2011 Version:2 Page 1 of 20

File name: Skin Formulary BNF Section 13 Original Date of issue: 30/03/2006 Last Reviewed: 01/05/2011 Version:2 Page 1 of 20 Department: Pharmacy...
Author: Alannah Owens
106 downloads 1 Views 290KB Size
File name: Skin Formulary BNF Section 13

Original Date of issue: 30/03/2006

Last Reviewed: 01/05/2011

Version:2

Page 1 of 20

Department: Pharmacy

Review Date: 01/05/2013

Authorised: Drug and Therapeutics Committee

13: Skin 13.1

Management of skin conditions

13.1.1

Vehicles

NIL

13.1.2

Suitable quantities for prescribing

Suitable quantities of dermatological preparations to be prescribed for specific areas of the body are: Creams and ointments Lotions Face 15-30g 100ml Both hands 25-50g 200ml Scalp 50-100g 200ml Both arms or legs 100-200g 200ml Trunk 400g 500ml Groins and genitalia 15-25g 100ml These amounts are usually suitable for an adult for twice daily application for 1 week. These recommendations do not apply to corticosteroid preparations. For suitable quantities of corticosteroids see section 13.4

13.1.3 See BNF

Excipients and sensitisation

File name: Skin Formulary BNF Section 13

Original Date of issue: 30/03/2006

Last Reviewed: 01/05/2011

Version:2

Department: Pharmacy

Review Date: 01/05/2013

Authorised: Drug and Therapeutics Committee

13.2

Emollient and barrier preparations

13.2.1

Emollients

Page 2 of 20

Emollients soothe, smooth and hydrate the skin and are indicated for all dry or scaling disorders. Their effects are short-lived and they should be applied frequently even after improvement occurs. They are useful in dry and eczematous disorders, and to a lesser extent in psoriasis. Light emollients such as aqueous cream are suitable for many patients with dry skin but a wider range of more greasy preparations, including white soft paraffin, emulsifying ointment and liquid and white soft paraffin ointment are available. Prescribing of emollients containing food based ingredients to children below the age of 2 is not recommended as it may put the child at risk of transcutaneous sensitisation and subsequent food allergy e.g. Aveeno and Balneum products.

Creams 1st line

Product

Comments

Zerobase Cream (50g, 500g pump pack)

Zerobase should be used as an equivalent, more economical, alternative to Diprobase in new patients. If patients come in on Diprobase they can continue on it. Zerocream should be used as an equivalent, more economical, alternative to E45 cream in new patients. If patients come in on E45 cream they can continue on it. Aqueous cream is recommended to only be used as a soap substitute. It should not be left on the skin as it contains sodium lauryl sulphate which can worsen eczema.

Zerocream Cream (50g, 500g pump pack)

Aqueous cream (30g, 500g)

2nd line

Diprobase Cream (50g, 500g) E45 Cream (50g, 500g) Oilatum Cream (40g) Unguentum M Cream (200ml Dispenser)

File name: Skin Formulary BNF Section 13

Original Date of issue: 30/03/2006

Last Reviewed: 01/05/2011

Version:2

Department: Pharmacy

Review Date: 01/05/2013

Authorised: Drug and Therapeutics Committee

3rd Line

Ointments 1st line 2nd line 3rd line

Bath products 1st line

Aveeno Cream (100ml)

These are expensive and should only be used when other products have been tried.

Emulsifying Ointment BP (500g) Paraffin Yellow Soft BP (15g) Diprobase Ointment (50g) Epaderm ointment (125g, 500g) Emulsifying ointment / Liquid Paraffin in equal parts (200g) Liquid paraffin / White soft paraffin 50:50 (500g)

These are expensive and should only be used when other products have been tried

Infacare Liquid (400ml)

2nd line

Balneum Bath Oil (200ml) Balneum Plus cream 100g Oilatum Emollient (250ml)

3rd line

Aveeno Bath Oil (250ml) Oilatum Plus Bath Additive (500ml) (with antimicrobial) Urea 10% cream ( 30g,100g)

