| Formulary Chapter 13: Skin - Full Chapter
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| Chapter Links... |
 APC Psoriasis Guideline (Adults & Children) |
| Atopic Dermatitis Treatment Algorithm for High Cost Drugs |
| Psoriasis Treatment Algorithm for High Cost Drugs |
| Specials recommended by the British Association of Dermatologist (BAD) |
| Details... |
| 13.02.01 |
Emollients |
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Epimax®
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First Choice
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Cream (Easy squeeze 500g), Ointment (500g tub)
- Epimax® ointment - First line option for severe dry skin as per Notts Emollient Formulary. Comparable to Hydromol®, Zeroderm®, Cetraben®, and Epaderm®.
- Epimax® original cream - First line option for moderately dry skin as per Notts Emollient Formulary. Comparable to Zerobase®, Cetraben® and Diprobase®.
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Liquid and White Soft Paraffin Ointment (50:50)
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First Choice
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Ointment (500g tub)
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Emulsifying Ointment BP (Ovelle®)
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First Choice
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Ointment
- First line option for severe dry skin as per Notts Emollient Formulary.
- Only the Ovelle® Emulsifying Ointment (£4.15 for 500g) is listed in the Drug Tariff (last checked Oct19). Prescribe by brand.
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Epimax excetra® cream
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First Choice
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Cream (Easy squeeze 500g)
- First line option for moderately dry skin as per Notts Emollient Formulary.
- Comparable to Diprobase® and Cetraben® cream.
- Recommended for additional use as soap substitute.
- Previously called Excetra® cream.
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Epimax® isomol gel (Liquid paraffin 15%, isopropyl myristate 15%)
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First Choice
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Gel (Easy squeeze 500g)
- First line option for moderately dry skin as per Notts Emollient Formulary.
- Comparable to DoubleBase® gel.
- Previously called Isomol®.
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ExoCream®
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First Choice
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Cream (500g pump dispenser)
 Patients with mild dry skin, who do not have a diagnosed dermatological condition or risk to skin integrity, should be advised to purchase a suitable product over the counter.
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Zeroderm®
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Second Choice
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Ointment (500g tub)
- Second line option for severe dry skin as per Notts Emollient Formulary.
- First line options are Ovelle® emulsifying ointment, Epimax ointment and Liquid & white soft paraffin ointment (50:50).
- Recommended for additional use as soap substitute.
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Hydromol®
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Second Choice
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Ointment (500g tub)
- Second line option for severe dry skin as per Notts Emollient Formulary.
- First line options are Ovelle® emulsifying ointment, Epimax ointment and Liquid & white soft paraffin ointment (50:50).
- Recommended for additional use as soap substitute.
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Zerobase® 11% cream
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Second Choice
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Cream (500g pump dispenser)
- Second line option for moderately dry skin as per Notts Emollient Formulary.
- First line options are Epimax® and Excetra® creams.
- Comparable to Diprobase® cream.
- Recommended for additional use as soap substitute.
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Zeroderm®
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Second Choice
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Ointment (500g tub)
- Second line option for severe dry skin as per Notts Emollient Formulary.
- First line options are Ovelle® emulsifying ointment, Epimax ointment and Liquid & white soft paraffin ointment (50:50).
- Recommended for additional use as soap substitute.
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AproDerm® (Isopropyl myristate 15%, liquid paraffin 15%)
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Second Choice
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Gel
- Second line option for moderately dry skin as per Notts Emollient Formulary.
- First line option is Isomol® gel.
- Comparable to DoubleBase® gel.
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Zerocream®
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Second Choice
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Cream (500g pump dispenser)
Patients with mild dry skin, who do not have a diagnosed dermatological condition or risk to skin integrity, should be advised to purchase a suitable product over the counter.
- Second line option for mild dry skin as per Notts Emollient Formulary.
- Comparable to Exocream® and E45® cream.
- Recommended for additional use as soap substitute.
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AproDerm® emollient
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 Restricted
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Cream (500g pump dispenser)
- Low paraffin (<20% paraffin) emollient
- Paraffin free / low paraffin products should be reserved for patients who are intolerant/unsuitable for paraffin containing products due to increased fire hazard risks despite appropriate counselling. As per Nottinghamshire Emollient Formulary.
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DoubleBase®
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Third Choice
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Gel
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Paraffin-free Emollient
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Restricted
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Ointment, Cream
- Paraffin-free emollients should be reserved for patients who are intolerant/unsuitable for paraffin containing emollients due to increased fire hazard risks despite appropriate counselling. As per Nottinghamshire Emollient Formulary.
