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13.2 Emollient and barrier preparations

Fire hazard with paraffin-based emollients

Emulsifying ointment or 50% Liquid Paraffin and 50% White Soft Paraffin Ointment in contact with dressings and clothing is easily ignited by a naked flame. The risk will be greater when these preparations are applied to large areas of the body, and clothing or dressings become soaked with the ointment. Patients should be told to keep away from fire or flames, and not to smoke when using these preparations. The risk of fire should be considered when using large quantities of any paraffin-based emollient. See DSU April 2016.

 

13.2.1 Emollient and barrier preparations

Aqueous cream (see notes below).  
Aveeno cream
Balneuem Plus Cream
Calmurid cream (Urea 10%)
Cetraben cream (10% LP, 13% WSP)
Cetraben ointment (45% LP, 35%  WSP)
Dermol 500
Dermol cream, lotion
Diprobase cream
Doublebase
Drapolene cream
E45 cream, lotion 
Emulsifying ointment
Epaderm ointment
Epimax cream
Hydromol Ointment
Liquid paraffin 50% in white soft paraffin
Oilatum cream/shower gel
Unguentum Merck
White soft paraffin
Yellow soft paraffin
ZeroAQS cream
Zerobase cream
ZeroCream
Zeroderm ointment
ZeroDouble gel 

 

Notes:

1. Emollient prescribing guidelines are available: Derbyshire Emollient Prescribing Guide (2013)

2. Emollients should be applied as frequently as required in any dry skin condition. Emollients are particularly useful for dry eczema; patients should be encouraged to use bland emollients as necessary rather than extra applications of steroid preparations.

3. Aqueous cream may be associated with skin reactions (stinging, burning, itching and redness) when used as a 'leave-on' emollient, often within 20 minutes of application, and especially in children with atopic eczema.

4. Aqueous cream may be useful as a soap substitute, but it is considered a poor choice as an emollient in eczema as it reduces the thickness of the stratum corneum, and increases the permeability to water loss. See the Drug Safety update March 2013.

 

13.2.1.1 Emollient Bath Additives

Those indicated (#) can be applied direct to the affected area, by rubbing a small amount onto wet skin.
Balneum bath oil #
Balneum Plus bath oil #
Diprobath bath additive
Emulsiderm liquid
Oilatum Emollient bath additive #
Oilatum Plus bath additive #

Notes:

1. If bathing worsens dryness, emulsifying ointment or aqueous cream should be used in place of soap and may be added to the bath if the affected areas are extensive.

2. Balneum bath oil is indicated for dry skin conditions including dermatitis and eczema. Balneum plus and oilatum plus are indicated where pruritus is associated.

 

13.2.2 Barrier preparations

Conotrane cream
Drapolene cream
Metanium ointment – treatment of nappy rash only, 
Mr Goodall's Ileostomy Cream ("Ostomy Barrier Cream" / "Ileostomy Skin Protection" / Mr Goodalls Formula cream).
Zinc and castor oil ointment

Note:

These preparations protect the skin from repeated exposure to water and other irritants. They are useful for areas around stomata, sore areas in the elderly, bedsores etc. They are no substitute for adequate nursing care. 

For link to BNF section: 13.2 Emollient & barrier preparations