Preparations containing urea

Page 3 of 20

These are expensive and should only be used when other products have been tried

File name: Skin Formulary BNF Section 13

Original Date of issue: 30/03/2006

Last Reviewed: 01/05/2011

Version:2

Department: Pharmacy

Review Date: 01/05/2013

Authorised: Drug and Therapeutics Committee

13.2.2

Page 4 of 20

Barrier preparations

Barrier preparations often contain water repellent substances such as dimeticone or other silicones. They are used on the skin around stomas and for incontinence dermatitis, where the skin is intact. Where the skin has broken down, barrier preparations have a limited role in protecting adjacent skin. They are no substitute for adequate nursing care and it is doubtful they are more effective than traditional compound zinc ointments. Compound zinc preparations are contra-indicated for use in pressure ulcer prevention (see below). Incontinence dermatitis (nappy rash, excoriation) Incontinence dermatitis (ID) is an irritant dermatitis which results in high moisture exposure, friction, bacteria and enzymatic activity. ID is a skin condition that affects people who are incontinent; this includes both children and adults. The condition results in inflamed, excoriated, infected and damaged skin that causes pain and discomfort. ID is associated as a contributory factor to the development of pressure ulcers (see Pressure Ulcer Policy link to separate document) and moisture lesions. The main risk factors for ID include: Ageing and the thinning effects on the skin Urinary incontinence and faecal incontinence Friction and shear when moving and handling Impaired cognition Skin problems Diarrhoea Poor quality of care Incontinence Dermatitis (Nappy Rash) in Children Barrier creams and ointments are used for protection against incontinence dermatitis (nappy rash). The first line of treatment is to ensure that the skin is kept clean and dry and that nappies are changed frequently and that tight fitting waterproof pants are avoided. The rash may clear if exposed to air and barrier preparations may be helpful. If the rash is associated with a fungal infection, an antifungal cream is useful instead (section 13.10.2). A mild corticosteroid such as hydrocortisone 1% may be useful but treatment should be limited to a week or less; the occlusive effect of nappies and waterproof pants may increase absorption. Product 1st line

Conotrane Cream (100g, 500g)

Comments

File name: Skin Formulary BNF Section 13

Original Date of issue: 30/03/2006

Last Reviewed: 01/05/2011

Version:2

Department: Pharmacy

Review Date: 01/05/2013

Authorised: Drug and Therapeutics Committee

Sudocrem Cream (25g, 400g) Zinc and Castor Oil Ointment (15g)

Page 5 of 20

File name: Skin Formulary BNF Section 13

Original Date of issue: 30/03/2006

Last Reviewed: 01/05/2011

Version:2

Department: Pharmacy

Review Date: 01/05/2013

Authorised: Drug and Therapeutics Committee

2nd line 3rd line

Drapolene Cream (100g) Metanium Ointment (30g) Savlon Barrier Cream (50g) Cavilon Barrier Cream (28g, 92g tube, 2g sachets)

Cavilon Film Spray (28ml) Sprilon spray (115g)

Page 6 of 20

This product is expensive but very effective if used appropriately. Apply sparingly. If the ‘afterfeel’ is oily you have applied too much. Cavilon barrier cream should not be applied to broken skin Can be used on broken skin Caution this is flammable

Incontinence Dermatitis in Adults The effects of age on the physiology of skin, combined with incontinence in the older population can result in the skin becoming increasingly vulnerable to damage from friction leading to pressure (see Pressure Ulcer Policy link to separate document) and/or moisture related ulceration. ID is caused by several factors, including changes in skin pH, wet soggy skin, skin damage caused by mixing urine and faeces and damage caused by faecal enzymes. When faeces and urine are mixed together, bacteria in the faeces convert urea in the urine to ammonia, which makes the skin more alkaline. Normal skin has a pH of 5.5 and should be maintained at this level of acidity. Commercial soaps and cleansers are alkaline with pH of 9 and following frequent episodes of cleansing can strip the skin of its acid mantle exposing the patient to an increased risk of bacterial and fungal infection. The first line of treatment of ID is to ensure that the skin is kept clean and dry, free of contamination by urine and faeces. This can be achieved through gentle cleansing with Aqueous cream or Infacare and the regular changing of incontinence aids. Emollients such as Oilatum can be applied to help prevent skin dehydration. To reduce the effect of moisture on the skin, barrier products such as Cavilon cream, which is compatible with many continence aids, may be applied. Zinc oxide cream (Sudocrem) and zinc and castor oil should be avoided in adults particularly if continence aids are used. Expert opinion

