Coal tar with zinc oxide 26-Aug-2016
The properties listed below are those particular to the
combination only. For the properties of the components
please consider, coal tar p. 745.
lINDICATIONS AND DOSE
Psoriasis|Chronic atopic eczema
▶TO THE SKIN
▶Child:Apply 1 – 2 times a dayIMPORTANT SAFETY INFORMATION
MHRA/CHM UPDATE (APRIL 2016): FIRE RISK WITH PARAFFIN-
BASED SKIN EMOLLIENTS ON DRESSINGS OR CLOTHING
See Emollient and barrier preparations p. 713.lPRESCRIBING AND DISPENSING INFORMATIONNo
preparations available—when prepared
extemporaneously, the BP states Zinc and Coal Tar Paste,
BP consists of zinc oxide 6 %, coal tar 6 %, emulsifying wax
5 %, starch 38 %, yellow soft paraffin 45 %.
lMEDICINAL FORMS
Forms available from special-order manufacturers include:
ointment, paste
IMMUNOSUPPRESSANTS›CALCINEURIN
INHIBITORS AND RELATED DRUGS
Pimecrolimus
lINDICATIONS AND DOSE
Short-term treatment of mild to moderate atopic eczema
(including flares) when topical corticosteroids cannot be
used (initiated by a specialist)
▶TO THE SKIN
▶Child 2–17 years:Apply twice daily until symptoms
resolve (stop treatment if eczema worsens or no
response after 6 weeks)lCONTRA-INDICATIONSApplication to malignant or
potentially malignant skin lesions.application under
occlusion.congenital epidermal barrier defects.contact
with eyes.contact with mucous membranes.generalised
erythroderma.immunodeficiency.infection at treatment
site
lCAUTIONSAlcohol consumption (risk of facialflushing
and skin irritation).avoid other topical treatments except
emollients at treatment site.UV light (avoid excessive
exposure to sunlight and sunlamps)
lINTERACTIONS→Appendix 1 : pimecrolimus
lSIDE-EFFECTS
▶Common or very commonIncreased risk of infection
▶Rare or very rareSkin discolouration
▶Frequency not knownSkin papilloma
lPREGNANCYManufacturer advises avoid; toxicity in
animalstudies following systemic administration.
lBREAST FEEDINGManufacturer advises caution; ensure
infant does not come in contact with treated areas.
lNATIONAL FUNDING/ACCESS DECISIONS
NICE decisions
▶Tacrolimus and pimecrolimus for atopic eczema (August
2004 )NICE TA82
Topical pimecrolimus is an option for atopic eczema not
controlled by maximal topical corticosteroid treatment or
if there is a risk of important corticosteroid side-effects
(particularly skin atrophy).
Topical pimecrolimus is recommended for moderate
atopic eczema on the face and neck of children aged
2 – 16 years. Pimecrolimus should be used within its
licensed indications.
http://www.nice.org.uk/TA82lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Cream
CAUTIONARY AND ADVISORY LABELS4, 11, 28
EXCIPIENTS:May contain Benzyl alcohol, cetostearyl alcohol (including
cetyl and stearyl alcohol), propylene glycol
▶Elidel(Meda Pharmaceuticals Ltd)
Pimecrolimus 10 mg per 1 gramElidel 1 % cream| 30 gramP
£ 19. 69 DT = £ 19. 69 | 60 gramP£ 37. 41 DT = £ 37. 41 |
100 gramP£ 59. 07 DT = £ 59. 07Tacrolimus 19-Mar-2018
lDRUG ACTIONTacrolimus is a calcineurin inhibitor.lINDICATIONS AND DOSE
Short-term treatment of moderate to severe atopic
eczema (including flares) in patients unresponsive to, or
intolerant of conventional therapy (initiated by a
specialist)
▶TO THE SKIN
▶Child 2–15 years:Apply twice daily for up to 3 weeks
(consider other treatment if eczema worsens or if no
improvement after 2 weeks), 0. 03 % ointment to be
applied thinly, then reduced to once daily until lesion
clears
▶Child 16–17 years:Apply twice daily until lesion clears
(consider other treatment if eczema worsens or no
improvement after 2 weeks), initially 0. 1 % ointment to
be applied thinly, reduce frequency to once daily or
strength of ointment to 0. 03 % if condition allows
Prevention of flares in patients with moderate to severe
atopic eczema and 4 or more flares a year who have
responded to initial treatment with topical tacrolimus
(initiated by a specialist)
▶TO THE SKIN
▶Child 2–15 years:Apply twice weekly, 0. 03 % ointment to
be applied thinly, with an interval of 2 – 3 days between
applications, use short-term treatment regimen during
an acuteflare; review need for preventative therapy
after 1 year
▶Child 16–17 years:Apply twice weekly, 0. 1 % ointment to
be applied thinly, with an interval of 2 – 3 days between
applications, use short-term treatment regimen during
an acuteflare; review need for preventative therapy
after 1 yearlCONTRA-INDICATIONSApplication to malignant or
potentially malignant skin lesions.application under
occlusion.avoid contact with eyes.avoid contact with
mucous membranes.congenital epidermal barrier defects.
generalised erythroderma.immunodeficiency.infection
at treatment site
lCAUTIONSUV light (avoid excessive exposure to sunlight
and sunlamps)
lINTERACTIONS→Appendix 1 : tacrolimus
lSIDE-EFFECTS
▶Common or very commonIncreased risk of infection.
sensation abnormal.skin reactions
▶UncommonLymphadenopathy
▶Frequency not knownNeoplasms
lALLERGY AND CROSS-SENSITIVITYContra-indicated if
history of hypersensitivity to macrolides.
lPREGNANCYManufacturer advises avoid unless essential;
toxicity inanimalstudies following systemic
administration.BNFC 2018 – 2019 Eczema and psoriasis 747
Skin13