Analysis of emollient formularies in Wales and England

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Created On: 28/02/2024

To distinguish and compare formulations of emollients or moisturizers among several clinical commissioning groups (CCGs) and local health boards (LHBs) in two countries of the UK.

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Key take away

White Soft + Liquid Paraffin 50/50, Emulsifying Wax Ointment, and Hydromol Ointment were found to be the most suggested emollients for dry and itchy skin conditions (such as atopic eczema) in Wales and England, although there is limited consensus on first-line choices.

Background

To distinguish and compare formulations of emollients or moisturizers among several clinical commissioning groups (CCGs) and local health boards (LHBs) in two countries of the UK.

Method

The Formularies were obtained from the CCG (Number in England = 209) /LHB (Number in Wales = 7) internet sites and via the Google search engine. Extraction of data was done on the formularies' structure and content, followed by descriptive analyses.

The study assessed the number and structure of formularies, the quantity, type, and names of recommended and not recommended emollients and bath additives, and any accompanying rationale specified.

Result

Out of 102 formularies recognized, 109 emollients and 24 bath additives were listed. The majority of formularies followed an 'order of preference' structure (63%) and/or a formulation-based format (51%). Emollients in the form of creams and ointments were often suggested, with 3 specific ointments being the most commonly endorsed (found in 71%-79% of formularies).

Despite this, there was limited agreement on the preferred first-line emollient. Four out of the best 10 suggested lotions and creams contained antimicrobials or urea (carbamide). Patient preference (60%) and cost considerations (58%) came out as the primary causes cited for these recommendations. Of the formularies endorsing the use of skin care bath additives (82%), many (75%) did not provide any rationale for their suggestion.

Conclusion

Emollient formularies in England and Wales differ a lot in how they are organized and the recommendations they provide. The reasons for these variations are unclear, and this can lead to mix-ups and uneven alterations across separate regions. Having numerous conflicting formularies lacks suitable justification.