The role and volume of emollients

1
The role and volumeof emollients
2
The role of emollients in atopic eczema

• In atopic eczema the skins outermost protective
  layer (stratum corneum) becomes damaged
• The skin is vulnerable to
• Moisture loss
• Penetration by irritants and allergens
• Emollients restore the defective skin barrier to
  keep moisture in and irritants out

3
Emollients are the primary treatment

• Emollients reduce
• The severity and frequency of flare-ups
• The need for topical steroids1,2
• Many patients with mild to moderate eczema can
  control their condition using emollients alone2

1. Primary Care Dermatology Society British
Association of Dermatology 2006 2. Cork MJ.
(1997) The importance of skin barrier function.
Journal of Dermatological Treatment (1997) 8,
S7-13
4
Emollients must be applied regularly and
frequently

• Every day, even when the skin looks clear
• In conjunction with other treatments during
  flare-ups
• Every 3-4 hours
• Helping patients to build emollient application
  into their daily routine can make it easier for
  them to concord

5
and in the right quantities

• To get the most out of emollients, patients need
  to know how much they should use
• Illustrating how much emollient your patients
  should apply, by using a familiar object such as
  a teaspoon, can be helpful
• However patients should not actually use a
  teaspoon to measure their emollient

6
Emollient choices

• Ointments
• Are most effective, but can be heavy and greasy
• Where cosmetic acceptability is an issue suggest
  use under clothing or at night
• Creams
• Most widely used, easily absorbed
• Can be used as soap substitute
• Lotions and gels
• Provide a thinner layer of protection and can be
  useful for hairy areas of the body

7
Complete emollient therapy

• Giving patients a combination of different
  formulations and sizes can encourage themto use
  them regularly, frequently and in sufficient
  volume, for example
• An ointment tube for use on severe areas or at
  night
• A large cream pump dispenser for daily
  moisturising and washing
• A smaller tube of cream for use when out and
  about
• A bath substitute in place of cosmetic products
  for regular cleansing

8
Prescribe emollients in sufficient volume

• 250-500g per week for children1
• Between 2-4 500g pump dispensers per month
• 600g per week for adults2
• 4 x 500g pump dispensers per month
• Prescribe brands that are low in sensitisers,
  such as perfumes, lanolin and parabens, to avoid
  ingredients which could trigger irritation or
  allergies

1. NICE (2007) Clinical Guideline 57, London,
December 2007 2. Primary Care Dermatology
Society British Association of Dermatology,
February 2006
9
The role of topical steroids

• Topical steroids are widely used to relieve
  acute symptoms and clear flare-ups
• They come as creams and ointments, and in a
  range of strengths
• So that patients can be given one that is ideal
  for the severity and location of their eczema
• Topical steroids should be applied to inflamed
  areas only and used twice a day at most
• They should be used sparingly and only for as
  long as is necessary to clear up the flare
• Finger tip units can be a useful way for patients
  to measure doses

10
Prescribing topical steroids

• Topical steroids are usually prescribed using a
  step-wise approach
• Starting with the correct potency based on the
  severity of eczema
• Stepping down as the severity decreases
• Or stepping up as required1
• The face and neck should normally only be treated
  with mild steroids - adverse effects are more
  likely in areas where the skin is thinner

