Dermatitis - contact

Prescribing Notes:

• All emollients (paraffin-based and paraffin-free) carry a risk of severe burns. Patients should avoid smoking or naked flames, as emollients can transfer to clothing, bedding, and dressings, where they dry, build up, and act as an accelerant if ignited. Though not flammable on skin, dried residues increase fire speed and intensity.
• Similar risks may occur with other skin products used widely or in large amounts. Clothing and bedding should be changed daily; washing at high temperatures reduces but does not remove residue.
• Resources are available for health and social care professionals to support the safe use of emollients see MHRA guidance.
• Content is available on the Dermatology Pathway pages of the Right Decision Service to provide an accessible resource for primary care practitioners to support the diagnosis and management of patients presenting with common skin conditions.
• General considerations on formulations:
  • Creams – less greasy, easier to apply, preferred cosmetically; useful for weeping lesions.
  • Gels – suitable for face and scalp.
  • Lotions – cooling; good for moist or hairy areas; alcohol-based lotions may sting on broken skin.
  • Ointments – greasy, less likely to sensitise; best for chronic dry lesions.
  • Absorption – creams and lotions absorb faster than ointments or gels.
• Rarely, severe adverse effects can occur on stopping treatment with topical corticosteroids, often after long-term continuous or inappropriate use of moderate to high potency products. To reduce the risks of these events, prescribe the topical corticosteroid of lowest potency needed and ensure patients know how to use it safely and effectively. See MHRA warning - Topical corticosteroids: information on the risk of topical steroid withdrawal reactions.
• As per the Scottish Government guidance document ‘Medicines - achieving value and sustainability in prescribing’ bath and shower emollient preparations should be reserved for situations where the use of regular emollient preparations is not sufficient (for example, in severe disease where combination of treatment modalities is required). In most cases regular emollient preparations are suitable for use as bath additives and soap substitutes.

Unlicensed / Special Manufacture Preparations

• The British Association of Dermatologists (BAD) list of preferred unlicensed dermatological preparations (‘Specials’) is available at the BAD website.

Corticosteroid creams

• Quantities are based on single daily application for 2 weeks in adults:

• Quantities are based on twice daily application for 1 week in adults:

Prescribing Notes:

• Most emollients (apart from white soft paraffin 50%/liquid paraffin 50%) may be used as soap substitutes (hand washing and in bath/shower) by firstly wetting the skin, washing with the cream or ointment, then rinsing off. Epimax products are considered body washes rather than soap substitutes so as to avoid contact with the eyes.
• It is more cost-effective to prescribe emollients in large pack sizes and products that come in pump dispensers may be more suitable for long term use in order to reduce the risk of microbial contamination.

Prescribing Notes:

• Most emollients (apart from white soft paraffin 50%/liquid paraffin 50%) may be used as soap substitutes (hand washing and in bath/shower) by firstly wetting the skin, washing with the cream or ointment, then rinsing off. Epimax products are considered body washes rather than soap substitutes so as to avoid contact with the eyes.
• It is more cost-effective to prescribe emollients in large pack sizes and products that come in pump dispensers may be more suitable for long term use in order to reduce the risk of microbial contamination.
• Epimax paraffin free ointment should not be applied to the face. See MHRA Drug Safety Update (July 2024) Epimax Ointment and Epimax Paraffin-Free Ointment: reports of ocular surface toxicity and ocular chemical injury.

Prescribing Notes:

• Preparations containing urea are suitable for the treatment of very dry or hyperkeratotic, scaling skin conditions.

Prescribing Notes:

• As per the Scottish Government guidance document ‘Medicines - achieving value and sustainability in prescribing’ bath and shower emollient preparations should be reserved for situations where the use of regular emollient preparations is not sufficient (for example, in severe disease where combination of treatment modalities is required).
• Most emollients (apart from white soft paraffin 50% / liquid paraffin 50%) may be used as soap substitutes for hand washing and in the bath or shower. First wet the skin, wash with the cream or ointment, then rinse off. Alternatively, emollients can be put on the skin before bathing or showering and then washed off to reduce stinging from broken areas.

Prescribing Notes:

• Water-miscible corticosteroid creams are suitable for moist areas e.g. axillae or groin or for weeping lesions.
• Ointments are generally chosen for dry, lichenified or scaly lesions or where a more occlusive effect is required. The occlusive effect of ointments increases penetration of the corticosteroid.
• Gloves should be worn during, or hands washed after, application of large quantities of steroid preparations.

Prescribing Notes:

• Water-miscible corticosteroid creams are suitable for moist areas e.g. axillae or groin or for weeping lesions.
• Ointments are generally chosen for dry, lichenified or scaly lesions or where a more occlusive effect is required. The occlusive effect of ointments increases penetration of the corticosteroid.
• Gloves should be worn during, or hands washed after, application of large quantities of steroid preparations.

Prescribing Notes:

• Palms of the hands and soles of the feet may require potent or very potent steroids.
• Water-miscible corticosteroid creams are suitable for moist areas e.g. axillae or groin or for weeping lesions.
• Ointments are generally chosen for dry, lichenified or scaly lesions or where a more occlusive effect is required. The occlusive effect of ointments increases penetration of the corticosteroid.
• Gloves should be worn during, or hands washed after, application of large quantities of steroid preparations.

Prescribing Notes:

• Palms of the hands and soles of the feet may require potent or very potent steroids.
• Water-miscible corticosteroid creams are suitable for moist areas e.g. axillae or groin or for weeping lesions.
• Ointments are generally chosen for dry, lichenified or scaly lesions or where a more occlusive effect is required. The occlusive effect of ointments increases penetration of the corticosteroid.
• Gloves should be worn during, or hands washed after, application of large quantities of steroid preparations.
• Patients prescribed very potent topical corticosteroids should be reviewed regularly (at least monthly) and the preparation should not be prescribed on repeat prescription except on specialist advice.

