Emollient and Barrier Preparations
There is no advantage in prescribing these products by generic name. Choice is largely based on patient preference.
Emollients
There is a risk of severe and fatal burns with ALL emollients. See MHRA/CHM advice (updated May 2021): Emollients: new information about risk of severe and fatal burns with paraffin-containing and paraffin-free emollients. Emollients and risk of severe and fatal burns: new resources available - GOV.UK
Mild dry skin is listed by NHS England as a condition where OTC medicines should not routinely be prescribed in primary care. Most patients should be able to relieve symptoms with OTC treatments. Emollients can continue to be prescribed for patients with long term dermatological conditions such as eczema and psoriasis.
Guidance on conditions for which over the counter items should not routinely be prescribed in primary care
‘Epimax’ and ‘Zero’ product ranges provide cost effective equivalents to many commonly used emollients and soap substitutes and are suitable for initial prescribing in most cases. These should be first choice. Patients already established on more expensive products should be encouraged to try the equivalent ‘Epimax’ or ‘Zero’ product.
See Northamptonshire Emollient Guidelines
See Northamptonshire OTC When To Prescribe
Emollients for Mild Dry Skin
| Creams containing paraffin: |
Epimax® Moisturising Cream Flexi-dispenser 500g
Zerocream® pump 500g
|
| Creams/lotions containing Colloidal Oatmeal: |
Epimax® Oatmeal Cream Flexi-dispenser 500g
Zeroveen® pump 500g
|
| Rich creams for mild dry skin |
Zeroguent cream® 500g
|
Aveeno preparations are Borderline Substances and have been classed as Double Red. Aveeno preparations are available OTC if patients prefer to purchase them instead of the formulary choices.
Emollients for Moderately Dry Skin
| Creams containing paraffin: |
Epimax® Original Cream Flexi-dispenser 500g
Zerobase® Cream Pump 500g
Epimax Excetra® Cream Flexi-dispenser 500g
|
| Gels containing paraffin |
Epimax Isomol® Gel Flexi-dispenser 500g
Zerodouble® Gel
|
| Creams containing urea |
ImuDERM® Emollient 5% Urea pump 500g
|
Emollients for Severe Dry Skin
| Ointments containing paraffin |
Epimax® Ointment 500g
Zeroderm® Ointment 500g
Epimax Ointment can harm the eyes if used on the face. Do not prescribe these ointments for use on the face. Tell patients to wash their hands and avoid touching their eyes after using these products. See MHRA advice
|
| Creams containing Urea 5% and Lauromacrogols 3% |
Balneum Plus® Cream 500g or 100g – use for itch if emollient alone not helped |
| Sprays containing paraffin |
Emollin® Spray 240ml
Use only when unable to use other preparations or where application without touching skin is necessary. Highly flammable.
|
| Emollients with Anti-bacterial |
Dermol® 500 lotion pump 500ml
Use for washing only when infection is present or recurrent. Avoid regular use.
Use should be targeted and short term. Avoid adding to repeat prescription.
Revert to non-antimicrobial containing emollient once condition is controlled
|
| Paraffin Free Emollient |
Epimax® Paraffin Free Ointment 500g
Epimax Paraffin-Free Ointment can harm the eyes if used on the face. Do not prescribe these ointments for use on the face. Tell patients to wash their hands and avoid touching their eyes after using these products. See MHRA advice.
|
| Soap Substitutes |
ZeroAQS® (does not contain sodium lauryl sulphate)
Aqueous cream® (contains sodium lauryl sulphate)
Emulsifying ointment® |
Bath and Shower Additives
Bath and shower additives have not been included in this formulary due to lack of evidence of efficacy.
Any emollient (except white soft paraffin) can be used as a soap substitute. This can be applied prior to washing and directly afterwards onto damp skin. They provide greater moisturising than emollients marketed specifically as bath or shower preparations that don’t have enough contact with the skin. The use of bath emollients/oils and shower products are not routinely recommended for the majority of dermatological conditions as they are less effective than alternatives.
There is an exception where a bath additive may be beneficial to patients and should be made available:
Balneum Plus Bath Oil can be used for managing itch that remains a problem despite optimum topical therapy. Follow the manufacturer’s instructions.
As per NHSE recommendations prescribers in primary care should not initiate bath and shower preparations for any new patients. However, where clinically advised by a specialist and appropriate, prescribing may continue.
Barrier Creams
See Northamptonshire Dressings Formulary
Topical Corticosteroids
Hydrocortisone preparations
Prices vary considerably between pack sizes; prescribe 1% preparations as multiples of 30g, not 50g.
