Emollient prescribing formularies and guidelines in England, 2021: a cross-sectional study

Abstract

Abstract Background Emollients are a mainstay of treatment for dry skin conditions. In the UK, prescribers are usually expected to follow local National Health Service (NHS) formularies. A previous study in 2018 showed that the recommended emollients across England and Wales varied widely. Evidence has since emerged that bath additives provide no additional clinical benefit in eczema. Aim To compare emollient formularies and guidelines in England. Methods Clinical Commissioning Group (CCG) formularies and guidelines were identified in April–May 2021, compiled and then analysed descriptively. Results In total, 105 CCGs, 72 emollient formularies and 47 emollient prescribing guidelines were identified. There were internal inconsistencies between formularies and their accompanying guidelines in 19% of cases. The majority (68%) of formularies/guidelines were organized using a ranking system. In total, 126 different leave-on emollients were named. Creams and ointments were universally available and were the most recommended first-line types. Cost was more likely than patient choice to be recommended as a criterion for selecting which emollient to prescribe. Aqueous cream was the leave-on emollient most commonly not recommended. Nearly three-quarters (74%) of formularies stated that bath additives should not be prescribed. Conclusion All CCGs in England have an emollient formulary/guideline, but there is still great variability between them in their recommendations. Although the number of formularies/guidelines has reduced since 2017, there has been an increase in the total number of unique recommended leave-on emollients. Most CCGs are no longer recommending bath emollients for eczema.