Ointments Formulary choices Hydromol® ointment (emulsifying wax 30%, yellow soft paraffin 30%, liquid paraffin 40%) or Epaderm® ointment (emulsifying wax 30%, yellow soft paraffin 30%, liquid paraffin 40%) or Cetraben ointment (35% soft paraffin, 45% light liquid paraffin) or Diprobase® ointment (white soft paraffin 95%, liquid paraffin 5% Dose: Apply into the skin as often as required Dose: Apply into the skin as often as required Dose: into the skin as often as required Dose: Apply into the skin as often as required Creams Formulary choices Oilatum® cream (light liquid paraffin 6%, Dose:
white soft paraffin 15%) or Ultrabase® cream (liquid paraffin 10% and white soft paraffin 10%) or Cetraben® emollient cream (white soft paraffin 13.2%, light liquid paraffin 10.5%) or Diprobase® cream (cetromacrogol 2.25%, cetostearyl alcohol 7.2%, liquid paraffin 6%, white soft paraffin 15%) or Epaderm® cream (yellow soft paraffin 15%, liquid paraffin 10%, emulsifying wax 5%) Apply into the skin as often as required Dose: Apply into the skin as often as required Dose: Apply into the skin as often as required Dose: into the skin as often as required Dose: Apply into the skin as often as required Prescribing notes
1st choice Hydrocortisone 1%/ clotrimazole 1%; cream (Canesten HC®) or Hydrocortisone 1% / miconazole nitrate 2%; cream and ointment (Daktacort®) Or Hydrocortisone 1%/ fusidic acid 2% cream (Fucidin H®) or Hydrocortisone 0.5%, nystatin 100 000 units/g, benzalkonium chloride solution 0.2%, dimeticone “350” 10%; cream (Timodine®) Dose: Apply 1-2 times Dose: Apply 1-2 times daily Dose: Apply 1-2 times Dose: Apply 1-2 times daily Moderately potent corticosteroid with antimicrobial No products in this category currently available (supply problems with Trimovate®) Potent corticosteroids with antimicrobial 1st choice Betamethasone (as valerate) 0.1%, fusidic acid 2%; cream and lipid cream (Fucibet®) Dose: Apply 1-2 times daily
whether they have any difficulties with application, cosmetic acceptability or tolerability and offer an alternative formulation if appropriate possible reasons for non-adherence Arrange a review appointment after starting a new topical treatment after 4 weeks in adults Phototherapy is available in specialist centres under the supervision of a dermatologist. UVB radiation is usually effective for chronic stable psoriasis and for guttate psoriasis Acitretin (Neotigason®), an oral retinoid (vitamin A derivate), is available as a RED list medication in Northern Ireland for psoriasis. It is to be prescribed and supplied solely within the secondary care environment. Identification of co-morbidities Discuss risk factors for cardiovascular co-morbidities with people who have any type of psoriasis (and their families or carers where appropriate) and give lifestyle advice as appropriate In patients with severe psoriasis, offer a cardiovascular risk assessment at presentation using a validated risk assessment tool. Repeat every 5 years (or more frequently if indicated) Psoriasis of any type, especially if severe, is a risk factor for venous thromboembolism in adults. This risk should be explained to adults with any type of psoriasis and advice offered on how to minimise and manage the risk in line with Venous Thromboembolism: reducing the risk Topical preparations for psoriasis Trunk and limbs Vitamin D and analogues (1st line agents) 1st choice Calcipotriol 50 micrograms/g; (Dovonex®) Dose: Apply 1-2 times daily; max 100g per week
1st choice Benzoyl peroxide 5% gel, 5% wash (Acnecide®) Dose: twice a day; Topical antibacterials for acne 1st choice Clindamycin 1% /benzoyl peroxide 5%; Clindamycin 1%/ benzoyl peroxide 3% - (Duac®) gel Dose: Apply once daily in the evening Topical retinoids and related preparations 1st choice Adapalene 0.1% cream and gel (Differin®) or Isotretinoin 0.05% gel (Isotrex®) Or Adapalene 0.1%, benzoyl peroxide 2.5% (Epiduo®) gel Dose: Apply thinly once daily in the evening Dose: Apply thinly 1-2 times daily Dose: Apply thinly once a day in the evening Prescribing Notes Benzoyl peroxide Topical treatment takes at least 30 days to become effective and should be reviewed after 2 months In mild to moderate acne, comedones and inflamed lesions respond well to benzoyl peroxide Benzoyl peroxide (or abrasive cleansers) may cause peeling which should be given time to subside before using a topical retinoid