Hydrocortisone 2.5% is much more expensive than 1% and is ‘Double Red’. Consider clobetasone preparations if hydrocortisone 1% is not effective.
| Mild potency steroids |
Hydrocortisone 1% cream/ointment - available OTC |
| Moderate potency steroids |
Betametasone 0.025% (Betnovate RD) cream/ointment
Clobetasone butyrate 0.05% (Eumovate) cream/ointment -15g cream available OTC |
| Potent steroid |
Betamethasone 0.1% (Betnovate) cream/ointment |
| Very potent steroid |
Clobetasol propionate 0.05% (Dermovate) cream/ointment |
| Mild steroids with anti-fungal |
Hydrocortisone 1%/miconazole 2% cream/ointment (Daktacort cream/ointment) -15g cream available OTC
Hydrocortisone 1%/clotrimazole1% cream (Canesten HC) -15g available OTC |
Preparations for Eczema and Psoriasis
Specialist led
See Management of Psoriasis (Adults & Children) in Primary Care
Drugs affecting the Immune Response
Tacrolimus and pimecrolimus for atopic eczema NICE TA 82 (Last reviewed: 13 July 2015)
Only use when atopic eczema is not controlled by maximal topical corticosteroid treatment. Initiation by Specialist or GP with special interest and experience.
Acne and Rosacea
For full acne guidance refer to NICE guideline NG198
Managing Acne Vulgaris
12-week course of 1 of the following first-line treatment options:
Any acne severity
a fixed combination of topical adapalene with topical benzoyl peroxide
a fixed combination of topical tretinoin with topical clindamycin
Mild to moderate acne severity
a fixed combination of topical benzoyl peroxide with topical clindamycin
Moderate to severe acne severity
a fixed combination of topical adapalene with topical benzoyl peroxide, together with either oral lymecycline or oral doxycycline
topical azelaic acid with either oral lymecycline or oral doxycycline
| Acne severity |
Treatment option |
Drug choices |
| Any |
Fixed combination of topical adapalene with topical benzoyl peroxide |
0.1% adapalene with 2.5% benzoyl peroxide gel (Epiduo)
0.3% adapalene with 2.5% benzoyl peroxide gel (Epiduo®) |
| Any |
Fixed combination of topical tretinoin with topical clindamycin |
0.025% tretinoin with 1% clindamycin gel (Treclin) |
| Mild to moderate |
Fixed combination of topical benzoyl peroxide with topical clindamycin |
3% benzoyl peroxide with 1% clindamycin gel (Duac Once Daily)
5% benzoyl peroxide with 1% clindamycin gel (Duac Once Daily) |
| Moderate to severe |
Oral antibiotic (in combination with a fixed combination of topical adapalene with topical benzoyl peroxide) |
Lymecycline 408mg capsule daily
Doxycycline 100mg capsule daily |
| Moderate to severe |
Topical azelaic acid (with either oral lymecycline or oral doxycycline) |
15% azelaic acid gel (Finacea)
20% azelaic acid cream (Skinoren) |
Preparations for Warts and Callouses
Available over the counter Over The Counter (OTC) Products - When to prescribe [pdf] 225KB
Warts and verrucae are listed by NHS England as a condition where OTC medicines should not routinely be prescribed in primary care. Most patients should be able to relieve symptoms with OTC treatments.
Wart and verruca preparations are ‘Double Red’ and should not be prescribed in primary care. They are available to purchase OTC.
Salicylic acid with lactic acid (Salatac gel or Salactol paint)
Shampoos and other preparations for Scalp and Hair Conditions
Available over the counter Over The Counter (OTC) Products - When to prescribe [pdf] 225KB
Dandruff is listed by NHS England as a condition where OTC medicines should not routinely be prescribed in primary care. Most patients should be able to relieve symptoms with OTC treatments.
Coal tar with salicylic acid and sulfur ointment (Cocois ointment)
Ketoconazole 2% shampoo
Antibacterial preparations
Fusidic acid 2% cream (Fucidin cream) - up to 10 days only, to prevent resistance
Metronidazole 0.75% cream or gel (as Rozex brand)
Silver sulfadiazine 1% cream (Flamazine cream) - for infection in burns wounds
Antifungal preparations
Available over the counter Over The Counter (OTC) Products - When to prescribe [pdf] 225KB
Clotrimazole 1% cream
Miconazole 2% cream (Daktarin® cream)
Fungal nail infections
Fungal nail infections are listed by NHS England as a condition where OTC medicines should not routinely be prescribed in primary care. Most patients should be able to relieve symptoms with OTC treatments. link
Fungal nail preparations are ‘Double Red’ drugs and should not be prescribed in Primary Care. They are available to purchase OTC.
Parasiticidal preparations
Available over the counter Over The Counter (OTC) Products - When to prescribe [pdf] 225KB
Dimeticone 4% lotion
Malathion 0.5% liquid
Permethrin 1% liquid
Skin Cleansers, Antiseptics and Desloughing Agents
Alcohols and Saline
Irripod saline solution 20ml x 25
Oxidisers and Dyes
Potassium permanganate 0.1% solution diluted 1 in 10 to provide a 0.01% solution - see Guidance on the safe use of potassium permanganate soaks
