Information-giving and prescribing: Emollients

Question 1

How would you explain to a patient what an emollient is?

Answer 1

Substance/moisturiser that provides a film over the skin to keep it hydrated and prevent irritation

Used to manage itchiness and dryness caused by skin conditions such as eczema, psoriasis

Question 2

What are the 3 main kinds of emollients, from heaviest to lightest?

Answer 2

Ointment
Cream
Lotion

Question 3

For mild dry skin, which type of emollient is prescribed?

Answer 3

Lotion or cream

Question 4

For moderate dry skin, which type of emollient is prescribed?

Answer 4

Gel
Cream
Ointment

Question 5

For severe dry skin, which type of emollient is prescribed?

Answer 5

Ointment with high paraffin content

Question 6

Give 5 examples of emollients that can be used for mild dry skin?

Answer 6

Epimax original cream

Epimax oatmeal cream

Epimax moisturising cream

Aquamax cream

ExoCream

Question 7

Give 2 examples of emollients that can be used for moderate dry skin?

Answer 7

Epimax isomol gel

Zerobase cream

Question 8

Give 3 examples of emollients that can be used for severe dry skin?

Answer 8

Epimax ointment

Zeroderm ointment

White soft paraffin or liquid paraffin ointment

Hydromol ointment

Question 9

If a patient’s skin condition is triggered by infections, what emollient should be prescribed?

Answer 9

Dermol cream/lotion

Question 10

How often should emollients be applied generally?

Answer 10

2-4 times a day

Use more frequently if skin still feels dry

Question 11

How often should emollients be applied on very dry skin?

Answer 11

2-3 hours

Question 12

How much emollient should you prescribe and why?

Answer 12

Small amount initially so that patient can see if it suits them eg. 200g

Prescribe generous amount to encourage frequent use after patient find ones suitable eg. 500g

Question 13

When would you recommend to use light emollients such as creams and lotions?

Answer 13

In the morning and during daytime applications, as it is less greasy and doesn’t look oily

Question 14

When would you recommend to use moderate emollients such as gels and creams?

Answer 14

During daytime application

Question 15

When would you recommend to use heavy emollients such as ointments?

Answer 15

During nighttime, as they are greasy and feel sticky

Question 16

When would you recommend to apply emollients in accordance with other activities that the patient does?

Answer 16

If they are doing activities that irritate skin eg. gardening, should apply emollient before they start

After washing hands, having baths or showers as the skin has less moisture now

Question 17

What products should you recommend for patients to use when washing?

Answer 17

Emollients that can be used as soap substitutes or body wash

Soaps, shower gels, detergents, bubble baths contain emulsifying lipids from skin and make it more dry

Question 18

Give 4 examples of emollients that can be used as soap substitutes?

Answer 18

Doublebase wash

Dermol lotion

Aqueous cream

E45 wash

Question 19

Should a patient keep applying emollients even if their skin isn’t currently dry?

Answer 19

Yes, as frequent application can help soothe skin and prevent long-term symptoms

Question 20

How do you advise a patient to apply emollient on their skin?

Answer 20

1. Apply when skin is still moist as this will trap in more moisture
2. Take emollient out of tub with a clean spatula, as this reduces risk of bacterial contamination on emollient
3. Smooth onto skin in direction of hair growth to reduce risk of folliculitis

Question 21

What hazard should you warn patients about, especially if the emollient contains paraffin?

Answer 21

Fire hazard risk

1. Don’t smoke or go near naked flames, as clothes/bedding/bandages with residue of emollient have fire risk
2. Wash clothes, bedding at high temperatures to remove as much emollient residue as possible (doesn’t remove completely)

Question 22

Give 5 risks of using emollients that you need to warn patient’s about?

Answer 22

Fire risk

Risk of infection due to bacterial contamination

Folliculitis

Overheating/burning/allergic rash reaction to an ingredient in the emollient

Slipping on surfaces with emollient

Question 23

If a patient also uses topical corticosteroids, when should they apply the emollient?