File name: Skin Formulary BNF Section 13

Original Date of issue: 30/03/2006

Last Reviewed: 01/05/2011

Version:2

Page 7 of 20

Department: Pharmacy

Review Date: 01/05/2013

Authorised: Drug and Therapeutics Committee

indicates that zinc oxide products may increase shear forces in adults at risk of developing pressure ulcers. Incontinence management and pressure relief requires a co-ordinated approach. Avoid plastic drawsheets and other non absorbent surfaces that may increase moisture against the skin, and talcum powder as this can ‘cake’ and cause irritation and friction. Film or hydrocolloid dressings may be used to protect the skin from friction. Care must be taken in their application to prevent ‘ruffling up’ which could cause further damage.

For Intact skin 1st Line

Product

Comments

Cavilon Barrier cream (28g, 92g, 2g sachets)

This product is expensive but very effective if used appropriately. Apply sparingly. If the ‘afterfeel’ is oily too much may have been applied. Barrier cream containing at least 10% dimeticone. Skin protection against incontinence.

Conotrane cream (100g, 500g)

For broken/excoriated skin 1st Line

Metanium Ointment

2nd Line

Cavilon spray (1ml foam applicator, 3ml foam applicator, 28ml pump spray)

Protective transparent barrier film. Alcohol free formulation is pain free on broken skin.

File name: Skin Formulary BNF Section 13

Original Date of issue: 30/03/2006

Last Reviewed: 01/05/2011

Version:2

Department: Pharmacy

Review Date: 01/05/2013

Authorised: Drug and Therapeutics Committee

13.3

Topical local anaesthetics and antipruritics

Calamine Lotion (200ml) Crotamiton 10% Cream (30g, 100g) (Eurax) Crotamiton 10% Lotion (100ml) (Eurax)

Page 8 of 20

File name: Skin Formulary BNF Section 13

Original Date of issue: 30/03/2006

Last Reviewed: 01/05/2011

Version:2

Department: Pharmacy

Review Date: 01/05/2013

Authorised: Drug and Therapeutics Committee

13.4

Page 9 of 20

Topical corticosteroids

Choice of formulation Water miscible corticosteroid creams are suitable for moist or weeping lesions. Ointments are generally chosen for dry, lichenified or scaly lesions or where a more occlusive effect is required. Lotions may be useful when minimal application to a large or hair-bearing area is required or for treatment of exudative lesions.

Side effects Mild and moderately potent topical corticosteroids are associated with few side effects but care is required in the use of potent or very potent topical corticosteroids. Absorption through the skin can rarely cause adrenal suppression depending on the area of body treated and the duration of treatment. Absorption is the greatest where the skin is thin or raw. It is increased by occlusion. Local side effects include: Spread and worsening of untreated infection Thinning of the skin Irreversible stiae atrophicae and telangiectasia Contact dermatitis Perioral dermatitis Acne or worsening of acne and acne rosacea Mild depigmentation which may be reversible Hypertrichosis In order to minimise the side effects of topical corticosteroids, it is important to apply it thinly to the affected areas only, no more frequently than twice a day and to use the least potent formulation which is fully effective.

