Fungal skin infection (not Tinea pedis)
▶ Adult: Apply 1–2 times a day
Treatment of seborrhoeic dermatitis and dandruff
▶ Child 12–17 years: Apply twice weekly for 2–4 weeks,
leave preparation on for 3–5 minutes before rinsing
▶ Adult: Apply twice weekly for 2–4 weeks, leave
preparation on for 3–5 minutes before rinsing
Prophylaxis of seborrhoeic dermatitis and dandruff
▶ Child 12–17 years: Apply every 1–2 weeks, leave
preparation on for 3–5 minutes before rinsing
▶ Adult: Apply every 1–2 weeks, leave preparation on for
Treatment of pityriasis versicolor
▶ Child 12–17 years: Apply once daily for maximum 5 days,
leave preparation on for 3–5 minutes before rinsing
▶ Adult: Apply once daily for maximum 5 days, leave
preparation on for 3–5 minutes before rinsing
Prophylaxis of pityriasis versicolor
▶ Child 12–17 years: Apply once daily for up to 3 days
before sun exposure, leave preparation on for
▶ Adult: Apply once daily for up to 3 days before sun
exposure, leave preparation on for 3–5 minutes before
l CONTRA-INDICATIONS Acute porphyrias p. 1058
l CAUTIONS Avoid contact with eyes . avoid contact with
l INTERACTIONS → Appendix 1: antifungals, azoles
▶ Common or very common Skin reactions
▶ Uncommon Alopecia . angioedema . excessive tearing . folliculitis . hair changes
▶ Rare or very rare Eye irritation .taste altered
l NATIONAL FUNDING/ACCESS DECISIONS
NHS restrictions Nizoral ® cream is not prescribable in NHS
primary care except for the treatment of seborrhoeic
dermatitis and pityriasis versicolor; endorse prescription
l EXCEPTIONS TO LEGAL CATEGORY A 15-g tube is available
for sale to the public for the treatment of tinea pedis, tinea
cruris, and candidal intertrigo.
Can be sold to the public for the prevention and
treatment of dandruff and seborrhoeic dermatitis of the
scalp as a shampoo formulation containing ketoconazole
maximum 2%, in a pack containing maximum 120 mL and
labelled to show a maximum frequency of application of
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), polysorbates, propylene glycol
Ketoconazole 20 mg per 1 gram Nizoral 2% cream | 30 gram P £4.24 DT = £4.24
EXCIPIENTS: May contain Imidurea
▶ Ketoconazole (Non-proprietary)
Ketoconazole 20 mg per 1 gram Ketoconazole 2% shampoo | 120 ml P £3.36 DT = £3.36
Ketoconazole 20 mg per 1 gram Dandrazol Anti-dandruff 2%
shampoo | 120 ml P £3.39 DT = £3.36
▶ Nizoral (Janssen-Cilag Ltd, Thornton & Ross Ltd)
Ketoconazole 20 mg per 1 gram Nizoral 2% shampoo | 120 ml P £3.59 DT = £3.36
▶ Child: Apply twice daily continuing for 10 days after
▶ Adult: Apply twice daily continuing for 10 days after
▶ Child: Apply 1–2 times a day
▶ Adult: Apply 1–2 times a day
▶ In children Licensed for use in children (age range not
l CAUTIONS Avoid in Acute porphyrias p. 1058 . contact with
eyes and mucous membranes should be avoided
l INTERACTIONS → Appendix 1: antifungals, azoles
▶ Common or very common Skin reactions
▶ Frequency not known Angioedema
l PREGNANCY Absorbed from the skin in small amounts;
l BREAST FEEDING Manufacturer advises caution—no
l PROFESSION SPECIFIC INFORMATION
Dental practitioners’ formulary
Miconazole cream may be prescribed.
