250 mL = £3.75 Aveeno c Bath oil , colloidal oatmeal, white oat

Excipients include butylated hydroxyanisole

fraction in emollient basis, net price 250 mL = £4.28 Dose for dry skin conditions including dermatitis, eczema, pru-

Excipients include beeswax, fragrance ritus of the elderly, and ichthyosis, add 15–30 mL/bath ( INFANT Dose ACBS: for endogenous and exogenous eczema, xeroderma,

and CHILD 7.5–15 mL) or rub into dry skin until absorbed ichthyosis, and senile pruritus (pruritus of the elderly) associated

c Skin

with dry skin, add 20–30 mL/bath or apply to wet skin and rinse

Oilatum (Stiefel)

Aveeno Colloidal c Bath additive , oatmeal, white oat Emollient bath additive (emulsion), acetylated wool alcohols 5%, liquid paraffin 63.4%, net price 250 mL = £2.75, 500 mL = £4.57

Excipients none as listed in section 13.1.3 Excipients include isopropyl palmitate, fragrance Dose ACBS: as for Aveeno Bath oil; add 50 g/bath ( INFANT and

Dose for dry skin conditions including dermatitis, pruritus of the CHILD under 12 years, 15 g)

elderly and ichthyosis; add 1–3 capfuls/bath ( INFANT 0.5–2 cap- fuls) or apply to wet skin and rinse

Balneum c (Almirall) Junior Emollient bath additive , light liquid paraffin Balneum c bath oil , soya oil 84.75%, net price

63.4%, net price 150 mL = £2.82, 250 mL = £3.25, 200 mL = £2.48, 500 mL = £5.38, 1 litre = £10.39 Excipients

300 mL = £5.10, 500 mL = £5.75

include butylated hydroxytoluene, propylene glycol, fra- Excipients include wool fat, isopropyl palmitate grance Dose

Dose for dry skin conditions including dermatitis, pruritus of the for dry skin conditions including those associated with

INFANT dermatitis and eczema; add 20–60 mL/bath ( INFANT 5–15 mL); do

elderly and ichthyosis; add 1–3 capfuls/bath ( 0.5–2 cap- fuls) or apply to wet skin and rinse not use undiluted

Balneum Plus c bath oil , soya oil 82.95%, mixed

QV c (Crawford)

lauromacrogols 15%, net price 500 mL = £6.66 Bath oil , light liquid paraffin 85.09%, net price 200 mL

Excipients include butylated hydroxytoluene, propylene glycol, fra-

= £2.20, 500 mL = £4.50

grance Excipients include hydroxybenzoates (parabens) Dose for dry skin conditions including those associated with

Dose for dry skin conditions including eczema, ichthyosis, and dermatitis and eczema where pruritus also experienced; add

pruritus of the elderly, add 10 mL/bath ( CHILD 7 mL, INFANT 4 mL) 20 mL/bath ( INFANT

5 mL) or apply to wet skin and rinse or apply to wet skin and rinse

13.2.2 Barrier preparations BNF 57 With antimicrobials

8%, in freshly boiled and cooled purified water, net Dermol c 600 (Dermal)

price 50 g = 50p Bath Emollient , benzalkonium chloride 0.5%, liquid

For nappy and urinary rash and eczematous conditions paraffin 25%, isopropyl myristate 25%, net price 600 mL = £7.90

Zinc Ointment, BP

Excipients include polysorbate 60

Ointment , zinc oxide 15%, in Simple Ointment BP Dose for dry and pruritic skin conditions including eczema and

1988 (which contains wool fat 5%, hard paraffin 5%, dermatitis, add up to 30 mL/bath ( INFANT up to 15 mL); do not use

cetostearyl alcohol 5%, white soft paraffin 85%), net undiluted

price 25 g = 22p Emulsiderm c (Dermal)

For nappy and urinary rash and eczematous conditions Liquid emulsion , liquid paraffin 25%, isopropyl myr-

istate 25%, benzalkonium chloride 0.5%, net price

Zinc and Castor Oil Ointment, BP

300 mL (with 15-mL measure) = £4.03, 1 litre (with 30- Ointment , zinc oxide 7.5%, castor oil 50%, arachis mL measure) = £12.55

(peanut) oil 30.5%, white beeswax 10%, cetostearyl

Excipients include polysorbate 60

alcohol 2%, net price 100 g = 70p Dose for dry skin conditions including eczema and ichthyosis;

For nappy and urinary rash add 7–30 mL/bath or rub into dry skin until absorbed

Oilatum c Plus (Stiefel) Proprietary barrier preparations Bath additive , benzalkonium chloride 6%, triclosan

