Section 13: Skin

Section Description

BNF 13.1.2

Prescribing suitable quantities of dermatological preparations

BNF 13.1.3

Excipients and sensitisation

BNF 13.2.1

Emollients

BNF 13.2.1.1

Emollient bath additives

BNF 13.2.2

Barrier preparations

BNF 13.3

Topical local anaesthetics and antipuritics

BNF 13.4

Topical corticosteroids

BNF 13.5.1

Preparations for eczema

BNF 13.5.2

Preparations for Psoriasis

BNF 13.5.3

Drugs affecting the immune response

BNF 13.6

Treatment of acne

BNF 13.7

Preparations for warts and calluses

BNF 13.8.1

Sunscreening preparations

BNF 13.8.2

Camouflagers

BNF 13.9

Shampoos and some other scalp preparations

BNF 13.10.1

Antibacterial preparations

BNF 13.10.2

Antifungal preparations

BNF 13.10.3

Antiviral preparations

BNF 13.10.4

Parasiticidal preparations

BNF 13.10.5

Preparations for minor cuts and abrasions

BNF 13.11.1

Alcohols and saline

BNF 13.11.2

Chlorhexidine salts

BNF 13.11.3

Cationic surfactants and soaps

BNF 13.11.4

Chlorine and iodine

BNF 13.11.5

Phenolics

BNF 13.11.6

Astringents, oxidisers and dyes

BNF 13.11.7

Preparations for promotion of wound healing

BNF 13.12

Antiperspirants

BNF 13.13

Wound Management products

BNF 13.1.2 Prescribing suitable quantities of dermatological preparations

Amount of emollient usually suitable for an adult for twice daily application for one week

Applied to

Creams & ointments

Lotions

Face

15 to 30g

100ml

Both hands

25 to 50g

200ml

Scalp

50 to 100g

200ml

Both arms or both legs

100 to 200g

200ml

Trunk

400g

500ml

Groins and genitalia

15 to 25g

100ml

BNF 13.1.3 Excipients and sensitisation

A small number of excipients in topical preparations may be associated with sensitisation, particularly of eczematous skin (see BNF for list).  The British National Formulary (BNF) entries indicate if one of these excipients is present in a topical preparation.

BNF 13.2.1 Emollients

Use of emollients

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. For the full NPSA alert please follow this link: Fire Hazard with Paraffin-based skin products

The choice of emollient depends on patient acceptability, thus a few emollients may need to be tried before the most appropriate one is identified for the individual patient.

There is a Dermatology Formulary for specially prepared preparations, these specials are only to be initiated by the Hospital Dermatology Service.


Least greasy

Aqueous cream

 

Suitable as soap substitute
All dry skin conditions
Acts as cooling agent on itchy skin if patient puts in the fridge prior to use
Usually contains phenoxyethanol as an antimicrobial but may contain an alternative
May cause skin irritation particularly in children with eczema (MHRA 2013)

ZeroAQS® cream Suitable as soap substitute
Dermol 500® lotion  Contains antiseptic
Suitable as soap substitute
200ml shower emollient available (£3.71) 

Diprobase® cream

Suitable as soap substitute
All dry skin conditions
Available with pump dispenser

Zerobase®

All dry skin conditions, available with pump dispenser

More Greasy

Aveeno® cream

 

Zeroveen®    

Cetraben®

Effective for refractory dry skin conditions

Doublebase® gel Tolerated by children, cooling on application

Zerodouble® gel

 

E45® cream

 

Zerocream® cream   

Hydromol® ointment

Consultant Dermatologist recommendation only

Zeroderm® ointment  cost effective moisturiser

Hydrous ointment

Also known as Oily cream

Unguentum M®

Good for moderately dry skin
200ml dispenser

Zeroguent® cream

For dry skin conditions

Most Greasy

Emulsifying ointment

Suitable as soap substitute
Good for very dry skin conditions
Difficult to apply due to thickness
Patient compliance is low

White soft paraffin

Bleached version of yellow soft paraffin
Contains no preservatives, colorants or perfumes
Ideal for people with many allergies

Yellow soft paraffin

Used in manufacture

Liquid and white soft paraffin ointment NPF

Also known as "50:50", 50% liquid paraffin and 50% white soft paraffin. Comforting effect on very dry eczematous skin following twice daily application
Messy to use

Preparations containing urea

Eucerin® Intensive cream & lotion

Dry ichthyotic skin

Calmurid® cream

Dry ichthyotic skin

Balneum Plus® cream

Antipruritic

E45® itch relief cream

Antipruritic

Dermatonics Once Heel Balm® Daily application to anhydrotic and callused foot skin as a prophylactic treatment for diabetic foot ulceration. 

