13: Skin - Gateshead

13: Skin

Please select a topic:

13.2 Emollient and barrier preparations

13.4 Topical corticosteroids

13.6 Acne and rosacea

13.8 Sunscreens and camouflagers

13.10 Anti-infective skin preparations

13.11b Other preparations

13.3 Topical local anaesthetics and antipruritics

13.5 Preparations for eczema and psoriasis

13.7 Preparations for warts and calluses

13.9 Shampoos and some other scalp preparations

13.11a Disinfectants and skin cleansers

13.13 Wound management products and elastic hosiery

Changes to the Formulary since previous version

(5.10.12)

Section Reason for change

13.5

13.6

Change

ADDED: Oral retinoids – reminder of measures to minimise teratogenic risk

ADDED: Dianette®: balance of benefits & risks remains positive

MHRA Drug Safety Alert

MHRA Drug Safety Alert

Red = Hospital use only

Green = GP & Hospital use. Drugs not classified as Red, Amber or Amber 2 are classified as Green by default

Amber 1 = Drugs with shared care agreement

Amber 2 = Initiated by Hospital specialist only

Gateshead Health NHS Foundation Trust Page 1 of 25

Drug Formulary

Date: 19.7.2013

13.1 Management of skin conditions

 The vehicle used in topical preparations influences skin hydration, has a mild antiinflammatory effect and facilitates penetration of the active component.

 Creams are more cosmetically acceptable than ointments. Gels are suitable for application to

 the face and scalp while lotions are used for moist conditions and hairy areas. Ointments are much less likely to sensitise and are suitable for chronic dry lesions.

Possible contact sensitivity to preservatives or antiseptics is the reason for the range of topical agents.

Body area Non-corticosteroid cream/ointment

(Qty based on twice daily application for 1 week in adults)

Corticosteroid cream/ointment

(Qty based on single daily application for 2 weeks in adults)

Face

Face and neck

Both hands

Scalp

Both arms

15 to 30g

25 to 50g

50 to 100g

100 to 200g

Both legs

Trunk

100 to 200g

400g

Groins and genitalia 15 to 25g

15 to 30g

15 to 30g

15 to 30g

30 to 60g

100g

100g

15 to 30g

Fire Hazard with Paraffin-based Emollients

 Emulsifying ointment or 50% liquid paraffin and 50% white soft paraffin ointment in contact with dressings and clothing is easily ignited by a naked flame. The risk will be greater when these preparations are applied to large areas of the body, and clothing or ointment become soaked with the ointment. Patients should be told to keep away from fire or flames and not to smoke when using these preparations. The risk of fire should be considered when using large quantities of any paraffin-based emollient.

 For further information refer to NPSA Rapid Response Report 4 dated 26.November 2007

 The following products are known to be paraffin based:

STEROIDS EMOLLIENTS

Betnovate ointment

Betnovate RD ointment

Cetreban Cream & bath additive

Dermol Cream, 500 lotion & 600 Bath Additive

Diprobase and Diprobath

Doublebase

E45 Cream and Bath Oil

Emulsifying Ointment

Epaderm

Hydromol Ointment and Bath additive

Oilatum Cream and Bath additive






Drug Formulary

Date: 19.7.2013

Yellow soft paraffin






Drug Formulary

Date: 19.7.2013

13.2 Emollient and barrier preparations

Emollients (moisturisers)



Aqueous cream 100g & 500g



Aveeno cream 100g



Balneum Plus cream 100g



Calmurid cream 100g



Cetraben emollient cream 500g



Dermol cream 500g



Diprobase cream 500g



Diprobase ointment 500g



E45 cream 50g & 100g



Emulsifying ointment 500g



Epaderm ointment 500g



Eucerin Intensive 10%w/w Urea Treatment Lotion 250ml



Hand cream 50g (STAFF USE ONLY)



Hydromol Ointment 125g & 500g



Oilatum cream 40g



Oilatum emollient 250ml



Oilatum Junior Cream 500ml & 1050ml



Yellow soft paraffin 15g

Dose

- Aqueous cream BP (emulsifying ointment 30%, phenoxyethanol 1% in freshly boiled and cooled

purified water) (100g): massage into skin 2-3 times daily; may be used as a soap substitute.