Suitable quantities of corticosteroid preparations to be prescribed for specific area of the body are: Face and neck Both hands Scalp Both arms Both legs Trunk

Creams and ointments 15g to 30g 15g to 30g 15g to 30g 30g to 60g 100g 100g

File name: Skin Formulary BNF Section 13

Original Date of issue: 30/03/2006

Last Reviewed: 01/05/2011

Version:2

Department: Pharmacy

Review Date: 01/05/2013

Authorised: Drug and Therapeutics Committee

Groins and genetalia 15g to 30g These amounts are usually suitable for an adult for a single daily application for two weeks

Page 10 of 20

File name: Skin Formulary BNF Section 13

Original Date of issue: 30/03/2006

Last Reviewed: 01/05/2011

Version:2

Page 11 of 20

Department: Pharmacy

Review Date: 01/05/2013

Authorised: Drug and Therapeutics Committee

Topical corticosteroid preparation potencies Potency of a topical corticosteroid preparation is a result of the formulation as well as the corticosteroid. Therefore proprietary names are included. Mild

Hydrocortisone Butyrate 0.1% Cream (30g) Hydrocortisone Butyrate 0.1% Scalp Lotion (100ml) Hydrocortisone 0.5% Ointment (15g) Hydrocortisone 0.5% Cream (15g) Hydrocortisone 1% Cream (30g, 50g) Hydrocortisone 1% Ointment (30g)

Mild with antimicrobials

Hydrocortisone 1% clotrimazole 1% (30g) (Canesten HC Cream) Hydrocortisone 1% miconazole nitrate 2%(30g) (Daktacort Cream) Hydrocortisone 1% miconazole nitrate 2% (30g) (Daktacort Ointment) Hydrocortisone 0.5%, nystatin 100,000units/g, benzalkonium chloride solution 0.2% , dimeticone ‘350’ 10% (30g) (Timodine Cream) Hydrocortisone 1%, nystatin 100,000units/g, chlorhexidine acetate 1% (Nystaform HC Ointment) Betamethasone Valerate 0.025% Cream (100g) (Betnovate RD) Clobetasone 0.05% Ointment (30g, 100g) (Eumovate) Clobetasone 0.05% Cream (30g) (Eumovate) Clobetasone butyrate 0.05%, Oxytetracycline 3%, nystatin 100,000 units/g Cream (30g) (Trimovate Cream)

Moderate

Moderate with antimicrobials Moderate with urea Potent

Hydrocortisone 1% Urea 10% (30g) (Alphaderm Cream) Hydrocortisone 1%, urea 10%, lactic acid 5% (30g) (Calmurid HC Cream) Betamethasone Dipropionate 0.05% Cream (30g) (Diprosone) Betamethasone Valerate 0.1% Scalp Application (100ml) (Betnovate) Betamethasone Valerate 0.1% Ointment (30g) (Betnovate) Betamethasone Valerate 0.1% Cream (30g) (Betnovate) Diflucortolone 0.1% Oily Cream (30g) (Nerisone) Diflucortolone 0.1% cream (30g) (Nerisone) Mometasone furoate 0.1% cream (100g, 30g) (Elocon) Mometasone furoate 0.1% ointment (100g, 30g) (Elocon)

File name: Skin Formulary BNF Section 13

Original Date of issue: 30/03/2006

Last Reviewed: 01/05/2011

Version:2

Department: Pharmacy

Review Date: 01/05/2013

Authorised: Drug and Therapeutics Committee

Potent with salicylic acid

Very potent

Betamethasone diproprionate 0.05%, salicylic acid 3% (Diprosalic Ointment) (30g, 100g) Betamethasone diproprionate 0.05%, salicylic acid 3% (Diprosalic scalp application) (100ml) Clobetasol 0.05% Cream (30g) (Dermovate) Clobetasol 0.05% Ointment (30g) (Dermovate) NOT TO BE USED ON THE FACE

13.5

Preparations for eczema and psoriasis

13.5.1

Preparations for eczema

Link See BNF chapter 13.5.1

13.5.2

Preparations for psoriasis

Link See BNF chapter 13.5.2 Topical preparations for psoriasis Alphosyl HC Cream (100g) Calcipotriol Cream (120g) (Dovonex) Calcipotriol Ointment (60g, 120g)(Dovonex) Oral retinoids for psoriasis Acitretin Capsules (10mg, 25mg)

