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Prescribing formulary - 12

file:///C|/Documents%20and%20Settings/james.lacey/Desktop/MAGGIE/ID%20816%20enc%2012.htm Chapter 13: Skin
The GHT Formulary applies to the treatment of adults only
13.1 Management of skin conditions
● Please refer to the BNF for information regarding vehicles, excipients, sensitisation and suitable quantities for prescribing.
13.2 Emollient and barrier preparations
How to locate a
drug in Hospital

13.2.1 Emollients
Emollient soap substitutes
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Emollients containing antimicrobials
13.2.1.1 Emollient bath additives
Emollient bath additives with antimicrobials
13.2.2 Barrier Preparations
Cavilon® no-sting barrier film applicators 1mL & 3mL - supplied by stores not pharmacy file:///C|/Documents%20and%20Settings/james.lacey/Desktop/MAGGIE/ID%20816%20enc%2012.htm (2 of 13)30/03/2011 16:04:14 file:///C|/Documents%20and%20Settings/james.lacey/Desktop/MAGGIE/ID%20816%20enc%2012.htm Siopel ® cream - Not to be used on broken skin
Zinc and castor oil ointment – zinc preparations are restricted to use by the dermatologists as Cavilon® and Siopel ® are the products in the Trust’s Wound Care Guidelines.
13.3 Topical local anaesthetics and antipruritics
Menthol in Aqueous cream 0.5% & 1% - are only available as ‘special’ preparations (i.e. not proprietary products). These preparations are not cost-effective in primary care and there may be a significant delay in obtaining such preparations.
Doxepin Hydrochloride 5% cream (Xepin®) – for small areas only. Restricted to dermatology. Doxepin cream can cause drowsiness that may affect skilled tasks and there may be a risk of sensitisation.
13.4 Topical corticosteroids
Suitable quantities of corticosteroid preparations to be prescribed for specific areas of the body Amount per application
Amount of
one leg grams per
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Clobetasone butyrate 0.05% (Eumovate®) cream/ointment Betamethasone valerate 0.025% (Betnovate RD®) cream/ointment Fludroxycortide 4 micrograms/cm2 (Haelan®) tape Fluocinolone 0.00625% (Synalar 1 in 4 Dilution®) cream/ointment Beclometasone dipropionate 0.025% (Propaderm®) cream/ointment Betamethasone valerate 0.1% (Betnovate®)cream/ointment/lotion Betamethasone dipropionate 0.05% with salicylic acid 3% (Diprosalic®) ointment Diflucortolone 0.1% (Nerisone®) oily cream Fluocinolone 0.025% (Synalar®) cream/ointment Mometasone furoate 0.1% (Elocon®) cream/ointment Very Potent
Clobetasol propionate 0.05% (Dermovate®) cream/ointment Diflucortolone 0.3% (Nerisone Forte®) oily cream Topical Steroids with antimicrobials
Hydrocortisone 1% and clioquinol 3% (Vioform–Hydrocortisone®) cream/ointment Hydrocortisone 1% and clotrimazole 1% (Canesten HC®) Hydrocortisone 1% and fusidic acid 2% (Fucidin H®) cream/ointment Hydrocortisone 1% and miconazole 2% (Daktacort®) cream/ointment Hydrocortisone 0.5% (cream), 1% (ointment), nystatin 100,000 units/g and chlorhexidine 1% (Nystaform HC®) Hydrocortisone 0.5%, nystatin 100,000 units/g, benzalkonium chloride solution 0.2% and dimeticone ‘350’ 10% (Timodine®) cream Moderate
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Clobetasol propionate 0.05%, neomycin sulphate 0.5% and nystatin 100,000 units/g (Dermovate NN®) cream/ointment Compound preparations
Hydrocortisone 0.25% and crotamiton 10% (Eurax-Hydrocortisone®) cream Moderate
Hydrocortisone 1% and urea 10% (Alphaderm®) cream Hydrocortisone 1%, urea 10%, lactic acid 5% (Calmurid HC®) cream Steroid scalp applications
Betamethasone 0.1% (Betacap®) scalp application, (Betnovate®) scalp application, (Bettamousse®) foam scalp application Betamethasone 0.05% and salicyclic acid 2% (Diprosalic®) scalp application Fluocinolone acetonide 0.025% (Synalar®) gel file:///C|/Documents%20and%20Settings/james.lacey/Desktop/MAGGIE/ID%20816%20enc%2012.htm (5 of 13)30/03/2011 16:04:14 file:///C|/Documents%20and%20Settings/james.lacey/Desktop/MAGGIE/ID%20816%20enc%2012.htm Very Potent
13.5 Preparations for Eczema and Psoriasis
13.5.1 Preparations for eczema
● Please refer to section 13.2 (emollients) and 13.4 (topical corticosteroids).
