Shampoos

Shampoos used for management of scalp psoriasis and listed elsewhere in the formulary:

• Etrivex, see section 13.4 Topical corticosteroids

NHS England (NHSE) has published new prescribing guidance for various common conditions for which over the counter (OTC) items should not be routinely prescribed in primary care (quick reference guide). These conditions include cradle cap and dandruff.

Many cradle cap and dandruff shampoos and other preparations for scalp and hair conditions are cheap to buy and are readily available OTC along with advice from pharmacies. Some self-care medicines are available from shops and supermarkets. Please click here for further information, exceptions, and a patient leaflet.

Cradle cap in infants may be treated with coconut oil or olive oil applications followed by shampooing.

Tars

Capasal

(Coal tar distilled 10mg/g / Coconut oil 10mg/g / Salicylic acid 5mg/g)

• Therapeutic shampoo (£5.29 = 250ml)

Indications

• Scalp psoriasis
• Seborrhoeic dermatitis
• Dandruff
• Cradle cap

Dose

• Apply as required

Notes

1. See OTC notes above regarding dandruff and cradle cap indications

Shampoo with antifungals / antimicrobials

Ketoconazole

• Shampoo 2% (£15.54 = 120ml)

Indications

• Seborrhoeic dermatitis

Dose

• Treatment: apply twice weekly for 2–4 weeks
• Prophylaxis: apply every 1-2 weeks

Notes

1. Leave preparation on for 3–5 minutes before rinsing
2. Not licensed for use in children under 12 years

Dermax

(Benzalkonium chloride 0.5%)

• Therapeutic shampoo (£5.69 = 250ml)

Indications

• Seborrhoeic scalp conditions

Dose

• Apply as required

Hirsutism

Women should be advised about local methods of hair removal, and in the mildest cases this may be all that is required.

Co-cyprindiol may be effective for moderately severe hirsutism. Metformin is an alternative in women with polycystic ovary syndrome (unlicensed indication). Systemic treatment is required for 6-12 months before benefit is seen.