Burns (burn) with paraffin-containing and paraffin-free emollients

The risk of severe and fatal burns with emollients containing more than 50% paraffins is well known

• however evaluation of further data has shown that products containing less than 50% paraffins have been associated with fatal burns and paraffin-free products also have a fire accelerant effect in tests when emollient residue builds up on fabric and the fabric is ignited (1)
• in England, between 2010 and 2018, more than 50 fatal incidents were recorded where emollients were known to have been used by the victim or were present at the scene; and between 2010 and 2017, at least 37 fire deaths were linked to emollient use (2)
  • while the number of recorded incidents is low, emollient use is widespread and under reporting is likely

Advice for healthcare professionals (1):

• emollients are an important and effective treatment for chronic dry skin conditions and people should continue to use these products. However, you must ensure patients and their carers understand the fire risk associated with the build-up of residue on clothing and bedding and can take action to minimise the risk
• when prescribing, recommending, dispensing, selling, or applying emollient products to patients, instruct them not to smoke or go near naked flames because clothing or fabric such as bedding or bandages that have been in contact with an emollient or emollient-treated skin can rapidly ignite
• there is a fire risk with all paraffin-containing emollients, regardless of paraffin concentration, and it also cannot be excluded with paraffin-free emollients. A similar risk may apply for other products which are applied to the skin over large body areas, or in large volumes for repeated use for more than a few days
• be aware that washing clothing or fabric at a high temperature may reduce emollient build-up but not totally remove it
• warnings, including an alert symbol, are being added to packaging to provide a visual reminder to patients and those caring for them about the fire hazard
• report any fire incidents with emollients or other skin care products to the Yellow Card Scheme

Reference:

• MRHA. Emollients: new information about risk of severe and fatal burns with paraffin-containing and paraffin-free emollients. Drug Safety Update volume 12, issue 5: December 2018: 3.
• Ridd M J, Hall S, Lane M E, Roberts A, Williams H C. Burns with emollients BMJ 2022; 376 :e066102 doi:10.1136/bmj-2021-066102