chapter 13 skin - gwh homeplease con tact your tissue viability nurse for further information and...

Chapter 13 page number 1

Produced: June 2012 Last Amended: 05.02.19

First line drugs Second line drugs Specialist initiated drugs Secondary care only drugs

Chapter 13 Skin

First line drugs

Drugs recommended in

both primary and

secondary care

Second line drugs

Alternatives (often in

specific conditions) in both

primary and secondary care

Specialist initiated drugs

Secondary care or GP with

special interest initiation.

Suitable for continuation by

primary care. Shared care

agreements may be applicable.

Secondary care only drugs

Drugs only suitable for

secondary care use and

initiated by appropriate team

or specialist. Primary care

prescribers should not be

asked to prescribe.

Primary & Secondary

Care

Notes Secondary Care

General points

The majority of extemporaneous preparations listed in this chapter are restricted to secondary care use. Please be

aware that extemporaneously prepared creams and ointments can be very costly and are often difficult to obtain

through normal routes. Discussion may be necessary either with your medicines management team at the PCT or the

formulary team at GWH for advice on licensed alternatives and appropriate supply routes.

Patients can be allergic to excipients or preservatives in preparations. Creams generally contain preservatives;

ointments do not. Some preparations contain nut oils, (e.g. zinc and castor oil cream); please check SPC or BNF if

treating young children or those with nut allergy.

13.2 Emollient & barrier preparations

13.2.1 Emollients

Consider using generic preparations before proprietary.

Use cheapest emollient, which is effective, cosmetically acceptable and that the patient is prepared to use regularly.

When prescribing an emollient for the first time the patient should be encouraged to trial the product to ensure they

find it acceptable, to facilitate this the initial amount issued should be as small as possible (e.g. initial supply of 50g, a

500g container can then be supplied if the patient is happy to use that preparation)

Patients should be encouraged to use liberally and 500g is the suggested minimum quantity to prescribe following

initial trial; many patients may need 500g a week.

Any patient prescribed a paraffin based preparation must be given information regarding fire risk.

Please refer to Wiltshire Emollient Prescribing Guideline for further information.

Very light moisturisers for mild dry skin

Isomol gel®

AproDerm Colloidal

Oat cream

Please note this replaces Doublebase gel.

ONLY for use in very sensitive patients and ONLY if

Isomol Gel has been tried and failed, as AproDerm

Colloidal Oat cream is considerably more expensive.

Please note this replaces Aveeno cream.

Creams for mild to moderate dry skin

Epimax cream®

Excetera cream®

Oilatum cream®

Please note this replaces aqueous cream, zerocream,

E45 cream, cetraben cream (in secondary care), and

diprobase cream.

Please note this replaces cetraben cream (in primary

care).

Greasy moisturisers for severe dry skin

Please MHRA Drug Safety Update on fire risk: https://www.gov.uk/drug-safety-update/paraffin-based-skin-

emollients-on-dressings-or-clothing-fire-risk. Emulsifying Ointment

Epimax ointment®

Hydromol ointment®

Please note this replaces cetraben ointment.

Please note Hydromol cream is NON-formulary due

to its high cost compared to formulary options.

Soft paraffins

Diprobase® Ointment – for sexual

health use only

https://www.gov.uk/drug-safety-update/paraffin-based-skin-emollients-on-dressings-or-clothing-fire-risk





Very greasy moisturisers for severe dry skin and acute flares (low risk of sensitivity)

Please MHRA Drug Safety Update on fire risk: https://www.gov.uk/drug-safety-update/paraffin-based-skin-

emollients-on-dressings-or-clothing-fire-risk. Liquid paraffin 50% &

white soft paraffin

50% ointment

Antimicrobial-containing preparations

Use long-term if needed to prevent frequent skin infections or for handwashing in carers with occupational irritant

hand dermatitis.

Use short-term if a single episode of skin infection- not for repeat prescription if this circumstance.