Soap substitutes

Aqueous cream

 

Dermol 500® lotion

Soap substitute with antimicrobial

Emulsifying ointment

 

Emulsiderm® liquid emulsion

Soap substitute with antimicrobial

Epaderm® ointment

 

BNF 13.2.1.1 Emollient bath additives

Lanolin-free bath additives Information from medicines information

First choice:

Hydromol® bath and shower emollient

 

Second choice:

E45® emollient bath oil [ACBS]

 

Zerolatum® bath oil  

Oilatum® emollient bath additive

 

More expensive preparations:

Balneum® bath oil   

Zeroneum® bath oil

 

BNF 13.2.2 Barrier preparations

Preparation

Peanut oil

Zinc

Dimethicone

Antibacterial

 

Conotrane® cream

 

 

 

Drapolene® cream

 

 

 

contains calamine

Metanium® cream

 

 

 

contains titanium

Siopel® barrier cream

 

 

Sudocrem® cream

 

 

 

Vasogen® cream

 

 

May also be used for ileostomy and colostomy care

Zinc and castor oil ointment

 

 

 

Zinc cream

 

 

 

BNF 13.3 Topical local anaesthetics and antipuritics

Aqueous cream with 0.5% or 1% menthol

Arjun® Click here for specials information

Calamine aqueous cream

 

Calamine lotion

 

Crotamiton cream

Eurax®

Pruritus in eczema

 

Doxepin 5% cream

Do not apply to more than 10% body surface area
Application for more than 8 days may lead to sensitisation
Maximum 3g per application applied three or four times daily

Pruritus in primary biliary cirrhosis and drug-induced cholestasis

Cholestyramine 4g sachets

1 – 2 sachets daily in water / liquid


BNF 13.4 Topical corticosteroids

Quantity to apply - Finger tip units

 

Prescribing Advice

Topical 

 

Suggested quantity of corticosteroid preparation to be prescribed for an adult
for twice daily application for one week

 

Applied to

Creams & ointments

 

Face

15 to 30g

 

Both hands

15 to 30g

 

Scalp

26 to 30g

 

Both arms

30 to 60g

 

Both legs

100g

 

Trunk

100g

 

Groins and genitalia

15 to 25g

 

 

Frequency of application of topical steroid for eczema. NICE has recommended that corticosteriods should not be applied to the affected skin of people with atopic eczema more than twice a day. If there is more than one type of topical corticosteroid that would be appropriate for a person's eczema, then the cheapest one should be used. The recommendations do not apply to topical steriod preparations that also contain other medicines, such as antibiotics. NICE TA81

MILDLY POTENT TOPICAL CORTICOSTEROID

Hydrocortisone 0.5% cream & ointment
Hydrocortisone 1% cream and ointment

 

Hydrocortisone 1% in white soft paraffin (WSP)

Click here for specials information

Fluocinolone acetonide 0.0025% cream

Synalar 1 in 10®

Mildly Potent Topical Corticosteroid + Antimicrobial

Hydrocortisone 1% + clotrimazole 1%

Canesten HC®

These combined preparations should not be put on repeat prescription to prevent the development of antimicrobial resistance.