13.5.3

Drugs affecting the immune response

NIL

13.6

Acne and rosacea

13.6.1

Topical preparations for acne

Panoxyl gel (5%, 10%) Formulary Product status

Restriction

Page 12 of 20

File name: Skin Formulary BNF Section 13

Original Date of issue: 30/03/2006

Last Reviewed: 01/05/2011

Version:2

Department: Pharmacy

Review Date: 01/05/2013

Authorised: Drug and Therapeutics Committee

C

13.6.2

Clindamycin 1% topical solution

Page 13 of 20

Restricted to the treatment of chemotherapy induced rash in oncology patients taking erlotinib, gefitinib or cetuximab

Oral preparations for acne

Oral antibacterials for acne – see BNF Hormone treatment for acne Co-Cyprindiol 2000/35 Tablets (cyproterone acetate 2mg, ethinyloestradiol 35micrograms) (Dianette) Oral retinoid for acne Formulary Product status C Isotretinoin Capsules (5mg, 20mg)

13.7

Restriction Consultant Dermatologist only

Preparations for warts and calluses

Salactol Paint (10ml) Silver Nitrate Caustic Applicator (40%, 75%, 95%) Formulary Product status R Imiquimod 5% cream S

S

Podophyllotoxin 0.5% Solution (3ml) Podophyllotoxin 0.5% Solution (3ml) (fem) Podophyllotoxin 0.15% Cream (5g)

Restriction Reserved for the treatment of resistant genital warts. GUM clinics only GUM clinics only

GUM clinics only

13.8

Sunscreens and camouflages

13.8.1

Sunscreen preparations

Uvistat SPF 30 Sun Cream (125g)

File name: Skin Formulary BNF Section 13

Original Date of issue: 30/03/2006

Last Reviewed: 01/05/2011

Version:2

Department: Pharmacy

Review Date: 01/05/2013

Authorised: Drug and Therapeutics Committee

13.8.2

Page 14 of 20

Camouflages

Nil

13.9

Shampoos and other preparations for scalp and hair conditions

Polytar Liquid (150ml)

13.10

Anti-infective skin preparations

13.10.1

Antibacterial preparations

13.10.1.1 Antibacterial preparations only used topically (Link to antibiotic formulary) Mupirocin 2% Cream (15g) Mupirocin 2% Ointment (15g) Silver Sulfadiazine 1% Cream (50g, 250g)

13.10.1.2 Antibacterial preparations also used systemically First line

Product Comments Metronidazole (Metrotop) 0.8% For malodorous tumours and skin Gel (30g) ulcers

Formulary Product status R Metronidazole (Metrogel) 0.75% Gel (40g)

13.10.2

Restriction Reserved for patients with Acne Roacea

Antifungal preparations

Clotrimazole 1% Cream Miconazole nitrate 2% Cream Formulary Product

Restriction

File name: Skin Formulary BNF Section 13

Original Date of issue: 30/03/2006

Last Reviewed: 01/05/2011

Version:2

Department: Pharmacy

Review Date: 01/05/2013

Authorised: Drug and Therapeutics Committee

status C R R

13.10.3

Clotrimazole 1% solution (20ml) Miconazole 2% Dusting Powder (20g) Terbinafine 1% Cream (15g)

For the treatment of skin ulcers with secondary fungal infection Apply thinly 1-2 times daily for up to 1 week for tinea pedis, 1-2 weeks for tinea corporis, 2 weeks for cutaneous candidiasis and pityriasis versicolor, review after 2 weeks

Antiviral preparations

Aciclovir 5% Cream

13.10.4

Parasiticidal preparations

Malathion 0.5% Liquid (Derbac M) 50ml

13.10.5

Preparations for minor cuts and abrasions

Cetrimide 0.5% Cream (50g) Liquiband Flow Control tissue adhesive Liquiband tissue adhesive Magnesium Sulphate Paste (25g)