Dermol cream®

Dermol 500 lotion®

Urea- and/ or lauromacrogol -containing preparations

Use after other emollients have been tried and failed to control symptoms of itching or dehydration.

Imuderm® Cream

Dermatonics Once

Heel Balm®

Contains 5% urea.

Please note this replaces Balneum cream

Contains 25% urea.

Please note this replaces Flexitol Heel Balm.

13.2.1.1 Emollient bath additives

Please note that any cream or ointment listed in the Wiltshire Emollient Prescribing Guideline (except 50:50

ointment) may be used as a soap substitute during baths or showers. Alternatively, patients may choose to self-

purchase bath oils from community pharmacies or supermarkets.

13.2.2 Barrier preparations

Greasier emollients are as effective as barrier creams.

Please contact your Tissue Viability Nurse for further information and advice on choice of barrier cream against

irritation from bodily fluids, prevention of skin damage associated with incontinence and as a moisturiser for severely

dry skin.

Hospital Tissue Viability Nurse on 01793 (60)4555.

Hospital Vascular Nurse Specialist on 01793 (60) 4374.

Hospital Dermatology Care Nurse on 01793 (60) 4045.

Zinc & castor oil

ointment

Conotrane®

Vasogen®

AproDerm Barrier®

cream

Sudocrem®

Sprilon spray®

Proshield®

Cavilon Barrier®

cream

Suitable for nappy rash.

1st-line barrier cream in primary care

Proshield available on Tissue Viabilty advice only

(continence dermatitis)

1st-line barrier cream in secondary care only






13.3 Topical local anaesthetics & antipruritics

Topical antihistamine preparations are not recommended for prescribing (1)

Topical local anaesthetics are not recommended for prescribing (1)

apart from use prior to venepuncture – see

Anaesthetics (Chapter 15).

Calamine Lotion

Menthol 1% in

aqueous cream

(Dermacool®)

Doxepin cream

(Xepin®)

Check with community pharmacist what strength they

have in stock to minimise delay to patient.

For Dermatologist initiation only (licensed indication).

The hospital dermatologists are

happy for pharmacy staff to

substitute this for other prescribed

strengths.

Please note oral doxepin has been removed from 3Ts Formulary, as it is prohibitively expensive. Specialists are asked to

utilise the other oral tricyclic antidepressants on formulary if topical antipuritic agents prove ineffective.

13.4 Topical corticosteroids

Use the weakest that controls symptoms. Mild and moderately potent steroids are rarely associated with side-effects

(1), unlike the potent and very potent ones. Topical steroids for eczema should always be prescribed in

conjunction with an emollient.

FP10s must state whether cream or ointment is required.

Topical corticosteroids should be applied no more than twice a day, if used for more than 7 days specialist advice should be sought.

If more than one preparation is suitable the product with the lowest acquisition cost should be chosen

Application to the face - Hydrocortisone only. Initiate at a strength of 0.5% or 1%. Consider increasing to 2.5% if 1% is ineffective. Please note hydrocortisone cream 2.5% is considerably more expensive than lower strengths.

Application to eyelids - use 0.5% or 1% Hydrocortisone only. Patients should be advised to apply for no more than 2

- 3 weeks, with infrequent intermittent use thereafter.

Please be mindful that clobetasone butyrate 0.05% (Eumovate) has moderate potency, whilst clobetasol propionate

0.05% (Dermovate) has very high potency, and prescribe with care according to potency required.

For Cheiropompholyx, use potent topical steroids.

Refer to 3Ts guidance on quantities of topical corticosteroids to prescribe and apply.

Actual potency may vary considerably depending on: site of application, skin condition, use of occlusion and individual patient variation.

Refer to NICE guidance TA 81 for frequency of application of topical corticosteroids in atopic eczema.(2)

Please see MHRA Drug Safety Update Aug 2017 for information and advice on the rare risk of central serous

chorioretinopathy with local and systemic administration of corticosteroids.




