Doncaster & Bassetlaw Medicines Formulary

Section 13.4: Topical

Potency: Mild 1% cream & ointment

Moderate 0.025% cream & ointment 0.05% cream & ointment

Potent Betamethasone 0.1% cream, ointment & scalp application

WITH SALICYLIC ACID Betamethasone 0.05% plus Salicylic Acid 3% ointment (Diprosalic) Betamethasone 0.05% plus Salicylic Acid 2% scalp Application (Diprosalic)

Approved by Drug and Therapeutics Committee: March 2018 Review Date: March 2021

Prescribing Guidance:

Topical corticosteroids are used for the treatment of inflammatory conditions of the skin. They are not curative and on stopping treatment a rebound exacerbation of the condition may occur.

Choice of formulation Corticosteroids are categorised as mild, moderate, potent and very potent (see above); the least potent preparation which is effective should be used.

Water miscible creams are suitable for moist or weeping lesions. Ointments are used for dry lichenified or scaly lesions where a more occlusive effect is required. Occlusion under polythene or a hydrocolloid dressing increases the absorption of the and thus the risk of side effects.

Side effects can occur particularly with the potent/very potent preparations. These include thinning of the skin, irreversible striae atrophicae, contact and perioral dermatitis, and acne or worsening acne.

To minimise side effects it is important to apply the topical thinly to the affected area only no more than twice a day.

KEY: [UL] Unlicensed Preparation; Drug – first line choice; Drug – hospital only; Drug – Amber (TLS), Drug – Red (TLS), see http://medicinesmanagement.doncasterpct.nhs.uk/ Contra-indications Use in untreated bacterial, fungal or viral skin lesions, acne rosacea, and perioral dermatitis. Potent corticosteroids are contraindicated in widespread plaque psoriasis.

The combining of a with an anti-infective drug should be used regularly for a short period of time (i.e. twice daily for one week) to minimise resistance and sensitisation.

Prescribing outside this formulary should only take place via a New Product Request Doncaster & Bassetlaw Medicines Formulary

Items for Restricted Prescribing

Potency: Moderate 0.05% cream & ointment (Modrasone) Fludroxycortide 4micrograms/cm2 tape (Haelan)

Potent 0.1% cream, lipocream, ointment & lotion (Locoid) Acetonide 0.025% cream & ointment (Synalar) Furoate cream, ointment & lotion (Elocon)

Very potent Proprionate 0.05% cream, ointment & scalp application (Dermovate)

WITH UREA Hydrocortisone 1% plus Urea 10% cream (Alphaderm) Hydrocortisone 1% plus Urea 10% plus Lactic Acid 5% Cream (Calmurid HC)

WITH ANTIMICROBIALS Mild Hydrocortisone 1% plus Clotrimazole 1% cream (Canesten HC) Hydrocortisone 1% plus 2% cream (Daktacort)

Moderate Clobetasone 0.05% plus Oxytetracycline 3% plus Nystatin 100,000units/g cream (Trimovate)

Potent Fluocinolone 0.025% plus Clioquinol 3% cream & ointment (Synalar C) Betamethasone 0.1% plus Neomycin 0.5% cream & ointment Hydrocortisone Butyrate 0.1% plus Clioquinol 3% cream & ointment (Locoid C)

Approved by Drug and Therapeutics Committee: March 2018 Review Date: March 2021

Prescribing outside this formulary should only take place via a New Product Request