Skin

Approved: 1 Aug 2012. Last amended: 26 Jun 2024.

Management of skin conditions
Emollient and barrier preparations
Antipruritics
Topical corticosteroids
Preparations for Eczema and Psoriasis
Acne and rosacea
Preparations for warts and calluses
Sunscreens and camouflagers
Shampoos and other preparations for scalp and hair conditions
Anti-infective skin preparations
Skin cleansers and antiseptics
Antiperspirants
Wound management products and elastic hosiery
Miscellaneous

13.2.1 Emollients

For Emollients, please see the Gloucestershire Emollient Formulary

13.2.2 Barrier Preparations

For recommended barrier preparations, please see the Gloucestershire Woundcare Formulary

Specific Indication

Zinc and castor oil ointment

Zinc preparations are restricted to use by the dermatologists

For recommended topical antipruritics, please see the Gloucestershire Emollient Formulary

Doxepin Hydrochloride 5%

Cream (Xepin®) – for small areas only. Restricted to dermatology. Doxepin cream can cause drowsiness that may affect skilled tasks and there may be a risk of sensitisation.

Frequency of application of topical corticosteroids for atopic eczema: NICE TA81

Head and neck

2.5 FTU/application, Approx 10g per week

Each arm

4 FTU/application, Approx 15g per week

Trunk

14 FTU/application, (7 FTU to front and 7 FTU to back), Approx 50g per week

Each leg

Each leg: 8 FTU/application, Approx 30g per week

13.4.1 Topical Steroids

13.4.1.1 Mild

Hydrocortisone 0.1, 0.5, 1.0 and 2.5%

Cream/ointment

Synalar 1 in 10 Dilution®

Cream (fluocinolone 0.0025%)

13.4.1.2 Moderate

Eumovate®

Cream/ointment (clobetasone butyrate 0.05%)

Betnovate RD®

Cream/ointment (betamethasone valerate 0.025%)

Haelan®

Tape (fludroxycortide 4 micrograms/cm2)
Information leaflet

Synalar 1 in 4 Dilution®

Cream/ointment (fluocinolone 0.00625%)

13.4.1.3 Potent

Betamethasone valerate 0.1%

Cream / Ointment / Lotion

Diprosalic®

Ointment (betamethasone dipropionate 0.05% with salicylic acid 3%)

Elocon®

Cream/ointment (mometasone furoate 0.1%)

13.4.1.4 Very Potent

Dermovate®

Cream/ointment (clobetasol propionate 0.05%)

Nerisone Forte®

Oily cream (diflucortolone 0.3%)

13.4.2 Topical Steroids with antimicrobials

13.4.2.1 Mild

Canesten HC®

Cream (hydrocortisone 1% and clotrimazole 1%)

Fucidin H®

Cream/ointment (hydrocortisone 1% and fusidic acid 2%)

Daktacort®

Cream/ointment (hydrocortisone 1% and miconazole 2%)

Timodine®

Cream (hydrocortisone 0.5%, nystatin 100,000 units/g, benzalkonium chloride solution 0.2% and dimeticone ‘350’ 10%)

13.4.2.2 Moderate

Trimovate®

Cream (clobetasone butyrate 0.05%,oxytetracycline 3% & nystatin 100,000 units/g)

13.4.2.3 Potent

Betnovate-C®

Cream/ointment (betamethasone 0.1% and clioquinol 3%)

Lotriderm®

Cream (betamethasone dipropionate 0.064% and clotrimazole 1%)

FuciBET®

Cream (betamethasone 0.1% and fusidic acid 2%)

Betnovate N®

Cream /ointment (betamethasone 0.1% and neomycin 0.5%)

Aureocort®

Ointment (triamcinolone 0.1% and chlortetracycline 3%)

13.4.3 Compound preparations

13.4.3.1 Mild

Eurax-Hydrocortisone®

Cream (hydrocortisone 0.25% and crotamiton 10%)

13.4.3.2 Moderate

Alphaderm®

Cream (hydrocortisone 1% and urea 10%)

Calmurid HC®

Cream (hydrocortisone 1%, urea 10%, lactic acid 5%)

13.4.4 Steroid scalp applications

13.4.4.1 Potent

Betamethasone 0.1%

(Betacap®) scalp application, (Betnovate®) scalp application, (Bettamousse®) foam scalp application

Diprosalic®

Scalp application (betamethasone 0.05% and salicyclic acid 2%)

Synalar®

Gel (fluocinolone acetonide 0.025%)

13.4.4.2 Very Potent

Clobetasol propionate 0.05%

Dermovate® scalp application
Clarelux® foam
Etrivex® shampoo

13.5.1 Preparations for eczema

Please refer to section 13.2 (emollients) and 13.4 (topical corticosteroids).