1. NICE (2007) Clinical Guideline 57, London,
December 2007
11
Diprobase Abbreviated Product Information Uses
Diprobase Cream and Ointment are emollients, with
moisturising and protective properties, indicated
for follow-up treatment with topical steroids or
in spacing such treatments. They may also be used
as diluents for topical steroids. Diprobase
products are recommended for the symptomatic
relief of red, inflamed, damaged, dry or chapped
skin, the protection of raw skin areas and as a
pre-bathing emollient for dry/eczematous skin to
alleviate drying effects. Dosage The cream or
ointment should be thinly applied to cover the
affected area completely, massaging gently and
thoroughly into the skin. Frequency of
application should be established by the
physician. Generally, Diprobase Cream and
Ointment can be used as often as required.
Contra-indications Hypersensitivity to any of
the ingredients. Side- Effects Rarely, mild skin
reactions have been observed. Package Quantities
Cream 50g tubes, 500g pump dispensers Ointment
50g tubes. Basic NHS Costs Cream 1.34 (50g),
6.76 (500g) Ointment 1.34 (50g). Legal
Category GSL. Marketing Authorisation Numbers
Cream 0201/0076 Ointment 0201/0075. Further
information available upon request from
Schering-Plough Ltd, Shire Park, Welwyn Garden
City, Herts, AL7 1TW. Date of Revision January
2006
Diprobath Abbreviated Product Information Diprobat
h is a liquid preparation for external use as a
bath additive. It contains Light Liquid Paraffin
Ph.Eur 46 w/w and Isopropyl Myristate BP 39
w/w. Uses As a bathing emollient for the
treatment of dry skin conditions and
hyperkeratoses including dermatitis and eczema.
Dosage 25ml (2.5 capfuls) to an adult size bath
(approx. 100 litres) or 10ml (1 capful) for
childrens baths (approx. 25-30 litres). For
particularly dry skin, these quantities may be
doubled. The frequency and duration of bathing
will depend on the nature of the condition.
Contra-indications, Warnings Hypersensitivity to
the ingredients contra-indicates use. Patients
should be advised to use care when entering or
leaving the bath which may be more slippery than
usual. Package Quantities 500ml bottle. Basic
NHS Costs 6.98 Legal Category P. Marketing
Authorisation Number 0201/0174. Further
information available upon request from
Schering-Plough Ltd, Shire Park, Welwyn Garden
City, Herts, AL7 1TW, England. Date of Revision
January 2006 Please refer to the full SPC text
before prescribing these products. Information
about adverse event reporting can be found at
www.yellowcard.gov.uk (UK) and www.imb.ie
(Ireland). Adverse events with these products
should also be reported to Schering-Plough Drug
Safety Department on 44 (0)1707 363773.
Date of preparation March 2008 Code DIP/08-432
12
ELOCON CREAM AND OINTMENT ABBREVIATED PRESCRIBING
INFORMATION Uses Elocon products contain
mometasone furoate 0.1 w/w, a synthetic topical
corticosteroid. Elocon Cream and Ointment are
indicated for the treatment of inflammatory and
pruritic manifestations of psoriasis (excluding
widespread plaque psoriasis) and atopic
dermatitis. Dosage A thin film of Elocon cream
or ointment should be applied to the affected
areas of skin once daily. Contraindications,
Precautions etc. Contraindications Rosacea,
acne vulgaris, perioral dermatitis, perianal and
genital pruritus, napkin eruptions, bacterial,
viral and fungal infections, varicella,
tuberculosis, syphilis or postvaccine reactions.
Hypersensitivity to mometasone furoate or to
other corticosteroids. Precautions Elocon
treatment should be discontinued if irritation or
sensitisation develop or in the presence of
infection not adequately controlled by antifungal
or antibacterial therapy. Courses on the face or
in children should be restricted to 5 days long
term continuous therapy should be avoided in all
patients and occlusion should not be used. Use in
psoriasis may result in rebound relapse due to
tolerance, risk of generalised pustular psoriasis
or local systemic toxicity due to impaired
barrier function of skin. Careful supervision is
important. Elocon topical preparations are not
for ophthalmic use. There is inadequate evidence
of safety in human pregnancy. Corticosteroids may
carry a very small risk of abnormalities in
foetal development. Side Effects Local reactions
include paresthesia, folliculitis, burning,
pruritus, tingling, stinging, allergic contact
dermatitis, hypopigmentation, hypertrichosis,
secondary infection, striae, acneiform reactions
and signs of skin atrophy. Paediatric patients
may demonstrate greater susceptibility to topical
corticosteroid-induced hypothalamic-pituitary-adre
nal axis suppression and Cushings Syndrome.
Presentations Elocon Cream 30g or 100g Elocon
Ointment 30g or 100g. Basic NHS Price Cream /
ointment 30g 4.54 Cream / ointment 100g 13.07.
Marketing Authorisation Numbers Elocon Cream -
0201/0117 Elocon Ointment - 0201/0118. Legal
Category POM Full prescribing information
available on request from the Marketing
Authorisation Holder Schering-Plough Ltd, Shire
Park, Welwyn Garden City, Hertfordshire, AL7 1TW,
UK. Date of revision of the text February 2006
Date of preparation March 2008 Code DIP/08-432