| Therapeutic Area | Formulary Choices | Cost for 28 (unless otherwise stated) | Rationale for decision / comments |
|---|---|---|---|
| 13.4 Topical corticosteroids | |||
| Are licenced for application ONCE or TWICE daily only. Aim for a break of 4 weeks between courses of treatment with potent or very potent corticosteroids. Do not use very potent corticosteroids continuously at any site for longer than 4 weeks. Do not use potent corticosteroids continuously at any site for longer than 8 weeks. Twice weekly maintenance therapy with a topical corticosteroid should be considered in patients with moderate to severe atopic eczema experiencing frequent relapses. The Finger Tip Unit (FTU) is a useful means of calculating approximate quantities required, as follows (1 FTU = 0.5g) Face and neck: 2.5 FTU , Trunk: 7 FTU (front) and 7 FTU (back), One arm: 3 FTU, One hand: 1 FTU, One leg: 6 FTU, One foot: 2 FTU Total quantities of topical steroids required per week based on “bd” application for an adult: Face and neck: 15-30g, Trunk: 100g, Both arms: 50g, both hands: 15-30g, Both legs: 100g, Groins and genitalia: 15-30g Specials information: Specials Recommended by the British Association of Dermatologists for Skin Disease |
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| Topical corticosteroids | Most available as creams and ointments. Patients with atopic eczema should be advised to apply topical corticosteroids once daily (SIGN CG125). Twice weekly maintenance therapy should be considered in frequently relapsing moderate to severe atopic eczema (SIGN CG125). NB Potency of a steroid is a product of the formulation as well as the corticosteroid |
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| Caution: Hydrocortisone butyrate is a potent steroid (Locoid®) Note: Hydrocortisone 2.5% is not cost-effective |
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| Mildly potent | |||
| First-line Hydrocortisone 1% |
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| 1st option | Mildison® Lipocream Hydrocortisone 1% | Cream: £1.71 (30g) | Oily cream |
| 2nd option | Hydrocortisone 1% | Cream: £1.09 (15g) £2.18 (30g) £3.63 (50g) Ointment: £1.13 (15g) £2.26 (30g) £3.77 (50g) |
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| Second line | Hydrocortisone 0.5% | Cream: £1.16 (15g) £2.96 (30g) Ointment: £4.90 (30g) |
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| Mild with Antimicrobials | Fucidin H®(Hydrocortisone 1% + Fusidic acid 2%) is non-formulary due to high levels of local resistance. |
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| First line | |||
| 1st option | Canesten HC® (Hydrocortisone 1% + Clotrimazole 1%) | Cream: £2.42 (30g) | |
| 2nd option | Daktacort® (Hydrocortisone 1% + Miconazole 2%) | Cream: £2.49 (30g) | |
| Second-line | Terra-cortril® (Hydrocortisone 1% + Oxytetracycline hydrochloride 3%) | Ointment: £5.01 (30g) | |
| Third line | |||
| Option 1 | Timodine® cream | £3.37 (30g) | Contains: nystatin 100,000iu/g, hydrocortisone 0.5%, benzalkonium chloride soln 0.2%, dimeticone 350 10% Potential sensitisers: benzalkonium chloride |
| Option 2 | Nystatin 100,000 units/g/ chlorhexidine acetate 1%/HC 1% oint | £5.29 (30g) Generic version of Nystaform HC which is discontinued | Contains: nystatin 100,000iu/g, chlorhexidine 1%, hydrocortisone 0.5% Potential sensitisers: chlorhexidine acetate |
| Option 3 | If topical triple combination (corticosteroid + antimicrobial + antifungal) is required, consideration can also be given to: Dual formulation of corticosteroid + antimicrobial: Terra-cortril® - Hydrocortisone 1% + Oxytetracycline hydrochloride 3%; Ointment: £5.01 (30g) & Adding miconazole nitrate cream 2% (Daktarin® 2% Cream 30g; £1.82) NB - clotrimazole 1% cream, including Canesten® 1%, contains cetostearyl alcohol which is a potential sensitiser |
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| Moderately potent | |||
| First-line | Betamethasone valerate 0.025% | Audavate RD® Cream: £2.52 (100g) Ointment: £2.52 (100g) Betnovate RD® Cream: £3.15 (100g) Ointment: £3.15 (100g) |
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| Second line | Clobetasone butyrate 0.05% | Clobavate® Ointment: £1.49 (30g) £4.35 (100g) Eumovate® Cream: £1.86 (30g) £5.44 (100g) Ointment: £1.86 (30g) £5.44 (100g) | |
| Moderate with antimicrobials | Trimovate® (Clobetasone butyrate 0.05%, Oxytetracycline 3%, Nystatin 100 000 units/g) | Cream: £12.45 (30g) | Trimovate Cream is a yellow water-miscible cream containing clobetasone butyrate 0.05% w/w, oxytetracycline 3.0% w/w as calcium oxytetracycline and nystatin 100,000 units per gram. |
| Potent | Potent topical steroids should not be prescribed on repeat prescriptions. The following preparations are deemed not cost-effective and are non-formulary: - Beclometasone dipropionate 0.025% cream and ointment - Bettamousse® (Betamethasone valerate 0.1%) foam scalp application - Clobetasol 500microgram /Neomycin 5mg / Nystatin 100,000units/g |
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| First-line | Betamethasone valerate 0.1% (branded versions are cheaper than generics) | Audavate® Ointment: £1.15 (30g) £3.24 (100g) Betnovate® Cream: £1.43 (30g) £4.05 (100g) Ointment: £1.14 (30g) £3.24 (100g) Lotion: £4.58 (100ml) Betacap® Scalp Application: £3.19 (100ml) |
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| Second-line 1st option | Locoid® (Hydrocortisone butyrate 0.1%) | Cream: £1.60 (30g) £4.93 (100g) Lipocream: £1.69 (30g) £5.17 (100g) Ointment: £1.60 (30g) £4.93 (100g) Scalp lotion: £6.83 (100ml) |
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| 2nd option | Diprosone® (Betamethasone Dipropionate 0.05%) | Cream: £2.16 (30g) £6.12 (100g) Ointment: £2.16 (30g) £6.12 (100g) Scalp lotion: £2.73 (30ml) £7.80 (100ml) |
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| Potent with antimicrobials | Betamethasone with clioquinol and betamethasone with neomycin are not cost effective options therefore they are classed as non-formulary. | ||
| First-line 1st option | Synalar C® (Clioquinol 3% / Fluocinolone acetonide 0.025%) | Cream: £2.66 (15g) Ointment: £2.66 (15g) |
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| 2nd option | Synalar N® (Neomycin sulfate 0.5% / Fluocinolone acetonide 0.025%) | Cream: £4.36 (30g) Ointment: £4.36 (30g) |
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| Second-line | Lotriderm® (Betamethasone Dipropionate 0.064%/ Clotrimazole 1.0%) | Cream: £6.34 (30g) | |
| Very potent | Very potent topical steroids should not be prescribed on repeat prescriptions. | ||
| Clobetasol propionate 0.05%) | ClobaDerm® Cream: £2.15 (30g) £6.32 (100g) Ointment: £2.15 (30g) £6.32 (100g) Etrivex® Shampoo: £10.29 (125ml) |
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