BNF for Children 2011-2012

BNFC 2011–2012 13.5 Preparations for eczema and psoriasis 565Indication and doseInflammatory skin disorders such as dermatitisand eczemas unresponsive to less potent corticosteroids,psoriasis see notes aboveApply thinly 1–2 times dailyCutivate c (GSK) ACream, fluticasone propionate 0.05%, net price 15 g =£2.27, 30 g = £4.24. Label: 28, counselling, application,see p. 559. Potency: potentExcipients include cetostearyl alcohol, imidurea, propylene glycolOintment, fluticasone propionate 0.005%, net price15 g = £2.27, 30 g = £4.24. Label: 28, counselling,application, see p. 559. Potency: potentExcipients include propylene glycolMOMETASONE FUROATECautions see notes aboveContra-indications see notes aboveSide-effects see notes aboveLicensed use licensed for use in children (age rangenot specified by manufacturer)Indication and doseSevere inflammatory skin disorders such aseczemas unresponsive to less potent corticosteroids,psoriasis see notes aboveApply thinly once daily (to scalp in case of lotion)Elocon c (Schering-Plough) ACream, mometasone furoate 0.1%, net price 30 g =£4.36, 100 g = £12.58. Label: 28, counselling, application,see p. 559. Potency: potentExcipients include propylene glycol, stearyl alcoholOintment, mometasone furoate 0.1%, net price 30 g =£4.32, 100 g = £12.44. Label: 28, counselling, application,see p. 559. Potency: potentExcipients include propylene glycolScalp lotion, mometasone furoate 0.1% in anaqueous isopropyl alcohol basis, net price 30 mL =£4.36. Label: 28, counselling, application, see p. 559.Potency: potentExcipients include propylene glycolTRIAMCINOLONE ACETONIDECautions see notes aboveContra-indications see notes aboveSide-effects see notes aboveLicensed use Aureocort c not licensed for use inchildren under 8 yearsIndication and doseSevere inflammatory skin disorders such aseczemas unresponsive to less potent corticosteroids,psoriasis see notes aboveApply thinly 1–2 times dailyWith antimicrobialsSee notes above for comment on compound preparationsAureocort c (Goldshield) AOintment, triamcinolone acetonide 0.1%, chlortetracyclinehydrochloride 3%, in an anhydrous greasybasis containing wool fat and white soft paraffin, netprice 15 g = £2.70. Label: 28, counselling, application,see p. 559. Potency: potentExcipients include wool fatNote Stains clothing13.5 Preparations for eczemaand psoriasis13.5.1 Preparations for eczema13.5.2 Preparations for psoriasis13.5.3 Drugs affecting the immune response13.5.1 Preparations for eczemaThe main types of eczema (dermatitis) in children areatopic, irritant and allergic contact; different types mayco-exist. Atopic eczema is the most common type and itusually involves dry skin as well as infection and lichenificationcaused by scratching and rubbing. Seborrhoeicdermatitis (see below) is also common in infants.Management of eczema involves the removal or treatmentof contributory factors; known or suspected irritantsand contact allergens should be avoided. Rarely,ingredients in topical medicinal products may sensitisethe skin (section 13.1.3); BNF for Children lists activeingredients together with excipients that have beenassociated with skin sensitisation.Skin dryness and the consequent irritant eczemarequires emollients (section 13.2.1) applied regularlyand liberally to the affected area; this can be supplementedwith bath or shower emollients. The use ofemollients should continue even if the eczema improvesor if other treatment is being used.Topical corticosteroids (section 13.4) are also requiredin the management of eczema; the potency of thecorticosteroid should be appropriate to the severityand site of the condition, and the age of the child.Mild corticosteroids are generally used on the faceand on flexures; the more potent corticosteroids aregenerally required for use on lichenified areas of eczemaor for severe eczema on the scalp, limbs, and trunk.Treatment should be reviewed regularly, especially if apotent corticosteroid is required. In children with frequentflares (2–3 per month), a topical corticosteroidcan be applied on 2 consecutive days each week toprevent further flares.Bandages (including those containing zinc and ichthammol)are sometimes applied over topical corticosteroidsor emollients to treat eczema of the limbs. Wetelasticated viscose stockinette is used for ‘wet-wrap’bandaging over topical corticosteroids or emollients tocool the skin and relieve itching, but there is anincreased risk of infection and excessive absorption ofthe corticosteroid; ‘wet-wrap’ bandaging should be usedunder specialist supervision.For details of elasticated viscose stockinette tubularbandages and garments, and silk clothing, see BNFsection A8.8.3For the role of topical pimecrolimus and tacrolimus inatopic eczema, see section 13.5.3.Infection Bacterial infection (commonly with Staphylococcusaureus and occasionally with Streptococcuspyogenes) can exacerbate eczema. A topical antibacterialsuch as fusidic acid (section 13.10.1) may beused for small areas of mild infection; treatment shouldbe limited to a short course (typically 1 week) to reducethe risk of drug resistance or skin sensitisation. Associatedeczema is treated simultaneously with a moder-13 Skin