- Aveeno® cream (colloidal oatmeal in emollient basis) (100mL): apply as often as required.

- Balneum® Plus cream (urea 5%, lauromacrogols 3%): apply as often as required.

- Calmurid cream (urea 10%, lactic acid 5%): apply twice a day.

- Cetraben emollient cream (white soft paraffin 13.2%, light liquid paraffin 10.5%): apply twice a day.

- Dermol cream (Benzalkonium Chloride 0.1% w/w; Chlorhexidine Hydrochloride 0.1% w/w; Liquid

Paraffin 105% w/w; Isopropyl Myristate 10% w/w): apply as often as required

- Diprobase® cream (cetomacrogol 2.25%, cetostearyl alcohol 7.2%, liquid paraffin 6%, white

soft paraffin 15%) (50g tube, 500g dispenser): apply as often as required.

- Diprobase® ointment (liquid paraffin 5%, white soft paraffin 95%) (50g tube, 500g dispenser): apply as often as required.






Drug Formulary

Date: 19.7.2013

- E45 Cream (light liquid paraffin 12.6%, white soft paraffin 14.5%, hypoallergenic anhydrous wool

fat 1% in self-emulsifying monostearin): apply as often as required.

- Epaderm® ointment (emulsifying wax 30%, yellow soft paraffin 30%, liquid paraffin 40%)

(125g, 500g): massage into skin as often as required; may be used as a soap substitute.

- Eucerin® Intensive cream (urea 10%): apply thinly and rub into area twice a day.

- Hydromol® ointment (yellow soft paraffin 30%, emulsifying wax 30%): apply as often as required; may be used as a soap substitute.

- Oilatum emollient (light liquid paraffin 63.4%): apply as often as required.

- Oilatum cream (light liquid paraffin 6%, white soft paraffin 15%): apply as often as required.

- Oilatum Junior Cream (light liquid paraffin 6%, white soft paraffin 15%)

- Yellow soft paraffin (yellow petroleum jelly): apply as often as required.

Prescribing notes

 Choice is guided by individual patient tolerance, preference and ease of use. It is dependent on previous use and adverse skin reactions (some may cause irritation or burning so advise testing on a small area of skin first and stop if a reaction occurs).

 Emollients soothe, smooth and hydrate the skin and are indicated for all dry scaling disorders.

 Emollients should be applied regularly to maintain improvement; most are best applied after a shower or bath.

 Use an oil-based emollient at night and during the day if skin is very dry/flaky.

 Use a cream which is easier to apply and less greasy throughout the day to aid compliance.

 These products, apart from white soft paraffin 50%/liquid paraffin 50%, may be used as soap substitutes by firstly wetting the skin, washing with the cream or ointment, then rinsing off.

 If emollients are being applied to the whole body twice daily, children may need 250g – 500g per week and adults 500g per week.

 It is most cost effective to prescribe emollients in very large quantities

 Hydromol contains less additives that Epaderm.

 Aqueous cream and emulsifying ointment should be used for washing only.

 Preparations that come in a pump dispenser presentation are good when product needed for use at school as more hygienic.

 Ointments should be used for dry skin and chronic eczema. Creams should be sued for acute inflammatory eczema.






Drug Formulary

Date: 19.7.2013

Emollient bath additives



Aveeno bath oil 250ml



Balneum bath oil 200ml



Diprobath 500ml



Dermol 600 600ml



E45 emollient bath oil 500ml



Hydromol emollient bath additive 500ml



Oilatum emollient bath additive 500ml



Oilatum Plus bath additive 500ml



Cetraban emollient bath additive 500ml

Dose

- Cetraban Emollient bath additive (light liquid paraffin 82.8%) (500mL): add 1-2 capfuls to bath

(1/2 to 1 capful if child).

- Oilatum® Emollient bath additive (acetylated wool alcohols 5%, liquid paraffin 63.4%)

(250mL, 500mL): add 5-15 mL/bath (2.5-10mL if an infant).