Hydrocortisone 1% + miconazole 2%

Daktacort®

Hydrocortisone 1% + sodium fusidate 2%

Fucidin-H® 

Hydrocortisone 0.5% + nystatin + benzalkonium Timodine®

Mildly Potent Topical Corticosteroid + Other Ingredients

Hydrocortisone 0.25% + crotamiton 10%

Eurax-Hydrocortisone®  

 

MODERATELY POTENT TOPICAL CORTICOSTEROID

 

Betametasone 0.025%

Betnovate RD®

Moderately potent topical corticosteroids may work faster if used twice daily, but this may lead to more side-effects.
Preparations containing antimicrobial should not be put on repeat prescription to prevent the development of antimicrobial resistance.

Betnovate ointment 10% in white soft paraffin

Specials information

Betnovate ointment 25% in white soft paraffin

Clobetasone butyrate 0.05%

Eumovate® 

Alclometasone 0.05%

 

Fludroxycortide 0.0125%

Haelan®

Fluocinolone 0.0625%

Synalar 1 in 4 dilution®

Moderately Potent Topical Corticosteroid + Antimicrobial

Clobetasone butyrate 0.05%+ nystatin
                                             + oxytetracycline

Trimovate®  
Stains clothing

Moderately Potent Topical Corticosteroid + Other ingredients

Hydrocortisone 1% + urea 10%

 Alphaderm®

 

POTENT TOPICAL CORTICOSTEROID

Potent topical corticosteroids may work faster if used twice daily, but this may lead to more side-effects.
Preparations containing antimicrobial should not be put on repeat prescription to prevent the development of antimicrobial resistance.

Betametasone valerate 0.1%

Betnovate®  

Betametasone valerate 0.1% scalp application

Betacap®  

Betametasone valerate 0.12% scalp application

Bettamousse®  

Fluocinolone acetonide 0.025%

Synalar®

Fluocinonide 0.05%

Metosyn®

Mometasone 0.1%

Elocon®

Potent Topical Corticosteroid + Antimicrobial

Betametasone 0.1% + fusidic acid 2%

FuciBET®  

Betametasone 0.05% + clotrimazole 1%

Lotriderm®

Potent Topical Corticosteroid + Salicylic Acid

Betametasone 0.05% + salicylic acid 3%

Diprosalic®  

 

VERY POTENT TOPICAL CORTICOSTEROID

Very potent topical steroids are as effective used once daily when compared to twice daily use.
Preparations containing antimicrobial should not be put on repeat prescription to prevent the development of antimicrobial resistance.

Clobetasol propionate 0.05%

Dermovate®                  

Diflucortolone valerate 0.3%

Nerisone Forte®

Very Potent Topical Corticosteroid + Antimicrobial

Clobetasol propionate 0.05% + neomycin + nystatin

 

BNF 13.5.1 Preparations for eczema

Eczema affects 15-20% of school children and 2-10% of all adults.

Use of emollients

Treatment with topical steroids Bacterial infection A sudden worsening of the condition

Mild eczema

Emollients
Bath Oil
Steroid

e.g. aqueous cream, emulsifying ointment
e.g. Hydromol®
Hydrocortisone 0.5% for face, hydrocortisone 1% for other parts.

Moderate eczema

Emollients
Bath Oil
Steroid

Also consider emollients with antimicrobial e.g. Dermol 500®
Consider oil with antimicrobials e.g. Oilatum Plus®
Start with moderate steroid (e.g. Betnovate RD®, Eumovate®) and then step down after the specific period i.e. 1-2 weeks.
Assess amount of steroid using fingertip units

Infection

Look for signs and treat infections. Consider systemic antibiotics e.g. oral flucloxacillin or erythromycin for 7 days

Itching

Reduce itching by using sedative antihistamine at night
Consider antipruritic emollients and bath oils

Severe eczema

Emollients
Bath oils

Also consider emollients with antimicrobial e.g. Dermol 500®
Consider oil with antimicrobials e.g. Oilatum Plus®

Steroid

Moderate/strong steroid (e.g. Betnovate®) for 2-3 weeks then step down

Infection

Systemic antibiotics for 7-14 days depending on severity

Other

Bandages for arms and legs
Wet wraps (children)
REFER TO HOSPITAL

  • If not responding
  • Frequent flare up
  • Use of large amounts of topical steroid

 

Wet Wraps

Tubifast beigeline

Body (larger children)

Tubifast yellowline

Body (smaller children)

