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BNSSG Adult Joint Formulary

13.2 Infections of the skin

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Last edited: 16-02-2024

13.2.1 Bacterial Skin infections

First line drugs

Second line drugs

Specialist drugs

Secondary care drugs

Recommended: (TLS Green)

Mupirocin 2% cream/ointment

For mupirocin nasal ointment see Chapter 12

Silver sulfadiazine (sulphadiazine) 1% cream (Flamazine^®)

Metronidazole 0.75% cream/gel

Fusidic acid 2% cream (Fucidin^®)

For the treatment of Impetigo (5 day course)

Clindamycin solution/lotion (Dalacin T^®) (TLS Green)

For the treatment of Hidradenitis suppurativa

Specific indication: (TLS Red)

Flammacerium cream (named patients)

Burns patients only

Gentamicin 0.1% cream

For decolonisation treatment of peritoneal dialysis exit sites as per NBT protocol

13.2.2 Antifungal preparations

Imidazole antifungals

Recommended: (TLS Green)

Clotrimazole 1% cream/solution

For vaginal use see Chapter 7

Alternatives: (TLS Blue)

Miconazole 2% cream (Daktarin^®)

Ketoconazole 2% cream (Nizoral^®)

In primary care, ketoconazole cream is only prescribable for seborrhoeic dermatitis and pityriasis versicolor

Other antifungals

Terbinafine 1% cream (Lamisil^®) (TLS Green)

Terbinafine is only fully effective against dermatophytes, not candida or other yeasts

Alternatives: (TLS Blue)

Nystatin cream/ointment (Nystan^®)

Specific indication: (TLS Blue)

Amorolfine 5% nail solution (Loceryl^®)

For nail infections

13.2.3 Parasitic Skin Infections

Refer to local Infestations Policies
Alcoholic lotions are not recommended for use in patients with severe eczema or asthma
Head lice can be mechanically removed by combing wet hair meticulously with a plastic detection comb (probably for at least 30 minutes) over the whole scalp at 4 day intervals for a minimum of 2 weeks, and continued until no lice are found on consecutive sessions; hair conditioner or vegetable oil can be used to facilitate the process

Parasiticides

Recommended: (TLS Green)

Dimeticone 4% lotion

Alternatives: (TLS Blue)

Malathion 0.5% liquid (TLS Blue)

Permethrin 5% dermal cream (TLS Blue)

Ivermectin (oral) (TLS Blue)

Treatment resistant classical scabies, not for children under 15kg.
To be used following permethrin failure only
Evidence suggests that ivermectin is less effective than permethrin

Ivermectin (oral) (TLS Red)

Specialist use only for treatment resistant 'crusted / Norwegian' scabies and for outbreaks, not for children under 15kg.

13.2.4 Viral skin infections

Recommended: (TLS Green)

Aciclovir 5% cream

Aciclovir cream should only be started at first sign of attack

Specific Indication: (TLS Blue)

Potassium hydroxide solution 5% (MolluDab^®)

ONLY for patients who are immunocompromised/immunosuppressed, those with other dermatological conditions and those in whom the condition is causing significant distress
For the majority of patients the current evidence based advice continues to be not to treat with anything and to let the virus naturally resolve over time

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13.2 Infections of the skin

13.2.1 Bacterial Skin infections

Mupirocin 2% cream/ointment

Silver sulfadiazine (sulphadiazine) 1% cream (Flamazine®)

Metronidazole 0.75% cream/gel

Fusidic acid 2% cream (Fucidin®)

Clindamycin solution/lotion (Dalacin T®) (TLS Green)

Flammacerium cream (named patients)

Gentamicin 0.1% cream

13.2.2 Antifungal preparations

Imidazole antifungals

Clotrimazole 1% cream/solution

Miconazole 2% cream (Daktarin®)

Ketoconazole 2% cream (Nizoral®)

Other antifungals

Terbinafine 1% cream (Lamisil®) (TLS Green)

Nystatin cream/ointment (Nystan®)

Amorolfine 5% nail solution (Loceryl®)

13.2.3 Parasitic Skin Infections

Parasiticides

Dimeticone 4% lotion

Malathion 0.5% liquid (TLS Blue)

Permethrin 5% dermal cream (TLS Blue)

Ivermectin (oral) (TLS Blue)

Ivermectin (oral) (TLS Red)

13.2.4 Viral skin infections

Aciclovir 5% cream

Potassium hydroxide solution 5% (MolluDab®)

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Silver sulfadiazine (sulphadiazine) 1% cream (Flamazine^®)

Fusidic acid 2% cream (Fucidin^®)

Clindamycin solution/lotion (Dalacin T^®) (TLS Green)

Miconazole 2% cream (Daktarin^®)

Ketoconazole 2% cream (Nizoral^®)

Terbinafine 1% cream (Lamisil^®) (TLS Green)

Nystatin cream/ointment (Nystan^®)

Amorolfine 5% nail solution (Loceryl^®)

Potassium hydroxide solution 5% (MolluDab^®)