Mild

Hydrocortisone-

0.5%, 1% & 2.5%

Fluocinolone acetonide

(Synalar 1 in 10

cream®)

Moderately potent

Clobetasone

butyrate 0.05%

(Eumovate®)

Betamethasone (as

valerate) 0.025%

(Betnovate RD®)

Fludroxycortide

(Haelan

cream/ointment®)

Potent

Betamethasone

valerate 0.1%

Fluocinolone 0.025%

(Synalar®)

Hydrocortisone

butyrate 0.1%

(Locoid®)

Mometasone furoate

0.1% (Elocon®)

Betamethasone 0.05%,

Salicylic acid 3%

(Diprosalic®)

Very potent

Clobetasol propionate

0.05% (Dermovate®)

Diflucortolone 0.3%

(Nerisone Forte®)

Fludroxycortide tape

(Haelan tape®)

Available as cream and ointment

Please note 2.5 % is considerably more expensive than

lower strengths. It should ONLY be used where 0.5%

and 1% have been ineffective AND a more potent

topical corticosteroid would be inappropriate e.g. in a

young child, on the face, etc.

Useful if steroid allergy suspected.





Useful if steroid allergy suspected.

Ointment and Cream.


Ointment.


May be appropriate for short-term use in primary care

overseen by experienced GPs.

Available as an oily cream and ointment.

Not for long-term use. Useful for hypertropic scars,

fissures on extremities.




Steroid Scalp applications

See sections 13.5.2 and 13.9 for further scalp applications.

Fluocinolone 0.025%

(Synalar gel®)

Betamethasone (as

valerate) 0.1% Scalp

Application

(Betacap®)

Betamethasone (as

valerate) 0.1% Foam

(Bettamousse®)

Diprosalic scalp®


0.05% shampoo

(Etrivex®)


0.05% scalp

application

(Dermovate®)

Useful if Synalar gel is not tolerated.

Only for use in patients who find Betacap® unsuitable

Useful for moderately scaly inflamed scalps.

Combination creams & ointments

Topical antibiotics should be used with care , if needed they should be used regularly for limited periods only because of

the risk of resistance and sensitisation. They may be useful in babies and young children with infected atopic eczema for

short courses only. Consider using oral antibiotics if infection is severe.

Refer to primary care and secondary care antibiotics guidelines.

Mild

Canesten HC® Cream

Daktacort®

Timodine® Cream

Nystaform HC

ointment and cream®

Fucidin H® Cream

Terra-Cortil®

Ointment

Moderately potent

Trimovate cream

Potent

Synalar N®

Synalar C®

Aureocort® Ointment

Dermovate NN®

cream and ointment

Fucibet® Cream


High level of Fucidin resistant staph aureus.

For treatment of inflammatory skin conditions at

flexures where there is a significant risk of skin atrophy

with more potent steroids.






13.5.1 Preparations for eczema

May be prescribed by GPs experienced with their use.(3)

Topical preparations for eczema

Pimecrolimus

Tacrolimus 0.03% &

0.1% ointment

See NICE guidance on use (NICE TA82).

Please also see 3Ts Topical Psoriasis Treatment

Algorithm for information on off-label use in the

treatment of psoriasis.

See NICE guidance on use (NICE TA82).

0.03%- for use in 2 to 16 year olds.

0.1% - for adults only.

Please also see 3Ts Topical Psoriasis Treatment

Algorithm for information on off-label use in the

treatment of psoriasis.

Use outside of license by consultant

dermatologists only.

Oral retinoid for eczema

Alitretinoin – see NICE guidance

on use (TA177).

13.5.2 Preparations for psoriasis




Topical preparations for psoriasis

Please see 3Ts Topical Psoriasis Treatment Algorithm for detailed information on locally agreed treatment pathway.

Patients should ALWAYS be prescribed proprietary products, ahead of unlicensed, special- order products, which are

prohibitively expensive in primary care (on average £300 per item per prescription).

