BNF for Children 2011-2012

556 13.2.2 Barrier preparations BNFC 2011–201213 SkinZerozole c (Thornton & Ross)Bath oil, refined soya bean oil 83.45%, macrogol 4-lauryl ether 15%, net price 500 mL = £5.55Excipients include butylated hydroxytoluene, fragrance, propylene glycolDoseNeonate add 5–15 mL to bath waterChild 1 month–12 years add 5–15 mL to bath water, orapply to wet skin and rinseChild 12–18 years add 20–60 mL to bath water, or applyto wet skin and rinseWith antimicrobialsDermol c (Dermal)Dermol c 600 bath emollient, benzalkonium chloride0.5%, liquid paraffin 25%, isopropyl myristate 25%,net price 600 mL = £7.55Excipients include polysorbate 60DoseChild 1 month–2 years add 5–15 mL to bath water; donot use undilutedChild 2–18 years add 15–30 mL to bath water; do notuse undilutedDermol c 200 Shower Emollient, benzalkoniumchloride 0.1%, chlorhexidine hydrochloride 0.1%,liquid paraffin 2.5%, isopropyl myristate 2.5%, netprice 200 mL = £3.55Excipients include cetostearyl alcoholDoseApply to skin or use as soap substituteEmulsiderm c (Dermal)Liquid emulsion, benzalkonium chloride 0.5%, liquidparaffin 25%, isopropyl myristate 25%, net price300 mL (with 15-mL measure) = £3.85, 1 litre (with 30-mL measure) = £12.00Excipients include polysorbate 60DoseChild 1 month–2 years add 5–10 mL to bath water orrub into dry skin until absorbedChild 2–18 years add 10–30 mL to bath water or rubinto dry skin until absorbedOilatum c Plus (Stiefel)Bath additive, benzalkonium chloride 6%, triclosan2%, light liquid paraffin 52.5%, net price 500 mL =£6.98Excipients include acetylated lanolin alcohols, isopropyl palmitateDoseChild 6 months–1 year add 1 mL to bath water; do notuse undilutedChild 1–18 years add 1–2 capfuls to bath water; do notuse undilutedZerolatum c Plus (Thornton & Ross)Bath additive, benzalkonium chloride 6%, triclosan2%, light liquid paraffin 51.66%, net price 500 mL =£5.81Excipients include acetylated lanolin alcohols, isopropyl palmitate,polysorbate 80DoseChild 6 months–1 year add 1 mL to bath water; do notuse undilutedChild 1–18 years add 1–2 capfuls to bath water; do notuse undilutedWith tarSection 13.5.213.2.2 Barrier preparationsBarrier preparations often contain water-repellent substancessuch as dimeticone, natural oils, and paraffins,to help protect the skin from abrasion and irritation;they are used to protect intact skin around stomas andpressure sores, and as a barrier against nappy rash. Inneonates, barrier preparations which do not containpotentially sensitising excipients (section 13.1.3) arepreferred. Where the skin has broken down, barrierpreparations have a limited role in protecting adjacentskin. Zinc ointments or barrier creams with zinc oxideor titanium salts, are used to aid healing of uninfected,excoriated skin.Nappy rash (Dermatitis) The first line of treatment isto ensure that nappies are changed frequently and thattightly fitting water-proof pants are avoided. The rashmay clear when left exposed to the air and a barrierpreparation, applied with each nappy change, can behelpful. A mild corticosteroid such as hydrocortisone0.5% or 1% (section 13.4) can be used if inflammation iscausing discomfort, but it should be avoided in neonates.The barrier preparation should be applied afterthe corticosteroid preparation to prevent furtherdamage. Preparations containing hydrocortisone shouldbe applied for no more than a week; the hydrocortisoneshould be discontinued as soon as the inflammationsubsides. The occlusive effect of nappies and waterproofpants may increase absorption of corticosteroids(for cautions, see section 13.4). If the rash is associatedwith candidal infection, a topical antifungal such asclotrimazole cream (section 13.10.2) can be used. Topicalantibacterial preparations (section 13.10.1) can beused if bacterial infection is present; treatment with anoral antibacterial may occasionally be required in severeor recurrent infection. Hydrocortisone may be used incombination with antimicrobial preparations if there isconsiderable inflammation, erosion, and infection.Non-proprietary barrier preparationsZinc Cream, BPCream, zinc oxide 32%, arachis (peanut) oil 32%,calcium hydroxide 0.045%, oleic acid 0.5%, wool fat8%, in freshly boiled and cooled purified water, netprice 50 g = 75pZinc Ointment, BPOintment, zinc oxide 15%, in Simple Ointment BP1988 (which contains wool fat 5%, hard paraffin 5%,cetostearyl alcohol 5%, white soft paraffin 85%), netprice 25 g = 30pZinc and Castor Oil Ointment, BPOintment, zinc oxide 7.5%, castor oil 50%, arachis(peanut) oil 30.5%, white beeswax 10%, cetostearylalcohol 2%, net price 500 g = £2.93Proprietary barrier preparationsConotrane c (Astellas)Cream, benzalkonium chloride 0.1%, dimeticone 22%,net price 100 g = 88p, 500 g = £3.51Excipients include cetostearyl alcohol, fragrance