Specific Indication

Ichthopaste®

(zinc paste and ichthammol) bandage – only to be applied by a Nurse skilled in paste bandage appplication

Steripaste®

Zinc Bandages. Only to be applied by a Nurse skilled in paste bandage appplication

Zipzoc®

(zinc paste) bandage

13.5.1.1 Oral retinoid for eczema

Alitretinoin

Severe chronic hand eczema: NICE TA177

13.5.2 Preparations for psoriasis

Topical preparations

Please refer to the BNF for information regarding vitamin D and analogues.

13.5.2.1 Vitamin D and analogues

Dovonex®

Scalp solution (calcipotriol)

Dovobet®

Gel (calcipotriol with betamethasone 0.05%) – body and scalp

Enstilar®

Cutaneous foam (calcipotriol with betamethasone 0.05%)

Silkis®

Ointment (calcitriol 3micrograms/g)

13.5.2.2 Topical retinoid

Tazarotene

0.05%, 0.1% gel

13.5.2.3 Compound product

Chelsea Day mix (Hospital Formula) is only available as a ‘special’ preparation (i.e. not a proprietary product).

These preparations are not cost-effective in primary care and there may be a significant delay in obtaining such preparations.

Chelsea Day mix

(Hospital Formula) possible price on FP10 prescription: up to £250 for 100g

13.5.2.4 Coal tar

Chelsea Night mix and Coal Tar 5% in Eumovate® ointments are only available as ‘special’ preparations (i.e. not proprietary products).

These preparations are not cost-effective in primary care and there may be a significant delay in obtaining such preparations.

Cocois®

Scalp ointment

Exorex®

Lotion

Alphosyl HC®

Cream (with hydrocortisone 0.5%)

Polytar Emollient®

Bath additive (contains peanut oil)

Coal Tar 5% in Eumovate®

Ointment possible price on FP10 prescription: up to £588 for 500g

Chelsea Night mix

Possible price on FP10 prescription: up to £250 for 100g

13.5.2.5 Dithranol

Dithrocream®

0.1%, 0.25%, 0.5%, 1% and 2% - specialist use only

Micanol®

1%, 3% cream.
Specialist use only

Dithranol in Lassar’s Paste

0.1%, 0.25%, 0.5%, 1%, 2%, 4%
Specialist use only

Dithranol in Lassar's Paste

GHNHSFT Local Guideline

Dithranol in Lassar's Paste

Sample drug chart

13.5.2.6 Salicylic Acid

The 'amber' topical salicylic acid preparations below are only available as ‘special’ preparations (i.e. not proprietary products).

These preparations are not cost-effective in primary care and there may be a significant delay in obtaining such preparations.

Salicylic acid 2% ointment

Possible price on FP10 prescription: £1 for 100g

Salicylic acid 5% in white soft paraffin

Second-line to Flexitol® (see section 13.2.4.5)
Possible price on FP10 prescription: up to £100 for 100g

Salicylic acid 10% in white soft paraffin

Second-line to Flexitol® (see section 13.2.4.5)
Possible price on FP10 prescription: up to £100 for 100g

13.5.2.7 Oral retinoids for psoriasis

Acitretin

Specialist use only

13.5.3 Drugs affecting the immune response

13.5.3.1 Topical

Protopic®

Ointment (tacrolimus 0.03% and 0.1%) – NICE TA82

Elidel®

Cream (pimecrolimus 1%) – NICE TA82

Abrocitinib

Atopic dermatitis: NICE TA814

Adalimumab

Psoriasis: NICE TA146, NICE TA455

Apremilast

Psoriasis: NICE TA419

Baricitinib

Atopic dermatitis: NICE TA681

Bimekizumab

Psoriasis: NICE TA723

Brodalumab

Psoriasis: NICE TA511

Certolizumab

Psoriasis: NICE TA574

Deucravacitinib

Psoriasis: NICE TA907

Dimethyl fumarate

Psoriasis:

NICE TA475
Local Criteria Based Access scheme

Dupilumab

Atopic dermatitis: NICE TA534

Etanercept

Psoriasis: NICE TA103, NICE TA455

Guselkumab

Psoriasis: NICE TA521

Infliximab

Psoriasis: NICE TA134

Ixekizumab

Psoriasis: NICE TA442

Risankizumab

Psoriasis: NICE TA596

Secukinumab

Psoriasis: NICE TA350, NICE TA734

Tildrakizumab

Psoriais: NICE TA575

Tralokinumab

Atopic dermatitis: NICE TA814

Upadacitinib

Atopic dermatitis: NICE TA814

Ustekinumab

Psoriasis: NICE TA180, NICE TA455

13.6.1 Comedonal Acne

13.6.2 Mild to Moderate Papulopustular Acne

13.6.3 Severe acne: Specialist initiation only

Isotretinoin

Specialist use only

13.6.4 Topical preparations for rosacea

Specific Indication

Soolantra®

Cream (ivermectin 10mg/g) – where the recommended choices are ineffective or not tolerated

13.6.5 Oral antibacterials for acne and rosacea

Specific Indication

Doxycycline MR

(Efracea®) 40mg od – Strictly reserved for patients wfho have demonstrated a definite intolerance to the recommended options

Salactol®

Paint (salicylic acid 16.7% and lactic acid 16.7%)

Posalfilin®

Ointmefnt (salicylic acid 25% and podophyllum 20%)

Cantharone Plus®

(cantharidin, podophyllum resin, salicylic acid) – unlicensed

13.7.1 Anogenital warts

Ideally all patients should first receive a full genito-urinary screen at GUM but there may be circumstances when Dermatologists may need to prescribe.

Warticon®

Cream (podophyllotoxin)

Aldara®

Cream (imiquimod 5%)

13.8.1 Sunscreen preparations

The following sunscreens may be prescribed for skin protection against ultraviolet radiation in abnormal cutaneous photosensitivity resulting from genetic disorders or photodermatoses, including vitiligo and those resulting from radiotherapy; chronic or recurrent herpes simplex labialis; patients taking photosensitising drugs and patients having PUVA.

RoC Total Sunblock® SPF 25

13.8.2 Photodamage Actinic Keratosis

Specific Indication

Actikerall®

Solution (Fluorouracil 0.5%, salycylic acid 10%) – Hypertrophic actinic keratosis. Lesion treatment where cryotherapy unavailable

Aldara® cream

(imiquimod 5%) – patients who have failed to respond to other options

Metvix® cream

(Methyl-5-Aminolevulinate). Treatment of actinic keratoses, superficial or nodular basal cell carcinoma and Bowen's Disease

13.8.3 Miscellaneous

Pigmanorm®

Cream (hydroquinone 5%, tretinoin 0.1%, hydrocortisone 1%) – melanin-induced hyperpigmentation of the skin (unlicensed)

Please refer to the BNF for information regarding constituents.

Alphosyl 2 in 1®

Shampoo

Capasal®

Shampoo

Dermax®

Shampoo

Ketoconazole 2%

Shampoo

Polytar®

Liquid

13.10.1 Antibacterial preparations

13.10.1.1 Antibacterial preparations only used topically

Bactroban®

Mupirocin 2% cream

Polyfax®

Polymixin B sulphate and bacitracin zinc ointment

Flamazine®

Silver sulfadiazine 1% cream

13.10.1.2 Antibacterial preparations also used systemically

Fucidin®

Ointment/cream (fusidic acid 2%)

Rozex®

Gel/cream (metronidazole 0.75%) – For malodorous tumours and skin ulcers

13.10.1.3 Rosacea

Rozex®

Gel/cream (metronidazole 0.75%)

13.10.2 Antifungal preparations

Alternative

Miconazole 2%

Cream

Terbinafine 1%

Cream

Nystatin

Cream/ointment

Nizoral®

Cream (Ketoconazole 2%)

Specific Indication

Amorolfine 5%

Nail laquer (prescribe generically) – nail infections, where oral therapy is contra-indicated.