- Balneum® bath oil (soya oil 84.75%) (200mL, 500mL, 1L): add 20mL/bath (5mL, if an infant).

- Aveeno® bath oil (colloidal oatmeal, white oat fraction in emollient basis (250mL): up to

30mL/bath (child, up to 30mL).

- Oilatum® Plus bath additive (benzalkonium chloride 6%, triclosan 2%, light liquid paraffin

52.5%) (500mL, 1L): 1-2 capfuls/bath (infant over 6 months, 1mL).

- Dermol® 600 Bath Emollient (benzalkonium chloride 0.5%, liquid paraffin 25%, isopropyl

myristate 25%) (600mL): up to 30mL/bath (infant up to 15mL).

- Hydromol® Emollient Bath Additive (isopropyl myristate 13%, light liquid paraffin 37.8%)

(500ml): up to 1-3 capfuls/bath.

- Diprobath® Bath Additive (isopropyl myristate 39%, light liquid paraffin 46%) (500ml): up to

25-50ml/bath.

- E45® Emollient Bath Oil (cetyl dimeticone 5%, liquid paraffin 95%) (500ml): up to 15ml/bath.


 Bath additives with antiseptic should be used in patients with infected eczema.





 Oilatum® Plus bath additive is not suitable for use in the shower.

Preparations containing benzalkonium chloride can cause skin irritation with continued use.

E45® Emollient Bath Oil contains no irritants or allergens.






Drug Formulary

Date: 19.7.2013

Soap substitutes



Aqueous cream 100g & 500g



Emulsifying ointment 500g



Epaderm ointment 500g



Hydromol ointment 500g



Dermol 500 lotion 500ml



Dermol 200 shower emollient 200ml



Oilatum shower emollient gel 150g

Dose

- Emulsifying Ointment (emulsifying wax 30%, white soft paraffin 50%, liquid paraffin 20%)

- Aqueous cream BP (emulsifying ointment 30%, phenoxyethanol 1% in freshly boiled and cooled

purified water) (100g)

- Epaderm® ointment (emulsifying wax 30%, yellow soft paraffin 30%, liquid paraffin 40%)

(500g)

- Hydromol® ointment (yellow soft paraffin 30%, emulsifying wax 30%) (500g)

- Dermol 500 lotion (Benzalkonium Chloride 0.1% w/w; Chlorhexidine Hydrochloride 0.1% w/w;

Liquid Paraffin 2.5% w/w; Isopropyl Myristate 2.5% w/w): apply as often as required; may be used as a soap substitute.

- Dermol 200 shower emollient (Benzalkonium Chloride 0.1% w/w; Chlorhexidine Hydrochloride

0.1% w/w; Liquid Paraffin 2.5% w/w; Isopropyl Myristate 2.5% w/w): apply as often as required; may be used as a soap substitute.

- Oilatum shower emollient gel (light liquid paraffin 70%): apply as often as required.


 Most emollients may be used as soap substitutes by firstly wetting the skin, washing with the cream or ointment, then rinsing off.

 Doublebase® Emollient Wash Gel and E45® Emollient Wash Cream come in pump dispensers so are more hygiengic to use a school and home particularly if Dermol products are not tolerated. They are available on a non-formulary basis.

 White soft paraffin 50%/liquid paraffin 50% is not suitable as a soap substitute.

 Hydromol contains less additives than Epaderm®

 Preparations containing benzalkonium chloride can cause skin irritation with continued use.

 A convenient way to apply emulsifying ointment and Hydromol® ointment is as "soap balls", which are made by putting a scoop of the ointment into tubinette or stockinette.






Drug Formulary

Date: 19.7.2013

Barrier preparations



Vasogen cream 50g



Drapolene cream 100g



Metanium ointment 30g

Dose

- Vasogen Cream (dimeticone 20%, calamine 1.5%, zinc oxide 7.5%)): for nappy and urinary rash and eczematous conditions, apply several times daily as necessary or after each nappy change.