Conotrane c (Astellas) 2%, light liquid paraffin 52.5%, net price 500 mL =

Cream , benzalkonium chloride 0.1%, dimeticone ‘350’ £6.98

22%, net price 100 g = 74p, 500 g = £3.51

Excipients include wool fat, isopropyl palmitate Excipients include cetostearyl alcohol, fragrance Dose for topical treatment of eczema including eczema at risk

For nappy and urinary rash and pressure sores from infection; add 1–2 capfuls/bath ( CHILD over 6 months 1 mL); do not use undiluted

Drapolene c (Chefaro UK) Cream , benzalkonium chloride 0.01%, cetrimide 0.2%

With tar in a basis containing white soft paraffin, cetyl alcohol Section 13.5.2

and wool fat, net price 100 g = £1.54, 200 g = £2.50, 350 g = £3.75 Excipients include cetyl alcohol, chlorocresol, wool fat For nappy and urinary rash; minor wounds

13.2.2 Barrier preparations

Medicaid c (LPC) Cream , cetrimide 0.5% in a basis containing light

Barrier preparations often contain water-repellent sub- liquid paraffin, white soft paraffin, cetostearyl alcohol, stances such as dimeticone (dimethicone) or other

glyceryl monostearate, net price 50 g = £1.69 silicones. They are used on the skin around stomas, Excipients include cetostearyl alcohol, fragrance, hydroxybenzoates

(parabens), wool fat

bedsores, and pressure areas in the elderly where the For nappy rash, minor burns and abrasions skin is intact. Where the skin has broken down, barrier preparations have a limited role in protecting adjacent

Metanium c (Ransom) skin. They are no substitute for adequate nursing care

Ointment , titanium dioxide 20%, titanium peroxide and it is doubtful if they are any more effective than zinc

5%, titanium salicylate 3% in a basis containing ointments.

dimeticone, light liquid paraffin, white soft paraffin, and benzoin tincture, net price 30 g = £2.01

Nappy rash Barrier creams and ointments are used for

Excipients none as listed in section 13.1.3

Skin protection against nappy rash which is usually a local

For nappy rash

Morhulin c 13 (Actavis)

dermatitis. The first line of treatment is to ensure that

nappies are changed frequently and that tightly fitting , cod-liver oil 11.4%, zinc oxide 38%, in a water-proof pants are avoided. The rash may clear when

Ointment basis containing liquid paraffin and yellow soft par-

left exposed to the air and a barrier preparation can be affin, net price 50 g = £1.72 helpful. If the rash is associated with a fungal infection,

Excipients include wool fat derivative

an antifungal cream such as clotrimazole cream (section For minor wounds, varicose ulcers, pressure sores, eczema and

13.10.2) is useful. A mild corticosteroid such as hydro-

nappy rash

cortisone 1% is useful in moderate to severe inflamma- tion, but it should be avoided in neonates. The barrier

Siopel c (Centrapharm) preparation is applied after the corticosteroid prepara-

Barrier cream , dimeticone ‘1000’ 10%, cetrimide tion to prevent further damage. Hydrocortisone can be

0.3%, arachis (peanut) oil, net price 50 g = £2.15 used in combination with antifungal and antibacterial

Excipients include butylated hydroxytoluene, cetostearyl alcohol, hydroxybenzoates (parabens)

drugs (section 13.4) if there is considerable inflamma- For protection against water-soluble irritants tion, erosion, and infection. Preparations containing hydrocortisone should be applied for no more than a

Sprilon c (Ayrton Saunders) week; the hydrocortisone should be discontinued as

Spray application , dimeticone 1.04%, zinc oxide soon as the inflammation subsides. The occlusive effect

12.5%, in a basis containing wool alcohols, cetostearyl of nappies and water-proof pants may increase absorp-

alcohol, dextran, white soft paraffin, liquid paraffin, tion (for cautions, see p. 622).

propellants, net price 115-g pressurised aerosol unit = £3.54

Non-proprietary barrier preparations

Excipients include cetostearyl alcohol, hydroxybenzoates (parabens),

Zinc Cream, BP wool fat

Cream For urinary rash, pressure sores, leg ulcers, moist eczema, fissures, , zinc oxide 32%, arachis (peanut) oil 32%, fistulae and ileostomy care calcium hydroxide 0.045%, oleic acid 0.5%, wool fat

Note Flammable

BNF 57

13.3 Topical local anaesthetics and antipruritics 621

Sudocrem c (Forest) Oily lotion (BP 1980), calamine 5%, arachis (peanut) Cream , benzyl alcohol 0.39%, benzyl benzoate 1.01%,

oil 50%, oleic acid 0.5%, wool fat 1%, in calcium benzyl cinnamate 0.15%, hydrous wool fat (hypoal-

hydroxide solution, net price 200 mL = £1.57 lergenic lanolin) 4%, zinc oxide 15.25%, net price 30 g = £1.13, 60 g = £1.25, 125 g = £1.84, 250 g = £3.09, 400 g = £4.34 Excipients include beeswax (synthetic), propylene glycol, fragrance