13.10.3 Antiviral preparations

Aciclovir 5%

Cream - should only be started at first sign of attack.

13.10.4 Parasiticidal preparations

Hedrin®

Lotion (Dimeticone 4%)

Derbac M®

Aqueous liquid (Malathion 0.5%)

Lyclear®

Dermal cream (Permethrin 5%)

13.10.5 Preparations for minor cuts and abrasions

Skin tissue adhesive

LiquiBand®

Histoacryl®

GHNHSFT Local Guideline: Infection Control Policy

13.11.1 Oxidisers and dyes

Permitabs®

(Potassium permanganate) 400mg

For external use only, toxic if swallowed. Only prescribe where use is absolutely necessary, and safe handling and storage have been clearly discussed.

Potassium permanganate application policy

GHNHSFT Local Guideline: Potassium permanganate application policy (intranet)

Driclor®

(Aluminium chloride hexahydrate 20%)

Gloucestershire Wound Management Formulary

13.13.1 Topical treatments for scar reduction

Dermatix®

Gel

Adalimumab

Moderate to severe hidradenitis suppurativa as per NICE TA392

Secukinumab

Moderate to severe hidradenitis suppurativa as per NICE TA935

Birch bark extract (Filsuvez® gel)

Epidermolysis bullosa, as per NICE HST28

Ritlecitinib

Severe alopecia areata, as per NICE TA958

Management of skin conditions
Emollient and barrier preparations
Antipruritics
Topical corticosteroids
Preparations for Eczema and Psoriasis
Acne and rosacea
Preparations for warts and calluses
Sunscreens and camouflagers
Shampoos and other preparations for scalp and hair conditions
Anti-infective skin preparations
Skin cleansers and antiseptics
Antiperspirants
Wound management products and elastic hosiery
Miscellaneous

13: Skin

On this page

13.1 Management of skin conditions

13.2 Emollient and barrier preparations

13.2.1 Emollients

13.2.2 Barrier Preparations

Specific Indication

Zinc and castor oil ointment

13.3 Antipruritics

Doxepin Hydrochloride 5%

13.4 Topical corticosteroids

Head and neck

Each arm

Trunk

Each leg

13.4.1 Topical Steroids

13.4.1.1 Mild

Hydrocortisone 0.1, 0.5, 1.0 and 2.5%

Synalar 1 in 10 Dilution®

13.4.1.2 Moderate

Eumovate®

Betnovate RD®

Haelan®

Synalar 1 in 4 Dilution®

13.4.1.3 Potent

Betamethasone valerate 0.1%

Diprosalic®

Elocon®

13.4.1.4 Very Potent

Dermovate®

Nerisone Forte®

13.4.2 Topical Steroids with antimicrobials

13.4.2.1 Mild

Canesten HC®

Fucidin H®

Daktacort®

Timodine®

13.4.2.2 Moderate

Trimovate®

13.4.2.3 Potent

Betnovate-C®

Lotriderm®

FuciBET®

Betnovate N®

Aureocort®

13.4.3 Compound preparations

13.4.3.1 Mild

Eurax-Hydrocortisone®

13.4.3.2 Moderate

Alphaderm®

Calmurid HC®

13.4.4 Steroid scalp applications

13.4.4.1 Potent

Betamethasone 0.1%

Diprosalic®

Synalar®

13.4.4.2 Very Potent

Clobetasol propionate 0.05%

13.5 Preparations for Eczema and Psoriasis

13.5.1 Preparations for eczema

Specific Indication

Ichthopaste®

Steripaste®

Zipzoc®

13.5.1.1 Oral retinoid for eczema

Alitretinoin

13.5.2 Preparations for psoriasis

Topical preparations

13.5.2.1 Vitamin D and analogues

Dovonex®

Dovobet®

Enstilar®

Silkis®

13.5.2.2 Topical retinoid

Tazarotene

13.5.2.3 Compound product

Chelsea Day mix

13.5.2.4 Coal tar

Cocois®

Exorex®