Emollient creams and ointments,
paraffin-containing 15-Jan-2019
Dry skin conditions | Eczema | Psoriasis | Ichthyosis |
▶ Child: (consult product literature)
▶ Adult: (consult product literature)
MHRA/CHM ADVICE (UPDATED DECEMBER 2018): EMOLLIENTS:
NEW INFORMATION ABOUT RISK OF SEVERE AND FATAL BURNS
WITH PARAFFIN-CONTAINING AND PARAFFIN-FREE EMOLLIENTS
See Emollient and barrier preparations p. 1221.
l DIRECTIONS FOR ADMINISTRATION Emollients should be
applied immediately after washing or bathing to maximise
the effect of skin hydration. Emollient preparations
contained in tubs should be removed with a clean spoon or
spatula to reduce bacterial contamination of the emollient.
Emollients should be applied in the direction of hair
growth to reduce the risk of folliculitis.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 15
▶ Dermamist (Alliance Pharmaceuticals Ltd)
White soft paraffin 100 mg per 1 gram Dermamist 10% spray | 250 ml p £5.97 DT = £5.97
Emollin aerosol spray | 150 ml £4.00 | 240 ml £6.39
CAUTIONARY AND ADVISORY LABELS 15
▶ AproDerm (isopropyl myristate / liquid paraffin) (Fontus Health
Isopropyl myristate 150 mg per 1 gram, Liquid paraffin 150 mg
per 1 gram AproDerm gel | 100 gram £1.99 DT = £2.65 | 500 gram
▶ Doublebase (Dermal Laboratories Ltd)
Isopropyl myristate 150 mg per 1 gram, Liquid paraffin 150 mg
per 1 gram Doublebase Dayleve gel | 100 gram p £2.65 DT = £2.65
Doublebase gel | 100 gram p £2.65 DT = £2.65 | 500 gram p
£5.83 DT = £5.83 | 1000 gram p £10.98
Doublebase emollient wash gel | 200 gram p £5.21
Doublebase emollient shower gel | 200 gram p £5.21
▶ Exmabase (Ascot Laboratories Ltd)
Isopropyl myristate 150 mg per 1 gram, Liquid paraffin 150 mg
per 1 gram Exmabase gel | 500 gram £2.85 DT = £5.83
▶ HypoBase (Aspire Pharma Ltd)
Isopropyl myristate 150 mg per 1 gram, Liquid paraffin 150 mg
per 1 gram HypoBase gel | 500 gram £5.83 DT = £5.83
Isopropyl myristate 150 mg per 1 gram, Liquid paraffin 150 mg
per 1 gram MyriBase gel | 100 gram £2.12 DT = £2.65 | 500 ml £4.66
▶ Zerodouble (Thornton & Ross Ltd)
Isopropyl myristate 150 mg per 1 gram, Liquid paraffin 150 mg
per 1 gram Zerodouble gel | 100 gram £2.25 DT = £2.65 | 500 gram
▶ Isomol (Dermato Logical Ltd)
Isopropyl myristate 150 mg per 1 gram, Liquid paraffin 150 mg
per 1 gram isomol gel | 100 gram £1.99 DT = £2.65 | 500 gram £2.92
CAUTIONARY AND ADVISORY LABELS 15
EXCIPIENTS: May contain Benzyl alcohol, cetostearyl alcohol (including
cetyl and stearyl alcohol), chlorocresol, disodium edetate, fragrances,
hydroxybenzoates (parabens), polysorbates, propylene glycol, sorbic
▶ Aquamol (Thornton & Ross Ltd)
Aquamol cream | 50 gram £1.22 | 500 gram £6.40
▶ Cetraben (Thornton & Ross Ltd)
Liquid paraffin light 105 mg per 1 gram, White soft paraffin
132 mg per 1 gram Cetraben cream | 50 gram £1.40 | 150 gram
£3.98 | 500 gram £5.99 | 1050 gram £11.62
Diprobase cream | 50 gram £1.28 | 500 gram £6.32
▶ E45 (Forum Health Products Ltd)
Wool fat 10 mg per 1 gram, Liquid paraffin light 126 mg per
1 gram, White soft paraffin 145 mg per 1 gram E45 cream |
50 gram G £1.93 | 125 gram G £3.22 | 350 gram G £5.81 | 500 gram G £5.99
