Information-giving and prescribing: Emollients Flashcards
How would you explain to a patient what an emollient is?
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
What are the 3 main kinds of emollients, from heaviest to lightest?
Ointment
Cream
Lotion
For mild dry skin, which type of emollient is prescribed?
Lotion or cream
For moderate dry skin, which type of emollient is prescribed?
Gel
Cream
Ointment
For severe dry skin, which type of emollient is prescribed?
Ointment with high paraffin content
Give 5 examples of emollients that can be used for mild dry skin?
Epimax original cream
Epimax oatmeal cream
Epimax moisturising cream
Aquamax cream
ExoCream
Give 2 examples of emollients that can be used for moderate dry skin?
Epimax isomol gel
Zerobase cream
Give 3 examples of emollients that can be used for severe dry skin?
Epimax ointment
Zeroderm ointment
White soft paraffin or liquid paraffin ointment
Hydromol ointment
If a patient’s skin condition is triggered by infections, what emollient should be prescribed?
Dermol cream/lotion
How often should emollients be applied generally?
2-4 times a day
Use more frequently if skin still feels dry
How often should emollients be applied on very dry skin?
2-3 hours
How much emollient should you prescribe and why?
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
When would you recommend to use light emollients such as creams and lotions?
In the morning and during daytime applications, as it is less greasy and doesn’t look oily
When would you recommend to use moderate emollients such as gels and creams?
During daytime application
When would you recommend to use heavy emollients such as ointments?
During nighttime, as they are greasy and feel sticky
When would you recommend to apply emollients in accordance with other activities that the patient does?
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
What products should you recommend for patients to use when washing?
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
Give 4 examples of emollients that can be used as soap substitutes?
Doublebase wash
Dermol lotion
Aqueous cream
E45 wash
Should a patient keep applying emollients even if their skin isn’t currently dry?
Yes, as frequent application can help soothe skin and prevent long-term symptoms
How do you advise a patient to apply emollient on their skin?
- Apply when skin is still moist as this will trap in more moisture
- Take emollient out of tub with a clean spatula, as this reduces risk of bacterial contamination on emollient
- Smooth onto skin in direction of hair growth to reduce risk of folliculitis
What hazard should you warn patients about, especially if the emollient contains paraffin?
Fire hazard risk
- Don’t smoke or go near naked flames, as clothes/bedding/bandages with residue of emollient have fire risk
- Wash clothes, bedding at high temperatures to remove as much emollient residue as possible (doesn’t remove completely)
Give 5 risks of using emollients that you need to warn patient’s about?
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
If a patient also uses topical corticosteroids, when should they apply the emollient?
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
When are topical corticosteroids used to treat skin conditions?
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
What are the 4 different strengths of topical corticosteroids?
Mild
Moderate
Potent
Very potent
How do you instruct a patient to apply their topical corticosteroids?
- Wash hands before applying
- Only apply corticosteroid to affected area eg. eczema patches only
- Smooth onto skin in direction of hair growth
- Wash hands after applying, unless skin lesion is on hands
- Wait 30 mins then apply emollients or apply emollients 30 min before corticosteroids
How should advise patients to check that they are applying the correct amount of topical corticosteroid cream?
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
Give an example of a very potent topical corticosteroid?
Dermovate
Difficult to manage steroid-responsive dermatoses
Give 2 examples of a potent topical corticosteroid?
Betnovate
Cutivate
Give an example of a moderate topical corticosteroid?
Eumovate
Give an example of a mild topical corticosteroid?
Hydrocortisone 1% cream
What is the most common side effect of applying topical corticosteroids?
Burning or stinging sensation when the medicine is applied
Should improve as skin gets used to treatment, otherwise go to gp to check medication
Give 9 possible dermatological side effects to using topical corticosteroids?
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
What are the side effects of potent or very potent topical corticosteroids, that can be absorbed into the skin and bloodstream? CORTICOSTEROIDS
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
What is oral isotretinoin (Roaccutane) used for?
Severe nodulocystic acne that doesn’t respond to other treatments
What are the common side effects of oral isotretinoin? Horrible ACID Treatment
H: Hepatitis
A: Alopecia
C: Chest pain, chronic fatigue
I: Increased lipids
D: Dryness of lips, eyes, nose, skin
T: Teratogenic
How do you advise a patient to take their oral isotretinoin?
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
