From Mr P. Lapsley, MRPharmS
SIR,—We are encouraged by the constructive approach to the issue surrounding
the prescribing of emollients taken by the prescribing advisers to primary care
groups in Camden and Islington health authority (PJ, September 30, p484).
Our decision to write to chief executives of primary care groups was taken in
the light of separate and unrelated reports from two consultant dermatologists,
both of whom expressed real concern at the simplistic approach to emollient
prescribing being taken by some pharmaceutical advisers to PCGs. Dr Michael
Cork, a consultant dermatologist in Sheffield, found up to 50 per cent of children
attending his clinics with atopic eczema to be sensitised to aqueous cream,
many of them severely.
Dr Cork has begun submitting yellow cards to the Committee on Saftey of Medicines
in respect of these adverse reactions. He says that it is important to emphasise
that the reaction appears to be to aqueous cream, predominantly in children,
but not with other emollients which contain high concentrations of sodium laurylsulphate
(SLS), such as emulsifying ointment. The difference relates to partitioning
of the SLS in cream and ointment formulations.
We recognise that aqueous cream may be suitable for many people with dry skin.
Our concern, however, is for people with skin diseases. The advice some pharmacists
have been giving has not differentiated between the two. For example, one PCG
formulary simply lists three emollients and barrier preparations (aqueous cream,
Diprobase cream/ointment and emulsifying ointment) and two bath additives (Oilatum
bath additive and Balneum Plus bath oil — with a note that the latter is
more expensive).
Your correspondents have made the point that there is a lack of good quality
comparative evidence where emollients are concerned. Because people’s skins
and preferences differ, that will always be the case. What is essential, as
was made clear in their letter, is that safety, efficacy, cosmetic acceptability
and cost-effectiveness must all be taken into account in the prescribing of
emollients. This supports strongly the argument for the widest possible range
of treatments for skin diseases being made available on prescription, an argument
endorsed unreservedly by the British Association of Dermatologists.
Peter Lapsley
Chief Executive,
The Skin Care Campaign