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BNSSG Adult Joint Formulary

13.2 Infections of the skin

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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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