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Correct diagnosis of skin conditions is essential to effective treatment. The local dermatologists have recommended the following websites which give useful information for GPs and their patients to assist diagnosis and treatment:
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.
It is extremely important to consider patient acceptability of a skin product to maximise compliance. A wide range of products is available and patient acceptance of individual preparations is variable. Specific dosage instructions should be included where possible as many patients use more than one preparation
The aim of this formulary is to provide guidance on initial choice and sequence of treatments and to include sufficient agents to cover the vast majority of patient needs. In specific circumstances, dermatologists may need to use a non-formulary product. In such cases, the GP will be given sufficient information to continue prescribing where appropriate.
Greasy preparations (ointments) are often preferable to creams in most circumstances because:
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.
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.
Information below shows suitable quantities of dermatological preparations to be prescribed for specific areas of the body based on twice daily application for one week.
See section Corticosteroids (topical) for suitable quantities for corticosteroid preparations.
|Area of body||Creams and Ointments||Lotions|
|Face||15–30 g||100 ml|
|Both hands||25–50 g||200 ml|
|Scalp||50–100 g||200 ml|
|Both arms or both legs||100–200 g||200 ml|
|Trunk||400 g||500 ml|
|Groins and genitalia||15–25 g||100 ml|
These amounts are usually suitable for an adult for twice daily application for 1 week. The recommendations do not apply to corticosteroid preparations.
Generic ointments or creams may differ in the excipients used in the formulations. Patients should be informed of this and advised which excipients they should avoid. In a small number of cases, branded preparations should be prescribed.
If a patient is not responding to treatment consider the effect of sensitizers in the product.
Patients with atopic eczema often find emollients cause stinging or irritation of the skin. Therefore an alternative preparation must be considered taking into account excipients.
Only commercially available products should be prescribed, unless otherwise advised by the dermatologist.
A product should only be extemporaneously prepared when there is no product commercially available. Depending on the formulation this may be done in a pharmacy, or by a specials manufacturer. 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 500g or 50g 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.