A patient MUST have tried and failed to tolerate the combination of proprietary products equivalent to the

ingredients of an unlicensed, special- order product, before a dermatology specialist may consider initiation of an

unlicensed, special-order product. Vitamin D analogues

Calcipotriol 50mcg/g

ointment (Dovonex®)

Calcitriol 3mcg/g

ointment (Silkis®)

Calcipotriol with

betamethasone ointment

(Dovobet®)

Calcipotriol with

betamethasone foam

(Enstilar®)

Coal tar preparations

Coal tar 5% lotion

(Exorex®)

Psoriderm Cream®

Coal Tar Cream 10%

(Carbo-Dome®)

Coal tar solution 5% in

Betnovate RD

ointment®

Dithranol preparations

Dithrocream® – all

strengths

Coal tar containing bath

emollients

Polytar emollient®

Scalp preparations

Calcipotriol

scalp application

Dovobet Gel®

Enstilar Foam®

Psorin Scalp Gel®

Sebco Scalp Ointment®

1st-line treatment

1st-line treatment

3rd

-line treatment

3rd

-line treatment

2nd

-line treatment

2nd

-line treatment

2nd

-line treatment

Unlicensed, special order medicine. Patient MUST

have tried and failed to tolerate combination therapy

with branded Exorex 5% lotion and branded

Betnovate RD ointment, before a dermatology

specialist may consider initiation of this unlicensed

special, which may be prohibitively expensive in

primary care.

Please note: PCTs will require an individual funding

request to be completed and approved before

prescribing this unlicensed combination product.

2nd

-line treatment

Dithranol preparations

Dithranol in lassar’s paste 0.1%

0.5%, 1%, 2%, 4%, 8%,

10%,15% and 20%.

See BAD specials list.

All medications used in hospital in

this next section require consultant

dermatologist approval.

Puvasoralen gel 0.005%

Puvasoralen bath solution 1.2%.

5 - Methoxypsoralen tablets 20mg

8 - Methoxypsoralen tablets 10mg all unlicensed.

50% Propylene glycol in 50%

Dermovate cream – order as

required for palmoplantar psoriasis.




Oral retinoids for psoriasis

Acitretin – consultant

dermatologist approval required.

13.5.3 Drugs affecting immune response

All require consultant dermatologist approval.

Ciclosporin

Azathioprine

Methotrexate

2.5mg tablets only

Hydroxycarbamide

(Hydroxyurea)

Mycophenolate

Nicotinamide

tablets/capsules

Amber for licensed indications. Red for unlicensed

indications.

Unlicensed use

Note ONCE WEEKLY dose.

Please refer to primary and secondary care guidelines

for prescribing and monitoring of Methotrexate

Unlicensed use

Unlicensed use

See MHRA Drug Safety Update Jan 2015 for

information on risk of bronchiectasis and risk

of hypogammaglobulinaemia.

For new pregnancy-prevention advice for women and

men see MHRA Drug Safety Update Dec 15.

See MHRA Drug Safety Update Feb 18 for updated

contraceptive advice for male patients.

Used with a tetracycline as a steroid sparing agent for

immunobullous disorders. Unlicensed preparation.

Yellow script only.

Biologic Treatments

Please note biologic treatments for plaque psoriasis MUST be prescribed in line with NHS BANES, Swindon & Wiltshire

CCGs Plaque Psoriasis Biologic Treatment Pathway in Adults and require CCG Bluteq application.

Please note biologic treatments for atopic dermatitis MUST be prescribed in line with NHS BANES, Swindon &

Wiltshire CCGs Atopic Dermatitis Biologic Treatment Pathway in Adults and require CCG Bluteq application.




Apremilast

Dimethyl Fumarate

(Skilarence)

Adalimumab

Brodalumab

Dupilumab

Etanercept

Guselkumab

Infliximab

Ixekizumab

Secukinumab

Ustekinumab

See NICE TA419.

Refer to MHRA Drug Safety Update Jan 17 for further

information and advice on risk of suicidal thoughts and

behaviour.

For the treatment of moderate to severe plaque

psoriasis in line with NICE TA 475.

See NICE TA146 & NICE TA455.

See MHRA Drug Safety Update for information on

risk of TB or reactivation of latent TB.

