Indications And Dose
Pruritus ▶TO THE SKIN ▶Adult: Apply 1–2 times a day
Source page 1355
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Individual generic drug information
Extracted information for Levomenthol only.
Pruritus ▶TO THE SKIN ▶Adult: Apply 1–2 times a day
Source page 1355
Extracted information for Levomenthol only.
There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: cream Cream ▶AquaSoothe (Ennogen Healthcare Ltd) Menthol 10 mg per 1 gram AquaSoothe 1% cream | 100 gram £3.70 DT = £3.97 | 500 gram £15.43 DT = £16.59 Menthol 20 mg per 1 gram AquaSoothe 2% cream | 50 gram £1.86 | 500 gram £15.43 DT = £16.97 ▶Arjun (Arjun Products Ltd) Menthol 5 mg per 1 gram Arjun 0.5% cream | 500 gram £15.30 DT = Skin £16.07 Menthol 10 mg per 1 gram Arjun 1% cream | 100 gram £3.25 DT = £3.97 | 500 gram £15.30 DT = £16.59 Menthol 20 mg per 1 gram Arjun 2% cream | 500 gram £15.30 DT = £16.97 ▶Dermacool (Pern Consumer Products Ltd) Menthol 5 mg per 1 gram Dermacool 0.5% cream | 100 gram £3.85 | 500 gram £16.07 DT = £16.07 Menthol 10 mg per 1 gram Dermacool 1% cream | 100 gram £3.97 DT = £3.97 | 500 gram £16.59 DT = £16.59 Menthol 20 mg per 1 gram Dermacool 2% cream | 100 gram £4.07 | 500 gram £16.97 DT = £16.97 Menthol 50 mg per 1 gram Dermacool 5% cream | 100 gram £4.69 | 500 gram £17.48 ▶Menthoderm (Derma UK Ltd) Menthol 5 mg per 1 gram Menthoderm 0.5% cream | 100 gram £3.12 | 500 gram £14.59 DT = £16.07 Menthol 10 mg per 1 gram Menthoderm 1% cream | 100 gram £3.20 DT = £3.97 | 500 gram £14.79 DT = £16.59 Menthol 20 mg per 1 gram Menthoderm 2% cream | 100 gram £3.85 | 500 gram £14.99 DT = £16.97 Rosacea and acne Rosacea and Acne Acne Treatment of acne should be commenced early to prevent scarring. Patients should be counselled that an improvement may not be seen for at least a couple of months. The choice of treatment depends on whether the acne is predominantly inflammatory or comedonal and its severity. Mild to moderate acne is generally treated with topical preparations. Systemic treatment with oral antibacterials is generally used for moderate to severe acne or where topical preparations are not tolerated or are ineffective or where application to the site is difficult. Another oral preparation used for acne is the hormone treatment co-cyprindiol p. 1335 (cyproterone acetate with ethinylestradiol); it is for women only. Severe acne, acne unresponsive to prolonged courses of oral antibacterials, scarring, or acne associated with psychological problems calls for early referral to a consultant dermatologist who may prescribe isotretinoin p. 1337 for administration by mouth. Acne: topical preparations In mild to moderate acne, comedones and inflamed lesions respond well to benzoyl peroxide p. 1336 or to a topical retinoid. Alternatively, topical application of an antibacterial such as erythromycin p. 569 or clindamycin p. 1335 may be effective for inflammatory acne. If topical preparations prove inadequate, oral preparations may be needed. Benzoyl peroxide and azelaic acid Benzoyl peroxide is effective in mild to moderate acne. Both comedones and inflamed lesions respond well to benzoyl peroxide. The lower concentrations seem to be as effective as higher concentrations in reducing inflammation. It is usual to start with a lower strength and to increase the concentration of benzoyl peroxide gradually. Adverse effects include local skin irritation, particularly when therapy is initiated, but the scaling and redness often subside with treatment continued at a reduced frequency of application. If the acne does not respond after 2 months then use of a topical antibacterial should be considered. Azelaic acid p. 1336 has antimicrobial and anticomedonal properties. It may be an alternative to benzoyl peroxide or to a topical retinoid for treating mild to moderate comedonal acne, particularly of the face. Some patients prefer azelaic acid because it is less likely to cause local irritation than Skin benzoyl peroxide. Topical antibacterials for acne For many patients with mild to moderate inflammatory acne, topical antibacterials may be no more effective than topical benzoyl peroxide or tretinoin. Topical antibacterials are probably best reserved for patients who wish to avoid oral antibacterials or who cannot tolerate them. Topical preparations of erythromycin and clindamycin are effective for inflammatory acne. Topical antibacterials can produce mild irritation of the skin, and on rare occasions cause sensitisation; gastro-intestinal disturbances have been reported with topical clindamycin. Antibacterial resistance of Propionibacterium acnes is increasing; there is cross-resistance between erythromycin and clindamycin. To avoid development of resistance: . when possible use non-antibiotic antimicrobials (such as benzoyl peroxide or azelaic acid); . avoid concomitant treatment with different oral and topical antibacterials; . if a particular antibacterial is effective, use it for repeat courses if needed (short intervening courses of benzoyl peroxide or azelaic acid may eliminate any resistant propionibacteria); . do not continue treatment for longer than necessary (however, treatment with a topical preparation should be continued for at least 6 months). Some manufacturers of topical antibacterial preparations for acne advise that preparations containing alcohol are not suitable for use with benzoyl