13.11

Skin cleansers and antiseptics

13.11.1

Alcohols and saline

Ethanol denatured spray (Stericlean) (900ml) Purell Alcoholic Hand Gel (Available from Supplies) Sodium Chloride 0.9% Irrigation Sachets (25ml) Sodium Chloride 0.9% Irrigation (150ml) Sodium Chloride 0.9% Irrigation (1L, 2L, 3L)

13.11.2

Chlorhexidine salts

Chlorhexidine Acetate 1% Powder (15g) Chlorhexidine 0.05% Sachets (25ml)

Page 15 of 20

File name: Skin Formulary BNF Section 13

Original Date of issue: 30/03/2006

Last Reviewed: 01/05/2011

Version:2

Page 16 of 20

Department: Pharmacy

Review Date: 01/05/2013

Authorised: Drug and Therapeutics Committee

Chlorhexidine acetate 0.02% Irrigation (1L) Chlorhexidine Acetate 0.015% Cetrimide 0.15% Solution Chlorhexidine Gluconate 0.5% Spray (500ml) Chlorhexidine Gluconate 0.5% (alcoholic pink) (500ml) Chlorhexidine Gluconate 0.02% spray (500ml) Chlorhexidine Gluconate 1% Obstetric Cream (250ml) Chlorhexidine Gluconate 4% Surgical Scrub (500ml, 5L) Savlon Cream (30g) Tisept Sachets

Formulary Product status R Chlorhexidine Gluconate 4% antimicrobial skin cleanser (Hibiscrub® Plus) (125ml) R Polyhexanide 0.3% Foam (Prontoderm®)

13.11.3 NIL

Restriction First-line treatment option for MRSA skin decolonisation Third-line treatment option for MRSA skin decolonisation under the recommendation of the Infection Control Team.

Cationic surfactants and soaps

File name: Skin Formulary BNF Section 13

Original Date of issue: 30/03/2006

Last Reviewed: 01/05/2011

Version:2

Department: Pharmacy

Review Date: 01/05/2013

Authorised: Drug and Therapeutics Committee

13.11.4

Chlorine and iodine

Chlor-clean Tablets Povidone-Iodine 10% Antiseptic (500ml) Povidone-Iodine 2.5% Dry Powder Spray (150g) Povidone-Iodine 7.5% Surgical Scrub (500ml) Povidone-Iodine 10% Alcohol (500ml) Povidone-Iodine 10% Ointment (80g)

13.11.5

Phenolics

Octenisan wash (150ml, 500ml)

13.11.6

Astringents, oxidisers, and dyes

Hydrogen Peroxide 6% Solution (20 vols)

13.12 Antiperspirants Talc Dusting Powder (Sterile) (4g)

13.13 Topical circulatory preparations Hirudoid cream (50g)

Page 17 of 20

File name: Skin Formulary BNF Section 13

Original Date of issue: 30/03/2006

Last Reviewed: 01/05/2011

Version:2

Page 18 of 20

Department: Pharmacy

Review Date: 01/05/2013

Authorised: Drug and Therapeutics Committee

Appendix 8 Wound management products and elastic hosiery Link For details of interactive wound care products link to full wound care guidelines Dressings in the Wound Care Guidelines must be recorded on the Wound Management record. They do not need to be prescribed on the Inpatient Prescription Chart and Administration record. This is because all of the dressings that are in the wound care guidelines are CE marked and as such are not medicines. However if a supply is needed on discharge they should be written on the discharge letter.