- Drapolene Cream (benzalkonium chloride 0.01%, cetrimide 0.2% in a basis containing white soft

paraffin, cetyl alcohol and wool fat): for nappy and urinary rash and eczematous conditions, apply several times daily as necessary or after each nappy change.

- Metanium Ointment (titanium dioxide 20%, titanium peroxide 5%, titanium salicylate 3% in

basis containing dimeticone, light liquid paraffin, white soft paraffin, and benzoin tincture): for nappy and urinary rash and eczematous conditions, apply several times daily as necessary or after each nappy change.


 Urinary (nappy) rash may clear if skin is left exposed to air; if associated with yeast

(candida) infection, an antifungal cream such as clotrimazole cream is useful.

 For information on the use of Cavilon® please consult the separate Trust Wound Care

Formulary.






Drug Formulary

Date: 19.7.2013

13.3 Topical local anaesthetics and antipruritics a) Topical antipruritics



Calamine lotion 200ml

Dose

- Calamine lotion: apply 2-3 times daily.


 Emollient preparations may be useful for pruritus due to dry skin; sedating oral antihistamines may also be helpful for itch

(b) Topical local anaesthetics

 LMX 4® cream

Dose

- LMX 4® cream (lidocaine 4%) (5g): for children & adults over 1 month, anaesthesia before e.g. venepuncture, apply a thick layer under an occlusive dressing 30 minutes before procedure






Topical local anaesthetics may be absorbed through mucosal surfaces.

Local anaesthetics may occasionally cause sensitisation.

 For information on the use of Ethyl Chloride Spray please consult the Anaesthetics Chapter of the formulary.






Drug Formulary

Date: 19.7.2013

13.4 Topical corticosteroids



Hydrocortisone 0.5% and 1% cream



Hydrocortisone 0.5% and 1% ointment



Hydrocortisone 1% plus clotrimazole 1% cream (Canesten HC)



Hydrocortisone 0.5% plus nystatin and chlorhexidine cream (Nystaform HC)



Hydrocortisone 0.5% plus nystatin and chlorhexidine ointment (Nystaform HC)



Hydrocortisone 0.5% plus nystatin, benzalkonium and dimeticone (Timodene)



Hydrocortisone 1% plus miconazole 2% (Daktacort)



Betamethasone valerate 0.1% cream (Betnovate) 100g & 30g



Betamethasone valerate 0.1% ointment (Betnovate) 100g & 30g



Betamethasone valerate 0.1% scalp application (Betnovate)



Betamethasone valerate 0.025% cream (Betnovate RD) 100g



Betamethasone valerate 0.025% ointment (Betnovate RD) 100g



Betamethasone valerate 0.1% plus clioquinol 3% ointment (Betnovate C)30g



Betamethasone valerate 0.1% plus neomycin 0.5% cream (Betnovate N) 30g



Betamethasone valerate 0.1% plus neomycin 0.5% ointment (Betnovate N) 30g



Clobetasol propionate 0.05% cream (Dermovate) 30g



Clobetasol propionate 0.05% ointment (Dermovate) 30g



Clobetasone butyrate 0.05% cream (Eumovate) 30g & 100g



Clobetasone butyrate 0.05% ointment (Eumovate) 30g & 100g



Clobetasone butyrate 0.05%, oxytetracycline and nystatin 0.05% ointment (Trimovate) 30g



Fluocinolone 0.025% ointment (Synalar) 30g

Dose

- Topical corticosteroids should be applied thinly as follows:

 Mild steroids = 1-2 times daily.

 Moderate, Potent & Very potent steroids = 1 x daily.






Drug Formulary

Date: 19.7.2013


 Topical corticosteroids are divided into four groups according to potency (see table) below).

Mild or moderately potent corticosteroids should control most cases of eczema. Therapy should be stepped-down once control achieved.

