Dithranol Ointment, BP Non-proprietary preparations A Oral retinoids for psoriasis

1 Dithranol Ointment, BP Non-proprietary preparations A Oral retinoids for psoriasis

Ointment , dithranol, in yellow soft paraffin; usual strengths 0.1–2%. Part of basis may be replaced by hard paraffin if a stiffer preparation is required.

ACITRETIN

Label: 28 Note Acitretin is a metabolite of etretinate

1. A if dithranol content more than 1%, otherwise may be Indications severe extensive psoriasis resistant to sold to the public

other forms of therapy; palmoplantar pustular psor- iasis; severe congenital ichthyosis; severe Darier’s

Dithranol Paste, BP

disease (keratosis follicularis) Paste , dithranol in zinc and salicylic acid (Lassar’s)

Cautions exclude pregnancy before starting (test for paste. Usual strengths 0.1–1% of dithranol. Label: 28

pregnancy within 2 weeks before treatment and monthly thereafter; start treatment on day 2 or 3 of

Proprietary preparations menstrual cycle)—women (including those with his- Dithrocream c (Dermal)

tory of infertility) should avoid pregnancy for at least 1 Cream , dithranol 0.1%, net price 50 g = £3.94; 0.25%,

month before, during, and for at least 3 years after

50 g = £4.23; 0.5%, 50 g = £4.87; 1%, 50 g = £5.67; A treatment; patients should avoid concomitant tetra- 2%, 50 g = £7.10. Label: 28

cycline or methotrexate, high doses of vitamin A

Excipients include cetostearyl alcohol, chlorocresol

(more than 4000–5000 units daily) and use of kerato- Dose for application to skin or scalp; 0.1–0.5% cream suitable for

lytics, and should not donate blood during or for at overnight treatment, 1–2% cream for max. 1 hour

least 1 year after stopping therapy (teratogenic risk); Micanol c (GP Pharma)

check liver function at start, then every 1–2 weeks for Cream , dithranol 1% in a lipid-stabilised basis, net

2 months, then every 3 months; monitor plasma price 50 g = £13.48;

lipids; diabetes (can alter glucose tolerance—initial Excipients none as listed in section 13.1.3 A 3%, 50 g = £16.79. Label: 28 frequent blood glucose checks); radiographic assess-

Dose for application to skin or scalp, apply 1% cream for up to 30 ment on long-term treatment; investigate atypical minutes once daily, if necessary 3% cream can be used under

musculoskeletal symptoms; in children use only in medical supervision

exceptional circumstances (premature epiphyseal Note At the end of contact time, use plenty of lukewarm (not hot) water to rinse off cream; soap may be used after the cream has

closure reported); avoid excessive exposure to sun- been rinsed off; use shampoo before applying cream to scalp and

light and unsupervised use of sunlamps; interactions: if necessary after cream has been rinsed off

Appendix 1 (retinoids)

c Contra-indications Psorin hepatic impairment (Appendix 2); (LPC) renal impairment (Appendix 3); hyperlipidaemia, Ointment , dithranol 0.11%, coal tar 1%, salicylic acid

pregnancy (important teratogenic risk: see Cau- 1.6%, net price 50 g = £9.22, 100 g = £18.44. Label: 28 Excipients include beeswax, wool fat

tions and Appendix 4); breast-feeding Dose for application to skin up to twice daily

Side-effects dryness of mucous membranes (some- Scalp gel , dithranol 0.25%, salicylic acid 1.6% in gel

times erosion), of skin (sometimes scaling, thinning, erythema especially of face, and pruritus), and of

Skin

basis containing methyl salicylate, net price 50 g = £7.03. Label: 28

conjunctiva (sometimes conjunctivitis and decreased

tolerance of contact lenses); sticky skin, dermatitis;

13 Dose for application to scalp, initially apply on alternate days for

other side-effects reported include palmoplantar 10–20 minutes; may be increased to daily application for max. 1

Excipients none as listed in section 13.1.3

exfoliation, epistaxis, epidermal and nail fragility, hour and then wash off

oedema, paronychia, granulomatous lesions, bullous