Tubifast greenline

Arms
Legs (over 5 years)

Tubifast blueline

Legs (under 5 years)

Tubifast redline

Arms (young babies)

Ichthammol

Zinc and ichthammol cream BP

 

Zinc paste and ichthammol 15/2% bandage

Icthaband®

Zinc paste and ichthamol 6/5% bandage

Ichthopaste®

Alitretinoin 

NICE Guidance: Eczema (chronic) - Alitretinoin NICE TA177

Alitretinoin is recommended as a treatment option for adults with severe (as defined by the physician global assessment [PGA]) chronic hand eczema if the disease has not responded to potent topical corticosteroids and the patient has a dermatology life quality index (DLQI) score ≥ 15. Treatment should be stopped:

  • when an adequate response (hands clear or almost clear) is achieved
  • if eczema remains severe [PGA scale] at 12 weeks
  • if an adequate response is not achieved by 24 weeks

Only physicians who are experienced in both the management of severe chronic hand eczema and the use of retinoids should start and monitor treatment with alitretinoin.

 

BNF 13.5.2 Preparations for Psoriasis 

The natural history of psoriasis is that it tends to appear for the first time in young adults, although it may start in infancy or old age, and it runs a chronic relapsing course. Treatment aims to control, not cure, the current attack and will not influence the future progress of the disease. Mild to moderate psoriasis can be managed in primary care.  

The assessment and management of psoriasis NICE CG153

Topical Preparations for Psoriasis

 

 

VITAMIN D ANALOGUE

Max. weekly

 

Vitamin D Analogue
Improvement gradual, restrict to maximum weekly amount.
Please check BNF for Children for license and dosage details in children and adolescents.
Vitamin D Analogue + steroid
Initial treatment (apply once daily for maximum of 4 weeks) of stable plaque psoriasis

Calcipotriol 50micrograms/g

100g

Dovonex®

Calcitriol 3 microgram/g

210g

Silkis®

Tacalcitol

70g

Curatoderm®

VITAMIN D ANALOGUE + STEROID

 

Calcipotriol + betametasone

100g

Dovobet®
Enstilar® cutaneous foam

TOPICAL RETINOIDS

Topical Retinoids
Use in limited disease – plaques. Skin irritation limits use.      

Tazarotene 0.05% gel

Zorac®

TAR PREPARATIONS

Tar Preparations
Refined tar products less smelly and less messy to use – but less effective, may stain clothes.

Coal tar 2% and salicylic acid 2% ointment BP

Specials information

Coal tar extract 2% shampoo

T-gel®

Prepared coal tar 1% lotion

Exorex®

Polytar® emollient contains peanut oil

 

Zinc and coal tar paste BP

White’s Tar Ointment (WTO)

DITHRANOL PREPARATION

Dithranol Preparation
Can be used as a short contact treatment (in increasing strengths, depending on irritation). Stains clothes and skin. Can be very effective and induces long remissions.

Dithranol 0.1% to 2% cream

Dithrocream®

Dithranol 1% cream

Micanol®

DITHRANOL and SALICYLIC ACID

Dithranol 0.25% + salicylic acid 1.6%

Psorin® scalp Gel

TOPICAL STEROIDS

Topical Steroids
Potent steroids not generally recommended. Moderate to potent steroids cause early clearance but rebound relapses. Useful for certain sites such as flexures/ face/ scalp/ genitalia – causes tachyphylaxis.

 

Daktacort®

Hydrocortisone 0.5% + nystatin + benzalkonium

Timodine® 

Oral retinoids for psoriasis  
Acitretin capsules   Neotigason®   Prescribed only by, or under the supervision of, a consultant Dermatologist. Not licensed for GPs to prescribe.