Potency

Mild

Examples

Hydrocortisone 0.5% and 1%

Hydrocortisone with antimicrobials

Fluocinolone acetonide

0.0025%

Trade Name

Non-proprietary

Canesten HC, Timodene,

Dakatacort, Vioform-HC

Synalar 1 in 10

Moderate

Potent

Betamethasone 0.025%

Clobetasone butyrate 0.5%

Clobetasone with antimicrobials

Betnovate RD

Eumovate

Trimovate

Fluocinolone acetonide

0.00625% Synalar 1 in 4

Betamethasone 0.1%

Betamethasone 0.1% with antimicrobials

Betnovate

Fluocinolone acetonide 0.025% Synalar

Betnovate C, Betnovate N

Clobetasol propionate 0.05% Dermovate Very Potent

 Topical corticosteroids are not recommended in urticaria, rosacea, acne or undiagnosed, possibly infective, disorders.

 Topical corticosteroids must not be applied more than twice a day.

 To minimise the risk of side-effects, the smallest effective amount should be used, reducing strength and frequency of application as the condition settles. The risk of systemic sideeffects increases with prolonged use on thin, inflamed or raw skin surfaces, use in flexures, or use of more potent corticosteroids. Occlusion increases efficacy and side-effects. Only mild corticosteroids should be used on the face.

 Gloves should be worn during, or hands washed after, application of large quantities of steroid preparations.

 The occlusive effect of ointments increases penetration of the corticosteroid.

 Cream based preparations contain preservatives.






Drug Formulary

Date: 19.7.2013

 Topical corticosteroids should not be used on infected skin unless the infection is being treated.

 Antibacterials and antifungals with corticosteroids may have a role if there is associated infection.

 Palms and soles may require potent or very potent steroids.






Drug Formulary

Date: 19.7.2013

13.5 Preparations for eczema and psoriasis

Preparations for eczema



PB7 Viscopaste bandages


 Medicated bandages are flammable

 All patients with eczema should use an emollient and soap substitute and/or bath oil.

 Emollients with antiseptics should be used to in patients with infected eczema.

 Exacerbation of eczema may represent secondary bacterial or viral infection. Appropriate swabs should be taken, and topical antibacterials applied. Systemic antibiotics may be required in widespread infected eczema.

 Ciclosporin, azathioprine or systemic corticosteroids should be initiated on specialist advice only, with responsibility for monitoring agreed.

 Topical corticosteroids should be reduced and withdrawn as the condition settles.

 Sedating antihistamines may be used short-term for pruritus.

Preparations for psoriasis



Acitretin 10mg and 25mg capsules



Exorex lotion 100ml (prepared coal tar 1% in an emollient basis)

 Calcipotriol 50microgram/gram cream 60g (Dovenex®)


 Treatment choice depends on site, extent of psoriasis and patient preference and tolerance.

 Potent and very potent topical corticosteroids should be used on specialist advice only; they may precipitate unstable and pustular psoriasis after stopping.

 Phototherapy, methotrexate, ciclosporin, acitretin should be initiated on specialist advice only, with responsibility for monitoring agreed.

Drugs affecting the immune response



Ciclosporin 25mg, 50mg and 100mg capsules



Methotrexate 2.5mg tablets



Tacroliumus 0.03% ointment






Drug Formulary

Date: 19.7.2013

13.6 Acne and rosacea

Preparations for acne





Isotretinoin 5mg and 20mg capsules (on advice on specialist only)

Dianette tablets


 Topical treatment takes at least 30 days to become effective.

 Benzoyl Peroxide is available to prescribe by GPs or for sale over the counter.

 Topical antibiotics are as effective as oral antibiotics but encourage resistance and are more expensive.

 Topical retinoids are recommended for comedonal acne; they may initially cause redness of the skin.

 Oxytetracycline may take up to 6 months of compliant use to achieve maximum benefit.

 Dianette® (cyproterone acetate with ethinylestradiol) is a treatment for severe acne and only in those patients may it also be used as an oral contraceptive. In those who do not require contraception, Dianette® should be withdrawn 3-4 cycles after the treated condition has completely resolved. If ongoing contraception is required, substitution with another COC is likely to maintain the improvement.

 Some drugs, including enzyme-inducers and antibiotics, may impair the efficacy of oral contraceptives; see BNF for details.

 Doxycycline can cause photosensitivity in some patients. Minocycline may be an alternative but prolonged use should be avoided due to the rare risk of liver damage; liver function tests should be monitored 3 monthly.