See NICE TA511.



See NICE TA534.




See NICE TA 521.



See NICE TA134.



See NICE TA442.

See NICE TA 350


See MHRA Drug Safety Update Jan 2015 for

information on risk of exfoliative dermatitis.

13.6.1 Topical preparations for acne (4)

Treatment should start as early as possible, with early referral in severe cases to prevent scarring.

Treat mild acne initially with topical agents.

Oral antibiotics should be added to topical therapy in moderate to severe acne.

Erythromycin is best reserved for patients in whom other antibiotics are unsuitable as resistance is common.

Where a topical antibiotic is indicated, Clindamycin is the topical antibiotic of choice.

Assess response of an adequate dose taken for at least three months.

Benzoyl peroxide for acne

Please see 3Ts Acne Prescribing Guidelines for place in therapy.

Benzoyl peroxide – all

strengths

DuacTM

once daily

aqueous gel ®-

(Benzoyl peroxide 5%,

clindamycin 1%)

First-line for inflammatory acne in adults and children

over 12. To be purchased over–the-counter.

Reserved for use where compliance with twice daily

application of separate products is an issue.

Please note: This preparation is more expensive

than the separate components.

Azelaic acid for acne


Azelaic acid

Topical antibacterials for acne





Clindamycin 1%

aqueous lotion

(Dalacin T®)

Second-line for inflammatory acne in adults and

children over 12.

Please note: safety for use in pregnancy has not

been established.

Zineryt®

(Erythromycin/Zinc

acetate)

For inflammatory acne in children under 12.

Second-line for inflammatory acne in adults and

children over 12 who are allergic to, intolerant of or

otherwise unable to use Clindamycin 1% aqueous

lotion.

Please note: this product has an 8- week expiry once

reconstituted.

Topical retinoids & related preparations for acne


These preparations, as well as oral retinoids below, are contra-indicated in pregnancy; women of a childbearing age

must use effective contraceptive precautions whilst using a retinoid.

Avoid ultraviolet lamps and exposure to sunlight. Adapalene gel

(Differin®)

Epiduo gel®

(adapalene 0.1%,

benzoyl peroxide

2.5%)

Isotrexin gel®

(contains

Erythromycin)

Treclin gel ® (tretinoin

0.025%, clindamycin

1%)

First-line for comedomal acne and for a combination of

inflammatory and comedomal acne.

Second-line for comedomal acne and for a combination

of inflammatory and comedomal acne.

13.6.2 Oral preparations for acne

Antibacterials


Treat for at least 12 weeks and review. If improving continue for another 3 months.

Oxytetracycline

Doxycycline

Lymecycline

Erythromycin

500mg BD on an empty stomach.

100mg daily. More likely to cause photosensitivity.

408mg OD.

First line in children and pregnant women.

Trimethoprim- unlicensed use in

acne.

Hormone treatment for acne

Please see 3Ts Acne Prescribing Guidelines for place in therapy. Co-Cyprindiol

(Clairette®

/Dianette®)

Note: Prescription charges are payable unless also used

as a contraceptive and the prescription is endorsed

appropriately.

Only suitable for use in female patients

See MHRA Drug Safety Update (June 2013)

Oral retinoids for acne

Please see 3Ts Acne Prescribing Guidelines for place in therapy. Isotretinoin - Consultant

dermatologist approval required.

See MHRA Drug Safety Update

Oct17 for further information and

advice on rare reports of erectile

dysfunction and decreased libido.




13.7 Preparations for warts & calluses

Treat for a minimum of 12 weeks with filing.

Patients should ALWAYS be prescribed branded products, ahead of unlicensed, special- order products, which are

prohibitively expensive in primary care (on average £300 per item per prescription).

A patient must have tried and failed to tolerate the combination of branded products equivalent to the ingredients of

an unlicensed, special- order product, before a dermatology specialist may consider initiation of an unlicensed,

special-order product.