 

BNF 13.5.3 Drugs affecting the immune response

Apremilast

Hospital/ specialist prescribing only

Apremilast for treating moderate to severe plaque psoriasis NICE TA419

Apremilast for treating active psoriatic arthritis NICE TA433
Ciclosporin

 

Dupilumab

Specialist/Hospital prescribign only

Dupilumab for treating moderate to severe atopic dermatitis NICE TA534 

Methotrexate

Prescribed and monitored within the guidance of a shared care agreement.
CAUTION: ORAL DOSE GIVEN ONCE WEEKLY ONLY
NPSA Improving compliance with oral methotrexate

Shared Care Agreement

Pimecrolimus

NICE has recommended that treatment should only be initiated by a dermatologist or GP with special interest and experience in dermatology. Initiation only after discussion with patient about potential risks and benefits of all appropriate second-line treatment options. Suitable for GP prescribing after specialist assessment. NICE TA82

Tacrolimus

Cytokine modulators

Adalimumab

Specialist/ Hospital prescribing only

Adalmumab for plaque psoriasis NICE TA146
Psoriatic arthritis NICE TA199
Adalimumab for treating moderate to severe hidradenitis suppurativa NICE TA392
Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people NICE TA455 

Brodalumab

Specialist/ Hospital prescribing only

Brodalumab for treating moderate to severe plaque psoriasis NICE TA511
Etanercept

Specialist/ Hospital prescribing only

Psoriasis - efalizumab and etanercept NICE TA103
Psoriatic arthritis NICE TA199
Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people NICE TA455

Golimumab 

Specialist/ Hospital prescribing only

Golimumab for the treatment of psoriatic arthritis NICE TA220

Infliximab (Remicade®, Inflectra®, Remsima®)

Specialist/ Hospital prescribing only

Psoriasis - infliximab NICE TA134
Psoriatic arthritis NICE TA199

Ixekizumab

 

Specialist/ Hospital prescribing only

Ixekizumab for treating moderate to severe plaque psoriasis NICE TA442  

Secukinumab

Specialist/ Hospital prescribing only

Secukinumab for treating moderate to severe plaque psoriasis NICE TA350

Ustekinumab

Specialist/ Hospital prescribing only

NICE has produced guidance NICE TA180 for the use of ustekinumab as a treatment option for adults with plaque psoriasis when the following criteria are met:

  • The disease is severe, as defined by a total Psoriasis Area Severity Index (PASI) score of 10 or more AND a Dermatology Life Quality Index (DLQI) score of more than 10.
  • The psoriasis has not responded to standard systemic therapies, including ciclosporin, methotrexate and PUVA or the person is intolerant of or has a contraindication to these treatments.
  • The manufacturer provides the 90mg dose (2 x 45mg vials) for people weighing more than 100kg as the same total cost as for a single 45mg vial.

Ustekinumab for treating active psoriatic arthritis NICE TA340 (replaces NICE TA313)
Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people NICE TA455

 

BNF 13.6 Treatment of acne

Mild acne (comedonal)

Topical Retinoids

Topical Retinoids
May cause irritation, build up frequency or duration of application over 2-3 weeks.
Contra-indicated in pregnancy

Adapalene 0.1%
Tretinoin 0.01% and 0.025%
Isotretinoin 0.05%

Differin®
Retin-A®
Isotrex®

Topical retinoid plus antibacterial

Peel Agent
May cause irritation, build up concentration starting at 2.5% to 5% then 10%
May bleach clothing

Isotretinoin 0.05% + erythromycin 2%

Isotrexin® gel

Mild acne (inflammatory)

Peel Agent

 

Azelaic acid 20% cream

Skinoren®

 

Topical Antibiotics

Topical antibiotics are probably best reserved for patients who wish to avoid oral antibiotics or cannot tolerate oral antibiotics.
Oral antibiotics should be stopped when using topical antibiotic preparations to prevent resistance developing

Clindamycin 1% topical solution
Erythromycin 2% solution
Erythromycin + zinc topical solution

Dalacin®
Stiemycin®
Zineryt®

Nicotinamide
Nicotinamide 4% gel

Nicam®

 

Mild to moderate acne
Comedones, papules and scattered pustules

Topical retinoid plus antibacterial 

Topical antibiotics are probably best reserved for patients who wish to avoid oral antibiotics or cannot tolerate oral antibiotics.
Oral antibiotics should be stopped when using topical antibiotic preparations to prevent resistance developing