 Tetracyclines and retinoids (systemic or topical) must be avoided in pregnancy.

 Severe acne requires oral antibiotics and referral for consideration of isotretinoin for treatment failures. Oral isotretinoin (Roaccutane®) is a toxic and teratogenic drug that is only prescribable by a consultant dermatologist.

 There is no effective treatment for redness of the skin due to rosacea; camouflagers may be required.

 Mild rosacea is best treated with a topical agent.

 Pustular rosacea is best treated with systemic antibiotics.

MHRA Drug Safety Update

Cyproterone acetate with ethinyloestradiol (co-cyprindiol): balance of benefits and

Article date: June 2013

Summary risks remain positive – updated prescribing advice

Following a Europe-wide review of cyproterone acetate with ethinylestradiol (co-cyprindiol), the balance of benefits and risks of Dianette (brand leader) and its generics remains positive. To






Drug Formulary

Date: 19.7.2013

further improve the benefit-risk balance some important changes have been made to clarify the indication—these are discussed below. Although the indications for co-cyprindiol relate to androgen-sensitive skin conditions and hirsuitism, the medicine also provides effective contraception for women who require it. Use of additional hormonal contraception with cocyprindiol is therefore contraindicated. The risk of venous thromboembolism is rare, but healthcare professionals and patients should remain vigilant for signs and symptoms of this important side effectine.

Link: http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON287002

MHRA Drug Safety Update

Oral retinioids: pregnancy prevention – reminder of measures to minimise teratogenic risk

Article date: June 2013

Summary

The risk of foetal malformation with oral retinoids is extremely high, even when used at a low dose or for a short time during pregnancy. All oral retinoids have an associated Pregnancy

Prevention Programme (PPP), which is supported by educational material for prescribers, pharmacists, and patients. Women of child-bearing potential should have pregnancy excluded before starting treatment. While taking these medicines, one—or preferably two—different forms of contraception must be consistently used.

Link: http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON287004






Drug Formulary

Date: 19.7.2013

13.7 Preparations for warts and calluses



Cuplex gel 5g (salicylic acid 11%, lactic acid 4% in collodion basis)



Silver nitrate caustic pencil 95%



Salicyclic acid 10% in colloidion solution (chiropody)



Imiquimod 5% cream 5g


 These preparations are contra-indicated in facial or genital warts.

 The wart surface should be rubbed with a file or pumice stone, and the surrounding skin protected, before each application. If application becomes painful, treatment should be withheld for a few days then recommenced.






Drug Formulary

Date: 19.7.2013

13.8 Sunscreens and camouflagers



Uvistat SPF 30 125g



Uvistat SPF 50 125g


 Sunscreens with SPF > 15 are prescribable for photosensitive skin disorders including genetic disorders, vitiligo, following radio-therapy, photo-aggravated rosacea, or recurrent herpes simplex labialis.

 Prescriptions should be endorsed "ACBS".

 The choice of sunscreens depends on individual patient need, tolerance and evidence of sensitivity to excipients.






Drug Formulary

Date: 19.7.2013

13.9 Shampoos and some other scalp preparations



Polytar shampoo 250ml



Ketoconazole 2% shampoo 120ml



Cocois scalp ointment 40g



Oilatum shampoo



Eucerin Dry Scalp Relief shampoo with 5% urea

Dose

- Ketoconazole 2% shampoo (120mL): for seborrhoeic dermatitis and dandruff apply twice weekly for 2-4 weeks; for pityriasis versicolor, once daily for up to 5 days.

- Cocois® scalp ointment (coal tar solution 12%, salicylic acid 2%, precipitated sulphur 4% in a

coconut oil emollient basis): for scaly scalp disorders including psoriasis, eczema, seborrhoeic dermatitis and dandruff, apply to scalp once weekly as necessary, shampoo off after 1 hour.

- Polytar® liquid (arachis (peanut) oil extract of crude coal tar 0.3%, cade oil 0.3%, coal tar

solution 0.1%, oleyl alcohol 1%, tar 0.3%) (250mL): scalp disorders, including psoriasis, seborrhoea, eczema, pruritus and dandruff, apply 1-2 times weekly.