l NATIONAL FUNDING/ACCESS DECISIONS
NHS restrictions Daktarin ® powder and Daktarin ® cream
15 g is not prescribable in NHS primary care.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
EXCIPIENTS: May contain Butylated hydroxyanisole
▶ Daktarin (McNeil Products Ltd, Janssen-Cilag Ltd, Johnson & Johnson
Miconazole nitrate 20 mg per 1 gram Daktarin 2% cream | 15 gram p £2.51 | 30 gram p £1.82 DT = £1.82
▶ Daktarin (McNeil Products Ltd)
Miconazole nitrate 20 mg per 1 gram Daktarin 2% powder | 20 gram p £2.95 DT = £2.95
▶ Child: Apply twice daily usually for up to 6 months
(may be extended to 12 months), apply to nails and
▶ Adult: Apply twice daily usually for up to 6 months
(may be extended to 12 months), apply to nails and
BNF 78 Fungal skin infections 1233
▶ In children Licensed for use in children (age range not
l CAUTIONS Contact with eyes and mucous membranes
should be avoided . use with caution if child likely to suck
▶ Common or very common Peripheral oedema
▶ Frequency not known Nail disorder. pain . paraesthesia . periorbital oedema
l PREGNANCY Manufacturer advises avoid.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Tioconazole (Non-proprietary)
Tioconazole 283 mg per 1 ml Tioconazole 283mg/ml medicated nail
lacquer | 12 ml P £27.38–£28.74 DT = £28.74
Tioconazole 283 mg per 1 ml Trosyl 283mg/ml nail solution | 12 ml P £27.38 DT = £28.74
▶ Child 12–17 years: Apply 1–2 times a week for 6 months
to treat finger nails and for toe nails 9–12 months
(review at intervals of 3 months), apply to infected
nails after filing and cleansing, allow to dry for
▶ Adult: Apply 1–2 times a week for 6 months to treat
finger nails and for toe nails 9–12 months (review at
intervals of 3 months), apply to infected nails after
filing and cleansing, allow to dry for approximately
l CAUTIONS Avoid contact with ears . avoid contact with
eyes and mucous membranes . use with caution in child
likely to suck affected digits
▶ Rare or very rare Nail discolouration . skin reactions
l PATIENT AND CARER ADVICE Avoid nail varnish or artificial
l EXCEPTIONS TO LEGAL CATEGORY
▶ In adults Amorolfine nail lacquer can be sold to the public
if supplied for the treatment of mild cases of distal and
lateral subungual onychomycoses caused by
dermatophytes, yeasts and moulds; subject to treatment of
max. 2 nails, max. strength of nail lacquer amorolfine 5%
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 10
▶ Amorolfine (Non-proprietary)
Amorolfine (as Amorolfine hydrochloride) 50 mg per
1 ml Amorolfine 5% medicated nail lacquer | 5 ml P £16.21 DT =
Amorolfine (as Amorolfine hydrochloride) 50 mg per 1 ml Loceryl
5% medicated nail lacquer | 2.5 ml P £7.26 | 5 ml P £9.08 DT
▶ Omicur (Morningside Healthcare Ltd)
Amorolfine (as Amorolfine hydrochloride) 50 mg per 1 ml Omicur
5% medicated nail lacquer | 2.5 ml P £9.09 | 5 ml P £9.09 DT
▶ Adult: Apply 400 micrograms once daily, apply to an
1.2 mg once daily for maximum treatment duration of
4 weeks, allow each spray to dry between application
l CAUTIONS Avoid contact with eyes and mucous
l INTERACTIONS → Appendix 1: griseofulvin
l SIDE-EFFECTS Paraesthesia . skin irritation
l PREGNANCY Manufacturer advises avoid unless potential
l BREAST FEEDING Manufacturer advises avoid unless
potential benefit outweighs risk.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 15
EXCIPIENTS: May contain Benzyl alcohol
Griseofulvin 10 mg per 1 gram Grisol AF 1% spray | 20 ml p £4.00
▶ Adult: Apply 1–2 times a day for up to 1 week, to be
▶ Adult: 250 mg once daily for 2-6 weeks
▶ Adult: Apply 1–2 times a day for up to 1–2 weeks, to be
applied thinly, review treatment after 2 weeks
▶ Adult: 250 mg once daily for 4 weeks
▶ Adult: Apply 1–2 times a day for up to 1–2 weeks, to be
applied thinly, review treatment after 2 weeks
▶ Adult: 250 mg once daily for 2-4 weeks
Dermatophyte infections of the nails
▶ Adult: 250 mg once daily for 6 weeks-3 months
(occasionally longer in toenail infections)
Cutaneous candidiasis | Pityriasis versicolor
▶ Adult: Apply 1–2 times a day for 2 weeks, to be applied
thinly, review treatment after 2 weeks
▶ With topical use contact with eyes and mucous membranes
l INTERACTIONS → Appendix 1: terbinafine
▶ Common or very common Skin reactions
1234 Infections of the skin BNF 78
▶ With oral use Taste altered . weight decreased
▶ With oral use Agranulocytosis . alopecia . cutaneous lupus
sickness-like reaction . smell altered .tinnitus . vasculitis . vision disorders
▶ With topical use Hypersensitivity
SIDE-EFFECTS, FURTHER INFORMATION Liver toxicity With
oral use; discontinue treatment if liver toxicity develops
(including jaundice, cholestasis and hepatitis).
