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Formulary

1 Topical Treatments

Our selection has been determined by personal prefer- should only be used when a licensed alternative is unavail-
ences and we accept that we have left out many effec- able. Many of these specials have a proven track record
tive remedies. However, the preparations listed here are over many years; however, the evidence for their usage
those that we use most often. As a result some appear is largely empirical. Nonetheless, they have become a
only in the UK column but not in the USA one, and trusted and essential part of the dermatological arma-
vice versa. To conform with current prescribing recom- mentarium. Due to a small potential market and short
mendations whenever possible we have listed these prod- shelf life they are often considered non-viable for com-
ucts under their active ingredients, with their proprietary mercial production, which is reflected in their dispro-
names in brackets. Up-to-date information can be found portionately high price. In an attempt to rationalize
at www.bnf.org.uk or www.fda.gov. the array of specials, the British Association of Der-
There is a limited range of licensed topical prod- matologists has produced an excellent booklet on the
ucts for the treatment of common skin conditions such most commonly used preparations, their indications and
as eczema and psoriasis. As a result dermatologists treatment regimes (http://www.bad.org.uk/healthcare-
may prescribe unlicensed alternatives or ‘specials’. These professionals/clinical-standards/specials).

Type of preparation and


general comments UK preparations USA preparations

Emollients
These are used to make dry Soft white paraffin BP Petrolatum alba USP
scaly skin smoother. Most Emulsifying ointment BP Vanicream – devoid of fragrances and
are best applied after a Liquid and White Soft Paraffin Ointment, NPF many sensitizers
shower or bath. The (liquid paraffin 50%, white soft paraffin 50%) Aquaphor – a hydrophilic petrolatum
opposite of dry is wet, not Aqueous cream BP – can be used as a soap Aveeno cream (Eczema Therapy)
greasy. While greasy substitute Plastibase – a hydrophilic polyglycol
formulations make the Aveeno range Eucerin – hydrophilic petrolatum
skin look moister, those Doublebase range containing water
containing humectants Hydromol cream and ointment Curel
such as glycerin, urea or Epaderm cream and ointment Moisturel
lactic acid generally Diprobase cream and ointment Lubriderm
moisturize better. On the E45 range Hydrolatum – petrolatum,
face, use moisturizers Oilatum range methylparaben
designed for the face to Unguentum M – a useful diluent: contains Carmol range – contains urea
minimize acne cosmetica propylene glycol and sorbic acid, which may humectant
sensitize Complex 15 facial – phospholipids
Neutrogena dermatological cream Lacticare lotion – contains
Aquadrate, Balneum, Eucerin Intensive, Hydromol alphahydroxy acid
Intensive and Calmurid creams contains urea
Dermol range – contains antimicrobials

Clinical Dermatology, Fifth Edition. Richard B. Weller, Hamish J.A. Hunter and Margaret W. Mann.
© 2015 John Wiley & Sons, Ltd. Published 2015 by John Wiley & Sons, Ltd.

397
398 Formulary 1

Type of preparation and


general comments UK preparations USA preparations

Bath additives/shower gels


These are a useful way of Balneum range Mineral oil bath emulsion (Keri
ensuring application to the Emulsiderm – contains benzalkonium chloride Moisture Rich Shower and Bath Oil,
whole skin. Most contain Oilatum range Eucerin Bath Therapy)
emollients which help with Aveeno range Colloidal oatmeal (Aveeno Eczema
dry itchy skin. Others Doublebase range Therapy Bath Treatment)
contain tar (see section on Hydromol bath emollient Balneum
psoriasis) or antibacterials. Dermol and Oilatum Plus ranges contain Hydromol Emollient
Caution: makes bathtubs antimicrobials
slippery

Shampoos
All contain detergents Containing tar Containing tar
which help to remove Alphosyl 2 in 1 DHS Tar Gel
debris and scales; some Polytar range Denorex shampoo – tingles on scalp
have added ingredients to T-Gel Neutrogena T-Gel
combat psoriasis, Capasal – also contains salicylic acid Tarsum Shampoo
seborrhoeic eczema and Polytar range
Others
bacterial infections. Most
Betadine – contains antibacterial povidone Others
work best if their lather is
iodine Selsun contains selenium sulfide and can
left on the scalp for
Ceanel concentrate – contains cetrimide, be used to treat pityriasis versicolor
5 minutes before being
undecenoic acid (p. 245)
rinsed off
Selsun – contains selenium sulfide and can be Nizoral – contains ketoconazole and is
used to treat pityriasis versicolor (p. 245) useful for seborrhoeic dermatitis and
Nizoral – contains ketoconazole and is useful for pityriasis versicolor
seborrhoeic dermatitis and pityriasis Head and Shoulders, Zincon – contains
versicolor zinc pyrethione
Meted – contains salicylic acid and sulfur Sebulex, Scalpicin, T-sal – contain
Dermax – contains benzalkonium chloride salicylic and sulfur
Caprex – contains fluocinonide