Salicylic acid as the

following;

Salatac® (12%)

Salactol Paint®

Occlusal® (26%)

Verrugon® (50%)

Silver nitrate

sticks/pencils

Salicylic acid 2% in

aqueous cream

Salicylic acid 5% and

10% in White soft

paraffin

Note high strength.

Not used for the treatment of warts but for other

indications.


have tried and failed to tolerate ALL appropriate

combinations of branded products, before a

dermatology specialist may consider initiation of this

unlicensed special, which may be prohibitively

expensive in primary care.


have tried and failed to tolerate ALL appropriate

combinations of branded products, before a

dermatology specialist may consider initiation of this

unlicensed special, which may be prohibitively

expensive in primary care.

Not routinely stocked within the

Trust

Anogenital warts

Other unlicensed preparations supplied as stock to clinic.

Imiquimod – ONLY for initiation

by specialist in Sexual Health.

Podophyllotoxin paint/cream

various strengths (Warticon®) –

ONLY for initiation by specialist in

Sexual Health.

Catephen 10% ointment – ONLY

for initiation by specialist in Sexual

Health.

13.8.1 Sun screen preparations

Sunscreens are borderline substances prescribable only in very specific circumstances. Prescriptions should be

endorsed “ACBS”.

Only preparations of factor 30 and above are available on prescription.

Sunsense ultra® Dundee sun screen cream -

consultant dermatologist approval

required (5 day order).




13.8.2 Camouflages

All cosmetic camouflage products should be considered to be amber drugs prescribeable by GPs on the advice of a

specialist.

The recommendation of cosmetic camouflage products by local Changing Faces clinics constitutes specialist advice.

Existing patients should be referred to Skin Camouflage Practitioners for advice:

Sue Bradbrooke Tel:01225 752825.

Sue Bardwell Tel:01793 692225.

In community, prescription must be endorsed ACBS as borderline substance.

Products can take a considerable time for community pharmacists to obtain.

Please note Dermablend® currently withdrawn from prescription supply.

Within the Acute Trust, the following will be ordered on receipt of prescription:

Dermacolor®

camouflage cream

Covermark® classic

foundation and

finishing powder

Veil® covercream and

finishing powder

Keromask® masking

cream and finishing

powder

Within the Acute Trust these will

be ordered on receipt of

prescription.

13.8 Photodamage

Actinic keratosis (incl. Bowens Disease)

Please refer to Pathway and Guidelines for Management of Actinic (Solar) Keratoses

Diclofenac sodium 3%

gel (Solaraze®)

Actikerall®

(Fluorouracil 0.5%

and Salicylic acid)

Ingenol Mebutate

(Picato®)

Fluorouracil 5%

cream (Efudix®)

Imiquimod 5% cream

(Aldara®)

For small lesions and mild to moderate damage.

For areas of thick, keratotic lesions.

For widespread, ill-defined areas of solar damage.



Metvix® Cream Consultant dermatologist approval

required within the trust.

13.9 Shampoos & some other scalp preparations

For patients with scalp eczema a mild baby shampoo is a useful first treatment.

Polytar liquid®

Ketoconazole 2%

shampoo

Capasal shampoo®

Ceanel concentrate

shampoo®

Cocois scalp

ointment®

Useful for treating pityriasis versicolor.

Useful if thick scaly plaques present.

.




13.10.1.1 & 2 Antibacterial preparations

Use with care because of the risk of bacterial resistance developing. The BNF suggests that choice should be limited

to those not used systemically. In hospital ,take swabs for microbiological testing before initiating topical treatment

which should only be short term.

Naseptin®

Fusidic acid 2%

cream/sodium fusidate

2%

Metronidazole 0.75%

(cream or gel)

Silver sulfadiazine

cream

Mupirocin 2% nasal

ointment

Mupirocin 2%

ointment and cream

Polyfax ointment®

Contains arachis oil.

See also section 12.2.3

Narrow spectrum antibacterial for treatment of

Staphylococcal skin infection. Does not influence

telangiectasia or erythema.