Prescribing Notes:

• All emollients (paraffin-based and paraffin-free) carry a risk of severe burns. Patients should avoid smoking or naked flames, as emollients can transfer to clothing, bedding, and dressings, where they dry, build up, and act as an accelerant if ignited. Though not flammable on skin, dried residues increase fire speed and intensity.
• Similar risks may occur with other skin products used widely or in large amounts. Clothing and bedding should be changed daily; washing at high temperatures reduces but does not remove residue.
• Resources are available for health and social care professionals to support the safe use of emollients see MHRA guidance.
• Content is available on the Dermatology Pathway pages of the Right Decision Service to provide an accessible resource for primary care practitioners to support the diagnosis and management of patients presenting with common skin conditions.
• General considerations on formulations:
  • Creams – less greasy, easier to apply, preferred cosmetically; useful for weeping lesions.
  • Gels – suitable for face and scalp.
  • Lotions – cooling; good for moist or hairy areas; alcohol-based lotions may sting on broken skin.
  • Ointments – greasy, less likely to sensitise; best for chronic dry lesions.
  • Absorption – creams and lotions absorb faster than ointments or gels.
• Rarely, severe adverse effects can occur on stopping treatment with topical corticosteroids, often after long-term continuous or inappropriate use of moderate to high potency products. To reduce the risks of these events, prescribe the topical corticosteroid of lowest potency needed and ensure patients know how to use it safely and effectively. See MHRA warning - Topical corticosteroids: information on the risk of topical steroid withdrawal reactions.
• As per the Scottish Government guidance document ‘Medicines - achieving value and sustainability in prescribing’ bath and shower emollient preparations should be reserved for situations where the use of regular emollient preparations is not sufficient (for example, in severe disease where combination of treatment modalities is required). In most cases regular emollient preparations are suitable for use as bath additives and soap substitutes.

Unlicensed / Special Manufacture Preparations

• The British Association of Dermatologists (BAD) list of preferred unlicensed dermatological preparations (‘Specials’) is available at the BAD website.

Corticosteroid creams

Quantities are based on single daily application for 2 weeks. Estimates are based on the number of adult finger tips units (FTUs) of cream to treat the area. 2 FTUs are about the same as 1g of topical steroid.

(*) Qty = Estimated prescribable quantity of corticosteroid cream/ointment.

Quantities are based on twice daily application for 1 week in a child 12-18 years; smaller quantities will be required for children under 12 years.

Prescribing Notes:

• Most emollients (apart from white soft paraffin 50%/liquid paraffin 50%) may be used as soap substitutes (hand washing and in bath/shower) by firstly wetting the skin, washing with the cream or ointment, then rinsing off. Epimax products are considered body washes rather than soap substitutes so as to avoid contact with the eyes.
• It is more cost-effective to prescribe emollients in large pack sizes and products that come in pump dispensers may be more suitable for long term use in order to reduce the risk of microbial contamination.

Prescribing Notes:

• Most emollients (apart from white soft paraffin 50%/liquid paraffin 50%) may be used as soap substitutes (hand washing and in bath/shower) by firstly wetting the skin, washing with the cream or ointment, then rinsing off. Epimax products are considered body washes rather than soap substitutes so as to avoid contact with the eyes.
• It is more cost-effective to prescribe emollients in large pack sizes and products that come in pump dispensers may be more suitable for long term use in order to reduce the risk of microbial contamination.
• Epimax paraffin free ointment should not be applied to the face. See MHRA Drug Safety Update (July 2024) Epimax Ointment and Epimax Paraffin-Free Ointment: reports of ocular surface toxicity and ocular chemical injury.

Prescribing Notes:

• Preparations containing urea are suitable for the treatment of very dry or hyperkeratotic, scaling skin conditions.

Prescribing Notes:

• As per the Scottish Government guidance document ‘Medicines - achieving value and sustainability in prescribing’ bath and shower emollient preparations should be reserved for situations where the use of regular emollient preparations is not sufficient (for example, in severe disease where combination of treatment modalities is required).
• Most emollients (apart from white soft paraffin 50% / liquid paraffin 50%) may be used as soap substitutes for hand washing and in the bath or shower. First wet the skin, wash with the cream or ointment, then rinse off. Alternatively, emollients can be put on the skin before bathing or showering and then washed off to reduce stinging from broken areas.

Prescribing Notes:

• Water-miscible corticosteroid creams are suitable for moist areas e.g. axillae or groin or for weeping lesions.
• Ointments are generally chosen for dry, lichenified or scaly lesions or where a more occlusive effect is required. The occlusive effect of ointments increases penetration of the corticosteroid.
• Gloves should be worn during, or hands washed after, application of large quantities of steroid preparations.

Prescribing Notes:

• Water-miscible corticosteroid creams are suitable for moist areas e.g. axillae or groin or for weeping lesions.
• Ointments are generally chosen for dry, lichenified or scaly lesions or where a more occlusive effect is required. The occlusive effect of ointments increases penetration of the corticosteroid.
• Gloves should be worn during, or hands washed after, application of large quantities of steroid preparations.

Prescribing Notes:

• Palms of the hands and soles of the feet may require potent or very potent steroids.
• Water-miscible corticosteroid creams are suitable for moist areas e.g. axillae or groin or for weeping lesions.
• Ointments are generally chosen for dry, lichenified or scaly lesions or where a more occlusive effect is required. The occlusive effect of ointments increases penetration of the corticosteroid.
• Gloves should be worn during, or hands washed after, application of large quantities of steroid preparations.