Cleansing agents
These are used to remove Solution of sodium chloride 0.9% (Normasol) – Syndets – neutral cleansers generally
debris and to combat used to clean wounds and ulcers milder than soap (Dove)
infection. Some are Potassium permanganate (Permitabs – one Chlorhexidine 4% (Hibiclens)
astringents which tablet in 4 L water makes a 0.01% solution) – concentrate – use diluted to 1 in 100
precipitate protein and in will stain clothing and skin (a 0.04% solution of chlorhexidine in
doing so help to seal the Aluminium acetate lotion – use at 0.65% in water for skin disinfection)
moist surface of a weeping water – is mildly astringent and used as wet Cetaphil gentle skin cleanser (lipid-free)
eczema or a stasis ulcer dressing Benzalkonium chloride (Ionax line)
Silver nitrate – use at 0.5% in water – is Triclosan (Dial, Lever 2000) –
astringent, stains skin brown deodorant, antibacterial
Chlorhexidine acetate 0.05% Sulfacetamide/Sulfur (Plexon) – cleanser
Chlorhexidine gluconate 4% (Hibiscrub) for rosacea
Ethyl alcohol gel (non-irritating
disinfectant for hand washing)
Topical Treatments 399

Type of preparation and general


comments UK preparations USA preparations

Barrier preparations
These are used to protect the skin Petrolatum Petrolatum
from irritants and are of value in Zinc and castor oil ointment BP Zinc oxide ointment
the napkin (diaper) area and Dimethicone and benzalkonium Kerodex 51 (water-miscible)
around stomas. Many contain the chloride (Conotrane) Kerodex 71 cream (water-repellent)
silicone, dimethicone. The choice Dimethicone and cetrimide (Siopel) Bentoquatum (Ivy Block Lotion)
of barrier creams for use at work protective against toxicodendron
depends upon individual (poison ivy allergy)
circumstances: recommendations Dermaguard spray
are not given here Flexible collodion (film)
Zinc oxide, lanolin, talc and vitamins
A and D (Desitin ointment)
Dimethicone (Diaper Guard
Ointment)
Anusol (zinc oxide plus pramoxine)
Bag Balm (contains
8-hydroxyquinoline sulfate)

Depigmenting agents
Most contain hydroquinone. The None in BNF but some preparations Hydroquinone 2–4% (Ambi Fade
use of agents containing available without prescription Cream (2% HQ), EpiQuin Micro
monobenzone causes permanent from chemists/cosmetic counters (4% HQ), Glyquin XM (4% HQ,
complete depigmentation Azelaic acid (Finacea gel 15%, oxybenzone, avobenzone and
Skinoren cream 20%) glycolic acid) Lustra (4% HQ),
Lustra-AF (4% HQ, sunscreen)
Hydroquinone (4%), tretinoin
(0.05%) and fluocinolone
acetonide (0.1%) (Tri-Luma)
Monobenzene/monobenzyl ether of
hydroquinone (Benaquin)
(Caution: permanent
depigmentation)
Azelaic acid (Finacea gel 15%, Azelex
cream 20%)

Camouflaging preparations
Blemishes that cannot be removed Covermark range Covermark range of products
can often be made less obvious by Dermablend range Dermablend
covering. Expert cosmetic advice Keromask range Powder Palette (Physician’s Formula –
may be needed to obtain the best Pierre Fabre) in green for
colour match correcting red blush of rosacea
400 Formulary 1

