29 Treatment of Psoriasis
• Principles of therapy: o Choice of therapy should be individualized. o Mild psoriasis can usually be treated by topical therapy. o In moderate to severe psoriasis, adequate control of skin lesion is not achieved using topical agents alone.
• The following considerations will influence the choice & frequency of therapy: o Severity, body surface area (BSA) and site of lesion o Effect of psoriasis on quality of life o Degree of psychological impairment caused by the disease o Risk versus benefit ratio must be considered for each treatment regimen o Co-morbidities (e.g.: diabetes, hypertension) o Patient’s preference o Cost of therapy
• Topical therapy : Erythrodermic psoriasis (PAPAA.org, 2016) • Severe generalised erythema affecting 80%-90% of the body surface area with various degrees of scaling • Skin’s protection function is lost, patient is more susceptible to infections, loss of fluids and nutrients. • Can be life threatening Inverse Psoriasis (PsoriasisSPEAKS) • Lesions consist of erythematous plaques with minimal scales • Located in the skin folds such as axillary, genitalia, perineal, inter-gluteal, inframmary areas a) Emollients (First-line treatment for all types of psoriasis) (Aqueous cream, Ung emulsificant ointment, 25% glycerine in Aqueous cream, 50% glycerine in aqueous cream, white/yellow soft paraffin and liquid paraffin) – refer to Eczema-Emollient section. 

Scene 1

29
   
Treatment of Psoriasis
• Principles of therapy:
 o Choice of therapy should be individualized. 
 o Mild psoriasis can usually be treated by topical therapy. 
 o In moderate to severe psoriasis, adequate control of skin lesion is not achieved 
using topical agents alone.
• The following considerations will influence the choice & frequency of therapy:
 o Severity, body surface area (BSA) and site of lesion
 o Effect of psoriasis on quality of life
 o Degree of psychological impairment caused by the disease
 o Risk versus benefit ratio must be considered for each treatment regimen
 o Co-morbidities (e.g.: diabetes, hypertension)
 o Patient’s preference
 o Cost of therapy
• Topical therapy : 
Erythrodermic psoriasis 
(PAPAA.org, 2016) 
• 
Severe generalised erythema affecting 80%-90% of the 
body surface area with various degrees of scaling 
• 
Skin’s protection function is lost, patient is more 
susceptible to infections, loss of fluids and nutrients.  
• 
Can be life threatening 
Inverse Psoriasis 
 
 
 
 
 
(PsoriasisSPEAKS) 
• 
Lesions consist of erythematous plaques with minimal 
scales 
• 
Located in the skin folds such as axillary, genitalia, perineal, 
inter-gluteal, inframmary areas 
 
 
 
 
a) Emollients  (First-line treatment for all types of psoriasis) 
 
(Aqueous cream, Ung emulsificant ointment, 25% glycerine in Aqueous cream, 50% 
glycerine in aqueous cream, white/yellow soft paraffin and liquid paraffin) – refer to 
Eczema-Emollient section

30
b) Tar-based preparation:  Coal Tar in Vaseline 1%, 3%, 6% (Liquor Picis Carbonis, LPC)  Coal Tar and Salicylic Acid shampoo,  Coal Tar Solution 20%  UngCocois Co MODE OF ACTION • Anti-inflammatory properties • Anti-scaling properties • Inhibits DNA replication in cells, which slows down cell division and stops the cells from multiplying excessively. Hence, reducing thickening and scaling of the skin. • Breaks down keratin, helping the skin cells shed from the treated area, thus reducing thickening and scaling. SIDE EFFECTS Stain and irritate skin, folliculitis COUNSELLING POINTS Coal tar in Vaseline 1%, 3%, 6% (LPC) • Start with coal tar in vaseline 1% and slowly titrate to higher strength if needed. • Test dose: To apply onto the affected area (small amount). If patient experienced irritation to LPC, please ask patient to see doctor immediately • Usually apply at night due to the unpleasant smell Coal tar and Salicylic acid shampoo • Use as shampoo for 2-3 times a week. • Apply for 5 minutes then wash off • Do not scratch the scalp as it will worsened the psoriasis Coal tar solution 20% • 1 cap (15 ml) added to 10L of water in a pail • Soak diluted solution for 20 minutes • Do not rinse again with tap water UngCocois Co • Separate hair • Apply to scalp once at night • Wrap scalp with towel or shower cap • Cover pillow (can stain pillow) • Shampoo off the next morning All tar-based preparation should not be used on body-folds, face and genitalia.. 

