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Rationale for using Balneum cream. Dr George Moncrieff. Balneum is ideal for the drier skin conditions. It is especially suitable for dry skin problems in the elderly (over 55) where dry skin related pruritus is often an issue. It contains 5% urea and at that strength, urea has natural antipruritic properties. In my experience, senile ichthyosis is extremely common and gets worse as we get older . It is especially common in residential care where the enthusiasm for daily washing reaps disastrous consequencies on elderly skin, aggravated by a dry, air-conditioned or centrally heated environment. Balneum contain a natural moisturising factor (5% urea) which means it is relatively more cost effective, as it offers full 24hr emollient effect, with just twice daily application (unlike Diprobase, for example, which probably should be applied every 4 hours). That is also a lot more convenient for children at school and adults with busy lives, as well as enabling carers to lead a normal life between delivering this treatment. Balneum is the only emollient that contains ceramide and is available on the NHS. Ceramide mimics the normal ‘cement’ layer that seals the epidermocytes and is typically in deficient in dry skin conditions. Although at first glance, it seems more expensive, these properties render it a substantially more intelligent emollient for drier skin conditions (such as eczema, psoriasis and even ichthyosis vulgaris). The full potential benefit of using Balneum may not become apparent until it has been used for a few weeks as the effect on the lipid lamellar envelope can take a while to reach peak effect. Dry skin conditions are generally worse in children before they reach the greasy pubertal years and in older age. These are the two groups who would benefit the most. Balneum plus cream Balneum Plus cream is moderately expensive. However (in my experience) a large proportion of patients who use this for intolerable itch enjoy considerable relief of their symptoms with this product. That can be a lot safer than adding in another oral medication to an older person’s typical polypharmacy, with risks of sedation, confusion over medication and even potential inter-reactions (e.g. from an antiihistamine).