▶ Enopen (Ennogen Healthcare Ltd)
Liquid paraffin light 105 mg per 1 gram, White soft paraffin
132 mg per 1 gram Enopen cream | 50 gram £1.40 | 150 gram £3.98
| 500 gram £5.99 | 1050 gram £11.62
▶ Epaderm (Molnlycke Health Care Ltd)
Epaderm cream | 50 gram £1.71 | 150 gram £3.58 | 500 gram £7.01
▶ Epimax (Dermato Logical Ltd)
Epimax cream | 100 gram £0.75 | 500 gram £2.49
▶ ExCetra (Dermato Logical Ltd)
Liquid paraffin light 105 mg per 1 gram, White soft paraffin
132 mg per 1 gram ExCetra cream | 100 gram £1.75 | 500 gram
▶ ExmaQS (Ascot Laboratories Ltd)
Liquid paraffin light 60 mg per 1 gram, White soft paraffin
150 mg per 1 gram ExmaQS cream | 500 gram £2.95
▶ Exmaben (Ascot Laboratories Ltd)
Liquid paraffin light 105 mg per 1 gram, White soft paraffin
132 mg per 1 gram Exmaben cream | 500 gram £4.25
▶ Exmalatum (Ascot Laboratories Ltd)
Liquid paraffin light 60 mg per 1 gram, White soft paraffin
150 mg per 1 gram Exmalatum cream | 500 gram £4.45
Lipobase cream | 50 gram p £1.46
▶ Oilatum (GlaxoSmithKline Consumer Healthcare)
Liquid paraffin light 60 mg per 1 gram, White soft paraffin
150 mg per 1 gram Oilatum cream | 150 gram G £3.06 DT =
£3.06 | 500 ml G £5.28 DT = £5.28
▶ Oilatum junior (GlaxoSmithKline Consumer Healthcare)
Liquid paraffin light 60 mg per 1 gram, White soft paraffin
150 mg per 1 gram Oilatum Junior cream | 150 gram G £3.06 DT
= £3.06 | 350 ml G £4.65 DT = £4.65 | 500 ml G £5.28 DT =
Liquid paraffin light 105 mg per 1 gram, White soft paraffin
132 mg per 1 gram Soffen cream | 500 gram £4.79
Unguentum M cream | 100 gram G £2.78 | 500 gram G £8.48
▶ ZeroAQS (Thornton & Ross Ltd)
ZeroAQS emollient cream | 500 gram £3.29
▶ Zerobase (Thornton & Ross Ltd)
Liquid paraffin 110 mg per 1 gram Zerobase 11% cream | 50 gram
▶ Zerocream (Thornton & Ross Ltd)
Liquid paraffin 126 mg per 1 gram, White soft paraffin 145 mg per
1 gram Zerocream | 50 gram £1.17 | 500 gram £4.08
▶ Zeroguent (Thornton & Ross Ltd)
White soft paraffin 40 mg per 1 gram, Soya oil 50 mg per 1 gram,
Liquid paraffin light 80 mg per 1 gram Zeroguent cream | 100 gram £2.33 | 500 gram £6.99
CAUTIONARY AND ADVISORY LABELS 15
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), polysorbates
▶ Emollient creams and ointments, paraffin-containing (Nonproprietary)
Liquid paraffin 200 mg per 1 gram, Emulsifying wax 300 mg per
1 gram, White soft paraffin 500 mg per 1 gram Emulsifying
Liquid paraffin 500 mg per 1 gram, White soft paraffin 500 mg
Magnesium sulfate dried 5 mg per 1 gram, Phenoxyethanol 10 mg
per 1 gram, Wool alcohols ointment 500 mg per 1 gram Hydrous
1226 Dry and scaling skin disorders BNF 78
Liquid paraffin 50 mg per 1 gram, White soft paraffin 950 mg per
1 gram Diprobase ointment | 50 gram G £1.28 DT = £1.28 | 500 gram G £5.99 DT = £5.99
Emulsifying wax 300 mg per 1 gram,Yellow soft paraffin 300 mg
per 1 gram Emelpin ointment | 125 gram £3.08 | 500 gram £3.97
▶ Epaderm (Molnlycke Health Care Ltd)
Emulsifying wax 300 mg per 1 gram,Yellow soft paraffin 300 mg
per 1 gram Epaderm ointment | 125 gram £3.88 | 500 gram £6.58 | 1000 gram £12.12
