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The way that the supply chain operates for 'specials' means that costs for the same product can vary significantly. Prescribers will not know the cost of a 'special' when it is prescribed. When applying a topical steroid along with an emollient, it does not matter which agent is applied first, although ideally there should be a minute gap between the two applications. If a topical steroid is required to be used in conjunction with a coal tar preparation, they should be used in an alternating regimen e.g. coal tar in the morning and steroid in the evening.
Do not apply the ointment to children, on any part of their body, for more than 5 days. If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine. An allergy to mometasone furoate or any of the other ingredients in this medicine or to other similar medicines. Psoriasis is a skin disease in which itchy, scaly, pink patches develop on the elbows, knees, scalp and other parts of the body.
Self Care Medicine - to be purchased when part of routine skin care in the absence of a moderate to severe skin condition. When considering switching between emollients to first line choices please do not switch stable patients with severe dermatological conditions. These medicines are considered suitable for prescribing in Primary Care following specialist initiation or recommendation. If used in psoriasis careful patient supervision is important. Use of topical corticosteroids in children or on the face should be limited to the least amount compatible with an effective therapeutic regimen and duration of treatment should be no more than 5 days.
It is more likely to occur when delicate skin sites such as the face and flexures are treated. Should there be a reoccurrence of the condition within days to weeks after successful treatment a withdrawal reaction should be suspected. Reapplication should be with caution and specialist advise is recommended in these cases or other treatment options should be considered. For drugs that can be initiated by primary care following written or verbal advice from a specialist and can then subsequently be safely prescribed in primary care with little or no monitoring required. Drugs designated GREEN with Specialist Initiation are suitable for on-going prescribing within primary care. Transfer of prescribing should occur after initiation and an initial review in secondary care.
Patients should be advised to purchase a suitable product over the counter first line. May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased - more information. Patients should be advised to purchase a suitable product over the counter.
Evaluation work has been undertaken locally by Community Nursing Teams within LCHS to determine the most clinically and cost effective products barrier products available for local use. Bath and shower emollients coat the surface of the bath and shower creating a very greasy and slippery surface; this can markedly increase the risk of slipping and falling, particularly in children and the elderly. Please refer to the BNF or contact the Medicines Management Team by email on hsccg.medicines- if you are unsure of a product’s status. Preparations marked ACBS are regarded as drugs when prescribed in accordance with the advice of the Advisory Committee on Boarderline Substances for the clinical conditions indicated.
Supplied via Homecare - please contact the pharmacy homecare team for more information via email to E45 cream is not advocated for use by ULH dermatologists due to its lanolin content. ZeroCream cream is a directly equivalent product at a significantly lower price. It is designated GREEN and approved for inclusion in the Lincolnshire Joint Formulary. It should be used first line in preference to E45 cream - more information. Alternative once daily treatments lymecycline or doxycyline are the preferred choice oral tetracyclines.
These medicines are put on the surface of the skin to reduce the redness and itchiness caused by certain skin problems. Characterisation of metabolites was not feasible owing to the small amounts present in plasma and excreta. In guinea pigs, mometasone was approximately twice as potent as betamethasone valerate in reducing m.ovalis-induced epidermal acanthosis (i.e. anti-psoriatic activity) after 14 applications. In the croton oil assay in mice, mometasone was equipotent to betamethasone valerate after single application and about 8 times as potent after five applications.
The British Medical Journal also published an article in 2009 questioning the role of bath emollients. Again, the lack of published evidence was highlighted as a problem. The article also pointed out that the quantity of emollient deposited on the skin from a bath emollient whilst bathing are likely to be far lower than that achieved with directly applied emollients. The authors conclude that, based on current evidence, bath emollients offer little or no benefit and that over-reliance on these products could lead to substandard emollient therapy. Where more than one alternative topical corticosteroid is considered clinically appropriate within a potency class, the drug with the lowest acquisition cost should be prescribed, taking into account pack size and frequency of application. Grey - Medicines, which the Drug & therapeutics Committee has actively reviewed and does not recommend for use at present following a review of clinical and/or cost effective data.
Drugs for hospital use or use by a specialist within specialist centre only. Initiation and monitoring of treatment should remain under the total responsibility of the appropriate hospital clinician or specialist. These drugs should only be prescribed under the direct supervision of that clinician or specialist and are not suitable for shared care arrangements. The drug should be supplied via the hospital or specialist centre for the duration of treatment. Initiated in secondary care or other specialist setting but are suitable for GPs to continue on-going prescribing under a shared care protocol, once the patient has been stabilised or dose predictable. Systemic or potent topical corticosteroids should be avoided or given only under specialist supervision in psoriasis, because, although they may suppress the psoriasis in the short term, relapse or vigorous rebound occurs on withdrawal .
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