The most cost-effective brand licensed for

inflammatory papules, pustules & rosacea is Rozex,

whilst the most cost-effective brand licensed for

malodorous fungating tumours is Anabact gel.

Use only to treat MRSA and peanut allergic patients.

Max duration 10 days.

Use only to treat MRSA. Max duration 10 days.

Avoid use on large areas, risk of ototoxicity.

13.10.2 Antifungal preparations

To prevent relapse local antifungal treatment should be continued for 1-2 weeks after disappearance of signs of

infection.

See section 5.2 for other oral antifungals. See section 13.4 for topical antifungals with steroids.

Nail clippings for mycology must be carried out before prescribing antifungals. Diagnosis should be confirmed by

nail clippings (repeat up to 3 times) before initiating treatment.

Refer to primary care antibiotic guidelines

Clotrimazole

Miconazole nitrate

Nystatin

Terbinafine cream

Terbinafine tablets

Salicylic Acid

(Phytex®) Paint

Amorolfine nail laquer

See MHRA Drug Safety Update June 2016 for further

information and advice on the potential for topical

miconazole, including oral gel, to seriously interact

with warfarin.

Used mainly in infants with G.I candidiasis.

Not effective for fungal nail infections.

13.10.3 Antiviral preparations – see 5.3. for oral antivirals

Aciclovir cream If only small amounts required prescribe 2g pack to

minimise wastage




13.10.4 Parasiticidal preparations

Treatment of head lice.

No district policy.

Rotate preparations for each individual patient if treatment fails.

See DoH Prevention & Treatment of head Lice.

See also MHRA Drug Safety Update Mar 18 for information and advice on the risk of serious burns if treated hair is

exposed to open flames or a source of ignition.

Treatment of scabies.

The itch and eczema of scabies persists for some weeks after the infestation has been eliminated. Treatment for pruritus

and eczema may be required.

Head lice

Dimeticone (Linicin

Lotion®)

Dimeticone (Hedrin®)

Malathion

Scabies

Permethrin (Lyclear

dermal cream®)

Malathion

Aqueous based preparation preferable.

Ivermectin 3mg tablets -

consultant dermatologist approval

required for treatment of scabies.

13.10.5 Preparations for minor cuts & abrasions

Magnesium sulfate

paste

Liquiband®

Within hospital - A&E only.

13.11 Disinfectants & cleansers - See antibiotics chapter

Sodium chloride 0.9%

sterile

Dermol 500®

Potassium

permanganate

(Permitabs®)

Povidone iodine

preparations

Advise patients to follow the dilution instructions and

make sure the tablets are completely dissolved.

Avoid long-term use.

Acute Trust Policy for Infection

Control is available on the hospital

intranet.

Octenisan, CX powder and

Bactroban® nasal ointment are

used within the hospital MRSA

Decolonisation Regime – see

MRSA Policy on hospital intranet

Hydrogen peroxide 3 and 6%

Solution

13.11.2 Chlorhexidine salts

Chlorhexidine

(Hibiscrub®)

13.11.7 Preparations for the promotion of wound healing

Hydrogen peroxide

cream (Crystacide®)

13.12 Antiperspirants

Aluminium salts

(Anhydrol Forte® or

ZeaSORB®)

Propantheline

Licensed for gustatory sweating

Glycopyrronium cream, tablets

and solution

Botulinum Toxin Type A

For use by consultant specialists

only.

See CNS Chapter section 4.9.3




Miscellaneous

Medicated bandages

Please refer to the joint wound formulary for dressing choices.

Consider in lichenified eczema and prurigo lesions on limbs.

Avoid in heavily exuding wounds, infected wounds and arterial ulcers.

Beware of sensitisation presenting initially as eczema under the bandage.

Zinc paste (Viscopaste

PB 7®)

Depigmenting agents

Kligmans - in Ung Merck in

aqueous cream.

Depigmenting Cream -

hydrocortisone 1%,

hydroquinone 5%, tretinoin 0.1%

cream 50g.