peroxide. Topical retinoids and related preparations for acne Topical tretinoin (available from ‘special-order’ manufacturers), its isomer isotretinoin, and adapalene p. 1337 (a retinoid-like drug), are useful for treating comedones and inflammatory lesions in mild to moderate acne. Several months of treatment may be needed to achieve an optimal response and the treatment should be continued until no new lesions develop. Isotretinoin is given by mouth in severe acne. Other topical preparations for acne Preparations containing aluminium oxide are not considered beneficial in acne. A topical preparation of nicotinamide p. 1339 is available for inflammatory acne. Acne: oral preparations Systemic antibacterial treatment is useful for inflammatory acne if topical treatment is not adequately effective or if it is inappropriate. Anticomedonal treatment (e.g. with topical benzoyl peroxide) may also be required. Either oxytetracycline p. 600 or tetracycline p. 600 is usually given for acne. If there is no improvement after the first 3 months another oral antibacterial should be used. Maximum improvement usually occurs after 4 to 6 months but in more severe cases treatment may need to be continued for 2 years or longer. Doxycycline p. 597 and lymecycline p. 599 are alternatives to tetracycline. Although minocycline p. 599 is as effective as other tetracyclines for acne, it is associated with a greater risk of lupus erythematosus-like syndrome. Minocycline sometimes causes irreversible pigmentation; it is given in a once or twice daily dose. Erythromycin in a twice daily dose is an alternative for the management of acne but propionibacteria strains resistant to erythromycin are becoming widespread and this may explain poor response. Trimethoprim p. 607 may be used for acne resistant to other antibacterials [unlicensed indication]. Prolonged treatment with trimethoprim may depress haematopoiesis; it should generally be initiated by specialists. Concomitant use of different topical and systemic antibacterials is undesirable owing to the increased likelihood of the development of bacterial resistance. Hormone treatment for acne Co-cyprindiol (cyproterone acetate with ethinylestradiol) contains an anti-androgen. It is licensed for use in women with moderate to severe acne that has not responded to topical therapy or oral antibacterials, and for moderately severe hirsutism. Although it is an effective hormonal contraceptive, it should not be used solely for contraception. Improvement of acne with co-cyprindiol probably occurs because of decreased sebum secretion which is under androgen control. Some women with moderately severe hirsutism may also benefit because hair growth is also androgen-dependent. Oral retinoid for acne The retinoid isotretinoin reduces sebum secretion. It is used for the systemic treatment of nodulo-cystic and conglobate acne, severe acne, scarring, acne which has not responded to an adequate course of a systemic antibacterial, or acne which is associated with psychological problems. It is also useful in women who develop acne in the third or fourth decades of life, since late onset acne is frequently unresponsive to antibacterials. Isotretinoin is a toxic drug that should be prescribed only by, or under the supervision of, a consultant dermatologist. It is given for at least 16 weeks; repeat courses are not normally required. Side-effects of isotretinoin include severe dryness of the skin and mucous membranes, nose bleeds, and joint pains. The drug is teratogenic and must not be given to women of child-bearing age unless they practise effective contraception (oral progestogen-only contraceptives not considered effective) and then only after detailed assessment and explanation by the physician. Women must also be registered with a pregnancy prevention programme. Although a causal link between isotretinoin p. 1337 use and psychiatric changes (including suicidal ideation) has not been established, the possibility should be considered before initiating treatment; if psychiatric changes occur during treatment, isotretinoin should be stopped, the prescriber informed, and specialist psychiatric advice should be sought. Rosacea Rosacea is not comedonal (but may exist with acne which may be comedonal). Brimonidine tartrate p. 1340 is licensed for the treatment of facial erythema in rosacea. The pustules and papules of rosacea respond to topical azelaic acid p. 1336, topical ivermectin p. 1339 or to topical metronidazole p. 1296. Alternatively oral administration of oxytetracycline p. 600 or tetracycline p. 600, or erythromycin p. 569, can be used; courses usually last 6–12 weeks and are repeated intermittently. Doxycycline p. 597 can be used [unlicensed indication] if oxytetracycline or tetracycline is inappropriate (e.g. in renal impairment). A modified-release preparation of doxycycline is licensed in low daily doses for the treatment of facial rosacea. Isotretinoin is occasionally given in refractory cases [unlicensed indication]. Camouflagers may be required for the redness. 6.1 Acne ANTI-ANDROGENS
Source pages 1355, 1356, 1357
Filter the extracted dose blocks for this individual drug.
First line only; read the complete Indications and dose section above.
Apply 1–2 times a day
This is a first-line fragment. Read the full Indications and Dose section above.
Candidate age grouping · source page 1355