▶ Epaderm Junior (Molnlycke Health Care Ltd)
Emulsifying wax 300 mg per 1 gram,Yellow soft paraffin 300 mg
per 1 gram Epaderm Junior ointment | 125 gram £3.85
▶ Fifty:50 (Ennogen Healthcare Ltd)
Liquid paraffin 500 mg per 1 gram, White soft paraffin 500 mg
per 1 gram Fifty:50 ointment | 250 gram £1.83 | 500 gram £3.66 DT
▶ Hydromol (Alliance Pharmaceuticals Ltd)
Emulsifying wax 300 mg per 1 gram,Yellow soft paraffin 300 mg
per 1 gram Hydromol ointment | 125 gram £2.92 | 500 gram £4.96
▶ KreaMoint (Essential-Healthcare Ltd)
Liquid paraffin 500 mg per 1 gram, White soft paraffin 500 mg
per 1 gram KreaMoint 50:50 ointment | 500 gram £3.17 DT = £4.57
▶ Thirty:30 (Ennogen Healthcare Ltd)
Emulsifying wax 300 mg per 1 gram,Yellow soft paraffin 300 mg
per 1 gram Thirty:30 ointment | 125 gram £3.81 | 250 gram £4.29 |
▶ Vaseline (Unilever UK Home & Personal Care)
White soft paraffin 1 mg per 1 mg Vaseline Pure Petroleum jelly | 50 ml G s
CAUTIONARY AND ADVISORY LABELS 15
EXCIPIENTS: May contain Benzyl alcohol, cetostearyl alcohol (including
cetyl and stearyl alcohol), hydroxybenzoates (parabens), isopropyl
▶ E45 (Forum Health Products Ltd)
E45 lotion | 200 ml £2.45 | 500 ml £4.59
▶ QV (Crawford Healthcare Ltd)
White soft paraffin 50 mg per 1 gram QV 5% skin lotion | 250 ml
Emollients, urea-containing 15-Jan-2019
l DRUG ACTION Urea is a keratin softener and hydrating
agent used in the treatment of dry, scaling conditions
(including ichthyosis) and may be useful in elderly
Dry, scaling, and itching skin
▶ Child: Apply twice daily, to be applied thinly
▶ Adult: Apply twice daily, to be applied thinly
Dry, scaling, and itching skin
Dry, scaling, and itching skin
▶ Child: Apply twice daily, apply a thick layer for
3–5 minutes, massage into area, and remove excess.
Can be diluted with aqueous cream (life of diluted
cream is 14 days). Half-strength cream can be used for
▶ Adult: Apply twice daily, apply a thick layer for
3–5 minutes, massage into area, and remove excess.
Can be diluted with aqueous cream (life of diluted
cream is 14 days). Half-strength cream can be used for
▶ Child 12–17 years: Apply once daily
Dry, scaling, and itching skin
Dry skin conditions including eczema, ichthyosis,
▶ Child: Apply twice daily, to be applied thinly and
▶ Adult: Apply twice daily, to be applied thinly and
Dry skin conditions including eczema, ichthyosis,
▶ Child: Apply twice daily, to be applied sparingly and
▶ Adult: Apply twice daily, to be applied sparingly and
Dry skin on soles of feet and heels
▶ Child 12–17 years: Apply 1–2 times a day
▶ Adult: Apply 1–2 times a day
Dry, scaling, and itching skin
▶ Child: Apply twice daily, to be applied thinly
▶ Adult: Apply twice daily, to be applied thinly
Dry skin conditions including eczema, psoriasis or
▶ Adult: Apply to skin or use as a soap substitute
Dry, scaling, and itching skin
▶ Child: Apply 2–3 times a day
▶ Adult: Apply 2–3 times a day
MHRA/CHM ADVICE (UPDATED DECEMBER 2018): EMOLLIENTS:
NEW INFORMATION ABOUT RISK OF SEVERE AND FATAL BURNS
WITH PARAFFIN-CONTAINING AND PARAFFIN-FREE EMOLLIENTS
See Emollient and barrier preparations p. 1221.
