emulsifying ointment + liquid paraffin + white soft paraffin: clinical use

Prescribing considerations

• Licensed as a leave-on emollient and soap substitute, but NHS patient guidance no longer recommends aqueous cream as a leave-on emollient because sodium lauryl sulfate can cause irritation. Some people may tolerate it as a soap substitute.
• Discuss fire precautions with every user or carer, especially with extensive application, dressings, impaired mobility or smoking.
• Consider contamination control for tubs and slip risk around bathing areas.

Contraindications and cautions

• Known hypersensitivity to phenoxyethanol.
• Avoid continued use if application causes clinically significant burning, stinging, itching, redness or contact dermatitis.
• Use particular caution as a leave-on product in children with atopic eczema because immediate skin reactions have been reported.

Monitoring

• Review local tolerability and improvement in dry-skin symptoms.
• Check for contact dermatitis, persistent stinging, folliculitis or acneiform facial reactions.
• Reassess understanding and management of fire risk where residue can accumulate on fabrics.

Clinical pharmacology

An occlusive emollient cream. Paraffins and emulsifying components form a surface film that reduces transepidermal water loss and supports rehydration of dry or chapped skin.

Formulation and product differences

• This is a water-containing cream rather than a simple anhydrous paraffin ointment.
• It contains sodium lauryl sulfate, cetostearyl alcohol and phenoxyethanol, which account for important irritation, allergy and formulation-specific cautions.
• It can be used for washing or left on the skin, but leave-on tolerability can be poorer than with some other emollients.