Type of preparation and general


comments UK preparations USA preparations

Sunscreens and sunblocks


These help the light-sensitive but Titanium dioxide (E45 Sun range) Avobenzone, homosalate, oxybenzone
are not a substitute for sun Cinnamate, oxybenzone and titanium (Neutrogena range, Aveeno range,
avoidance and sensible protective dioxide (Sunsense Ultra, Roc Sante Solbar range)
clothing. The sun protection Soleil, Uvistat range) Titanium dioxide, zinc oxide (Blue
factor (SPF) is a measure of their Lizard, Aveeno Natural Protection,
effectiveness against UVB more CoTZ, MelaShade, Neutrogena Pure
than UVA, but those & Free, TiZO3, Vanicream)
recommended here block Helioplex – stabilizes avobenzone and
UVA also oxybenzone, prolonging duration of
Allergic contact dermatitis protection (Neutrogena Ultra Sheer
from the sunscreen ingredients Dry Touch, Neutrogena Age Shield)
may be missed and the rash put Mexoryl SX – contains a photostable
down to a deterioration of the UVA-absorbing chemical ecamsule
original photosensitivity (Anthelios)

Antipruritics
Remember that these are of Calamine lotion BP Calamine lotion
limited value. Try to make a firm Oily Calamine lotion BP – contains Crotamiton (Eurax cream and lotion)
diagnosis that will lead to an arachis oil also used to treat scabies
effective line of treatment Menthol (0.5–2%) or phenol (1.0%) in Menthol and camphor (Sarna lotion)
aqueous cream contains menthol and camphor
Crotamiton cream and lotion (Eurax) – Doxepin (Zonalon cream)
also used to treat scabies Pramoxine (Prax, Pramegel, Itch-X)
Doxepin (Xepin cream) Pramoxine and hydrocortisone
(Pramosone, Aveeno Anti-itch
cream, Epifoam)
Benzocaine (Boil ease ointment,
solarcaine) – caution: may sensitize

Antiperspirants
Most antiperspirants are Aluminium chloride hexahydrate 20% Aluminum zirconium
deodorants too, but many (Anhydrol Forte solution or Driclor tetrachlorhydroxy gly (many
deodorants (e.g. triclosan) are solution). Botulinum toxin (Botox) drugstore products, e.g. Gillette and
not antiperspirants injections – for local temporary Speed stick lines)
anhidrosis of axillae or palms Aluminum chlorate 20% (Drysol)
Glycopyrronium bromide 0.05% solution 12.5% (CertainDri Roll-On), 6.25%
by iontophoresis (Robinul) to palmar or (Xerac-AC)
plantar skin Formaldehyde 10% solution
(Lazerformaldehyde) – caution: may
sensitize
Botulinum toxin (Botox) injections –
for local temporary anhidrosis of
axillae or palms
Glycopyrronium bromide 0.05%
solution by iontophoresis (Robinul)
to palmar or plantar skin
Topical Treatments 401

Type of preparation and general


comments UK preparations USA preparations

Keratolytics
These are used to counter an Salicylic acid, 2–4% in emulsifying Salicylic acid (6% Keralyt gel, Salex, Salkera)
excessive production of keratin. ointment or soft white paraffin Salicylic acid, 2–4% in emulsifying
Salicylic acid preparations should Zinc and salicylic acid (2%) paste ointment or soft white paraffin
be used for limited areas only (Lassar’s paste). Useful for Urea preparations at high concentrations
and not above 6%, as absorption hyperkeratotic, fissured skin (Carmol 20%, 40%)
and toxicity may follow their disorders Propylene glycol (Epilyt)
prolonged and extensive Urea preparations (see Emollients)
application, especially in infants Propylene glycol, 20% in aqueous cream

Depilatories
Over-the-counter depilatories are Eflornithine 11.5% (Vaniqa) retards Sulfides (Magic Shaving Powder)
used to remove unwanted facial hair regrowth Thioglycollates (Nair line, Neet line)
hairs and are all irritating. Zip wax, Nair microwave wax – mechanical
Eflornithine inhibits ornithine hair removal
decarboxylase in hair follicles Eflornithine hydrochloride cream 13.9%
(Vaniqa) retards hair regrowth