BNF 78 Dry and scaling skin disorders 1227
l DIRECTIONS FOR ADMINISTRATION Emollients should be
applied immediately after washing or bathing to maximise
the effect of skin hydration. Emollient preparations
contained in tubs should be removed with a clean spoon or
spatula to reduce bacterial contamination of the emollient.
Emollients should be applied in the direction of hair
growth to reduce the risk of folliculitis.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 15
EXCIPIENTS: May contain Benzyl alcohol, cetostearyl alcohol (including
cetyl and stearyl alcohol), hydroxybenzoates (parabens), isopropyl
palmitate, polysorbates, propylene glycol, woolfat and related substances
▶ Aquadrate (Alliance Pharmaceuticals Ltd)
Urea 100 mg per 1 gram Aquadrate 10% cream | 30 gram £1.64 |
Balneum cream | 50 gram £2.85 | 500 gram £9.97
Lauromacrogols 30 mg per 1 gram, Urea 50 mg per
1 gram Balneum Plus cream | 100 gram G £3.29 DT = £4.28 | 500 gram G £14.99 DT = £14.99
▶ Calmurid (Galderma (UK) Ltd)
Lactic acid 50 mg per 1 gram, Urea 100 mg per 1 gram Calmurid
cream | 100 gram p £5.75 DT = £5.75 | 500 gram p £33.40 DT =
▶ E45 Itch Relief (Forum Health Products Ltd)
Lauromacrogols 30 mg per 1 gram, Urea 50 mg per 1 gram E45
▶ Eucerin Intensive (Beiersdorf UK Ltd)
Urea 100 mg per 1 gram Eucerin Intensive 10% cream | 100 ml G £7.59
▶ Hydromol Intensive (Alliance Pharmaceuticals Ltd)
Urea 100 mg per 1 gram Hydromol Intensive 10% cream | 30 gram
imuDERM emollient | 500 gram £6.55
▶ Nutraplus (Galderma (UK) Ltd)
Urea 100 mg per 1 gram Nutraplus 10% cream | 100 gram p
CAUTIONARY AND ADVISORY LABELS 15
EXCIPIENTS: May contain Benzyl alcohol, isopropyl palmitate
▶ Eucerin Intensive (Beiersdorf UK Ltd)
Urea 100 mg per 1 gram Eucerin Intensive 10% lotion | 250 ml G £7.93 DT = £7.93
CAUTIONARY AND ADVISORY LABELS 15
EXCIPIENTS: May contain Beeswax, benzyl alcohol, cetostearyl alcohol
(including cetyl and stearyl alcohol), fragrances, lanolin
▶ Dermatonics Once (Dermatonics Ltd)
Dermatonics Once Heel Balm | 75 ml £3.60 | 200 ml £8.50
▶ Flexitol (Thornton & Ross Ltd)
Flexitol 25% Urea Heel Balm | 40 gram £2.75 | 75 gram £3.80 | 200 gram £9.40 | 500 gram £14.75
Antibacterial preparations for the skin
Cellulitis, a rapidly spreading deeply seated inflammation of
the skin and subcutaneous tissue, requires systemic
antibacterial treatment. Lower leg infections or infections
spreading around wounds are almost always cellulitis.
Erysipelas, a superficial infection with clearly defined edges
(and often affecting the face), is also treated with a systemic
In the community, acute impetigo on small areas of the
skin may be treated by short-term topical application of
fusidic acid p. 571; mupirocin p. 1232 should be used only to
treat meticillin-resistant Staphylococcus aureus. If the
impetigo is extensive or longstanding, an oral antibacterial
such as flucloxacillin p. 554 (or clarithromycin p. 538 in
penicillin allergy) should be used. Mild antiseptics can be
Although many antibacterial drugs are available in topical
preparations, some are potentially hazardous and frequently
their use is not necessary if adequate hygienic measures can
be taken. Moreover, not all skin conditions that are oozing,
crusted, or characterised by pustules are actually infected.
