The London Fire Brigade is urging doctors to be aware of the risks of prescribing flammable emollient creams for skin conditions such as eczema and psoriasis.
The risks are especially great for smokers, the elderly and patients on oxygen therapy.
Many moisturising creams used for common skin conditions such as eczema are based on flammable components, such as paraffin and petroleum. Diprobase ointment for example contains 95% white soft paraffin.
These creams can be dangerous if they leach into bedding and clothing, allowing flames to spread rapidly. And because many sufferers use these creams on large areas of their body, there is a high risk of severe burns. This often happens when patients are smoking and drop a cigarette.
The Fire Brigade say 15 people in London alone have died in the past three years in fires caused by flammable skin creams . According to a BBC investigation, 37 deaths have been linked to the creams since 2010.
The London Fire Brigade is therefore urging doctors and carers to stop using flammable emollient creams, especially when the patient is a known smoker.
Dan Daly, the Brigade’s assistant commissioner for fire safety, said: ‘It’s a horrific reality but if you’re wearing creams with flammable ingredients and you accidently drop ash or a match, you are literally setting yourself on fire.
‘Dropping cigarettes or matches onto clothing is dangerous but when flammable creams are involved, this increases the chance of a fire starting and becoming much more intense.’
The risk is highest for the elderly and the less mobile.
‘If they are smokers too, it’s a deadly combination,’ says Daly. ‘I can’t stress how important it is to switch to a non-flammable brand,’ he added.
GPs are recommended to refer to the NHS guidance on emollient creams, which lists a number of products with low or no paraffin content. These include E45 lotion, Oilatum and ZeroAQS cream.
The guidance says formularies should stock at least one product with the lowest paraffin content possible and a completely non-paraffin emollient for patients on oxygen therapy .
This issue has been raised before (the National Patient Safety Agency issued a warning back in 2007), but patients continue to be at risk.
The Medicines and Healthcare products Regulatory Agency (MHRA) is working to get all creams containing paraffin to carry a warning, but this may be some way off.
‘We are working with companies to make sure that important safety messages are included in the product information,’ said Dr Sarah Branch, deputy director of MHRA’s Vigilance and Risk Management of Medicines Division.
In the meantime, the fire service asks GPs to be aware of this issue and consider any patients who may be at risk.
Skin cream safety – What to tell patients
- Ideally, patients should switch to a non-flammable alternative, such as Nutraplus or E45 lotion.
- Advise patients not to smoke or use naked flames (e.g. gas fires, hobs, candles) when using paraffin-containing creams.
- Patients who require 100g or more of emollient should use a water-based product (e.g. cream or lotion) rather than a paraffin based one (e.g. ointment).
- Never smoke in bed.
- Use fire retardant bedding and clothing.
- Change clothing and bedding regularly, and wash with biological washing powder.
Source: UK Government