Isotretinoin + erythromycin gel
Tretinoin + erythromycin solution

Isotrexin®
Aknemycin Plus®

Benzoyl peroxide plus antibacterial

Benzoyl peroxide+ clindamycin 1%

Duac® Once Daily gel

 

Topical retinoid plus benzoyl peroxide   
Adapalene 0.1% and Benzoyl Peroxide 2.5%  Epiduo®   

Moderate acne
Widespread papules and pustules

Oral antibiotics plus topical therapy (as for mild acne)

Oral antibiotics
Should be given for periods of 3-6 months. If no response, question compliance or possible resistance to drug.
Doxycycline – take with food, avoid sunlight.
Minocycline may cause irreversible pigmentation and is expensive.

Antibiotic where compliance likely to be good
Oxytetracycline 500mg twice a day  or        
Tetracycline 500mg twice a day                          
Review treatment after 3 months

Antibiotic where poor compliance likely e.g. teenagers or need simple dosage unrestricted by meals or previous antibiotics failed (resistance?)
Lymecycline300mg once daily or
Doxycycline 100mg daily

Antibiotic where pregnancy is possible
Erythromycin

Hormone treatment
Co-cyprindiol tablets

 

Severe acne
Deep papules, pustules and cystic lesions and scarring

Refer to Dermatologist.
NICE Referral Advice suggests patients with painful, deep nodules or cysts (nodulocystic acne) are at high risk of scarring and treatment should be started while awaiting the hospital appointment.
Oral retinoid
Isotretinoin

Oral retinoid
Isotretinoin should be prescribed only by or under the supervision of (a) a Consultant Dermatologist (b) the Community Dermatology service. Supply from hospital or specified community pharmacy only.”

 

BNF 13.7 Preparations for warts and calluses

Warts and Calluses

Salicylic acid 50% ointment

Verrugon®

Salicylic acid 26% solution

Occlusal®   For resistant veruccas

Salicylic acid 16.7% + lactic acid 16.7% paint

Duofilm®

Silver nitrate applicator (various strengths)

Used for removing granulation tissue, warts (including verrucae) for cautery as a caustic.

Anogenital Warts

Podophyllotoxin 0.5% alcoholic solution

Condyline®, Warticon Fem®

Podophyllotoxin 0.15% cream

Warticon®

Plain warts

 

Imiquimod 5% cream Aldara®. Restricted to specialist use only. Topical treatment of clinically typical genital warts in immunocompetent adult patients when size or number of lesions limit the efficacy and/or acceptability of cryotherapy and other topical treatment options have failed are contraindicated or less appropriate. Review FEB 2011.

BNF 13.8.1 Sunscreening preparations

Sunscreening Patient Information Leaflet

Anthelios® XL Melt-in cream (UVA, UVB protection; UVB-SPF 50+)

Sunscreens may only be prescribed for patients requiring protection from UV radiation in abnormal cutaneous photosensitivity resulting from genetic disorders or photodermatoses, including those resulting from radiotherapy and chronic or recurrent herpes simplex labialis.

Prescriptions must be endorsed “ACBS”.
Apply thickly and frequently (approximately every 2 hours)

Sunsense® Ultra Lotion (UVA, UVB protection; UVB-SPF 50)

Uvistat® cream (UVA, UVB protection; UVB-SPF 50)

Photodamage - Actinic keratosis

Diclofenac sodium 3% gel

Solareze®

Imiquimod 5% cream  Aldara®. Restricted to hospital specialist and Community Dermatology service use only.
Ingenol mebutate gel  2nd line. Suitable for prescribing in primary care where there is a confident diagnosis of actinic keratosis
Superficial basal cell carcinoma
Imiquimod 5% cream  Aldara®. Restricted to hospital specialist and Community Dermatology service use only. 

Photodynamic therapy in combination with methyl-5-aminolevulinate cream (Metvix®)

Treatment of melasma

First Line

Tretinoin (Retin-A®)

 
Azelaic acid (Skinoren®)   

Second Line (To be prescribed by specialist in dermatology only)

Tretinoin bleaching cream (Hydroquinone 5%, Hydrocortisone 1%, Tretinoin 0.1% in Aqueous Cream)

Applied daily for one month and alternate with other creams. If there is no benefit it should be stopped after 6 months.

