Treatment for specific situations

Sunscreens

These give a degree of protection—mainly to ultraviolet B but also to ultraviolet A. They depend on their effect on a physical barrier (usually titanium dioxide) and chemicals that combine with epidermal cells, usually esters of PABA or oxybenzone.

Camouflage

Scars, congenital naevi and other blemishes that cannot be removed can be covered with suitable creams. Proprietary preparations are available.

Antiperspirants

Aluminium chloride for hyperhidrosis: aluminium chloride 20% (Driclor, Stiefel, or Anhydrol, Dermal Laboratories).

Depigmenting agents

2% hydroquinone cream is available without prescription as "fade-out". Preparations containing corticosteroids are also prescribed but not available as proprietary preparations.

Antimitotic agents

5-Flourouracil cream is useful for treating incipient malignancies—that is, solar keratoses, but not actual carcinomas. It is available as Efudix cream (Roche), which is applied daily for one to two weeks. It produces a variable degree of inflammation that is allowed to subside before the treatment is repeated.

Infestations

(1) Scabies. The correct procedure for treatment is more important than the preparation used. Benzyl benzoate 25% application BP is still available and is cheap but tends to irritate the skin. Malathion is available as Derbac (SSL), Prioderm (SSL), and Quellada M (Stafford-Miller), and Permethrin as Lyclear cream (Kestrel) preparations are more effective and less likely to irritate. 6% sulphur in white soft paraffin or permethrin are recommended for young children and pregnant or lactating women. The procedures for treatment set out on page 107 should be followed and clearly explained to the patient. For resistant cases ivermectin (Mectizan, MSD) by mouth is available on a named patient basis.

(2) Pediculosis. Preparations containing malathion, carbaryl, and permethrin are used either as shampoos or lotions. Lotions are most effective and should be left on the skin for 12 hours before washing off. The same preparations are available as for treating scabies, with the addition of 0-5% malathion lotion as Suleo-M (SSL). Recently a lotion of phenothrin (Full Marks, SSL) has become available for treating head and pubic lice.

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