Inflammatory skin conditions

Prescribing Notes:

• MHRA Drug Safety update information on risk of burns, is applicable to all emollients whether they contain paraffin or not.
• The choice of emollient is guided by individual patient tolerance, preference and ease of use.
• Emollients soothe, smooth and hydrate the skin and are indicated for all dry scaling disorders.
• Emollients should be applied regularly to maintain improvement; most are best applied after a shower or bath. Emollients should be applied in the direction of hair growth.
• Most emollients may be used as soap substitutes by firstly wetting the skin, washing with the cream or ointment, then rinsing off.
• Fragrance Free preparations are preferable to avoid irritation or sensitivity.
• Preparations containing antimicrobials are useful where an antiseptic would be of benefit.
• Aqueous cream is no longer recommended as a soap substitute or for use as an emollient. Aqueous cream contains sodium lauryl sulphate which can damage the skin barrier.
• Patients should be informed of the potential fire hazard when using paraffin based emollients.
• If emollients are being applied to the whole body twice daily, children may need 250g per week and adults 500g per week.
• Topical corticosteroids are not recommended in urticaria, rosacea, acne or undiagnosed, possibly infective disorders. 
• When using topical corticosteroids, wait 30 minutes before applying emollients to prevent diluting the steroid.
• Indication and age restrictions apply to 'over the counter' (OTC) products refer to product information for full details. Individuals aged 1 month and over with symptoms of skin inflammation, who are not eligible for treatment with an 'over the counter' (OTC) product (either sold OTC or supplied from NHS PFS Approved List) may be eligible for supply of a Prescription Only Medicine (POM) under the Pharmacy First hydrocortisone PGD for inflammatory skin conditions, Refer to the PGD for information on dose, age, indication, duration and referral criteria.
• Clobetasone should not be used in those aged under 12 years.
• To minimise the risk of side effects with topical corticosteroids, the smallest effective amount should be used, reducing strength and frequency of application as the condition settles. The risk of systemic side effects increases with prolonged use on thin, inflamed or raw skin surfaces, use in flexures, or use of more potent corticosteroids. 
• Topical corticosteroids should not be used on infected skin unless the infection is being treated. Palms and soles may require potent or very potent steroids.  

When to advise patient to contact GP

Regular emollients are advised for managing chronic inflammatory skin conditions like eczema, refer to GP for regular supply.

Refer to GP practice if symptoms worsen during the first 7 days of topical corticosteroid treatment or do not resolve following completion of treatment.