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Letters to the Editor
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Aqueous cream
Involve patients in choice of emollient
Dr R. P. Tucker, MRPharmS
I read with interest the article (PDF 75K) by Michael Cork et al (PJ, 29 November,
p747) on the problems associated with aqueous cream. This mirrors to
some degree my own experience of dealing with patients with skin problems.
I have also noticed that patients complain that the cream can cause a
burning or stinging sensation, although I should add that such adverse
reactions can also occur with other emollient preparations. As a result,
I tend to recommend that patients use aqueous cream as a soap substitute
(though many also find it of benefit for shaving) and allow them to select
an alternative product for use during the day.
The simple fact that aqueous cream is inexpensive should not be the main
reason for its inclusion in primary care trust formularies. Although
there is a paucity of clinical evidence to demonstrate superiority of
one emollient over another, the importance of patient choice should not
be overlooked.
Furthermore, involving patients in the choice of an emollient achieves
a greater degree of compliance. With a potentially large number of patients
with atopic eczema and other dry skin conditions, helping patients to
select an appropriate emollient, and advising on its use, is perhaps
an ideal role for community pharmacists as suggested in a recent report.1 Such a role will be of enormous benefit and serve as yet another example
of the ways in which community pharmacists can make a valuable contribution
to the health and well-being of the general public.
Rod Tucker
Beverley, East Yorkshire
Reference
1. Report on the enquiry into primary care dermatology services. London:
Associate Parliamentary Group on Skin; 2002.
Patients should try a variety of emollients
From Mr P. Lapsley
We were interested to see the paper (PDF 75K) “An audit of adverse drug
reactions to aqueous cream in children with atopic eczema” (PJ,
29 November, p747). In the study, an irritant reaction occurred in 56.3
per cent of
children with atopic eczema when aqueous cream was used as an emollient,
compared with only 17.8 per cent of children using all other emollients.
This is of serious concern to the Skin Care Campaign (SCC) and provides
research evidence of a problem of which we have been aware anecdotally
for several years.
Reports to the SCC suggest that many health care professionals are not
aware either that aqueous cream used as an emollient causes such irritant
reactions or that such irritant reactions are frequently a cause of non-compliance
with agreed disease management regimens.
We are sometimes asked which emollient we would recommend. The answer
is that we cannot recommend any particular treatment. People’s
skins vary and different people react differently to different treatments.
People with eczema and related conditions tend to have very sensitive
skin, and not every product is suited to every patient. Some people will
need a range of treatments for different degrees of dry skin, different
body sites, different social situations, to
encourage compliance and reduce topical steroid use, to address personal
preference issues, and on occasion to avoid contact hypersensitivity
or other irritant side-effects. And needs may change over time.
If a patient dislikes a treatment, he or she may not use it, which undermines
the treatment regimen and is wasteful of National Health Service resources.
It is therefore important that the widest possible range of treatments — including
a wide range of emollients — should be available. It is important
also that people with skin diseases should be given every opportunity
to try a variety of emollients to find the ones that suit them best.
The SCC is an umbrella organisation representing the interests of all
people with skin diseases in the United Kingdom (www.skincarecampaign.org).
These views are endorsed unreservedly by the British Association of Dermatologists,
the Primary Care Dermatology Society and the British Dermatological Nursing
Group.
Peter Lapsley
Chief Executive
Skin Care Campaign
www.skincarecampaign.org |
* PDF files on PJ Online require Acrobat
Reader 4 or later.