- Paraffin free options:
- Epimax® Paraffin-Free ointment
- Aproderm® colloidal oat cream
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Emollients containing Urea
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Formulary
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Cream
- Emollients containing urea for severely dry skin as per Notts Emollient Formulary:
- First line - Balneum® Plus Cream (100g tube) - also contains lauromacrogols. Use only if emollient alone has not helped itching.
- Emollients containing urea for moderately dry skin as per Notts Emollient Formulary:
- First line - ImuDERM® emollient. 5% urea (500g pump dispenser, CliniSupplies Ltd)
- Second line - Hydromol® Intensive 10% urea cream (100g tube)
- Eucerin® Intensive 10% urea lotion can be used if lotion required.
- See separate entry for heel balm.
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Dermol®
(Emollient preparation with antimicrobials)
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Restricted
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Lotion, Cream (500g pump disenser)
- Use in confirmed staphylococcal infection e.g. recurrent folliculitis and impetiginised eczema as per Notts Emollient Formulary.
- First choice - Dermol® 500 Lotion (less greasy than Dermol® cream)
- Second choice - Dermol® Cream
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Emollient Heel Balm
(Urea 25%)
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Restricted
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Balm
- For initial treatment of callused, fissured and hard foot skin as per Notts Emollient Formulary.
- Any other emollient with low percentage urea can be used for maintenance following the treatment phase.
- First line is Dermatonics ONCE Heel Balm®, 25% urea
- Second line is Flexitol 25% Urea Heel Balm®
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Emollin®
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Restricted
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Spray (240ml)
- Only for patients unable to use ointment/creams/lotions, or where application without touching skin is required, as per Notts Emollient Formulary.
- Highly Flammable
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Oat based Emollient
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Formulary
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Cream
Patients with mild dry skin, who do not have a diagnosed dermatological condition or risk to skin integrity, should be advised to purchase a suitable product over the counter.
- For mild dry skin as per Notts Emollient Formulary.
- First line is Epimax® oatmeal cream (500g easy squeeze).
- Second line is Zeroveen® cream (500g pump dispenser).
- Epimax® oatmeal cream and Zeroveen® cream are additionally recommended for use as a soap substitute.
- Comparable to Aveeno® cream
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QV 5%® skin lotion
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Formulary
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Lotion (500ml pump dispenser)
Patients with mild dry skin, who do not have a diagnosed dermatological condition or risk to skin integrity, should be advised to purchase a suitable product over the counter.
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Urea 5% Special Preparation
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Restricted
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Cream
NUH:Restricted for ichthyosis
NUH:Manufactured by Pharmacy Non Sterile Production Unit (Unlicensed Product)
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Yellow Soft Paraffin BP
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Formulary
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Yellow petroleum jelly
- Greasy level 4/4 (most greasy)
- Not in Nottinghamshire emollient formulary. Use alternative if a leave on emollient is required -see formulary for options.
- At SFH, obtained from NHS Supplies if needed for other uses eg for lips.
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| 13.02.01 |
Emollients - preparations containing urea |
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| 13.02.01.01 |
Emollient bath and shower preparations |
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Oilatum® Plus
(MRSA treatment)
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Restricted
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NUH only: In line with NUH MRSA policy, where Octenisan® is not appropriate.
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| Non Formulary Items |
Aquadrate®
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Non Formulary
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Cream
10% urea
Removed from emolllient formulary Jan 2013 |
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Aquamax®
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Non Formulary
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Cream
no formal assessment |
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Aqueous Cream BP
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Non Formulary
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Cream
- Agreed GREY non formulary for NEW PATIENTS (APC Jan 2020). Other creams available as soap substitutes and leave on emollients.
- Aqueous cream may be associated with skin reactions (stinging, burning, itching and redness) when used as a 'leave-on' emollient, often within 20 minutes of application, and especially in children with atopic eczema. See MHRA Drug Safety update March 2013.
- Do not use on eczema
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 MHRA: Fire Risk - Paraffin-based skin emollients on dressings or clothing
UKMI Q & A: Why aqueous cream is not recommended as a leave on moisturiser
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Aveeno Cream®
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Non Formulary
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Cream
Patients with mild dry skin, who do not have a diagnosed dermatological condition or risk to skin integrity, should be advised to purchase a suitable product over the counter.
- First line is Epimax® oatmeal cream (500g easy squeeze) as per Notts formulary 2019
- Second line is Zeroveen® cream (500g pump dispenser)
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Cetraben®
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Non Formulary
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Ointment, cream, lotion
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Diprobase®
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Non Formulary
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- Removed from formulary Jan APC 2013
- First choice Epimax®, second choice Zerobase®
- SFH: Can be used for existing patients where switching to Epimax or Zerobase is not acceptable to the patient.