Zinc paste and ichthammol bandage – only to be applied by a Nurse skilled in ● Ichthammol cream (Hospital Formula 2%) is only available as a ‘special’ preparation (i.
e. not a proprietary product). These preparations are not cost-effective in primary care and there may be a significant delay in obtaining such preparations.
13.5.2 Preparations for psoriasis
Topical preparations
● Please refer to the BNF for information regarding vitamin D and analogues. Vitamin D and analogues
Calcipotriol with betamethasone 0.05% (Dovobet®) ointment Calcipotriol with betamethasone 0.05% (Dovobet®) gel – body and scalp Calcitriol 3micrograms/g (Silkis®) ointment ● Treatment with Dovobet® should be initiated by a specialist and not exceed 4 weeks. There is no experience of repeated use. Refer to BNF for dose information.
Topical retinoid
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● Chelsea Day mix (Hospital Formula) is only available as a ‘special’ preparation (i.e. not a proprietary product). These preparations are not cost-effective in primary care and there may be a significant delay in obtaining such preparations.
Alphosyl HC® Cream (with hydrocortisone 0.5%) Polytar® bath emollient (contains peanut oil) ● Chelsea Night mix and Coal Tar and Salicylic Acid ointments are only available as ‘special’ preparations (i.e. not proprietary products). These preparations are not cost-effective in primary care and there may be a significant delay in obtaining such preparations.
Dithranol
Dithrocream® 0.1%, 0.25%, 0.5%, 1% and 2% Dithranol in Lassar’s Paste 0.1%, 0.25%, 0.5%, 1%, ● Dithranols in Lassar’s Paste are only available as ‘special’ preparations (i.e. not proprietary products). These preparations are not cost-effective in primary care and there may be a significant delay in obtaining such preparations.
Oral retinoids for psoriasis
13.5.3 Drugs affecting the immune response
Tacrolimus 0.03% and 0.1% (Protopic®) ointment - specialist use only file:///C|/Documents%20and%20Settings/james.lacey/Desktop/MAGGIE/ID%20816%20enc%2012.htm (7 of 13)30/03/2011 16:04:14 file:///C|/Documents%20and%20Settings/james.lacey/Desktop/MAGGIE/ID%20816%20enc%2012.htm Pimecrolimus 1% cream - specialist use only Systemic
● Please refer to section 8.2.1 for systemic preparations 13.6 Acne and rosacea
13.6.1 Topical preparations for acne
Benzoyl peroxide and azelaic acid
Benzoyl peroxide aqueous gel (PanOxyl Aquagel®) 2.5%, 5%, 10% Benzoyl peroxide aqueous/alcoholic gel (Panoxyl® ) 5%, 10% Benzoyl peroxide 5% and clindamycin 1% (Duac® Once Daily) Topical antibacterials for acne
Clindamycin (aqueous)(Dalacin T® lotion) Clindamycin (aqueous/alcoholic) (Dalacin T® solution) Erythromycin 40mg/mL and zinc acetate 12mg/mL (Zineryt®) topical solution Topical retinoids and related preparations for acne
● Topical retinoids are contra-indicated in pregnancy. Women of childbearing age should take adequate contraceptive precautions.
