BNF for Children 2011-2012

BNFC 2011–2012 13.5.2 Preparations for psoriasis 571Scalp gel, dithranol 0.25%, salicylic acid 1.6% in gelbasis containing methyl salicylate, net price 50 g =£7.03. Label: 28Excipients none as listed in section 13.1.3DoseFor application to scalp, initially apply on alternate daysfor 10–20 minutes; may be increased to daily applicationfor max. 1 hour and then wash offSalicylic acidSALICYLIC ACIDFor coal tar preparations containing salicylic acid, see underTars p. 569; for dithranol preparations containing salicylic acidsee under Dithranol, aboveCautions see notes above; avoid broken or inflamedskinSalicylate toxicity Salicylate toxicity may occur particularlyif applied on large areas of skin or on neonatal skinSide-effects sensitivity, excessive drying, irritation,systemic effects after widespread use (see underCautions)Indication and doseHyperkeratotic skin disorders see under preparationAcne section 13.6.1Warts and calluses section 13.7Scalp conditions section 13.9Fungal nail infections section 13.10.2Zinc and Salicylic Acid Paste, BPPaste, (Lassar’s Paste), zinc oxide 24%, salicylic acid2%, starch 24%, white soft paraffin 50%, net price 25 g= 17pDoseChild 1 month–18 years apply twice dailyOral retinoids for psoriasisACITRETINNote Acitretin is a metabolite of etretinateCautions in children use only in exceptional circumstances(premature epiphyseal closure reported); infemales of childbearing age exclude pregnancy beforestarting (test for pregnancy within 2 weeks beforetreatment and monthly thereafter; start treatment onday 2 or 3 of menstrual cycle)—females of childbearingage (including those with history of infertility)should avoid pregnancy and use effective contraceptionfor at least 1 month before, during, and for atleast 3 years after treatment (oral progestogen-onlycontraceptives not considered effective); patientsshould avoid concomitant tetracycline or methotrexate,high doses of vitamin A (more than 4000–5000 units daily), and use of keratolytics, and shouldnot donate blood during or for at least 1 year afterstopping therapy (teratogenic risk); check liver functionat start, at least every 4 weeks for first 2 monthsand then every 3 months; monitor serum-triglycerideand serum-cholesterol concentrations at least every 4weeks for first 2 months, then every 3 months; diabetes(can alter glucose tolerance—initial frequentblood glucose checks); radiographic assessment onlong-term treatment; investigate atypical musculoskeletalsymptoms; avoid excessive exposure to sunlightand unsupervised use of sunlamps; interactions:Appendix 1 (retinoids)Contra-indications hyperlipidaemiaHepatic impairment avoid—risk of further impairmentRenal impairment avoid; increased risk of toxicityPregnancy avoid—teratogenic; effective contraceptionmust be used—see Cautions aboveBreast-feeding avoidSide-effects dryness of mucous membranes (sometimeserosion), of skin (sometimes scaling, thinning,erythema especially of face, and pruritus), and ofconjunctiva (sometimes conjunctivitis and decreasedtolerance of contact lenses); sticky skin, dermatitis;other side-effects reported include palmoplantarexfoliation, epistaxis, epidermal and nail fragility,peripheral oedema, vulvovaginal candidiasis, paronychia,granulomatous lesions, bullous eruptions,reversible hair thinning and alopecia, myalgia andarthralgia, occasional nausea, headache, malaise,drowsiness, rhinitis, sweating, taste disturbance,stomatitis, cheilitis, and gingivitis; benign intracranialhypertension (discontinue if severe headache, vomiting,diarrhoea, abdominal pain, and visual disturbanceoccur; avoid concomitant tetracyclines);photosensitivity, corneal ulceration, rarely jaundiceand hepatitis (avoid concomitant methotrexate);raised serum-triglyceride or serum-cholesterol concentration;decreased night vision reported; skeletalhyperostosis and extraosseous calcification reportedfollowing long-term administration of etretinate (andpremature epiphyseal closure in children, see Cautionsabove)Indication and doseHarlequin ichthyosis (under expert supervisiononly). By mouthNeonate 500 micrograms/kg once daily with foodor milk (occasionally up to 1 mg/kg daily) withcareful monitoring of musculoskeletal developmentSevere extensive psoriasis resistant to otherforms of therapy, palmoplantar pustular psoriasis,severe congenital ichthyosis, severeDarier’s disease (keratosis follicularis) (all underexpert supervision only). By mouthChild 1 month–12 years 500 micrograms/kgonce daily with food or milk (occasionally up to1 mg/kg daily) to max. 35 mg daily with carefulmonitoring of musculoskeletal development (seealso p. 567)Child 12–18 years initially 25–30 mg daily(Darier’s disease 10 mg daily) for 2–4 weeks, thenadjusted according to response, usual range 25–50 mg daily; up to 75 mg daily for short periods inpsoriasis and ichthyosis (see also p. 567)13 Skin