BNF 13.8.2 Camouflagers

Borderline substances – please see BNF for details

BNF 13.9 Shampoos and some other scalp preparations


Coal Tar Preparations

First choice:

Neutrogena T/Gel® shampoo

Coal tar extract 2%.
Apply daily as needed.

Second choice:

 

 

 

Alphosyl 2 in 1® shampoo

Alcoholic coal tar extract 5%
Dandruff: Apply 1-2 times weekly as needed
Psoriasis, seborrhoeic dermatitis: use every 2-3 days

Capasal® shampoo

Coal tar 1%, coconut oil 1%, salicylic acid 0.5%
Use daily as needed

Sebco® scalp ointment

Coal tar solution 12% salicylic acid 2% precipitated sulphur 4% in coconut oil emollient base. 
Apply as needed (if severe, use daily for first 3 - 7 days)

Selsun® shampoo

Selenium sulphide 2.5%

Anti-Infective Preparations

Ceanel Concentrate®

Apply twice weekly.

Ketoconazole 2% shampoo

Apply twice a week x 2 – 4 weeks

Hirsutism

Eflornithine 11.5% cream

Vaniqa® Use only under the guidance of a Consultant Dermatologist or Endocrinologist

BNF 13.10.1 Antibacterial preparations

MRSA Infections
Apply mupirocin 2% ointment (Bactroban®) three times a day for 5 days.  Wait 2 days, then re-swab.  If MRSA still isolated – repeat course for a further 5 days. Instructions for the Application of MRSA Treatment with Hibiscrub and Mupirocin for Decolonisation

Polyfax® for mupirocin-resistant strains

Fusidic acid 2%

Fucidin®

Metronidazole 0.75%
Rosacea: Rozex® cream
Malodorous tumours: Anabact® gel

 

Mupirocin 2% ointment

Bactroban®

Silver sulfadiazine 1% cream

Flamazine®

BNF 13.10.2 Antifungal preparations

Skin scrapings should be examined especially where systemic therapy is being considered or there is doubt about diagnosis.

Skin infections

Amorolfine

Loceryl®

Clotrimazole 1%

 

Miconazole 2%

 

Nystatin + chlorhexidine

Nystaform®

Terbinafine 1%

Lamisil®

Nail infections

Tioconazole 28% nail solution

Trosyl®

BNF 13.10.3 Antiviral preparations

Aciclovir cold sore cream 5%

Apply 5 times a day for 5 days.

Please note: Brand prescribing for aciclovir costs 4-7 times more than generic prescribing


BNF 13.10.4 Parasiticidal preparations

HEAD LICE

Wet combing method

Suitable for all ages, those with skin conditions and those with asthma. For successful treatment 30 minutes combing, using hair conditioner plus a detection comb, must be performed on four occasions over a two week period.

Bug Buster Kit 

1 Nit Buster comb, 1 wide tooth comb plus a protective cap. No additional medicinal products required.
Nitty Gritty NitFree

 
Steel Nit comb with microgroved teeth

 

Chemical treatment

Shampoos are diluted too much to be effective – lotion, liquid or cream rinse formulations should be used.  Phenothrin and carbaryl are no longer available in UK, permethrin is no longer recommended.

  Age<2 years  Age>2 years  
Malathion 0.5% aqueous liquid (Derbac-M®) 

50ml

100ml

Suitable for all ages and those with skin conditions. It should be applied twice, with 7 days between applications. Apply to hair from roots to tips, left on hair and scalp for 12 hours or overnight, and then washed out using shampoo.
Isopropyl myristate and cyclomethicone solution (Full Marks Solution®) Not suitable 100ml

 

Not suitable for those with skin conditions, but suitable for those with asthma. It should be applied twice, with 7 days between applications. It is left in place for 10mins. Systematically comb the hair to remove lice and then wash solution out using shampoo.
Dimeticone 4% lotion (Hedrin®) 50ml

100ml

 

Suitable for all ages and those with skin conditions. It should be applied twice, with 7 days between applications. Apply to hair from roots to tips, left on hair and scalp for 8 hours or overnight, and then washed out using shampoo.
Coconut, anise, and ylang ylang spray (Lyclear Spray Away®) Not suitable

60ml

Not suitable for people with skin conditions or those with asthma. It should be applied twice, with 7 days between applications. It is left in place for 15mins. The hair is then washed using shampoo to remove the spray, and then hair systematically combed with fine comb to remove the lice.

