The BNF states that barrier creams are not a substitute for adequate nursing care, or regular nappy changing (babies), and it is doubtful that they are any more effective than the traditional compound zinc ointments.

NHS England (NHSE) has published new prescribing guidance for various common conditions for which over the counter (OTC) items should not be routinely prescribed in primary care (quick reference guide). One of these conditions is nappy rash.

Many of these products are cheap to buy and are readily available OTC along with advice from pharmacies. Some self-care medicines are available from shops and supermarkets. Please click here for further information, exceptions, and a patient leaflet.

Click here for Tissue cleansing and protection information

NB: Medi Derma-S cream, Medi Derma-S barrier cream, Medi Derma-Pro Foam & Spray and Medi Derma-Pro Ointment are included as part of the Wound Management Formulary but should not be used for routine barrier cream application.

Sudocrem Antiseptic Healing Cream

(Benzyl alcohol with benzyl benzoate, benzyl cinnamate, lanolin and zinc oxide)

• Cream (£10.99 = 400g) (£13.74 = 500g)

Indications

• Nappy rash

Notes

1. Sudocrem is water repellent; protects skin from moisture, irritants and chafing
2. Reduces inflammation, weak local anaesthetic action

Conotrane Cream

(benzalkonium chloride and dimeticone)

• Cream (£4.98 = 500g)

Indications

• Nappy rash
• Urinary rash (not suitable for use on patients with continence pads)

Notes

1. Tube has longer in-use shelf life than pots; only a small amount is required for each application
2. Water repellent, protects skin from moisture, irritants, chafing and contamination with yeasts or bacteria

The following products should not be used for routine barrier cream application

A soap substitute (e.g. proprietary shower gel)

• For normal skin care cleansing/hygiene when the skin is vulnerable for example with incontinence. (Soap and water is not recommended for cleansing a patient with urinary or faecal incontinence as it is alkaline and can upset the pH balance of the skin) (Beldon 2007)
• Products should only be prescribed if there is a therapeutic need. There should be a clear rationale for the prescriber item documented in the notes/careplan, and there should be regular review of the indication for the prescribed item

A liquid barrier cream, Medi Derma-S

• To prevent skin damage from moisture exposure and for moisturising patients' skin who are at high risk of developing a moisture lesion or incontinence-associated dermatitis, as identified by a skin assessment (such as those with incontinence, oedema, dry or inflamed skin). This can be applied to dry, intact skin and damaged/ excoriated skin. They provide a barrier between the skin and the irritant. Sachets should only be used in the Secondary Care setting. In the Primary Care setting, in patient's homes and in care homes, tubes should be used.

A liquid barrier film, Medi Derma-S

• To prevent skin damage from moisture exposure, and can be applied to damaged/ excoriated and/or intact skin, without stinging and dry quickly to provide a waterproof barrier protective against irritants such as faeces and urine. They contain silicone polymers such as dimethicone and create a dry, water repellent, transparent barrier. The film locks in moisture to hydrate and protect the skin. For use in small areas such as around stomas and wounds. The aerosol is used for greater surface areas and difficult to reach areas.

Medi Derma-Pro Foam and Spray Cleanser

• Incontinence cleanser that is pH balanced, skin friendly, no-rinse, moisturising cleanser suitable for use on compromised and at-risk skin from moisture associated skin damage, particularly severe incontinence and excessive moisture.

Medi Derma-Pro Ointment

• Skin protectant and moisture barrier ointment designed to provide effective skin protection from the effects of urine, faeces, friction and shear for both at risk and compromised skin. It forms a long lasting protective waterproof barrier that protects and prevents associated trauma to at-risk skin, whilst repairing and restoring the integrity of compromised skin. Can be applied to broken and unbroken skin. For moderate to severe skin damage and can be used with continence pads.

Please note that applying multiple layers of barrier products should be avoided. It will make the area uncomfortable for the patient and cracking of the product can occur which will allow moisture to penetrate.