Scene 2

30
b) Tar-based preparation:  
 
Coal Tar in Vaseline 1%, 3%, 6% (Liquor Picis Carbonis, LPC) 
 
Coal Tar and Salicylic Acid shampoo,  
 
Coal Tar Solution 20% 
 
UngCocois Co 
MODE OF 
ACTION 
• 
Anti-inflammatory properties 
• 
Anti-scaling properties 
• 
Inhibits DNA replication in cells, which slows down cell division 
and stops the cells from multiplying excessively. Hence, 
reducing thickening and scaling of the skin. 
• 
Breaks down keratin, helping the skin cells shed from the 
treated area, thus reducing thickening and scaling. 
 
SIDE EFFECTS 
Stain and irritate skin, folliculitis 
COUNSELLING 
POINTS 
Coal tar in Vaseline 1%, 3%, 6% (LPC)  
 
• 
Start with coal tar in vaseline 1% and slowly titrate to higher 
strength if needed.  
• 
Test dose: To apply onto the affected area (small amount). 
If patient experienced irritation to LPC, please ask patient to 
see doctor immediately 
• 
Usually apply at night due to the unpleasant smell  
 
Coal tar and Salicylic acid shampoo 
• 
Use as shampoo for 2-3 times a week.  
• 
Apply for 5 minutes then wash off 
• 
Do not scratch the scalp as it will worsened the psoriasis 
 
 Coal tar solution 20% 
• 
1 cap (15 ml) added to 10L of water in a pail 
• 
Soak diluted solution for 20 minutes  
• 
Do not rinse again with tap water 
 
UngCocois Co 
• 
Separate hair 
• 
Apply to scalp once at night 
• 
Wrap scalp with towel or shower cap 
• 
Cover pillow (can stain pillow) 
• 
Shampoo off the next morning 
 
All tar-based preparation should not be used on body-folds, face 
and genitalia.

31
c) Topical Corticosteroids - refer to Eczema- topical Corticosteroids section d) Vitamin D Analogues MODE OF ACTION Regulates proliferation and differentiation of keratinocytes after binding to vitamin D receptors SIDE EFFECTS Itching, rash, thinning of the skin, skin burning COUNSELLING POINTS • Do not use more than recommended dose because of the risk of hypercalcaemia. Recommended dose:  Adult: 100gm/week  Children (2-14 years) : 50 gm/ week • Not recommended for use on face and flexures • Avoid excessive exposure to sunlight • Avoid in erythrodermic and generalised pustular psoriasis Calcipotriol + Betamethasone Ointment • Once daily application (usually at night) Calcipotriol + Betamethasone Gel • To be used on scalp once a day after shampoo e) Dithranol (Anthralin) MODE OF ACTION Reduce proliferation of stem cells & prevents T-lymphocyte activation so that normal keratinization may occur SIDE EFFECTS Skin irritation, burning sensation, staining of skin and clothing COUNSELLING POINTS • Apply on the skin lesion for 30 minutes and wash off • Not suitable for flexural areas and face • Start by applying a low-strength preparation (such as 0.1% dithranol) for a week, and then increase the strength gradually over the next few weeks until the best suitable strength. It should be possible to clear the patches within about 4-6 weeks of treatment.. 