Steroids
Our selection here has had to be Mildly potent Mildly potent
ruthless as so many brands and Hydrocortisone 0.5, 1.0, 2.5% Hydrocortisone 0.5, 1.0, 2.5% (numerous
mixtures are now on the market preparations manufacturers)
Conventionally, they are Fluocinolone acetonide (Synalar cream Desonide (Desowen, Tridesilon, Desonate)
classified according to their 1 in 10) Alclometasone (Aclovate)
potency. Your aim should be to Fluocinolone acetonide 0.01% (Synalar,
use the least potent preparation Dermasmoothe)
that will cope with the skin
Moderately potent Moderately potent
disorder being treated. Side
Alclometasone dipropionate Betamethasone valerate (Valisone, Luxiq
effects and dangers are listed in
(Modrasone cream and ointment) Foam)
Table 26.2, p. 361.
Betamethasone valerate (Betnovate RD Hydrocortisone valerate (Westcort)
Nothing stronger than 1%
cream and ointment) Triamcinolone 0.025%, 0.1% (Kenalog,
hydrocortisone should be used
Clobetasone butyrate cream and Aristocort, various manufacturers)
on the face (except in special
ointment (Eumovate)
circumstances, e.g. discoid lupus
erythematosus) or in infancy. Be Potent Potent
reluctant to prescribe more than Betamethasone valerate (Betnovate Betamethasone dipropionate (Diprosone)
200 g of a mildly potent, 50 g of a range including scalp application, Mometason Furoate (Elocon)
moderately potent or 30 g of a Betacap scalp application, Fluticasone propionate (Cutivate)
potent preparation per week for Bettamousse scalp application) Fluocinonide (Lidex)
any adult for more than 1 month Fluticasone propionate (Cutivate cream Desoximetasone (Topicort range)
Most of the preparations listed and ointment) Hydrocotisone butyrate (Locoid range)
are available as lotions, creams, Mometasone furoate (Elocon range)
oily creams and ointments; your Hydrocortisone butyrate (Locoid range)
choice of vehicle will depend Fluocinolone acetonide (Synalar range)
upon the condition under
treatment (p. 363). Use twice Very potent Very potent
daily except for Cutivate and Clobetasol propionate (Dermovate Clobetasol propionate (Temovate, Olux
Elocon, which are just as range, Clarelux foam scalp treatment Foam, Clobex)
effective if used once a day and Etrivex shampoo) Halobetasol propionate(Ultravate)
Diflucortolone valerate (Nerisone Forte Betamethasone dipropionate in enhanced
range) vehicle (Diprolene)
Diflorasone diacetate (Psorcon)
402 Formulary 1

Type of preparation and


general comments UK preparations USA preparations

Steroid combinations
With antiseptics Potent Mildly potent
Betamethasone valerate and clioquinol cream Clioquinol and hydrocortisone (1%)
and ointment Iodoquinol 1% and hydrocortisone 1%
Fluocinolone acetonide with clioquinol (Vytone cream)
(Synalar-C cream and ointment) Iodoquinol 1% and hydrocortisone 2%
(Alcortin cream)
Iodoquinol 1.25% and aloe (Aloquin gel)
With antibiotics Mildly potent Mildly potent
Hydrocortisone and fusidic acid (Fucidin H Neomycin, bacitracin, hydrocortisone 1%
cream) (Corticosporin)
Hydrocortisone and oxytetracycline
(Terra-Cortril ointment)

Moderately potent and potent


Betamethasone valerate and neomycin
(Betnovate-N cream and ointment)
Fluocinolone acetonide and neomycin
(Synalar-N cream and ointment)
With antifungals Mildly potent Very potent
Hydrocortisone and clotrimazole (Canesten HC Clotrimazole and betamethasone
cream) dipropionate (Lotrisone)
Hydrocortisone and miconazole (Daktacort
cream and ointment)

Potent
Betamethasone dipropionate and clotrimazole
(Lotriderm cream)
With antibacterials and Mildly potent Moderately potent
antifungals Hydrocortisone, chlorhexidine and nystatin Nystatin and triamcinolone (Mycolog II)
(Nystaform HC cream and ointment)
Hydrocortisone, benzalkonium, nystatin and
dimeticone (a silicone) (Timodine cream)

Moderately potent
Clobetasone butyrate, oxytetracycline and
nystatin (Trimovate cream)

Very potent
Clobetasol propionate with neomycin and
nystatin cream and ointment
With calcipotriol Potent Potent
(For psoriasis) Betamethasone dipropionate (Dovobet ointment Betamethasone dipropionate (Taclonex
and gel) ointment)
With salicylic acid Potent
Betamethasone dipropionate and salicylic acid
(Diprosalic ointment – and scalp application)
Topical Treatments 403

