Management of skin conditions

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:

Silk garments

Following national guidance from NHS England, silk garments are not recommended for use due to a lack of robust evidence of clinical effectiveness. Silk garments are relatively expensive and unlikely to be cost-effective for the NHS. Click here for more information. Prescribers should not initiate silk garments for any new patient.

Suitable quantities for prescribing

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.

Suitable quantities of dermatological preparations to be prescribed
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.

Excipients and sensitisation

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.

Extemporaneous preparation

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.

 

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