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DoubleBase Dayleve®
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Non Formulary
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No formal submission |
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E45®
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Non Formulary
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- Replaced with Exocream/Zerocream as per Notts emollient formulary
- Can be used for existing patients if switching toExocream/Zerocream is not acceptable to the patient.
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Emollient Bath/Shower Additive
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Non Formulary
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- ALL bath and shower emollients should never be prescribed and are on the Nottinghamshire list of Medicines & Appliances of Limited Clinical Value.
- Note that Oilatum® Plus is
 for MRSA treatment at NUH where Octenisan is not appropriate in line with NUH MRSA policy.
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Emollient preparation (Decubal® Clinic)
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Non Formulary
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Emollient preparation (Dermamist®)
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Non Formulary
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Emollient preparation (Drapolene®)
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Non Formulary
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Emollient preparation (Epaderm®)
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Non Formulary
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MHRA: Fire Risk - Paraffin-based skin emollients on dressings or clothing |
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Emollient preparation (Hewletts®)
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Non Formulary
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Emollient preparation (Kamillosan®)
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Non Formulary
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Emollient preparation (Keri®)
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Non Formulary
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Emollient preparation (Linola® Gamma)
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Non Formulary
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Emollient preparation (Lipobase®)
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Non Formulary
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Emollient preparation (Neutogena® Dermatological Cream)
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Non Formulary
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Emollient preparation (Ultrabase®)
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Non Formulary
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Emollient preparation (Vaseline Dermacare®)
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Non Formulary
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Emollient preparation (ZeroAQS®)
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Non Formulary
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Emollient preparation (Zeroguent®)
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Non Formulary
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Emollient preparation containing Urea (Calmurid®)
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Non Formulary
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Cream
Discontinued |
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Emollient preparation containing Urea (E45® Itch Relief Cream)
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Non Formulary
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Emollient preparation containing Urea (Nutraplus®)
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Non Formulary
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Emollient preparation with antimicrobials (Eczmol®)
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Non Formulary
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Lanolin emollient spray
(Evolve plus)
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Non Formulary
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Oilatum®
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Non Formulary
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Cream |
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Proprietary Emollient Preparations (Doublebase®)
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Non Formulary
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Skin Salvation Cream®
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Non Formulary
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No formal submission |
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Unguentum M®
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Non Formulary
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Cream
Greasy level 3/4
Removed from emollient formulary Jan 2013 |
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White Soft Paraffin BP
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Non Formulary
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White petroleum jelly
- Greasy level 4/4 (most greasy)
- Not in Nottinghamshire emollient formulary. Use alternative if a leave on emollient is required -see formulary for options.
- At SFH if needed for other uses eg for lips, then use yellow soft paraffin, available from NHS supplies.
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MHRA: Fire Risk - Paraffin-based skin emollients on dressings or clothing
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Zerodouble® Gel
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Non Formulary
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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Cancer Drugs Fund
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NHS England |
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Homecare |
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CCG |
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Traffic Light Status Information
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Description |
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Grey / Non-Formulary: Medicines, which the Nottinghamshire APC has actively reviewed and does not recommend for use at present due to limited clinical and/or cost effective data.
Grey / Non-Formulary (undergoing assessment): Work is ongoing and will be reviewed at a future APC meeting.
Grey / Non-Formulary (no formal assessment): APC has not formally reviewed this medicine or indication because it had never been requested for formulary inclusion. Often used for drugs new to market.
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Medicines which should normally be prescribed by specialists only. eg hospital only.
For patients already receiving prescriptions in primary care - continue. No new patients to receive prescriptions in primary care.
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Medicines that should be initiated by a specialist and prescribed by primary care prescribers only under a shared care protocol, once the patient has been stabilised.
Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred. The shared care protocol must have been agreed by the relevant secondary care trust Drugs and Therapeutics Committee(s) (DTC) and approved by the Nottinghamshire APC.
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Medicines suitable to be prescribed in primary care / general practice after specialist* recommendation or initiation.
A supporting prescribing guideline may be requested which must have been agreed by the relevant secondary care trust DTCs and approved by the Nottinghamshire APC.
*Specialist is defined by the APC as a clinician who has undertaken an appropriate formal qualification or recognised training programme within the described area of practice
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Primary care/ non specialist may initiate as per APC guideline.
The supporting prescribing guideline must have been agreed by the relevant secondary care trust D&TC(s) and approved by the Nottinghamshire APC.
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Medicines suitable for routine use within primary care.
Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing. |
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