Type of preparation and general


comments UK preparations USA preparations

Preparations for use in the mouth


Useful mouth washes
Topical analgesics Benzydamine hydrochloride solution Cetylpyridinium (Cepacol antiseptic
(Difflam oral rinse) – an analgesic mouthwash)
for painful inflammation in the Listerine antiseptic mouth rinse (contains
mouth thymol, eucalyptol, methylsalicylate,
Chlorhexidine gluconate 1% (Corsodyl menthol)
mouth wash) ‘All-purpose mouthwash’ – different
Hexetidine solution (Oraldene) an formulations – e.g. compounded as
antiseptic gargle nystatin suspension 100 000 U/mL,
120 mL; diphenhydramine elixir
12.5 mg/5 mL, 480 mL; hydrocortisone
powder 240 mg; sodium
carboxymethylcellulose 2%, 720 mL
‘Magic mouthwash’ – different
formulations – e.g. compounded as
equal parts Maalox (Magnesia and
alumina oral suspension) and
diphenhydramine elixir
12.5 mg/5 mL) – some also add
dexamethasone
Mucotrol – slow dissolving wafer,
diphenhydramine elixir 12.5 mg/5 mL)
Topical steroids Betamethasone soluble tablets Triamcinolone acetonide (Kenalog in
Hydrocortisone mucoadhesive buccal orabase) – a paste that adheres to
tablets to be dissolved slowly in mucous membranes
mouth near the lesion – usually an Fluocinonide gel (Lidex gel)
aphthous ulcer Clobetasol gel (Temovate gel)
For yeast infections Miconazole (Daktarin oral gel) Clotrimazole (Mycelex troches)
Nystatin (Nystan oral suspension) Nystatin oral suspension or pastilles
(Nilstat, Mycostatin)

Topical immunomodulators
Long-term safety data not yet Pimecrolimus (Elidel cream 1%). For Pimecrolimus (Elidel cream 1%). For mild
available, so should not generally be mild to moderate eczema to moderate eczema
used as first-line agents Tacrolimus (Protopic ointment 0.03%, Tacrolimus (Protopic ointment 0.03%,
0.1%). For moderate to severe 0.1%). For moderate to severe eczema
eczema

Preparations for otitis externa


Otitis externa, essentially an Aluminium acetate ear drops 8% – an Aluminium acetate ear drops 8% – an
eczema, is often complicated by effective astringent for the weeping effective astringent for the weeping
bacterial or yeast overgrowth – phase; best applied on ribbon gauze phase; best applied on ribbon gauze
hence the combinations listed here Hydrocortisone with neomycin and Hydrocortisone, neomycin and polymyxin
polymyxin (Otosporin drops) (Corticosporin drops)
Cotrimazole (Canesten solution) Ciprofloxacin 0.2% and hydrocortisone
1% (Cipro HC Otic)
Acetic acid 2% with or without
hydrocortisone (VoSol/VoSol-HC)
Tridesilon otic solution
404 Formulary 1

Type of preparation and general


comments UK preparations USA preparations

Antibacterial preparations
The ideal preparation should have Mupirocin (Bactroban cream and Mupirocin (Bactroban 2% ointment, 2%
high antibacterial activity, low ointment) cream)
allergenicity and the drug should Fusidic acid (Fucidin ointment and Nitrofurazone (Furacin ointment, cream
not be available for systemic use; cream) or solution)
this combination is hard to find. Polymyxin and Bacitracin (Polyfax Bacitracin
Some compromises are given here ointment) Gentamicin (Garamycin ointment)
Bacitracin and polymyxin (Polysporin
To eliminate nasal carriage of
ointment)
staphylococci
Silver sulfadiazine 1% cream – various
Mupirocin (Bactroban Nasal ointment)
manufacturers
Chlorhexidine and neomycin (Naseptin
Benzoyl peroxide 5–10% (antiseptic)
cream)
To eliminate nasal carriage of
staphylococci
Mupirocin (Bactroban nasal ointment)

Antifungal preparations
In our view, imidazole, terbinafine, Clotrimazole (Canesten cream) Clotrimazole (Lotrimin cream, solution
butenafine and amorolfine creams Miconazole (Daktarin cream) and powder, Mycelex)
have now supplanted their messier, Ketoconazole (Nizoral cream) Miconazole (Micatin cream)
more irritant and less effective rivals Terbinafine (Lamisil cream) Econazole (Spectazole cream,
(e.g. Whitfield’s ointment). They are Amorolfine (Loceryl nail lacquer) Zeasorb-AF Powder)
fungicidal and the fungistatic azoles Tioconazole (Trosyl cutaneous Terbinafine (Lamisil cream)
such as ketoconazole and solution) – applied locally it may Butenafine (Mentax cream)
clotrimazole have the added increase the success rate of Ciclopirox (Loprox cream and lotion,
advantage of combating yeasts as griseofulvin. Used by itself it may also Penlac nail lacquer, Ciclodan Kit)
well as dermatophytes cure or improve some nails Naftifine (Naftin cream)
Systemic therapy will be needed Oxiconazole (Oxistat)
for tinea of the scalp, of the nails Sertaconazole (Ertaczo)
and of widespread or chronic skin
infections that prove resistant to
topical treatment