Serious skin reactions With oral use; discontinue
▶ With topical use Manufacturer advises use only if potential
benefit outweighs risk— animal studies suggest no adverse
▶ With oral use Manufacturer advises use only if potential
benefit outweighs risk—no information available.
▶ With topical use Manufacturer advises avoid—present in
milk. Less than 5% of the dose is absorbed after topical
application of terbinafine; avoid application to mother’s
▶ With oral use Avoid—present in milk.
▶ With oral use Manufacturer advises avoid (risk of increased
Dose adjustments ▶ With oral use Use half normal dose if
eGFR less than 50 mL/minute/1.73 m2 and no suitable
▶ With oral use Monitor hepatic function before treatment
and then periodically after 4–6 weeks of treatment—
discontinue if abnormalities in liver function tests.
▶ With oral use Manufacturer advises that patients should
immediately report any signs or symptoms suggestive of
liver dysfunction such as pruritus, unexplained persistent
nausea, decreased appetite, anorexia, jaundice, vomiting,
fatigue, right upper abdominal pain, dark urine, or pale
stools. Patients with these symptoms should discontinue
taking terbinafine and the patient’s liver function should
l EXCEPTIONS TO LEGAL CATEGORY
▶ With topical use Preparations of terbinafine hydrochloride
(maximum 1%) can be sold to the public for use in those
over 16 years for external use for the treatment of tinea
pedis as a cream in a pack containing maximum 15 g, or for
the treatment of tinea pedis and cruris as a cream in a pack
containing maximum 15 g, or for the treatment of tinea
pedis, cruris, and corporis as a spray in a pack containing
maximum 30 mL spray or as a gel in a pack containing
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 9
▶ Terbinafine (Non-proprietary)
Terbinafine (as Terbinafine hydrochloride) 250 mg Terbinafine
250mg tablets | 14 tablet P £18.11 DT = £1.20 | 28 tablet P £2.40–£34.93
▶ Lamisil (Novartis Pharmaceuticals UK Ltd)
Terbinafine (as Terbinafine hydrochloride) 250 mg Lamisil 250mg
tablets | 14 tablet P £21.30 DT = £1.20 | 28 tablet P £41.09
EXCIPIENTS: May contain Benzyl alcohol, cetostearyl alcohol (including
cetyl and stearyl alcohol), polysorbates
▶ Terbinafine (Non-proprietary)
Terbinafine hydrochloride 10 mg per 1 gram Terbinafine 1% cream
| 15 gram P £3.17 DT = £1.27 | 30 gram P £6.33 DT = £2.54
▶ Lamisil (GlaxoSmithKline Consumer Healthcare)
Terbinafine hydrochloride 10 mg per 1 gram Lamisil 1% cream | 30 gram P £8.76 DT = £2.54
ANTISEPTICS AND DISINFECTANTS ›
▶ Child: Apply twice daily, continue use for 7 days after
▶ Adult: Apply twice daily, continue use for 7 days after
▶ In children Mycota ® licensed for use in children (age range
not specified by manufacturer).
l CAUTIONS Avoid broken skin . contact with eyes should be
avoided . contact with mucous membranes should be
▶ Rare or very rare Skin irritation
SIDE-EFFECTS, FURTHER INFORMATION Treatment should
be discontinued if irritation is severe.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
▶ Mycota (zinc undecenoate / undecenoic acid) (Thornton & Ross
Undecenoic acid 50 mg per 1 gram, Zinc undecenoate 200 mg per
1 gram Mycota cream | 25 gram G £2.01
EXCIPIENTS: May contain Fragrances
▶ Mycota (zinc undecenoate / undecenoic acid) (Thornton & Ross
Undecenoic acid 20 mg per 1 gram, Zinc undecenoate 200 mg per
1 gram Mycota powder | 70 gram G £3.04
BNF 78 Fungal skin infections 1235
ANTISEPTICS AND DISINFECTANTS › OTHER
Skin infections due to Candida spp.
