BNF for Children 2011-2012

568 13.5.2 Preparations for psoriasis BNFC 2011–201213 Skinlients should be encouraged and topical corticosteroidscan be continued if necessary.Acitretin is teratogenic; in females of child-bearing age,the possibility of pregnancy must be excluded beforetreatment and effective contraception must be usedduring treatment and for at least 3 years afterwards(oral progestogen-only contraceptives not consideredeffective). Common side-effects derive from its widespreadbut reversible effects on epithelia, such as dryand cracking lips, dry skin and mucosal surfaces, hairthinning, paronychia, and soft and sticky palms andsoles.Topical preparations for psoriasisVitamin D and analoguesCalcipotriol, calcitriol, and tacalcitol are used for themanagement of plaque psoriasis. They should beavoided by those with calcium metabolism disorders,and used with caution in generalised pustular or erythrodermicexfoliative psoriasis (enhanced risk of hypercalcaemia).Local skin reactions (itching, erythema,burning, paraesthesia, dermatitis) are common. Handsshould be washed thoroughly after application to avoidinadvertent transfer to other body areas. Aggravation ofpsoriasis has also been reported.CALCIPOTRIOLCautions see notes above; avoid use on face; avoidexcessive exposure to sunlight and sunlampsContra-indications see notes abovePregnancy manufacturer advises avoid unless essentialBreast-feeding no information availableSide-effects see notes above; also photosensitivity,dry skin; rarely facial or perioral dermatitisLicensed use Calcipotriol ointment and scalp solution,Dovobet c , and Xamiol c not licensed for use inchildrenIndication and dosePlaque psoriasisChild 6–18 years apply cream or ointment twicedaily; 6–12 years max. 50 g weekly, over 12 yearsmax. 75 g weekly (less with scalp solution, seebelow)Note Patient information leaflets for Dovonex c creamand ointment advise liberal application (but note max.recommended weekly dose, above)Scalp psoriasis (specialist use only)Child 6–12 years apply scalp solution twice daily;max. 30 mL weekly (less when used with cream orointment, see below)Child 12–18 years apply scalp solution twicedaily; max. 45 mL weekly (less when used withcream or ointment, see below)Note When preparations used together max. total calcipotriol2.5 mg in any one week for child 6–12 years (e.g. scalpsolution 20 mL with cream or ointment 30 g); max. 3.75 mg inany one week for child 12–18 years (e.g. scalp solution 30 mLwith cream or ointment 45 g)Calcipotriol (Non-proprietary) AOintment, calcipotriol 50 micrograms/g, net price120 g = £24.04Scalp solution, calcipotriol 50 micrograms/mL, netprice 60 mL = £12.53, 120 mL = £26.07Dovonex c (LEO) ACream, calcipotriol (as hydrate) 50 micrograms/g, netprice 120 g = £22.66Excipients include cetostearyl alcohol, disodium edetateOintment, calcipotriol 50 micrograms/g, net price120 g = £23.10Excipients include disodium edetate, propylene glycolWith betamethasoneFor prescribing information, and for comment on the limitedrole of corticosteroids in psoriasis, see section 13.4.Dovobet c (LEO) AOintment, betamethasone (as dipropionate) 0.05%,calcipotriol (as monohydrate) 50 micrograms/g, netprice 60 g = £32.99, 120 g = £61.27. Label: 28Excipients none as listed in section 13.1.3DoseStable plaque psoriasis (specialist use only)Child 12–18 years apply once daily to max. 30% ofbody surface for up to 4 weeks; max. 75 g weekly; ifnecessary, subsequent courses repeated on the advice ofa specialistNote When different preparations containing calcipotriolused together, max. total calcipotriol 3.75 mg in any oneweek for child 12–18 yearsGel, betamethasone (as dipropionate) 0.05%, calcipotriol(as monohydrate) 50 micrograms/g, netprice 60 g = £36.50, 2 60 g = £67.79. Label: 28Excipients include butylated hydroxytolueneDoseScalp psoriasis (specialist use only)Child 12–18 years apply 1–4 g to scalp once daily,shampoo off after leaving on scalp overnight or duringthe day; usual duration of therapy 4 weeks; if necessary,subsequent courses repeated on the advice of a specialistMild to moderate plaque psoriasis (specialist useonly)Child 12–18 years apply once daily to max. 30% ofbody surface for up to 4 weeks; max. 75 g weekly; ifnecessary, subsequent courses repeated on the advice ofa specialistNote When different preparations containing calcipotriolused together, max. total calcipotriol 3.75 mg in any oneweek for child 12–18 yearsXamiol c (LEO) AScalp gel, betamethasone (as dipropionate) 0.05%,calcipotriol (as monohydrate) 50 micrograms/g, netprice 60 g = £36.50. Label: 28Excipients include butylated hydroxytolueneDoseScalp psoriasis (specialist use only)Child 12–18 years apply 1–4 g to scalp once daily,shampoo off after leaving on scalp overnight or duringthe day; usual duration of therapy 4 weeks; if necessary,subsequent courses repeated on the advice of a specialistNote When different preparations containing calcipotriolused together, max. total calcipotriol 3.75 mg in any oneweek for child 12–18 yearsCALCITRIOL(1,25-Dihydroxycholecalciferol)Cautions see notes aboveContra-indications see notes above; do not applyunder occlusionHepatic impairment manufacturer advises avoid—noinformation availableRenal impairment manufacturer advises avoid—noinformation available