Antiviral preparations
Topical products have little part to Aciclovir (Zovirax cream) Penciclovir (Denavir cream)
play in the management of herpes Penciclovir (Vectavir cream) Aciclovir (Zovirax cream)
zoster. However, if used early and Docosanol (Abreva cream)
frequently, they may help with
recurrent herpes simplex infections

Wart treatments
Palmoplantar warts Salicylic acid and lactic acid (Salactol Salicylic acid (Duofilm, Occlusal-HP)
paint or Salatac and Cuplex gel) Salicylic acid plasters 40%
Salicylic acid (at 26%, Occlusal solution: (Compound W)
at 50%, Verrugon ointment)
Glutaraldehyde (Glutarol solution)
Formaldehyde (Veracur gel)
Topical Treatments 405

Type of preparation and general


comments UK preparations USA preparations

Anogenital warts
Podophyllum should only be used Imiquimod (Aldara cream) – an Podophyllin resin, 15% (Podophyllin paint
for non-keratinized warts immunomodulator (p. 230) compound – use with care (p. 230)
Podophyllotoxin (Condyline solution, Podophyllin/benzoin (Podocon-25 powder)
Warticon cream and solution) Podofilox (Condylox gel)
Imiquimod (Aldara cream) (p. 230)

Preparations for treatment of scabies (p. 253)


Poor results follow inefficient usage Permethrin (Lyclear Dermal Cream) Permethrin (Elimite cream)
rather than ineffective preparations. Malathion (Derbac-M liquid) Lindane (Kwell lotion)
We prefer permethrin or sulfur in Benzyl benzoate application (BP). Crotamiton (Eurax cream) for use if itching
young children, and pregnant and Irritant and less effective than persists after treatment with more
lactating women. Written malathion or permethrin. effective scabicides
instructions are helpful (p. 256) Crotamiton (Eurax cream) for use if Precipitated sulfur 6% in soft white paraffin
itching persists after treatment with
more effective scabicides

Preparations for treatment of pediculosis (p. 249)


Resistance is a growing problem. Malathion (Derbac-M liquid) Malathione (Ovide)
Lotions left on for a minimum of Permethrin (Lyclear Creme Rinse) Permethrin (Nix)
12 hours are more effective, Permethrin/piperonyl butoxide (Rid)
although less convenient than Benzyl benzoate solution 20–25%
shampoos Precipitated sulfur 6% in Nivea Oil

Preparations for acne


Active ingredient
Benzoyl peroxide (an antibacterial Benzoyl peroxide (Panoxyl ranges) Benzoyl peroxide (Panoxyl, Benzac,
agent) induces dryness during the Potassium hydroxyquinoline with Desquam-X Oxy, Clearasil range 2.5, 5
first few weeks; this usually settles, benzoyl peroxide (Quinoderm range) and 10%)
even with continued use With sulfur (Sulphoxyl)
Retinoids
Potent comedolytic agents, also used Isotretinoin (Isotrex gel) Tretinoin (Retin-A preparations)
to reverse photoageing. May irritate. Isotretinoin and erythromycin Tretinoin and clindamycin (Ziana, Veltin)
Must be avoided during (Isotrexin gel) Tazarotene (Tazarac gel 0.05 and 0.1%)
pregnancy/lactation Tretinoin (Retin-A preparations) Adapalene (Differin gel, lotion and cream)
Adapalene (Differin gel and cream) Adapalene and benzoyl peroxide
Adapalene and benzoyl peroxide (Epiduo gel)
(Epiduo gel)
Antibiotics
Bacterial resistance is increasing, Clindamycin (Dalacin-T solution or Clindamycin (Cleocin-T solution and gel,
but can be reduced by concomitant roll-on) Evoclin Foam)
administration of benzoyl peroxide Erythromycin (Stiemycin solution) Erythromycin 2% solution – various
Erythromycin and zinc acetate (Zineryt) manufacturers
Clindamycin and benzoyl peroxide Sulfacetamide (Klaron lotion)
(Duac Once daily gel) Clindamycin and benzoyl peroxide (Duac,
Benzaclin, Acanya)
Erythromycin and benzoyl peroxide
(Benzamycin)
Sulfur and sulfacetamide (Sulfacet-R,
Sumadan)
406 Formulary 1

