Notes for: SkinLast edited [06/01/2023 11:35:01]NHS Kernow emollient prescribing guideline September 2021
NHS Kernow moisture associated skin damage pathway September 2021
Emollient Pathway 2022
Fire risk with paraffin-containing products
Management of skin conditions
With skin disease it is extremely important to consider patient acceptability of a product to maximise patient compliance. There is a wide range of products available and patient acceptance of individual products is very variable.
Where a consultant or GP with specialist interest asks a GP to prescribe a non-formulary agent they should check that formulary agents have been tried and not tolerated by the patient
Greasy preparations (ointments) are often preferable to creams in most circumstances because:
- They contain fewer skin sensitisers
- They are more hydrating (i.e. water retaining)
- There is better penetration of active ingredients
However, patient preference or activity may necessitate a combination of ointments and creams, for example, patients may prefer to apply creams during the day and use ointments at night, or different preparations on different parts of the body.
Application technique: It is important to educate patients with the correct application technique. Ointments and creams should be applied down the direction of hair growth. They should also be smeared on and not rubbed in.
Pot Hygiene: When supplying patients with pots of emollient, it is important to educate them about the hygiene required. Patients should be advised to decant from the pot onto plate/bowl etc. using a spoon or a spatula. Hands should not be put into the pot as this will lead to the introduction of foreign particles.
In many cases generic prescribing will be difficult because products contain a combination of active ingredients. In this chapter brand names are used for products which should not be prescribed generically.
Extemporaneous preparations: A product should only be extemporaneously prepared when there is no product with a marketing authorisation available. Depending on the formulation this may be done in a pharmacy, or by a specials manufacturer, usually depending on the formulation. Where a specials manufacturer prepares the product, additional charges will be incurred. The cost can, and usually does, exceed £100 for a cream. The cost is usually the same whether 500 g or 50 g of a product is ordered. Specials all have a very short shelf life with an expiry date of a maximum of 28 days from manufacture.
A range (but not all) of specials preferred by the British Association of Dermatologists has been approved for use within Cornwall mainly for prescribing by secondary care.
Notes for: Preparations For PsoriasisLast edited [10/07/2012 13:09:58]
5-methoxypsoralen, 8-methoxypsoralen, puvasoralen bath lotion and puvasoralen 8 emulsion are only used under supervision in secondary care as part of UVA light therapy. They have no therapeutic use other than this. When applied or ingested the patient becomes very photosensitive and must avoid sunlight for at least 24 hours.
Last edited [02/08/2013 13:01:52]
Emollients and soap substitutes are general measures for the treatment of plaque psoriasis. The main groups of treatment are:-
-
Salicylic acid - useful for its keratolytic action where there is thickening and scaling of skin. Side effects are few but include irritation, or, when large areas are treated, salicylate toxicity.
Coal tar - more active than salicylic acid and has anti-inflammatory and anti-scaling properties. The formulation and strength chosen depends on patient acceptability, severity and site of the condition. Some of the new commercial preparations may be more acceptable. Because of safety concerns over coal tar, extemporaneous dispensing in the community is now an uncommon practice. When extemporaneously dispensed items are prescribed in secondary care % coal tar relates to % strong coal tar solution.
Dithranol - the most potent topical preparation available. It can cause severe skin irritation and should only be prescribed by those experienced in its use.
Calcipotriol / Tacalcitol - vitamin D derivatives that do not have an unpleasant smell and do not stain clothing, though they may irritate the face. More expensive than other topical treatments but equally or slightly more effective than the alternatives, other than for guttate psoriasis when vitamin D derivatives are generally less effective. Dovonex gel is generally a third line option after emollients and calcipotriol ointment for the body, and after tar or steroid preparations or Dovonex scalp solution for the scalp. As with all commonly used topical therapies for psoriasis it is important that patients are told how to use the product and to persevere with the treatment
Calcitriol should be used for those patients not responding to calcipotriol, or where application is on the face or flexure.
Calcitriol can be applied to the face with caution, as there is an increased risk of irritation on this area. There is limited clinical experience for the use of calcitriol prescribed for more than 6 weeks
Irritant preparations (tar, dithranol, vitamin D derivatives) should be avoided in flexure psoriasis. A mild steroid with or without an antiseptic is appropriate.
For severe resistant psoriasis oral treatments (acitretin, ciclosporin, hydroxycarbamide or WEEKLY methotrexate) may be initiated and supervised by a Consultant.