Topical antibacterials should be avoided on leg ulcers unless
used in short courses for defined infections; treatment of
bacterial colonisation is generally inappropriate.
To minimise the development of resistant organisms it is
advisable to limit the choice of antibacterials applied
topically to those not used systemically. Unfortunately some
of these, for example neomycin sulfate p. 1230, may cause
sensitisation, and there is cross-sensitivity with other
aminoglycoside antibiotics, such as gentamicin p. 519. If
large areas of skin are being treated, ototoxicity may also be a
hazard with aminoglycoside antibiotics (and also with
polymyxins p. 1231), particularly in children, in the elderly,
and in those with renal impairment. Resistant organisms are
more common in hospitals, and whenever possible swabs
should be taken for bacteriological examination before
Mupirocin is not related to any other antibacterial in use;
it is effective for skin infections, particularly those due to
Gram-positive organisms but it is not indicated for
pseudomonal infection. Although Staphylococcus aureus
strains with low-level resistance to mupirocin are emerging,
it is generally useful in infections resistant to other
antibacterials. To avoid the development of resistance,
mupirocin or fusidic acid should not be used for longer than
10 days and local microbiology advice should be sought
povidone-iodine p. 1276, chlorhexidine p. 1277, or alcohol
can be used; their use should be discussed with the local
Tedizolid p. 573 is licensed for the treatment of acute
bacterial skin and skin structure infections.
Silver sulfadiazine p. 1231 is used in the treatment of
Antibacterial preparations also used systemically
Fusidic acid is a narrow-spectrum antibacterial used for
staphylococcal infections. Fusidic acid has a role in the
An ointment containing fusidic acid is used in the fissures
of angular cheilitis when associated with staphylococcal
infection. See Oropharyngeal fungal infections p. 1218 for
further information on angular cheilitis.
Metronidazole p. 1230 is used topically for rosacea and to
reduce the odour associated with anaerobic infections; oral
metronidazole is used to treat wounds infected with
Antifungal preparations for the skin
Most localised fungal infections are treated with topical
preparations. To prevent relapse, local antifungal treatment
should be continued for 1–2 weeks after the disappearance
of all signs of infection. Systemic therapy is necessary for
scalp infection or if the skin infection is widespread,
disseminated, or intractable; although topical therapy may
be used to treat some nail infections, systemic therapy is
more effective. Skin scrapings should be examined if
systemic therapy is being considered or where there is doubt
Ringworm infection can affect the scalp (tinea capitis), body
(tinea corporis), groin (tinea cruris), hand (tinea manuum),
1228 Infections of the skin BNF 78
foot (tinea pedis, athlete’s foot), or nail (tinea unguium).
Scalp infection requires systemic treatment; additional
application of a topical antifungal, during the early stages of
treatment, may reduce the risk of transmission. A topical
antifungal can also be used to treat asymptomatic carriers of
scalp ringworm. Most other local ringworm infections can be
treated adequately with topical antifungal preparations
(including shampoos). The imidazole antifungals
clotrimazole p. 1232, econazole nitrate p. 1232,
ketoconazole p. 1233, and miconazole p. 1233 are all
effective. Terbinafine p. 1234 cream is also effective but it is
more expensive. Other topical antifungals include
griseofulvin p. 1234 and the undecenoates. Compound
benzoic acid ointment (Whitfield’s ointment) has been
used for ringworm infections but it is cosmetically less
acceptable than proprietary preparations. Topical
preparations for athlete’s foot containing tolnaftate are on
Antifungal dusting powders are of little therapeutic value
in the treatment of fungal skin infections and may cause skin
irritation; they may have some role in preventing reinfection.