Specially prepared – usually

available within 1 week. Requires

consultant dermatologist approval.

Patch tests

Not useful in urticaria or food allergy.

Antihistamines:

For general antihistamine, use see section in Chapter 3.

Sedating antihistamines

Chlorphenamine

Hydroxyzine


risk of QT interval prolongation & Torsade de Pointes.

Please note Alimemazine has been removed from 3Ts Formulary, as it is prohibitively expensive. Prescribers are asked to

utilise other formulary options.

Non-sedating antihistamines

Cetirizine

Loratadine

Fexofenadine 180 mg

Symptomatic relief of chronic idiopathic urticaria. Not

recommended for children under 12 years.

Dermatitis:

The following items are specials available on receipt of prescription with a 2-3 day delivery, from the hospital pharmacy.

Used for cradle cap/ seborrhoeic dermatitis.

Used for painful fissures.

To remove toenails

2% sulphur and 2% salicylic acid

in aqueous cream

50% lassar's paste in 50% WSP

40% urea in WSP

Miscellaneous

Dapsone

Hydroxychloroquine

Mepacrine

© NHS Swindon, NHS Wiltshire and Great Western Hospitals NHS Foundation Trust in collaboration with Avon & Wilts

Mental Healthcare Partnership Trust.




References:

1. BNF 63 Edition March 2012

2. NICE Technology Appraisal Guidance 81: Frequency of application of topical corticosteroids for atopic eczema.

August 2004.

3. NICE Technology Appraisal Guidance 82: Tacrolimus and pimecrolimus for atopic eczema. August 2004.

4. The Treatment of Acne Vulgaris – an update MeReC Bulletin 1999 Vol. 10 No 8

5. Skin Care: Practical Aspects. Nurse 2 Nurse: Volume 02 issue 11

6. Emollients: application of topical treatments to the skin. Gail Dunning: British Journal of Nursing 2007, Vol 16, No 21

7. Skin barrier breakdown; a renaissance in emollient therapy. Michael J Cork, Simon Danby; British Journal of Nursing

2009, Vol 18, No 14

8. Emollients: effective use and pump dispenser waste. Steve Chaplin MRPharmS; Prescriber, 5 October 2007

9. Emollient therapy for dry and inflammatory skin conditions. Green L; Nursing Standard, Sept 7, vol 26 no 1, 2011

10. Exploring the use of emollient therapy in dermatological nursing. Jill Peters, British Journal of Community Nursing.

Vol 11, no 5

11. A guide to emollient therapy. Brown A, Butcher M. Nursing Standard, Feb 23, vol 19, no 24, 2005

12. Practical Issues for emollient therapy in dry and itchy skin. Sandra Lawton, British Journal of Nursing, 2009, Vol 18

no 16

13. Recommended use of emollients in inflammatory dermatoses. Alison Hepplewhite BSc (Hons), RGN. Prescriber 5 Dec

2006

14. Using emollients to maintain and restore skin integrity. Watkins P, Nursing Standard, June 18, vol 22 no 41, 2008

15. Us of emollients in the treatment of dry skin conditions. Tina Dyble, Jennifer Ashton, British Journal of Community

Nursing. Vol 16, No 5

16. NHS Clinical Knowledge Summary, Itch – Widespread Management

17. Choosing topical corticosteroids. Jonathan D Ference, Allen R Last, American Family Physician, January 15, 2009

Volume 79, Number 2

18. NHS Clinical Knowledge Summary, Corticosteroids – topical (skin) nose, and eyes – management

19. Topical Treatments for chronic plaque psoriasis. Cochrane Review 2009

20. NHS Clinical Knowledge Summary, Warts and Calluses

21. NICE: Psoriasis: The management of psoriasis. Draft Clinical Guideline Planned publication Oct 12

22. NHS Clinical Knowledge Summary, Psoriasis

23. NHS Clinical Knowledge Summary, Seborrhoeic dermatitis and scalp psoriasis

chapter 13 skin - gwh homeplease con tact your tissue viability nurse for further information and...

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