Increased moisture resulting from episodes of incontinence combined with bacterial and enzymatic activity can result in the breakdown of vulnerable skin. Incontinence associated dermatitis is a skin condition that affects people who are incontinent and results in inflamed, excoriated, infected and damaged skin that causes pain, discomfort and increases the risk of pressure ulcers.

Medi Derma-S and Medi Derma-Pro can be used in conjunction with continence products.

The diagnosis of a pressure ulcer is more difficult than one assumes and there is often confusion between a pressure ulcer and a skin moisture lesion that is caused by the presence of moisture due to for example incontinence. The treatment strategies vary and the consequences of the outcome for the patient are of immense importance.

Medi Derma-S Cream

• Barrier cream 28g (£2.98), 90g (£5.95)
• Barrier cream 2g sachet (£5.85 = 20 sachets)

Indication

• Use on healthy skin for protection
• Use on reddened and mildly excoriated skin

Notes

1. Medi Derma-S Barrier Cream is useful when used in very small amounts (apply in pea-sizes amounts only) to increase the adhesion of film dressings, besides its use as a protective barrier.
2. Highly concentrated so a little goes a long way
3. For the prevention of skin breakdown from incontinence dermatitis
4. Non-petrolatum based so will not clog or reduce the absorbency of incontinence pad
5. Resists wash-off – no need for frequent application, saving time
6. Can be used in very small amounts when adhesive dressings or tapes are being used as does not decrease dressing or tape adhesion; use of excessive quantities however may prevent effective adhesion
7. Hypoallergenic and pH balanced
8. Can also be used in small amounts on peri-wounds and peri-stomal surfaces to prevent breakdown but barrier film is normally better for this indication
9. Where skin is severely excoriated and broken use Medi Derma-Pro Ointment

Medi Derma-S Film

• Non-sting barrier film pump spray 30ml, 50ml (£5.35, £8.95)
• Non-sting barrier film applicator 1ml (£3.70 = 5), 3ml (£5.95 = 5)

Indication

• As a primary barrier against irritation from bodily fluids
• Prevention of skin damage associated with incontinence
• Use on severely excoriated skin.
• Use as skin protection to wound edges in moderate to heavily exuding wounds

Notes

1. Barrier film is a liquid intended for use as a film forming product. The spray and foam applicator should be used sparingly or the residue build-up can resemble a skin disorder.
2. Barrier film skin coverage:
   1. 1ml foam applicator covers 15 x 15cm
   1. 3ml foam applicator covers 25 x 25cm
3. Film should last 48-72 hours, but needs re-applying after each stoma or adhesive dressing change.

Medi Derma-Pro Foam and Spray Cleanser

• Foam & spray incontinence cleanser 250ml (£5.95)

Indication

• Removal of urine and faeces following episodes of incontinence
• Breakdown and removal of stubborn dried bodily fluids, such as faeces and blood, post-operative antiseptic cleansing solutions and skin barrier protectants
• Use on severely excoriated skin, can be used on broken skin

Notes

1. May be used prior to the application of Medi Derma-Pro Ointment, where clinically indicated. Does not require rinsing prior to applying the ointment.
2. Suitable for use on Paediatric patients
3. Do not use with adhesive dressings or appliances.
4. Can be used in a foam or spray mode, depending on area of use
5. Foam mode is indicated for use on difficult to clean areas

Medi Derma-Pro Ointment

• Skin protectant ointment 115g (£8.50)

Indication

• Protection of intact, injured and at-risk skin from severe irritation due to incontinence

Notes

1. Fragrance and latex free
2. Provides protection from urine, faeces and incontinence associated dermatitis, may provide protection from friction and shearing forces
3. Can be applied over fungal creams required to treat skin infections to ensure they remain in contact with the skin and protection is still provided
4. Non-Sting formulation, pain free application
5. Suitable for use on Paediatric patients
6. Do not use with adhesive dressings or appliances