Antifungal treatment may not be necessary in
asymptomatic patients with tinea infection of the nails. If
treatment is necessary, a systemic antifungal is more
effective than topical therapy. However, topical application
of amorolfine p. 1234 or tioconazole p. 1233 may be useful
for treating early onychomycosis when involvement is
limited to mild distal disease, or for superficial white
onychomycosis, or where there are contra-indications to
Pityriasis (tinea) versicolor can be treated with ketoconazole
shampoo. Alternatively, selenium sulfide shampoo
[unlicensed indication] can be used as a lotion (diluting with
a small amount of water can reduce irritation) and left on the
affected area for 10 minutes before rinsing off; it should be
applied once daily for 7 days, and the course repeated if
Topical imidazole antifungals such as clotrimazole,
econazole nitrate, ketoconazole, and miconazole, or topical
terbinafine are alternatives, but large quantities may be
If topical therapy fails, or if the infection is widespread,
pityriasis versicolor is treated systemically with a triazole
antifungal. Relapse is common, especially in the
Candidal skin infections can be treated with a topical
imidazole antifungal, such as clotrimazole, econazole
nitrate, ketoconazole, or miconazole; topical terbinafine is
an alternative. Topical application of nystatin p. 1219 is also
effective for candidiasis but it is ineffective against
dermatophytosis. Refractory candidiasis requires systemic
treatment generally with a triazole such as fluconazole
p. 595; systemic treatment with terbinafine is not
appropriate for refractory candidiasis.
Miconazole cream is used in the fissures of angular cheilitis
Combination of an imidazole and a mild corticosteroid (such
as hydrocortisone 1% p. 1247) may be of value in the
treatment of eczematous intertrigo and, in the first few days
only, of a severely inflamed patch of ringworm.
Combination of a mild corticosteroid with either an
imidazole or nystatin p. 1219 may be of use in the treatment
of intertrigo associated with candida.
Antiviral preparations for the skin
Aciclovir cream p. 1238 is licensed for the treatment of initial
and recurrent labial and genital herpes simplex infections;
treatment should begin as early as possible. Systemic
treatment is necessary for buccal or vaginal infections and
Aciclovir cream can be used for the treatment of initial and
recurrent labial herpes simplex infections (cold sores). It is
best applied at the earliest possible stage, usually when
prodromal changes of sensation are felt in the lip and before
Penciclovir cream is also licensed for the treatment of
herpes labialis; it needs to be applied more frequently than
Systemic treatment is necessary if cold sores recur
frequently or for infections in the mouth.
Parasiticidal preparations for the skin
Suitable quantities of parasiticidal preparations
Area of body Skin creams Lotions Cream rinses
Scalp (head lice) 50–100 mL 50–100 mL
Body (crab lice) 30–60 g 100 mL
These amounts are usually suitable for an adult for single
Permethrin p. 1237 is used for the treatment of scabies
(Sarcoptes scabiei); malathion p. 1237 can be used if
Benzyl benzoate p. 1236 is an irritant and should be
avoided in children; it is less effective than malathion and
Ivermectin p. 604 (available on a named patient basis from
‘special-order’ manufacturers or specialist importing
companies) by mouth has been used, in combination with
topical drugs, for the treatment of hyperkeratotic (crusted or
‘Norwegian’) scabies that does not respond to topical
treatment alone; further doses may be required.
Although acaricides have traditionally been applied after a
hot bath, this is not necessary and there is even evidence
that a hot bath may increase absorption into the blood,
removing them from their site of action on the skin.
All members of the affected household should be treated
simultaneously. Treatment should be applied to the whole
body including the scalp, neck, face, and ears. Particular
attention should be paid to the webs of the fingers and toes
and lotion brushed under the ends of nails. It is now
recommended that malathion and permethrin should be
applied twice, one week apart; in the case of benzyl benzoate
in adults, up to 3 applications on consecutive days may be
needed. It is important to warn users to reapply treatment to
the hands if they are washed. Patients with hyperkeratotic
scabies may require 2 or 3 applications of acaricide on
consecutive days to ensure that enough penetrates the skin
The itch and eczema of scabies persists for some weeks after
the infestation has been eliminated and treatment for
pruritus and eczema may be required. Application of
crotamiton p. 1265 can be used to control itching after
treatment with more effective acaricides. A topical
corticosteroid may help to reduce itch and inflammation
after scabies has been treated successfully; however,
persistent symptoms suggest that scabies eradication was
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