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Doncaster & Bassetlaw Medicines Formulary

Section 13.5: Preparations for Eczema and

Calcipotriol 50micrograms/g cream, ointment & scalp application (Dovonex) 50micrograms/g plus Betamethasone 0.05% ointment & gel (Dovobet) Calcipotriol 50micrograms/g plus Betamethasone 0.05% foam (Enstilar)

Coal Tar & Salicylic Acid scalp ointment (Sebco/Cocois)

Coal Tar pomade

Coal Tar 1% in emollient base (Exorex)

Coal Tar 1% plus Coconut Oil 1% plus Salicylic Acid 0.5% shampoo (Capasal)

Dithranol 0.1%-2% cream (Dithrocream) in Lassars Paste 0.1%-8% Dithranol 1% & 3% (Micanol)

Items for Restricted Prescribing

Calcitriol 3micrograms/g ointment (Silkis) Tacalcitrol 4micrograms/g lotion (Curatoderm)

Acitretin 10mg and 25mg capsules

Ciclosporin 10mg, 50mg and 100mg capsules Methotrexate 2.5mg tablets

Tacrolimus 0.03% and 0.1% ointment (Protopic) Pimecrolimus 1% cream (Elidel)

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

Prescribing Guidance:

Psoriasis

Emollients, as well as having an effect on dryness, scaling and cracking, may have an antiproliferative effect in psoriasis. Emollients are particularly useful in inflammatory psoriasis and plaque psoriasis of the palms and soles.

KEY: [UL] Unlicensed Preparation; Drug – first line choice; Drug – hospital only; Drug – Amber (TLS), Drug – Red (TLS), see http://medicinesmanagement.doncasterpct.nhs.uk/ For chronic stable plaque psoriasis, analogues, coal tar and dithranol are used. Vitamin D analogues affect cell division and differentiation. The topical preparations do not smell or stain, however local skin irritation is common. A maximum daily or weekly amount to be used is stated for these preparations.

Coal tar has anti-inflammatory and anti-scaling properties. However preparations of coal tar are smelly, messy and are not well tolerated by patients. Coal tar preparations are not generally harmful to normal skin, but irritation and contact allergy can occur.

Dithranol is effective for chronic plaque psoriasis but does cause irritation, and staining of the skin and clothing. Treatment should be started with the lowest concentration 0.1% and increased gradually every few days according to tolerance up to 3%. Short contact method is applied with the preparation being washed off the skin after 5 to 60 minutes.

Items for Restricted Prescribing:

Allitretinoin 10mg and 30mg Capsules

For dermatologist use only in severe chronic hand eczema unresponsive to treatment with potent topical corticosteroids

Oral

Acitretin is indicated for severe extensive resistant psoriasis and palmoplantar pustular psoriasis but is contra-indicated in pregnancy due to a risk of teratogenicity – see current version of the BNF for further information. It is also contra-indicated in hepatic impairment, renal impairment, hyperlipidaemia and breastfeeding.

Drugs Affecting Immune Response

Due to varying between brands of Ciclosporin, Neoral is the brand of choice.

Only 2.5mg tablets of Methotrexate are available to reduce the risk of errors. A single dose is given once weekly. Prescribers should pay close attention to the strength and frequency in order to avoid errors.

A Methotrexate patient information booklet is available from the Trust Internet website via the following link:

Prescribing outside this formulary should only take place via a New Product Request http://www.dbh.nhs.uk/Library/Patient_Information_Leaflets/WPR19951- Methotrexat.pdf

Topical Tacrolimus and Pimecrolimus are not recommended for the treatment of mild atopic eczema or as first-line treatments for atopic eczema of any severity.

See also NICE Guidance: Tacrolimus and Pimecrolimus for Atopic Eczema

Cytokine Modulators

Use of cytokine modulators is restricted to that detailed within the relevant NICE guidance by a Consultant specialising in the management of the specific disease state. Concordance with details of the guidance is assured using the Blueteq system.

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