Emollients - Epimax instead of Diprobase

[SmallBlueThing]

I asked my GP for some more Diprobase, but was refused as my NHS area's formulary no longer lists it. I remembered a nurse using Fifty:50 so asked for that, and it was allowed.

The formulary now lists Epimax as the first choice alternative to Aproderm, Aqueous cream, Aquamax, Diprobase cream, E45 cream, Oilatum cream, ZeroAQS and Zerobase.

Hydromol cream is still listed, and is the formulary's preferred alternative to Zeroderm.

Isomol gel is listed as an alternative to Doublebase gel and Zerodouble gel.

The Fifty:50 I got isn't listed, but the British National Formulary has "Liquid and White Soft Paraffin Ointment, NPF", which is the same stuff (50% liquid paraffin, 50% white soft paraffin), at £4.57 for 500 g.

Diprobase in the 500 g pump pack is £6.32.

Hydromol cream (still listed by my area's formulary) is £11.92 for 500 g (yet Zeroderm, which it's meant to replace, is £4.10). Hydromol ointment (which I use as a soap substitute) is £4.89 for 500 g.

Isomol in a 500 g pump pack is £3.99.

Epimax (the now-preferred choice) is £2.49 for 500 g.

I don't know how these prices relate to over-the-counter prices for those who buy their own supplies. When I had to pay for my prescriptions, the first time I was prescribed Diprobase was in a 50 g tube, which was an absolute rip-off (ignoring the argument that it helps pay for the NHS). I then bought my own for a few years, but the cost meant I didn't use it every day.

I wouldn't recommend the Fifty:50 -- it can ruin clothes and bedding, and is a fire-risk!

I trust that Epimax is a worthy successor to Diprobase when I get to try it.

[Jennymary]

If you are entitled to free prescriptions, you may be able to get hydromol through that, as that's what I do

[SmallBlueThing in reply to Jennymary]

As mentioned, Hydromol cream is still listed as available in my area, but it's the most expensive option of the 500 g alternatives, listed by the BNF:

evidence.nhs.uk/formulary/b...

I've checked the websites of Boots and Lloyds, but they don't list Epimax, which I want to buy and test for myself, as the Fifty:50 is pretty awful (it was under dressings and bandages when a nurse used it on me).

[veriterc]

What you write is very interesting, but why on earth isn't the NHS safeguarding OUR needs? Fifty:50 sounds a good bet, until I read your comments! With so many other products mentioned, it would be good if LSN stepped in, did a trial of different products and came out with an analysis, so we could make up our own minds instead of trial and error system we have now! I did ask my very helpful Dermatologist which he recommended, but he was dismissive of all I mentioned; knowing I use La Roche Posay, he said he recommended this as the best. So Frenchwomen get the benefit (I first came across this when being treated in France).

[SmallBlueThing in reply to veriterc]

I was first recommended plain old E45, but then told not to use it, due to the lanolin content. I see that the ingredients now state it's hypoallergenic lanolin.

My local formulary's guidelines:

"There are a wide variety of emollients and limited evidence that one is better than another. There are variations in consistency and patient preference so it is important to find something the patient will use.

The formulary choices below are the recommended first line choices, however if none of these suit then alternative products may be used. Please see the prescribing guidelines for further information Consider cost.

Preferred Emollients and Soap substitutes include: Epimax cream, ZeroAQS cream, Aquamax cream, Isomol gel, Zerodouble gel, AproDerm cream, Zerobase cream, Oilatum Cream, Emulsifying ointment, WSP 50% / LP 50%, Zeroderm ointment and Hydromol ointment."

There's a unit advising the NHS on the most cost-effective options. They've already had a negative impact on my care, as Mepilex foam dressings were withdrawn and the nurses either hadn't been supplied with an alternative or had been instructed to dress ulcers in an "improved" way (which was less comfortable and protective for me).

When I first bought my own emollient I think it was Doublebase, but didn't like the smell. So, patient preference is very important if the product doesn't get used, leading to the possibility of additional problems.

Maybe your dermatologist has been wined and dined?

LA ROCHE-POSAY. RECOMMENDED BY DERMATOLOGISTS

For over 30 years, La Roche-Posay has worked with dermatologists throughout the world to invent skincare and make-up products that meet their needs and requirements. La Roche-Posay also supports them in their training and their role of taking daily care of patients, through a number of actions including educational workshops for patients.

[veriterc in reply to SmallBlueThing]

I know that a decade ago dermatologist were definitely wined and dined - given some hospitality myself (lovely!) But I always try out product on myself - and I have so many skin problems, that if something works for me it will work for most! I know that hospitals have cracked down on company hospitality - which has a certain negative effect, because in the old days at least some unknown products were bought to doctor's attention. But I do notice there no longer Gucci briefcases and 'executive toys' to be seen in doctor's consulting rooms. I gather that La Roche Posay was developed in the French clinic of that name, but was so successful (used in over 90 countries) that they sold out to l'Oreal.

[SmallBlueThing]

Well I rang my pharmacy to see if they had any Epimax (which they did, for £4.99) and they advised me to contact the prescriptions' office at the surgery, where I was told Zerobase in a pump dispenser was what they regard as standard, despite it being on the list to be superseded by Epimax.

[Hidden in reply to SmallBlueThing]

I use zerobase it is nice and thick.

[meem1947]

Hello small blue thing, I am also a sufferer and have just purchased 5 minutes ago Diprobase two pump versions cream and a single Diprobase for the 3 £32 worth a look on Amazon.

[franti]

I've been using Zerobase for varicose eczema for a couple of years, I have now developed eczema all over & the doctor has now changed Zerobase for Epimax, I have checked with the chemist & Epimax does not come in a pump dispenser which I prefer as its more hygienic when putting the cream on before taking a shower, never thought much of Zerobase but it was better than nothing.