Scene 3

31
c) Topical Corticosteroids - refer to Eczema- topical Corticosteroids section 
 
d) Vitamin D Analogues 
MODE OF 
ACTION 
Regulates proliferation and differentiation of keratinocytes after 
binding to vitamin D receptors 
SIDE EFFECTS 
Itching, rash, thinning of the skin, skin burning 
COUNSELLING 
POINTS 
• 
Do not use more than recommended dose because of the risk 
of hypercalcaemia. Recommended dose: 
 Adult: 100gm/week 
 Children (2-14 years) : 50 gm/ week 
• 
Not recommended for use on face and flexures 
• 
Avoid excessive exposure to sunlight 
• 
Avoid in erythrodermic and generalised pustular psoriasis  
 
Calcipotriol + Betamethasone Ointment 
• 
Once daily application (usually at night) 
 
Calcipotriol + Betamethasone Gel  
• 
To be used on scalp once a day after shampoo 
 
e) Dithranol  (Anthralin) 
MODE OF ACTION 
Reduce proliferation of stem cells & prevents T-lymphocyte 
activation so that normal keratinization may occur 
SIDE EFFECTS 
Skin irritation, burning sensation, staining of skin and clothing 
COUNSELLING 
POINTS 
• 
Apply on the skin lesion for 30 minutes and wash off 
• 
Not suitable for flexural areas and face 
• 
Start by applying a low-strength preparation (such as 0.1% 
dithranol) for a week, and then increase the strength 
gradually over the next few weeks until the best suitable 
strength. It should be possible to clear the patches within 
about 4-6 weeks of treatment.

CHAPTER 3: ACNE VULGARIS
Acne Vulgaris (Acne) is a common skin condition that occurs when hair follicles become clogged with dead skins and oil, and eventually become inflamed. Acne sign includes whiteheads, blackheads, red pimples, nodules and cyst. It can occur on the face, neck, shoulders, back, or chest. Acne can be classified as: • Non-inflammatory: Characterised by comedones • Inflammatory: Characterised by papules, pustules, nodules, and cysts
Acne Vulgaris has a multifactorial pathogenesis in which the key factor is genetics. Acne develops as a result of interplay of the following 4 factors: i. Follicular epidermal hyper-proliferation with subsequent plugging of the follicle ii. Excess sebum production iii. The presence and activity of the commercial bacteria Propionibacterium Acnes iv. Inflammation 32
Figure 17: Diferent presentations of Acne Vulgaris (Acne.com). 

Scene 4

CHAPTER 3: ACNE VULGARIS
Acne Vulgaris (Acne) is a common skin condition that occurs when hair follicles 
become clogged with dead skins and oil, and eventually become inflamed. Acne sign 
includes whiteheads, blackheads, red pimples, nodules and cyst. It can occur on the 
face, neck, shoulders, back, or chest. Acne can be classified as:
 
• Non-inflammatory: Characterised by comedones
 
• Inflammatory: Characterised by papules, pustules, nodules, and cysts
Acne Vulgaris has a multifactorial pathogenesis in which the key factor is genetics. 
Acne develops as a result of interplay of the following 4 factors:
 
