Home' Australian Pharmacist : Australian Pharmacist June 2015 Contents Australian Pharmacist June 2015 I ©Pharmaceutical Society of Australia Ltd.
Note, consumers should also be warned
that paraffin grease is flammable,
especially if they smoke.
Aqueous cream caution
Aqueous cream is best used as a
cleanser rather than a leave‐on
The Australian Medicines
Handbook (AMH) (2013) advises against
the use of products containing sodium
lauryl sulphate, such as aqueous cream
or emulsifying ointment, as they can dry
and irritate the skin.
However, the AMH
does not mention using aqueous
cream as a wash off preparation, as
does the Medicines and Healthcare
Products Regulatory Agency, UK
The MHPRA Report, following
a literature review, determined aqueous
cream is appropriate as a low‐cost
consider this, ensuring the aqueous
cream has clear instructions that the
product should be washed off. If the
product, when washed off, still irritates
skin within 20 minutes of application,
use should be discontinued and an
alternative cleanser utilised.
‘I’ve used everything and nothing
Consumers usually have many
‘emollients that did not work’ at
home, some may even be the same
product, with a different brand name.
Often consumers do not recognise
identical products under different
brand names, such as cetomacrogol
aqueous cream and sorbolene.
Poor understanding from limited
explanation about the need to use the
emollients long‐term contributes to this
phenomenon.20 Pharmacists, for ECE,
must emphasise the need to continue
using the leave‐on emollient after the
eczema has ‘cleared up’. Pharmacists can
ask three simple questions:
1. were the preparations in a pump
2. what volume of the moisturiser did
you use each week?
3. how long did the container of
emollient last you?
Using an emollient in a pump dispenser
indicates the product is unlikely to be
providing the required rehydration
and barrier protection for consumers.
Quantifying the amount consumers
should use is vital:
an adult should use 500 gm of
leave‐on emollient per week.
a child should use 250 gm per week.
Most sufferers of eczema are usually
using insufficient preparation because
the amount has never been clearly
quantified for them. Frequently MPs
use the term ‘apply liberally’ but this
term does not guide consumers in
how much to use. By actively showing
consumers the correct amounts, using
a container of the appropriate size,
pharmacists provide visual cues which
help consumers better understand
This enables long‐term
behavioural changes needed to master
Pharmacists also must
stress that skin needs to be rehydrated
on a long term basis with once or
twice daily application becoming an
activity of daily living for consumers
The stinging sensation
of some emollients when applied is
more likely to occur if consumers are
using insufficient emollient unless
there are indications a reaction or
sensitivity has occurred.
42,44,45 Use of
enough emollient regularly also reduces
the need for Topical Corticosteroids
products feared by most
TCS are the main and cost‐effective
form of treatment for the inflammatory,
itchy patches of eczema.
CNIs, such as
pimecrolimus, are being increasingly
prescribed by MPs, but there are
higher associated costs and less
Weaker steroids, such as hydrocortisone
1%, are needed on the face and
genital region where skin is
thinner than on other body areas.
Consumers’ preferences need to be
accepted by pharmacists when it
comes to stronger TCS preparations as
some consumers find ointments more
effective and less stinging. If the MP has
prescribed an ointment but only a cream
is available, the issue must be discussed
with the MP and not substituted without
prescriber permission. The amount of
active ingredient is the same in creams
and ointments but the nature of the
ointment, as an occlusive and emollient,
results in greater penetration.
However, robust evidence on this issue
This situation has been
frequently described by consumers
using betamethasone valerate 0.02%
ointment which is no longer available
Effective consumer education (ECE)
about the use and application of TCS
greatly influences adherence.
problem with eczema management
has been the confusing, vague advice
‘to apply sparingly’. Consumers, fearing
TCS side‐effects, often apply far too little
or opt for none at all.
4,10,17,19,22 The good
interpersonal communication skills of
pharmacists can avert this. The routine
labelling ‘Apply sparingly...’ of TCS,
as is the case with some dispensing
Figure 2. Application of emollients14,24
(used with permission)
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