-

Oilatum® shampoo: Wet the hair and massage OILATUM Scalp Treatment gently over the scalp to produce a lather. Leave on for 3-5 minutes. Rinse thoroughly, and repeat if necessary. Use twice weekly for two weeks to clear the scales and improve the condition of your scalp. Then just use once a week to maintain a clear scalp.


 Shampoo formulations are preferred for moderate scaly slap conditions whereas more severe conditions may require an ointment.

 Ketoconazole shampoo is often helpful for seborrhoeic dermatitis of the scalp.






Drug Formulary

Date: 19.7.2013

13.10 Anti-infective skin preparations

Antibacterial preparations



Mupirocin 2% ointment 15g

 Silver sulfadiazine 1% cream 50g (Flamazine®)



Fusidic acid 2% cream 15g



Fucidin-H cream 15g



Metronidazole 0.75% gel (Anabact) 15g

 Potassium permanganate solution tablets 400mg (Permitabs®)

 Octenisan

 Oilatum Plus

 Dermol 600

Dose

- Fusidic acid 2% cream, gel; sodium fusidate 2% ointment (15g, 30g): apply 3-4 times daily.

- Metronidazole gel 0.75% : apply 1-2 times daily.

- Silver sulfadiazine cream 1% (20g, 50g, 250g, 500g): burns, apply daily or more frequently if required; leg ulcers, apply every 1 to 2 days; fingertip injuries, apply every 2-3 days.

- Potassium permanganate solution tablets 400mg (Permitabs®): 1 tablet dissolved in 4 litres of water provides a 0.01% (1 in 10,000) solution.

- Mupirocin 2% ointment; cream (15g): apply up to 3 times daily for up to 3 days.

- Fucidin H cream (hydrocortisone acetate 1%, fusidic acid 2%): apply 1-2 times daily.


 Topical antibiotics should only be used short-term and for localised infections.

 If potassium permanganate tablets are prescribed, ensure tablets are dissolved in a jug prior to being poured into the bath as direct contact with the skin can cause burning.

Antifungal preparations



Clotrimazole 1% cream 20g



Canesten-HC cream 30g



Amorolfine 5% nail lacquer 5ml



Nystatin 100 000 unit/g cream 30g



Miconazole 2% cream 15g & 30g

Dose

- Clotrimazole cream 1% (20g): apply 2-3 times daily.

- Terbinafine cream 1% (30g): apply 1-2 times daily.

- Clotrimazole HC cream 1% (20g)(clotrimazole 1%, hydrocortisone 1%): apply 2-3 times daily.






Drug Formulary

Date: 19.7.2013

- Amorolfine nail lacquer 5% (5ml): apply 1-2 weekly.

- Miconazole cream 2% (30g): apply 1-2 times daily.

Antiviral preparations



Aciclovir 200mg and 400mg tablets

Parasiticidal preparations



Malathion 0.5% in an aqueous basis (Derbac-M) 50ml



Permethrin 5% dermal cream (Lyclear) 30g

(a) Scabies

Dose

- Malathion 0.5% liquid in an aqueous basis (Derbac-M®) (50ml): apply over whole body and wash off after 24 hours; if hands are washed with soap within 24 hours they should be retreated. In young children, application may need to be extended to the face, neck, scalp and ears; this extended application may also be necessary for the elderly, immunocompromised and those who have experienced treatment failure.

- Permethrin 5% dermal cream (Lyclear® Dermal Cream, 30g): apply over whole body and wash off after 8-12 hours. In young children, application may need to be extended to the face, neck, scalp and ears; this extended application may also be necessary for the elderly, immunocompromised and those who have experienced treatment failure. If hands are washed with soap within 8 hours of application, they should be treated again with cream.


 Aqueous preparations are preferable to alcoholic lotions.





All members of the household and close contacts should be treated.

Clothes and bedlinen should be washed at normal temperatures at time of treatment.

 In pregnancy, malathion in an aqueous basis is preferred.