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Oral antibacterials for acne
Hormone treatment for acne
Oral retinoid for acne
Isotretinoin capsules – Hospital consultant only 13.7 Preparations for warts and calluses
Salicylic acid 16.7% and lactic acid 16.7% (Salactol®) paint Salicylic acid 12% and lactic acid 4% (Salatac®) gel Salicylic acid 25% and podophyllum 20% (Posalfilin®) ointment Cantharone Plus® (Cantharidin, podophyllum resin, salicylic acid) – unlicensed Anogenital warts
file:///C|/Documents%20and%20Settings/james.lacey/Desktop/MAGGIE/ID%20816%20enc%2012.htm (9 of 13)30/03/2011 16:04:14 file:///C|/Documents%20and%20Settings/james.lacey/Desktop/MAGGIE/ID%20816%20enc%2012.htm ● Ideally all patients should first receive a full genito-urinary screen at GUM but there may be circumstances when Dermatologists may need to prescribe.
13.8 Sunscreens and camouflagers
13.8.1 Sunscreen preparations
● The following sunscreens may be prescribed for skin protection against ultraviolet radiation in abnormal cutaneous photosensitivity resulting from genetic disorders or photodermatoses, including vitiligo and those resulting from radiotherapy; chronic or recurrent herpes simplex labialis; patients taking photosensitising drugs and patients having PUVA.
Photodamage
13.9 Shampoos and other preparations for scalp and hair
conditions

● Please refer to the BNF for information regarding constituents. Polytar AF® shampoo (contains peanut oil) Polytar Plus® liquid (contains peanut oil) file:///C|/Documents%20and%20Settings/james.lacey/Desktop/MAGGIE/ID%20816%20enc%2012.htm (10 of 13)30/03/2011 16:04:14 file:///C|/Documents%20and%20Settings/james.lacey/Desktop/MAGGIE/ID%20816%20enc%2012.htm Salicylic acid and sulphur Hospital Formula scalp cream ● Salicylic acid and sulphur Hospital Formula scalp cream is only available as a ‘special’ preparation (i.e. not a proprietary product). These preparations are not cost-effective in primary care and there may be a significant delay in obtaining such preparations.
13.10 Anti-infective skin preparations
13.10.1 Antibacterial preparations
13.10.1.1 Antibacterial preparations only used topically
Polyfax® - polymixin B sulphate and bacitracin zinc ointment Flamazine® - silver sulfadiazine 1% cream Flammacerium ® cream (named patients) – burns patients only ● For mupirocin nasal ointment see section 12.2.3 13.10.1.2 Antibacterial preparations also used systemically
Metronidazole 0.75% cream/gel – For malodorous tumours and skin ulcers 13.10.2 Antifungal preparations
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Aciclovir 5% cream - should only be started at first sign of attack.
13.10.4 Parasiticidal preparations
● Alcoholic lotions are the treatment of choice for head lice but use aqueous solutions for patients with severe eczema or asthma.
Malathion 0.5% aqueous liquid (Derbac M®), 0.5% alcoholic lotion Carbaryl 1% aqueous liquid, 0.5% alcoholic lotion (Carylderm®) Phenothrin 0.5% aqueous liquid (Full Marks®) 13.10.5 Preparations for minor cuts and abrasions
Skin tissue adhesive
13.11 Skin cleansers and antiseptics
● Please refer to GHNHSFT Infection Control policy Astringents, oxidisers and dyes
Potassium permanganate (Permitabs® 400mg) 13.12 Antiperspirants
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● Please refer to the GHNHSFT Wound Management Formulary Topical treatments for scar reduction
Topical treatments for malignant and pre-malignant lesions
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Source: http://www.gloshospitals.nhs.uk/SharePoint2/Freedom%20of%20Information/disclosures/2011/February/ID%20816%20enc%2012.pdf

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