i. Follicular epidermal hyper-proliferation with subsequent plugging of the   
 
   follicle
 
ii. Excess sebum production
 
iii. The presence and activity of the commercial bacteria Propionibacterium 
 
     Acnes
 
iv. Inflammation 
    
32
Figure 17: Diferent presentations of Acne Vulgaris (Acne.com)

33
a) Cetrimide 1%, 2% solution MODE OF ACTION Bactericidal activity against gram-positive bacteria SIDE EFFECTS Burning sensation COUNSELLING POINTS • Apply solution onto the face twice daily • Cetrimide mix with water on palms, rub hand together until froth • Apply froth on face • Then rinse off with water • Dap dry b) Benzyl Peroxide 5%; 10% MODE OF ACTION • Antibacterial activity against Propionibacteria Acnes • It decomposes to release free oxygen radicals, which have potent bactericidal activity in the sebaceous follicles and anti-inflammatory action SIDE EFFECTS Dryness, skin irritation, bleaching or discoloration of fabrics (e.g. clothing, bed linen, towels) COUNSELLING POINTS • Apply on the acne spot after washing skin. May apply twice/ thrice a day if needed. • Start on night for a week, if no irritation, then can apply twice a day. • Stop if skin irritation occurs. c) Adapalene, Tretinoin Cream/Gel MODE OF ACTIONS • Normalisation or differentiation of follicular epithelial cells resulting in decreased micromedone formation • Reducing inflammatory components of acne (papules and pustules) SIDE EFFECTS Erythema, scaling, dryness, pruritus, burning, photosensitivity COUNSELLING POINTS • Apply thin layer to the entire face or other affected area at night after washing. • Wash well in the morning. • Protect face from direct sunlight. • Pregnancy should be avoided during treatment & at least 4 weeks after stopping treatment for Tretinoin cream/gel. d) Azelaic Acid 20% cream MODE OF ACTION Inhibit the growth of susceptible organism (Propionibacterial acnes) on the skin surface and inhibits follicular keratinisation. This restricts the development of comedone. SIDE EFFECTS Local skin irritation (erythema, scaling, burning, itching), photosensitivity COUNSELLING POINTS Massage a thin layer onto the affected area on the face twice a day. Treatment of Acne vulgaris • Topical therapy:. 

Scene 5

33
a) Cetrimide 1%, 2% solution 
MODE OF 
ACTION 
Bactericidal activity against gram-positive bacteria 
SIDE EFFECTS 
Burning sensation 
COUNSELLING 
POINTS 
• 
Apply solution onto the face twice daily 
• 
Cetrimide mix with water on palms, rub hand together until froth 
• 
Apply froth on face 
• 
Then rinse off with water 
• 
Dap dry 
 
b) Benzyl Peroxide 5%; 10% 
MODE OF 
ACTION 
• 
Antibacterial activity against Propionibacteria Acnes 
• 
It decomposes to release free oxygen radicals, which have potent 
bactericidal activity in the sebaceous follicles and anti-inflammatory 
action 
SIDE EFFECTS 
Dryness, skin irritation, bleaching or discoloration of fabrics (e.g. clothing, 
bed linen, towels) 
COUNSELLING 
POINTS 
• 
Apply on the acne spot after washing skin. May apply twice/ thrice a day 
if needed. 
• 
Start on night for a week, if no irritation, then can apply twice a day. 
• 
Stop if skin irritation occurs. 
 
c) Adapalene, Tretinoin Cream/Gel 
MODE OF 
ACTIONS 
• 
Normalisation or differentiation of follicular epithelial cells resulting in 
decreased micromedone formation 
• 
Reducing inflammatory components of acne (papules and pustules) 
SIDE EFFECTS 
Erythema, scaling, dryness, pruritus, burning, photosensitivity 
COUNSELLING 
POINTS 
• 
Apply thin layer to the entire face or other affected area at night after 
washing. 
• 
Wash well in the morning.  
• 
Protect face from direct sunlight. 
• 
Pregnancy should be avoided during treatment & at least 4 weeks after 
stopping treatment for Tretinoin cream/gel. 
 
d) Azelaic Acid 20% cream 
MODE OF 
ACTION 
Inhibit the growth of susceptible organism (Propionibacterial acnes) on the 
skin surface and inhibits follicular keratinisation. This restricts the 
development of comedone. 
SIDE EFFECTS 
Local skin irritation (erythema, scaling, burning, itching), photosensitivity 
COUNSELLING 
POINTS 
Massage a thin layer onto the affected area on the face twice a day. 
 
     Treatment of Acne vulgaris
 
• Topical therapy:

34
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lines/psoriasis/topical-therapy/recommendations-for-vitamin-d-analogues

37
Appendix i
CARTA ALIR PROSES KAUNSELING PRODUK DERMATOLOGI TOPIKAL
TANGGUNGJAWAB CARTA ALIR
Pegawai Farmasi Pegawai Farmasi Pegawai Farmasi Pegawai Farmasi Pegawai Farmasi Pegawai Farmasi Pegawai Farmasi Terima pesakit Perkenalkan diri dan jelaskan tujuan kaunseling Jalankan penilaian (jika berkaitan) Beri kaunseling & dispens ubat kepada pesakit Tetapkan temujanji susulan jika perlu Lengkapkan borang kaunseling Failkan borang kaunseling a) rekod dalam borang kaunseling b) Ubat dilabel dengan kod yang ditentukan seperti dalam Rajah Pendispensan Ubat Dermatologi Topikal. 