CROTAMITON

For nappy rash and pressure sores Indications pruritus (including pruritus after Vasogen c (Forest)

scabies—section 13.10.4); see notes above Barrier cream , dimeticone 20%, calamine 1.5%, zinc

Cautions avoid use near eyes and broken skin; use on oxide 7.5%, net price 50 g = 80p, 100 g = £1.36

doctor’s advice for children under 3 years

Excipients include hydroxybenzoates (parabens), wool fat

For nappy rash, pressure sores, ileostomy and colostomy care acute exudative dermatoses

Contra-indications

Dose . Pruritus, apply 2–3 times daily; CHILD below 3 years,

apply once daily

Eurax c (Novartis Consumer Health) Cream , crotamiton 10%, net price 30 g = £2.27, 100 g

Topical local anaesthetics

Excipients and antipruritics include beeswax, fragrance, hydroxybenzoates (parabens),

stearyl alcohol Lotion , crotamiton 10%, net price 100 mL = £2.99 Excipients include cetyl alcohol, fragrance, propylene glycol, sorbic

Pruritus may be caused by systemic disease (such as

acid, stearyl alcohol

drug hypersensitivity, obstructive jaundice, endocrine disease, and certain malignant diseases), skin disease (e.g. psoriasis, eczema, urticaria, and scabies) or as a

DOXEPIN HYDROCHLORIDE

side-effect of opioid analgesics. Where possible the underlying causes should be treated. An emollient

Indications pruritus in eczema; depressive illness (section 13.2.1) may be of value where the pruritus is

(section 4.3.1)

associated with dry skin. Pruritus that occurs in other- Cautions susceptibility to angle-closure glaucoma, wise healthy elderly people can also be treated with an

urinary retention, severe liver impairment, mania; emollient. For advice on the treatment of pruritus in

avoid application to large areas; pregnancy and palliative care, see p. 17.

breast-feeding; interactions: Appendix 1 (anti- Preparations containing crotamiton are sometimes

depressants, tricyclic) used but are of uncertain value. Preparations containing

Driving Drowsiness may affect performance of skilled tasks (e.g. driving); effects of alcohol enhanced

calamine are often ineffective. Side-effects drowsiness; local burning, stinging, irri-

A topical preparation containing doxepin 5% is licensed tation, tingling and rash; systemic side-effects such as for the relief of pruritus in eczema; it can cause drowsi-

antimuscarinic effects, headache, fever, dizziness, ness and there may be a risk of sensitisation.

gastro-intestinal disturbances also reported Pruritus is common in biliary obstruction, especially in

Dose

primary biliary cirrhosis and drug-induced cholestasis. . ADULT and CHILD over 12 years, apply thinly 3–4 times Oral administration of colestyramine (cholestyramine)

daily; usual max. 3 g per application; usual total max. is the treatment of choice (section 1.9.2).

12 g daily; coverage should be less than 10% of body Topical antihistamines and local anaesthetics are only

surface area

marginally effective and occasionally cause sensitisa-

A Cream , doxepin hydrochloride 5%, net price 30 g = topical corticosteroid is appropriate. Short-term treat-

Xepin c

(CHS)

tion. For insect stings and insect bites, a short course of a

Skin

£11.70. Label: 2, 10, patient information leaflet ment with a sedating antihistamine (section 3.4.1) may

Excipients include benzyl alcohol

help in insect stings and in intractable pruritus where sedation is desirable. Calamine preparations are of little value for the treatment of insect stings or bites.

TOPICAL LOCAL ANAESTHETICS U

For preparations used in pruritus ani, see section 1.7.1. Indications relief of local pain, see notes above. See section 15.2 for use in surface anaesthesia

Cautions occasionally cause hypersensitivity Indications pruritus

CALAMINE U

Note Topical local anaesthetic preparations may be absorbed, especially through mucosal surfaces, therefore

Calamine (Non-proprietary) U excessive application should be avoided and they should Aqueous cream , calamine 4%, zinc oxide 3%, liquid

preferably not be used for more than about 3 days; not paraffin 20%, self-emulsifying glyceryl monostearate

generally suitable for young children 5%, cetomacrogol emulsifying wax 5%, phenox-

yethanol 0.5%, freshly boiled and cooled purified water 62.5%, net price 100 mL = 59p

TOPICAL ANTIHISTAMINES U

Lotion (= cutaneous suspension), calamine 15%, zinc Indications see notes above oxide 5%, glycerol 5%, bentonite 3%, sodium citrate

Cautions may cause hypersensitivity; avoid in eczema; 0.5%, liquefied phenol 0.5%, in freshly boiled and

photosensitivity (diphenhydramine); not recom- cooled purified water, net price 200 mL = 63p

mended for longer than 3 days