lPATIENT AND CARER ADVICE
Medicines for Children leaflet: Aciclovir cream for
herpeswww.medicinesforchildren.org.uk/aciclovir-cream-for-
herpes
lPROFESSION SPECIFIC INFORMATION
Dental practitioners’formulary
Aciclovir Cream may be prescribed.
lEXCEPTIONS TO LEGAL CATEGORYA 2 -g tube and a pump
pack are on sale to the public for the treatment of cold
sores.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Cream
EXCIPIENTS:May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), propylene glycol
▶Aciclovir (Non-proprietary)
Aciclovir 50 mg per 1 gramAciclovir 5 % cream| 2 gramP
£ 1. 09 DT = £ 1. 09 | 10 gramP£ 5. 45 DT = £ 5. 45
▶Zovirax(GlaxoSmithKline UK Ltd, GlaxoSmithKline Consumer
Healthcare)
Aciclovir 50 mg per 1 gramZovirax 5 % cream| 2 gramP£ 4. 63
DT = £ 1. 09 | 10 gramP£ 13. 96 DT = £ 5. 453Inflammatory skin
conditions
3.1 Eczema and psoriasis
Eczema
Types and management
The main types of eczema (dermatitis) in children are atopic,
irritant and allergic contact; different types may co-exist.
Atopic eczemais the most common type and it usually
involves dry skin as well as infection and lichenification
caused by scratching and rubbing.Seborrhoeic dermatitisis
also common in infants.
Management of eczema involves the removal or treatment
of contributory factors; known or suspected irritants and
contact allergens should be avoided. Rarely, ingredients in
topical medicinal products may sensitise the skin;BNF for
Childrenlists active ingredients together with excipients that
have been associated with skin sensitisation.
Skin dryness and the consequent irritant eczema requires
emollientsapplied regularly (at least twice daily) and
liberally to the affected area; this can be supplemented with
bath or shower emollients. The use of emollients should
continue even if the eczema improves or if other treatment is
being used.
Topical corticosteroidsare also required in the
management of eczema; the potency of the corticosteroid
should be appropriate to the severity and site of the
condition, and the age of the child. Mild corticosteroids are
generally used on the face and onflexures; the more potent
corticosteroids are generally required for use on lichenified
areas of eczema or for severe eczema on the scalp, limbs, and
trunk. Treatment should be reviewed regularly, especially if a
potent corticosteroid is required. In children with frequent
flares ( 2 – 3 per month), a topical corticosteroid can be
applied on 2 consecutive days each week to prevent further
flares.
Bandages (including those containing ichthammol with
zinc oxide p. 744 ) are sometimes applied over topical
corticosteroids or emollients to treat eczema of the limbs.
Dry-wrap dressings can be used to provide a physical barrier
to help prevent scratching and improve retention of
emollients. Wet elasticated viscose stockinette is used for‘wet-wrap’bandaging over topical corticosteroids or
emollients to cool the skin and relieve itching, but there is an
increased risk of infection and excessive absorption of the
corticosteroid;‘wet-wrap’bandaging should be used under
specialist supervision.
SeeWound management products and elasticated garments
for details of elasticated viscose stockinette tubular
bandages and garments, and silk clothing.
See Eczema and psoriasis, drugs affecting the immune
response p. 732 for the role of topical pimecrolimus p. 747
and tacrolimus p. 522 in atopic eczema.
Infection
Bacterial infection (commonly withStaphylococcus aureus
and occasionally withStreptococcus pyogenes) can exacerbate
eczema. A topical antibacterial may be used for small areas
of mild infection; treatment should be limited to a short
course (typically 1 week) to reduce the risk of drug resistance
or skin sensitisation. Associated eczema is treated
simultaneously with a topical corticosteroid which can be
combined with a topical antimicrobial.
Eczema involving moderate to severe, widespread, or
recurrent infection requires the use of a systemic
antibacterial that is active against the infecting organism.
Preparations that combine an antiseptic with an emollient
application and with a bath emollient can also be used;
antiseptic shampoos can be used on the scalp.
Intertriginous eczema commonly involves candida and
bacteria; it is best treated with a mild or moderately potent
topical corticosteroid combined with a suitable antimicrobial
drug.
Widespreadherpes simplex infectionmay complicate atopic
eczema (eczema herpeticum) and treatment under specialist
supervision with a systemic antiviral drug is indicated.
Secondary bacterial infection often exacerbates eczema
herpeticum.Management of other features of eczema
Lichenification, which results from repeated scratching, is
treated initially with a potent corticosteroid. Bandages
containing ichthammol p. 744 (to reduce pruritus) and other
substances such aszinc oxidecan be applied over the
corticosteroid or emollient.Coal tarand ichthammol can be
useful in some cases ofchronic eczema.Discoid eczema, with
thickened plaques in chronic atopic eczema, is usually
treated with a topical antiseptic preparation, a potent topical
corticosteroid, and paste bandages containing ichthammol
with zinc oxide.
Anon-sedatingantihistamine may be of some value in
relieving severe itching or urticaria associated with eczema.
Asedatingantihistamine can be used at night if itching
causes sleep disturbance, but a large dose may be needed
and drowsiness may persist on the following day.
Exudative (‘weeping’) eczemarequires a potent
corticosteroid initially; infection may also be present and
require specific treatment. Potassium permanganate
solution ( 1 in 10 , 000 )p. 761 can be used as a soak in
exudating eczema for its antiseptic and astringent effects;
treatment should be stopped when exudation stops.
Severe refractory eczemais best managed under specialist
supervision; it may require phototherapy or drugs that act on
the immune system.
Seborrhoeic dermatitis
Seborrhoeic dermatitis (seborrhoeic eczema)is associated with
species of the yeastMalassezia.Infantile seborrhoeic
dermatitisaffects particularly the body folds, nappy area and
scalp; it is treated with emollients and mild topical
corticosteroids with suitable antimicrobials. Infantile
seborrhoeic dermatitis affecting the scalp (cradle cap)is
treated by hydrating the scalp using natural oils and the use
of mild shampoo.
In older children, seborrhoeic dermatitis affects the scalp,
paranasal areas, and eyebrows. Shampoos active against the730 Inflammatory skin conditions BNFC 2018 – 2019
Skin13