13.2.2 Barrier preparations

Barrier preparations often contain water-repellent substances such as dimeticone or other silicones. They are used on the skin around stomas, bedsores, and pressure areas in the elderly where the skin is intact. Where the skin has broken down, barrier preparations have a limited role in protecting adjacent skin. They are no substitute for adequate nursing care and it is doubtful if they are any more effective than zinc ointments.

Nappy rash

The first line of treatment is to ensure that nappies are changed frequently and that tightly fitting water-proof pants are avoided. The rash may clear when left exposed to the air and a barrier preparation, applied with each nappy change, can be helpful. A mild corticosteroid such as hydrocortisone 0.5% or 1% (section 13.4) can be used if inflammation is causing discomfort, but it should be avoided in neonates. The barrier preparation should be applied after the corticosteroid preparation to prevent further skin damage. Preparations containing hydrocortisone should be applied for no more than a week; the hydrocortisone should be discontinued as soon as the inflammation subsides. The occlusive effect of nappies and water-proof pants may increase absorption of corticosteroids (for cautions, see section 13.4). If the rash is associated with candidal infection, a topical antifungal such as clotrimazole cream (section 13.10.2) can be used. Topical antibacterial preparations (section 13.10.1) can be used if bacterial infection is present; treatment with an oral antibacterial may occasionally be required in severe or recurrent infection. Hydrocortisone may be used in combination with antimicrobial preparations if there is considerable inflammation, erosion, and infection.

Sub-sections

  • Non-proprietary barrier preparations
    • Zinc Cream, BP

      Cream, zinc oxide 32%, arachis (peanut) oil 32%, calcium hydroxide 0.045%, oleic acid 0.5%, wool fat 8%, in freshly boiled and cooled purified water, net price 50 g = 75p

      For nappy and urinary rash and eczematous conditions

    • Zinc Ointment, BP

      Ointment, zinc oxide 15%, in Simple Ointment BP 1988 (which contains wool fat 5%, hard paraffin 5%, cetostearyl alcohol 5%, white soft paraffin 85%), net price 25 g = 30p

      For nappy and urinary rash and eczematous conditions

    • Zinc and Castor Oil Ointment, BP

      Ointment, zinc oxide 7.5%, castor oil 50%, arachis (peanut) oil 30.5%, white beeswax 10%, cetostearyl alcohol 2%, net price 500 g = £3.35

      For nappy and urinary rash

  • Proprietary barrier preparations
    • Conotrane®

      (Astellas)

      Cream, benzalkonium chloride 0.1%, dimeticone ‘350’ 22%, net price 100 g = 88p, 500 g = £3.51

      Excipients

      include cetostearyl alcohol, fragrance

      For nappy and urinary rash and pressure sores

    • Drapolene®

      (Chefaro UK)

      Cream, benzalkonium chloride 0.01%, cetrimide 0.2% in a basis containing white soft paraffin, cetyl alcohol and wool fat, net price 100 g = £1.54, 200 g = £2.50, 350 g = £3.75

      Excipients

      include cetyl alcohol, chlorocresol, wool fat

      For nappy and urinary rash; minor wounds

    • Medicaid®

      (LPC)

      Cream, cetrimide 0.5% in a basis containing light liquid paraffin, white soft paraffin, cetostearyl alcohol, glyceryl monostearate, net price 50 g = £1.69

      Excipients

      include cetostearyl alcohol, fragrance, hydroxybenzoates (parabens), wool fat

      For nappy rash, minor burns, and abrasions

    • Metanium®

      (Thornton & Ross)

      Ointment, titanium dioxide 20%, titanium peroxide 5%, titanium salicylate 3% in a basis containing dimeticone, light liquid paraffin, white soft paraffin, and benzoin tincture, net price 30 g = £2.06

      Excipients

      none as listed in section 13.1.3.

      For nappy rash

    • Morhulin®

      (Actavis)

      Ointment, cod-liver oil 11.4%, zinc oxide 38%, in a basis containing liquid paraffin and yellow soft paraffin, net price 50 g = £1.91

      Excipients

      include wool fat derivative

      For minor wounds, varicose ulcers, pressure sores, eczema, and nappy rash

    • Siopel®

      (Derma UK)

      Barrier cream, dimeticone ‘1000’ 10%, cetrimide 0.3%, arachis (peanut) oil, net price 50 g = £2.15

      Excipients

      include butylated hydroxytoluene, cetostearyl alcohol, hydroxybenzoates (parabens)

      For protection against water-soluble irritants

    • Sprilon®

      (Ayrton Saunders)

      Spray application, dimeticone 1.04%, zinc oxide 12.5%, in a basis containing wool alcohols, cetostearyl alcohol, dextran, white soft paraffin, liquid paraffin, propellants, net price 115-g pressurised aerosol unit = £3.54

      Excipients

      include cetostearyl alcohol, hydroxybenzoates (parabens), wool fat

      For urinary rash, pressure sores, leg ulcers, moist eczema, fissures, fistulae and ileostomy care

      Note

      Flammable

    • Sudocrem®

      (Forest)

      Cream, benzyl alcohol 0.39%, benzyl benzoate 1.01%, benzyl cinnamate 0.15%, hydrous wool fat (hypoallergenic lanolin) 4%, zinc oxide 15.25%, net price 60 g = £1.25, 125 g = £1.84, 250 g = £3.09, 400 g = £4.34

      Excipients

      include beeswax (synthetic), propylene glycol, butylated hydroxyanisole, fragrance

      For nappy rash and pressure sores

    • Vasogen®

      (Forest)

      Barrier cream, dimeticone 20%, calamine 1.5%, zinc oxide 7.5%, net price 100 g = £2.72

      Excipients

      include hydroxybenzoates (parabens), wool fat

      For nappy rash, pressure sores, ileostomy and colostomy care