Offer second and third line therapies if topical therapies unlikely to control psoriasis, such as extensive disease e.g. > 10% body surface area affected, or at least “moderate” on the static Physicians Global Assessment. NHSE commissioned drug for Paediatric indications (where Adult TA available) - see Specialised Commissioning: Key documents

In patients with eczema, use of moisturisers and emollients may be sufficient to control mild disease and eliminate symptoms; reduce severity of flare-ups; and reduce requirements for topical steroids.Emollients help soften, moisturise and protect the skin. They play a central role in the treatment and management of dry skin conditions. For maximum effect, they should be applied regularly and as often as needed. Occlusives provide a layer of oil on the surface of the skin to slow water loss and thus increase the moisture content of the stratum corneum. Pan Mersey APC (2019). CALCIPOTRIOL 50 micrograms and BETAMETHASONE 500 micrograms per 1 gram cutaneous foam (Enstilar®) for psoriasis vulgaris in adults

Drugs carrying the NHS England logo are commissioned by them. Links to key documents, national programmes of care, and clinical reference groups are found below. Humectant agents are hydrophilic (‘water-loving’), therefore attract and retain water in the stratum corneum, similar to the natural hydrating factors found in corneocytes. They include: NICE (2017). Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people [TA455]Used to treat dry, sensitive skin as well as eczema and itching, cetomacrogol cream FNA is a mitigating and protective skin cream. It contains cetomacrogol (an emulsifying agent), cetiol (a fast-spreading dry emollient), sorbitol (a humectant and texturizing agent), water and the preservative sorbic acid. Urea is a keratin softener and hydrating agent used in the treatment of dry, scaling conditions (including ichthyosis) and may be useful in elderly patients. It is occasionally used with other topical agents such as corticosteroids to enhance penetration of the skin. MHRA (2020). Ingenol mebutate gel (Picato▼): suspension of the licence due to risk of skin malignancy NHS England commissioned for paediatrics (aged 12-17); must meet the criteria within NICE TA814- see Specialised Commissioning: Key documents

AproDerm Colloidal Oat Cream, a light, paraffin-free emollient which has all the benefits of colloidal oat including protecting and restoring the skin barrier, soothing the itch, irritation and redness associated with dry skin conditions like eczema and psoriasis, as well as having humectant properties and maintaining the skin’s normal pH. As well as being a moisturiser it can also be used as an effective soap substitute, to prevent the skin from drying out further. In line with NICE TA 177 - Alitretinoin for the treatment of severe chronic hand eczemaNo BNFc entry: Paediatrics seek specialist advice Danby SG, Chalmers J, Brown K, Williams HC, Cork MJ. A functional mechanistic study of the effect of emollients on the structure and function of the skin barrier. Br J Dermatol 2016; 175: 1011–9. DOI: 10.1111/bjd.14684. Journal solution for injection (Taltz ®) prefilled syringe; prefilled penNo BNFc entry;Paediatrics, seek specialist advice Not recommended for use. Deviation from the policy may be considered on an individual basis where exceptional circumstances exist.

How to use moisturisers and emollients

SC1 Requires specialist assessment to enable patient selection and also initiation, stabilisation and review of treatment and the patient`s condition. Expert opinion locally is that mycophenolate does not require brand prescribing – significant cost savings are available with generic prescribing Oral preparation Off label In women of child-bearing potential, exclude pregnancy up to 3 days before treatment (start treatment on day 2 or 3 of menstrual cycle), every month during treatment (unless there are compelling reasons to indicate that there is no risk of pregnancy), and 5 weeks after stopping treatment—perform pregnancy test in the first 3 days of the menstrual cycle. Women must practise effective contraception for at least 1 month before starting treatment, during treatment, and for at least 1 month after stopping treatment. Women should be advised to use at least 1 method of contraception, but ideally they should use 2 methods of contraception. Oral progestogen-only contraceptives are not considered effective. Barrier methods should not be used alone, but can be used in conjunction with other contraceptive methods. Each prescription for isotretinoin should be limited to a supply of up to 30 days' treatment and dispensed within 7 days of the date stated on the prescription; repeat prescriptions or faxed prescriptions are not acceptable. Women should be advised to discontinue treatment and to seek prompt medical attention if they become pregnant during treatment or within 1 month of stopping treatment. Considered for patients who fail to respond to aluminium antiperspirants, tap water/glycopyrrolate solution iontophoresis and glycopyrrolate cream or where these are not suitable

Combinations of products are often used, eg, soap substitutes +/- bath oils, as well as leave-on products.

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Glycopyrrolate in cetomacrogol cream2% Cream; 100 g Restricted prescribing - For hyperhidrosis This unlicensed special may be considered in exceptional circumstances. NHSE commissioned drug for Paediatric indications (in line with NICE TA 455) - see Specialised Commissioning: Key documents