CRAB LICE

Malathion and permethrin are used to eliminate crab lice (Pthirus pubis). An aqueous preparation of malathion 0.5% (Derbac-M®)or permethrin 5% (Lyclear Dermal cream®) should be applied to all hairy parts of the body, not just the pubic region; paying particular attention to the eye brows and other facial hair. The treatment should be allowed to dry naturally and washed off after 12 hours; a second treatment is needed after 7 days to kill lice emerging from surviving eggs.  

SCABIES

Permethrinand malathion are indicated for scabies.  All members of the household should be treated.  Treatment should be applied to the whole body, paying particular attention to the webs of the fingers and toes, and under the ends of the nails.  Patients should not wash their hands since this would require reapplication.  Patients with crusted or “Norwegian” scabies may require two or three applications on consecutive days, to ensure enough penetrates the skin crusts to kill all the mites.

 

Age

Supply

 

Permethrin 5% dermal cream (Lyclear Dermal cream®)

2 months to 11 years 11 months

30g

Single thorough application. Leave on 8-12 hours or overnight. Wash off. Repeat after 7 days

From 12 years onwards

60g

Malathion 0.5% aqueous liquid (Derbac-M®)

2 months to 1 year 11 months

100ml

Single thorough application. Leave on 24 hours. Wash off. Repeat after 7 days

From 2 years onwards

200ml

BNF 13.10.5 Preparations for minor cuts and abrasions

Proflavine 0.1% cream

Stains clothing

Skin tissue adhesive
For personal administration by the prescriber in primary care

Histoacryl® tissue adhesive

0.2g

LiquiBand® tissue adhesive

0.5g


BNF 13.11.1 Alcohols and saline

Sodium Chloride 0.9%

Flowfusor 120ml bellows pack

Normasol® 25 x 25ml sachet

BNF 13.11.2 Chlorhexidine salts

Hibiscrub® (chlorhexidine gluconate 4%)

Instructions for the Application of MRSA Treatment with Hibiscrub and Mupirocin for Decolonisation

Hibisol® (alcohol chlorhexidine gluconate 2.5%)

 

Hibitane 5% concentrate® (pink perfumed aqueous chlorhexidine gluconate 5%)

Dilute 1 in 100 with water (chlorhexidine gluconate 0.05% solution) for general skin disinfection. 

Unisept® (sterile pink chlorhexidine gluconate 0.05%, 25ml)

 

BNF 13.11.3 Cationic surfactants and soaps

Not routinely used.

BNF 13.11.4 Chlorine and iodine

Povidone iodine 2.5% dry powder spray

 

Povidone iodine 4% skin cleanser

 

BNF 13.11.5 Phenolics

Triclosan 2% bath concentrate

Ster-Zac®

Triclosan 2% skin cleanser

Aquasept®

BNF 13.11.6 Astringents, oxidisers and dyes

Potassium permanganate solution tablets (Permitabs®)

One tablet dissolved in 4 litres of water provides a 0.01% (1 in 10,000) solution, suitable for wet dressings or soaks.  Caution required - the solution will stain.

BNF 13.11.7 Preparations for promotion of wound healing

Desloughing agents

Hydrogen peroxide 1.5% cream

Hioxyl®

 

BNF 13.12 Antiperspirants

Aluminium chloride hexahydrate 20% in alcoholic base

Anhydrol Forte®, Driclor®

Aldioxa 0.22% chloroxylenol 0.5%

ZeaSORB®

Glycopyrronium bromide

Robinul®

BNF 13.13 Wound Management products

Please see the Wolverhampton Wound Management policy and guidelines

NICE Guidance: Surgical site infection NICE CG74