Type of preparation and general


comments UK preparations USA preparations

Azelaic acid and salicylic acid


Azelaic acid (Skinoren cream, Azelaic acid (Azalex cream, Finacea gel)
Finacea gel) Salicylic acid (Neutrogena clear pore gel,
Clearasil stick, Stridex gel)

Preparations for rosacea


Metronidazole (Metrogel, Rozex cream, Metronidazole gel, lotion, cream
Rosiced cream) (Metrogel, Metrocream, Metrolotion,
Azelaic acid (Finacea gel) Noritate)
Sulfur and Sulfacetamide (Sulfacet-R)
Sulfacetamide (Klaron)

Preparations for psoriasis


Vitamin D derivatives
Calcipotriol (calcipotriene, USA) Calcipotriol ointment and scalp solution Calcipotriene (Dovonex cream, lotion
and tacalcitol. Avoid using in (Dovonex ointment). Maximum and ointment)
patients with disorders of calcium weekly doses: 6–12 years, 50 g; over Calcitriol (Vectical)
metabolism 12–16 years, 75 g; adults, 100 g. Can Maximum doses same as UK
be irritant. Avoid on face
Calcitriol (Silkis ointment). Maximum
daily dose for adults, 30 g. Less irritant
than calcipotriol. Can be used on
face/flexures.
Tacalcitol (Curatoderm ointment and
lotion). Maximum daily dose for
adults, 10 g. Not recommended for
children
Steroids
Routine long-term treatment with Calcipotriol with betamethasone Calcipotriene with betamethasone
potent or very potent steroids is not diproprionate (Dovobet ointment diproprionate (Taclonex)
recommended. For indications and gel)
(p. 60)
Scalp applications Betamethasone (Betnovate scalp Clobetasol (Temovate scalp application,
application, Diprosalic scalp lotion – Olux foam)
also contains salicylic acid) Fluocinonide (Lidex solution)
Fluocinolone (Synalar gel) Fluocinonide in peanut oil
Dovobet gel (Dermasmoothe FS)
Clobetasol propionate (Etrivex Betamethasone valerate (Valisone
shampoo) lotion), Luxiq foam)
Dithranol/anthralin
Stains normal skin and clothing. Micanol range 1% Micanol 1%
May be irritant, therefore start with Dithrocream range 0.1, 0.25, 0.5, 1, 2% Dithrocreme 0.1, 0.25, 0.5, 1%
low concentration (for 30-minute Dritho-Scalp
regimen see p. 61)
Retinoid
Contraindicated in pregnancy and Tazarotene (Zorac gel) Tazarotene (Tazorac gel)
during lactation
Topical Treatments 407

Type of preparation and general


comments UK preparations USA preparations

Tar
These clean refined tar preparations
are suitable for home use. Messier,
although more effective,
formulations exist but are best used
in treatment centres
Bath additives Polytar emollient bath additive Balnetar liquid
Psoriderm bath emulsion
Applications Exorex lotion Denorex Psoriasis overnight treatment
Carbo-Dome cream MG-217 2% ointment
Psoriderm cream
Scalp applications Polytar liquid 10% Liquor carbonis detergens in
Exorex lotion Nivea oil
Psoriderm scalp lotion DHS Tar Gel
T-Gel shampoo Denorex shampoo
Neutrogena T-Gel
Tarsum Shampoo
Polytar range
Tar – salicylic acid combinations Sebco scalp ointment Sebulex, Scalpicin, T-sal
Cocois ointment
Capasal shampoo

Preparations for venous ulcers


Regardless of topical applications,
venous ulcers will heal only if local
oedema is eliminated. Remember
that the surrounding skin is easily
sensitized. To choose treatment for
an individual ulcer see p. 150
For cleansing Saline, potassium permanganate (see Saline, potassium permanganate (see
Cleansing agents) Cleansing agents)
Hydrogen peroxide solution (3%) Hydrogen peroxide solution (3%)
Bleach (sodium hypochlorite) 1/4 cup to
bathtub of water, or 1 tablespoon per
quart for soaking) – may bleach
fabrics
Low adherent dressings Tulle dressings (e.g. Bactigras, contains Telfa
chlorhexidine; Jelonet, paraffin gauze) Vaseline gauze (contains petrolatum)
Textiles (e.g. Mepitel)
Enzymes Enzymes (Elase Ointment – contains
fibrinolysin and deoxyribonuclease;
Collagenase Santyl ointment –
contains collagenase)
Antiseptics Silver sulfadiazine – active against Silver sulfadiazine (Silvadene cream)
Pseudomonas (Flamazine cream) Nitrofurazone (Nitrofurazone solution)
Cadexomer iodine (Iodosorb powder) Mupirocin (Bactroban Ointment)
408 Formulary 1