(b) Head lice

Dose

- Malathion 0.5% liquid in an aqueous basis (Derbac-M®) or alcoholic basis (Prioderm® lotion)

(50ml): rub into dry hair and scalp, allow to dry naturally, remove by washing after 12 hours.


 Head lice should be treated with lotion or liquid formulations; shampoos are diluted too much during use to be effective and should not be used. Products with short application times (e.g. cream rinse & mousse formulations) are not recommended.

 A second application 7 days after the first is needed.






Drug Formulary

Date: 19.7.2013

 Aqueous formulations are preferred in severe eczema, asthmatic patients and small children.

 A rotational policy for insecticides is outmoded; a mosaic strategy is suggested whereby if a course of treatment fails then a different insecticide is used for the next course.

 Malathion should not be applied at intervals of less than 1 week or for more than 3 consecutive weeks since effectiveness is not increased.

 In pregnancy, dimeticone or wet combing are preferred. If malathion is required the liquid in aqueous basis should be used.

 Malathion should not be applied at intervals of less than 1 week or for more than 3 consecutive weeks since effectiveness is not increased.

 Permethrin is not recommended for the treatment of head lice since currently available formulations are diluted too much during use.

(c) Crab lice

Dose

- Malathion 0.5% aqueous liquid (Derbac-M®) (50mL): apply over whole body, allow to dry naturally, wash off after 12 hours or overnight.


 An aqueous preparation should be applied to all parts of the head and body for 12 hours or overnight; a second treatment is needed after 7 days to kill lice emerging from surviving eggs.

 Alcoholic lotions are not recommended due to irritation of excoriated skin and genitalia.






Drug Formulary

Date: 19.7.2013

Preparations for minor cuts and abrasions



Proflavine cream BPC 100ml (Theatres only)


 For information on the use of Cavilon® and Opsite® please consult the separate Trust

Wound Care Formulary.






Drug Formulary

Date: 19.7.2013

13.11 Disinfectants and cleansers

Alcohols and saline



Methylated spirit external solution 70%



Sodium chloride 0.9% sachets 100ml (Normasol)



Isopropyl alcohol swabs

Chlorhexidine salts



Chlorhexidine gluconate 0.05% sachet (Unisept) 25ml & 100ml



Chlorhexidine gluconate 0.5% solution (Hibisol and Hydrex) 500ml



Chlorhexidine gluconate 4% surgical scrub (Hydrex) 500ml



Chlorhexidine gluconate 1% obstetric cream 250g



Chlorhexidine gluconate 0.015% and cetrimide 0.15% solution 1L (Travasept)

Chlorine and iodine



Povidone iodine 7.5% surgical scrub(Videne) 500ml



Povidone iodine 2.5% dry powder spray (Betadine) 150g



Povidone iodine 10% ointment (Betadine) 80g



Povidone iodine 10% antiseptic solution (Videne) 500ml



Povidone iodine 10% alcoholic antiseptic solution (Videne) 500ml

Other



Oilatum Plus 500ml



Octenisan 450ml

Astringents, oxidisers and dyes



Hydrogen peroxide 3% solution 200ml


 Sodium chloride solution 0.9% is suitable for irrigation of skin and wounds.

 Povidone-iodine may produce systemic adverse effects, such as metabolic acidosis, hypernatraemia and renal impairment, if applied to large wounds or severe burns.






Drug Formulary

Date: 19.7.2013

Other preparations



Infacare bath solution 500ml



Iodine alcoholic solution BP 25ml



Plaster remover solution 50ml



Sterile water for irrigation 1L



Sodium dichloroisoocyanurate external tablets (Haz-tabs)



Sodium hypochlorite 2% solution 500ml (Milton)



Sodium chloride 0.9% for irrigation 1L



Aluminium chloride hexahydrate 20% roll-on 60ml



Hirudoid cream 50g



Lubricating jelly 42g & sachets



Gigasept PA solution 5L






Drug Formulary

Date: 19.7.2013

13.13 Wound management products and elastic hosiery

See separate wound management formulary






Drug Formulary

Date: 19.7.2013

13: Skin - Gateshead

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