Answer 23

Doesn’t matter which one patient prefers to apply first and second

Leave at least 30 min between the two treatments to avoid diluting the
strength of the topical corticosteroid, and to prevent the spread of topical steroids and calcineurin inhibitors to areas not affected by eczema

Question 24

When are topical corticosteroids used to treat skin conditions?

Answer 24

They are anti-inflammatory medications, so are used to treat flare ups and autoimmune conditions that cause rashes

eg. Eczema, contact dermatitis, psoriasis, alopecia areata, bullous pemphigoid, dermatitis herpetiformis, pemphigus, necrobiosis lipoidica

Question 25

What are the 4 different strengths of topical corticosteroids?

Answer 25

Mild Moderate Potent Very potent

Question 26

How do you instruct a patient to apply their topical corticosteroids?

Answer 26

1. Wash hands before applying 2. Only apply corticosteroid to affected area eg. eczema patches only 3. Smooth onto skin in direction of hair growth 4. Wash hands after applying, unless skin lesion is on hands 5. Wait 30 mins then apply emollients or apply emollients 30 min before corticosteroids

Question 27

How should advise patients to check that they are applying the correct amount of topical corticosteroid cream?

Answer 27

Use Finger Tip Units (FTU) 1 FTU: Squeeze a line from the tip of an adult finger to the first crease of the finger Enough to treat size of skin that is 2 flat hands put together with fingers together (500 micrograms) 0.5 FTU for genitals 1 FTU for hands, elbows or knees 1.5 FTUs for the feet, including the soles 2.5 FTUs for the face and neck 3 FTUs for the scalp 4 FTUs for a hand and arm together, or the buttocks 8 FTUs for 1 leg and foot, the chest or back

Question 28

Give an example of a very potent topical corticosteroid?

Answer 28

Dermovate Difficult to manage steroid-responsive dermatoses

Question 29

Give 2 examples of a potent topical corticosteroid?

Answer 29

Betnovate Cutivate

Question 30

Give an example of a moderate topical corticosteroid?

Answer 30

Eumovate

Question 31

Give an example of a mild topical corticosteroid?

Answer 31

Hydrocortisone 1% cream

Question 32

What is the most common side effect of applying topical corticosteroids?

Answer 32

Burning or stinging sensation when the medicine is applied Should improve as skin gets used to treatment, otherwise go to gp to check medication

Question 33

Give 9 possible dermatological side effects to using topical corticosteroids?

Answer 33

Worsening or spreading of a skin infection you already have Folliculitis Skin thinning and easy bruising Striae that can be permanent Contact dermatitis Acne, or worsening of acne Rosacea Changes in skin colour – this is usually more noticeable in people with dark skin Excessive hair growth on area being treated

Question 34

What are the side effects of potent or very potent topical corticosteroids, that can be absorbed into the skin and bloodstream? CORTICOSTEROIDS

Answer 34

C: Cushing's disease: Moon face, buffalo hump O: Osteoporosis R: Retardation of growth in children T: Thinning skin I: Immunosuppressive C: Cateracts and glaucoma O: Oedema S: Suppression of HPA T: Tetragonic E: Emotional disturbances R: Raised bp O: Obesity I: Increased hair growth D: Diabetes (hyperglycaemia) S: Striae, stomach ulcers

Question 35

What is oral isotretinoin (Roaccutane) used for?

Answer 35

Severe nodulocystic acne that doesn't respond to other treatments

Question 36

What are the common side effects of oral isotretinoin? Horrible ACID Treatment

Answer 36

H: Hepatitis A: Alopecia C: Chest pain, chronic fatigue I: Increased lipids D: Dryness of lips, eyes, nose, skin T: Teratogenic

Question 37

How do you advise a patient to take their oral isotretinoin?

Answer 37

Take 2 times a day unless told otherwise by doctor, with a meal Swallow pill with water, don't chew or suck on capsule: can hurt throat if not swallowed whole If you miss a dose, skip it: Don't take 2 pills at the same time Check with doctor before taking other prescribed medications, herbal remedies or OTC medications with roaccutane