Type of preparation and general


comments UK preparations USA preparations

Other applications
Medicated bandages Zinc paste and ichthammol Zinc oxide
Beware of allergic contact reactions (Ichthopaste) Dextranomer (Debrisan) – for absorbing
to parabens preservatives which are Zinc oxide (Viscopaste PB7, steripaste) exudates
in most bandages Becaplermin (Regranex) – growth factor
Other dressings
Hydrocolloid (Granuflex, DuoDERM Hydrocolloid (Duoderm)
Extra Thin) Vapour-permeable film dressing (Opsite,
Calcium alginate (Kaltostat) Tegaderm)
Hydrogels (Intrasite, Aquaform) Hydrogel (Vigilon)
Polyurethane foam (Tielle) Calcium alginate
Vapour-permeable film dressing (Opsite) Biafin – recruits macrophages
Activated charcoal with silver (Actisorb
silver 200)

For photodamage
5-Fluorouracil
The treatment of individual lesions Efudix cream fluorouracil 5% cream Efudex cream 2% or 5%)
in patients with multiple actinic containing 5-fluorouracil is useful. It Fluroplex 1% cream
keratoses is tedious or impossible. should be applied twice daily for 2–3 Carac 0.5% solution – drug incorporated
Lesions on the scalp and face do weeks. For such cases patients should into microsphere
better than those on the arms and be warned about the inevitable
hands inflammation and soreness which
appears after a few days
Actikerall fluorouracil 0.5%, salicylic
acid 10%, apply once daily for up to
12 weeks
Imiquimod
Enhances the immune response to Imiquimod 5% (Aldara) Imiquimod 5% (Aldara)
superficial basal cell carcinomas and Applied 5 days per week for 6 weeks. The Applied 5 days per week for 6 weeks for
actinic keratoses response is related to the degree of treatment of superficial basal cell
inflammation. When used to treat carcinomas. The response is related to
actinic keratoses, apply three times the degree of inflammation. When
per week for 4 weeks used to treat actinic keratoses, apply
two times per week for 16 weeks and
wash off after 8 hours

Miscellaneous
For actinic keratoses
Diclofenac
3% Diclofenac sodium in sodium 3% Diclofenac sodium in sodium
hyaluronate base (Solaraze gel). hyaluronate base (Solaraze). Applied
Applied twice daily for 60–90 days twice daily for 60–90 days
Ingenol mubutate
Picato. For treatment of face and scalp, Picato 0.015% or 0.05%.
use 0.015% gel daily for 3 days. For For treatment of face and scalp, use
treatment of trunk and extremities, 0.015% gel daily for 3 days. For
use 0.05% gel daily for 2 days treatment of trunk and extremities,
use 0.05% gel daily for 2 days
Topical Treatments 409

Type of preparation and general


comments UK preparations USA preparations

Minoxidil
May be used as a possible treatment for Regaine liquid 2 or 5% – only on private Rogaine 2% solution
early male-pattern alopecia. The prescription Rogaine 5% solution for men
response is slow, and only a small
minority of patients will obtain a dense
regrowth even after 12 months. Hair
regained will fall out when treatment
stops – warn patients about this
Capsaicin
A topical pepper that depletes Axsain cream (0.075%), Zacin cream Zostrix cream (0.025%)
substance P. Useful for the treatment of (0.075%) Capzasin HP cream (0.075%)
post-herpetic neuralgia. May itself Axsain cream (0.075%)
sting. Apply up to 3–4 times daily after
lesions have healed. May take 2–4
weeks to relieve pain
Lidocaine/prilocaine
A local anaesthetic for topical use. Lidocaine and prilocaine (EMLA cream) Lidocaine 4% (LMX 4)
Applied on skin as a thick layer of Lidocaine 5% (LMX 5)
cream under an occlusive dressing or Lindocaine 2.5%/prilocaine 2.5%
on adult genital mucosa with no (EMLA cream)
occlusive dressing. Read manufacturer’s
instructions for times of application