BNF for Children 2011-2012

552 13.2 Emollient and barrier preparations BNFC 2011–201213 Skin13.2 Emollient and barrierpreparations13.2.1 Emollients13.2.2 Barrier preparationsBorderline substances The preparations marked‘ACBS’ are regarded as drugs when prescribed in accordancewith the advice of the Advisory Committee onBorderline Substances for the clinical conditions listed.Prescriptions issued in accordance with this advice andendorsed ‘ACBS’ will normally not be investigated. SeeAppendix 2 for listing by clinical condition.13.2.1 EmollientsEmollients hydrate the skin, soften the skin, act asbarrier to water and external irritants, and are indicatedfor all dry or scaling disorders. Their effects are shortlivedand they should be applied frequently even afterimprovement occurs. They are useful in dry and eczematousdisorders, and to a lesser extent in psoriasis(section 13.5.2); they should be applied in the directionof hair growth immediately after washing or bathing tomaximise the effect of skin hydration. The choice of anappropriate emollient will depend on the severity of thecondition, the child’s (or carer’s) preference, and the siteof application. Ointments may exacerbate acne andfolliculitis. Some ingredients rarely cause sensitisation(section 13.1.3) and this should be suspected if aneczematous reaction occurs. The use of aqueouscream as a leave-on emollient may increase the risk ofskin reactions, particularly in eczema.Fire hazard with paraffin-based emollientsEmulsifying ointment or 50% Liquid Paraffin and50% White Soft Paraffin Ointment in contact withdressings and clothing is easily ignited by a nakedflame. The risk is greater when these preparationsare applied to large areas of the body, and clothing ordressings become soaked with the ointment. Childrenand their carers should be told to keep awayfrom fire or flames and not to smoke when usingthese preparations. The risk of fire should be consideredwhen using large quantities of any paraffinbasedemollient.Preparations such as aqueous cream and emulsifyingointment can be used as soap substitutes; the preparationis rubbed on the skin before rinsing off completely.The addition of a bath oil (section 13.2.1.1) may also behelpful.In the neonate, a preservative-free paraffin-based emollienthydrates the skin without affecting the normal skinflora; substances such as olive oil are also used. Thedevelopment of blisters (epidermolysis bullosa) orichthyosis may be alleviated by applying liquid andwhite soft paraffin ointment while awaiting dermatologicalinvestigation.Preparations containing an antibacterial (section13.10.1) should be avoided unless infection is presentor is a frequent complication of the dry skin condition.Urea is a keratin softener and hydrating agent used inthe treatment of dry, scaling conditions (includingichthyosis). It is occasionally used with other topicalagents such as corticosteroids to enhance penetration ofthe skin.Non-proprietary emollient preparationsAqueous Cream, BPCream, emulsifying ointment 30%, 1 phenoxyethanol1% in freshly boiled and cooled purified water, netprice 100 g = £1.51, 500 g = £1.86Excipients include cetostearyl alcohol1. The BP permits use of alternative antimicrobials providedtheir identity and concentration are stated on the labelEmulsifying Ointment, BPOintment, emulsifying wax 30%, white soft paraffin50%, liquid paraffin 20%, net price 500 g = £2.22Excipients include cetostearyl alcoholHydrous Ointment, BPOintment, (oily cream), dried magnesium sulphate0.5%, phenoxyethanol 1%, wool alcohols ointment50%, in freshly boiled and cooled purified water, netprice 500 g = £2.92Liquid and White Soft Paraffin Ointment, NPFOintment, liquid paraffin 50%, white soft paraffin50%, net price 500 g = £6.09Paraffin, White Soft, BPWhite petroleum jelly, net price 100 g = 51pParaffin, Yellow Soft, BPYellow petroleum jelly, net price 100 g = 49pProprietary emollient preparationsAquamol c (Thornton & Ross)Cream, containing liquid paraffin, white soft paraffin,net price 50 g = £1.22, 500-g pump pack = £6.40Excipients include cetostearyl alcohol, chlorocresolAveeno c (J&J)Cream, colloidal oatmeal in emollient basis, net price100 mL = £3.78, 300-mL pump pack = £6.80Excipients include benzyl alcohol, cetyl alcohol, isopropyl palmitateACBS: For endogenous and exogenous eczema, xeroderma, andichthyosisLotion, colloidal oatmeal in emollient basis, net price400 mL = £6.42Excipients include benzyl alcohol, cetyl alcohol, isopropyl palmitateACBS: as for Aveeno c CreamCetraben c (Genus)Emollient cream, white soft paraffin 13.2%, light liquidparaffin 10.5%, net price 50-g pump pack = £1.40,150-g pump pack = £3.98, 500-g pump pack = £5.99,1.05-kg pump pack = £11.62Excipients include cetostearyl alcohol, hydroxybenzoates (parabens)Dermamist c (Alliance)Spray application, white soft paraffin 10% in a basiscontaining liquid paraffin, fractionated coconut oil,net price 250-mL pressurised aerosol unit = £5.97Excipients none as listed in section 13.1.3Note FlammableDiprobase c (Schering-Plough)Cream, cetomacrogol 2.25%, cetostearyl alcohol7.2%, liquid paraffin 6%, white soft paraffin 15%,water-miscible basis used for Diprosone c cream, netprice 50 g = £1.28; 500-g pump pack= £6.32Excipients include cetostearyl alcohol, chlorocresolOintment, liquid paraffin 5%, white soft paraffin 95%,basis used for Diprosone c ointment, net price 50 g =£1.28, 500 g = £5.99Excipients none as listed in section 13.1.3