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