▶ Child: Apply 2–3 times a day, continuing for 7 days
▶ Adult: Apply 2–3 times a day, continuing for 7 days
▶ In children Licensed for use in children (age range not
l CAUTIONS Avoid contact with eyes and mucous
l SIDE-EFFECTS Hypersensitivity . skin reactions
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
EXCIPIENTS: May contain Benzyl alcohol, cetostearyl alcohol (including
cetyl and stearyl alcohol), polysorbates
▶ Chlorhexidine with nystatin (Non-proprietary)
Chlorhexidine hydrochloride 10 mg per 1 gram, Nystatin
100000 unit per 1 gram Nystatin 100,000units/g / Chlorhexidine
hydrochloride 1% cream | 30 gram P £4.99 DT = £4.99
Benzoic acid with salicylic acid
▶ In children Licensed for use in children (age range not
l CAUTIONS Avoid broken or inflamed skin . avoid contact
with eyes . avoid contact with mucous membranes
▶ Salicylate toxicity Salicylate toxicity may occur particularly
if applied on large areas of skin.
l SIDE-EFFECTS Hypersensitivity . skin burning sensation
SIDE-EFFECTS, FURTHER INFORMATION Treatment should
be discontinued if side effects are severe.
l PRESCRIBING AND DISPENSING INFORMATION Benzoic
Acid Ointment, Compound, BP has also been referred to as
l MEDICINAL FORMS Forms available from special-order
manufacturers include: cream, ointment
Other drugs used for Parasitic skin infections Ivermectin,
▶ Adult: Apply over the whole body; repeat without
bathing on the following day and wash off 24 hours
later; a third application may be required in some cases
l CAUTIONS Avoid contact with eyes and mucous
membranes . children (not recommended). do not use on
broken or secondarily infected skin
l SIDE-EFFECTS Skin burning sensation (especially on
genitalia and excoriations). skin reactions
l BREAST FEEDING Suspend feeding until product has been
l PRESCRIBING AND DISPENSING INFORMATION When
prepared extemporaneously, the BP states Benzyl
Benzoate Application, BP consists of benzyl benzoate 25%
Some manufacturers recommend application to the
body but to exclude the head and neck. However,
application should be extended to the scalp, neck, face,
and ears. Note—dilution to reduce irritant effect also
l LESS SUITABLE FOR PRESCRIBING Benzyl benzoate is less
l MEDICINAL FORMS Forms available from special-order
▶ Child: Apply once weekly for 2 doses, rub into dry hair
and scalp, allow to dry naturally, shampoo after
minimum 8 hours (or overnight)
▶ Adult: Apply once weekly for 2 doses, rub into dry hair
and scalp, allow to dry naturally, shampoo after
minimum 8 hours (or overnight)
▶ In children Not licensed for use in children under 6 months
except under medical supervision.
MHRA/CHM ADVICE: HEAD LICE ERADICATION PRODUCTS: RISK OF
SERIOUS BURNS IF TREATED HAIR IS EXPOSED TO OPEN FLAMES
OR OTHER SOURCES OF IGNITION (MARCH 2018)
l CAUTIONS Avoid contact with eyes . children under
6 months, medical supervision required
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Hedrin (Thornton & Ross Ltd)
Dimeticone 40 mg per 1 gram Hedrin 4% lotion | 50 ml p £3.28
DT = £3.28 | 150 ml p £7.62 DT = £7.62
▶ Hedrin (Thornton & Ross Ltd)
Dimeticone 40 mg per 1 gram Hedrin 4% spray | 120 ml G £7.85
1236 Infections of the skin BNF 78
▶ Child: Apply once weekly for 2 doses, rub preparation
into dry hair and scalp, allow to dry naturally, remove
▶ Adult: Apply once weekly for 2 doses, rub preparation
into dry hair and scalp, allow to dry naturally, remove
▶ Child: Apply once weekly for 2 doses, apply preparation
over whole body, allow to dry naturally, wash off after
▶ Adult: Apply once weekly for 2 doses, apply
preparation over whole body, allow to dry naturally,
wash off after 12 hours or overnight
▶ Child: Apply once weekly for 2 doses, apply preparation
over whole body, and wash off after 24 hours, if hands
are washed with soap within 24 hours, they should be
▶ Adult: Apply once weekly for 2 doses, apply
preparation over whole body, and wash off after
24 hours, if hands are washed with soap within
24 hours, they should be retreated
▶ In children Not licensed for use in children under 6 months
except under medical supervision.