Alginate Dressings

Barrier creams Carbon Dressings

Product Activheal Alginate Cavity Dressing 30cm Activheal Alginate Dressing 10cm x 10cm Activheal Alginate Dressing 10cm x 20cm Activheal Alginate Dressing 5cm x 5cm Cavilon barrier cream 28g tube Cavilon barrier cream 2g sachet

Comments

Clinisorb dressing 10cm x 10cm Clinisorb dressing 10cm x 20cm Clinisorb dressing 15cm x 25cm

These are first line for malodorous wounds and can be used in conjunction with other dressings. These are available on request for malodorous fungating wounds only. They are stand alone dressings that help 1. Stop bleeding 2. Absorb exudate 3. Reduce odour

Carboflex Dressing 10 x 10cm Carboflex Dressing 8 x 15cm Carboflex Dressing 15 x 20cm

File name: Skin Formulary BNF Section 13

Original Date of issue: 30/03/2006

Last Reviewed: 01/05/2011

Version:2

Page 19 of 20

Department: Pharmacy

Review Date: 01/05/2013

Authorised: Drug and Therapeutics Committee

Film Dressings

A full range of film dressings are available from Supplies

Film Applications

Cavilon 28ml Pump action spray bottle Cavilon foam applicator 1ml and 3ml

Long lasting nonsting barrier film to be reapplied every 48 to 72 hours

Foam Dressings

Activheal Foam Island Adhesive Dressing 10cm x 10cm Activheal Foam Island Adhesive Dressing 15cm x 15cm Activheal Foam Island Adhesive Dressing 20cm x 20cm

These dressings do not require a secondary dressing

Activheal Foam Non-Adhesive Dressing 10cm x 10cm Activheal Foam Non-Adhesive Dressing 20cm x 20cm Activheal Foam Non-Adhesive Dressing 5cm x 5cm Activheal Foam Non-Adhesive Dressing 7.5cm x 7.5cm Activheal Foam Non-Adhesive Dressing 10cm x 18cm

These dressings do require a secondary dressing for fixing

These dressings do require a secondary dressing for fixing. Will be bought in if required

Allevyn Sacrum Dressing 17 x 17cm Allevyn Sacrum Dressing 22 x 22cm Mepilex Border Dressing 10cm x 12.5cm Mepilex Border Dressing 15cm x 17.5cm Mepilex Border Dressing 17.5cm x 20cm Mepilex Border Dressing 7cm x 7.5cm Hydrocolloid Dressings

Mepilex has a silicone coating to help prevent the dressing from sticking

Duoderm extra thin 10cm x 10cm Duoderm extra thin 15cm x 15cm Duoderm Signal 10cm x 10cm Duoderm Signal 14cm x 14cm Duoderm Signal 20cm x 20cm

Useful for difficult to dress areas

File name: Skin Formulary BNF Section 13

Original Date of issue: 30/03/2006

Last Reviewed: 01/05/2011

Version:2

Department: Pharmacy

Review Date: 01/05/2013

Authorised: Drug and Therapeutics Committee

Hydrofibre Dressings

Aquacel Dressing 5cm x 5cm Aquacel Dressing 10cm x 10cm Aquacel Dressing 15cm x 15cm Aquacel RIBBON 2cm x 45cm

Hydrogel Dressings

Activheal Hydrogel (15g)

Medicated Preparations

Metronidazole 0.8% gel (Metrotop) Povidone–Iodine Dressing 5cm x 5cm Povidone–Iodine Dressing 9.5cm x 9.5cm

Silicone Dressings

Silflex Dressing 7.5cm x 5cm Silflex Dressing 8cm x 10cm Silflex Dressing 12cm x 15cm Silflex Dressing 20cm x 30cm (available to order)

Silver Dressings

Aquacel Silver Dressings 10cm x 10cm Aquacel Silver Dressings 15cm x 15cm Aquacel Silver Dressings 20cm x 30cm Aquacel Silver Dressings 5cm x 5cm Aquacel Silver Dressings 2cm x 45cm

Formulary Product status R Leeches R

Maggots Biobag Large (6 x 12cm) Maggots Biobag Medium(5 x 6cm) Maggots Biobag Small (4 x 5cm) Maggots Loose 300 Maggots Loose 150

Page 20 of 20

(ordered if required)

Restriction

Under recommendation of the diabetic team