MHRA/CHM ADVICE: HEAD LICE ERADICATION PRODUCTS: RISK OF
SERIOUS BURNS IF TREATED HAIR IS EXPOSED TO OPEN FLAMES
OR OTHER SOURCES OF IGNITION (MARCH 2018)
l CAUTIONS Alcoholic lotions not recommended for head
lice in children with severe eczema or asthma, or for
scabies or crab lice . avoid contact with eyes . children
under 6 months, medical supervision required . do not use
lotion more than once a week for 3 consecutive weeks . do
not use on broken or secondarily infected skin
l SIDE-EFFECTS Angioedema . eye swelling . hypersensitivity . skin reactions
l PRESCRIBING AND DISPENSING INFORMATION For scabies,
manufacturer recommends application to the body but not
necessarily to the head and neck. However, application
should be extended to the scalp, neck, face, and ears.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), fragrances, hydroxybenzoates (parabens)
▶ Derbac-M (G.R. Lane Health Products Ltd)
Malathion 5 mg per 1 gram Derbac-M 0.5% liquid | 50 ml p £4.26
DT = £4.26 | 200 ml p £9.91 DT = £9.91
▶ Child: Apply once weekly for 2 doses, apply 5%
preparation over whole body including face, neck, scalp
and ears then wash off after 8–12 hours. If hands are
washed with soap within 8 hours of application, they
should be treated again with cream
▶ Adult: Apply once weekly for 2 doses, apply 5%
preparation over whole body including face, neck, scalp
and ears then wash off after 8–12 hours. If hands are
washed with soap within 8 hours of application, they
should be treated again with cream
▶ Adult: Apply once weekly for 2 doses, apply 5% cream
over whole body, allow to dry naturally and wash off
after 12 hours or after leaving on overnight
▶ Adult: Not recommended; no information given
▶ In children Dermal Cream (scabies), not licensed for use in
children under 2 months; not licensed for treatment of
crab lice in children under 18 years. Creme Rinse (head lice)
not licensed for use in children under 6 months except
MHRA/CHM ADVICE: HEAD LICE ERADICATION PRODUCTS: RISK OF
SERIOUS BURNS IF TREATED HAIR IS EXPOSED TO OPEN FLAMES
OR OTHER SOURCES OF IGNITION (MARCH 2018)
l CAUTIONS Avoid contact with eyes . children aged
2 months–2 years, medical supervision required for dermal
cream (scabies). children under 6 months, medical
supervision required for cream rinse (head lice). do not use
on broken or secondarily infected skin
l SIDE-EFFECTS Scalp irritation . skin reactions
l PRESCRIBING AND DISPENSING INFORMATION
Manufacturer recommends application to the body but to
exclude head and neck. However, application should be
extended to the scalp, neck, face, and ears.
Larger patients may require up to two 30-g packs for
l LESS SUITABLE FOR PRESCRIBING Lyclear ® Creme Rinse is
less suitable for prescribing.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 10 (Dermal cream only)
EXCIPIENTS: May contain Butylated hydroxytoluene, woolfat and related
substances (including lanolin)
▶ Permethrin (Non-proprietary)
Permethrin 50 mg per 1 gram Permethrin 5% cream | 30 gram p
Permethrin 50 mg per 1 gram Lyclear 5% dermal cream | 30 gram p £5.73 DT = £7.28
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
Permethrin 10 mg per 1 gram Lyclear 1% creme rinse | 59 ml p
£4.20 DT = £4.20 | 118 ml p £6.79 DT = £6.79
No comments:
Post a Comment
اكتب تعليق حول الموضوع