Scene 9

37
Appendix i
CARTA ALIR PROSES KAUNSELING PRODUK DERMATOLOGI TOPIKAL
TANGGUNGJAWAB  
 
 
 
CARTA  ALIR
Pegawai Farmasi  
Pegawai Farmasi   
Pegawai Farmasi 
 
Pegawai Farmasi 
 
 
 
 
 
Pegawai Farmasi 
Pegawai Farmasi 
Pegawai Farmasi 
 
Terima pesakit 
Perkenalkan diri dan jelaskan tujuan kaunseling 
Jalankan penilaian (jika berkaitan) 
Beri kaunseling & dispens ubat kepada pesakit 
Tetapkan temujanji susulan jika perlu 
Lengkapkan borang kaunseling 
 
Failkan borang kaunseling 
 
a) rekod dalam borang kaunseling 
b) Ubat dilabel dengan kod yang ditentukan seperti dalam Rajah 
Pendispensan Ubat Dermatologi Topikal

38
ITEM CODE ITEM CODE ITEM CODE Aqueous Cream Clobetasol Propionate 0.05% Ointment Magnesium Sulphate 45% Paste Adapalene 0.1% Cream/Gel Castellani's Paint Neomycin 0.5% Cream Amorolﬁne 5% Nail Lacquer Coal Tar 20% Solu�on Nysta�n 100,000 units/g Cream Benzoic Acid Compound Ointment Coal Tar 1% with Vaseline Paraﬃn, White so� Benzyl Benzoate Emulsion 12.5 % (Child) / 25% (Adult) Coal Tar 3% with Vaseline Permethrin 5% w/v Lo�on Benzoyl Peroxide 5% Gel Coal Tar 6% with Vaseline Podophyllum 10% Paint BVC 0.01% (1:10) Clotrimazole 1% Cream Pot. Permanganat 0.1% Solu�on BVC 0.05% (1:2) Emulsifying Ointment Pot. Permanganat 5% Solu�on BVC 0.025% (1:4) Fusidic acid 2% Ointment Salicylic acid 2% Ointment BVC 0.1% Fusidic acid 2% in BVC 0.1% Salicylic acid 5% Ointment BVO 0.1% Gamma Benzene Hexa 1% Lo�on Salicylic acid 10% Ointment BVO 0.05% (1:2) Gentamicin 0.1% Cream Salicylic acid 20% Ointment BVO 0.25% (1:4) Glycerin 25% in Aqueous Cream Salicylic acid 2% in BVO 0.025%(1:4) Calamine + 6% Sulphur Lo�on Glycerin 50% in Aqueous Cream Selenium Sulphide 2.5% Shampoo Calamine with 0.5% Menthol Lo�on Hydrocor�sone 1% Cream Silver Nitrate 0.5% Lo�on Calcipotriol 50mcg/g Cream Hydrocor�sone 1% Ointment Sod. Chloride 0.9% (For Irriga�on) Calcipotriol 50mcg/g + Betamet. 0.5mg/g Gel (Xamiol) Hydroquinone Comb Depigmenta�on Cream Sulfacetamide 15% Solu�on Calcipotriol 50mcg/g + Betamet. 0.5mg/g Ointment (Daivobet) Ketoconazole 2% Shampoo Tar, Coal Tar, and Salicylic Acid Liquid (Sebitar) Carbamide (urea) 10% Cream Methoxsalen 0.01% Ointment Tre�noin 0.05% Cream / Gel Cetrimide 2% Lo�on Methoxsalen 0.05% Ointment Zinc Oxide Cream Clobetasone Butyrate 0.05% Cream Miconazole cream Clobetasone Butyrate 0.05% Ointment Mometasone Furoate 0.1% Cream Clobetasol Propionate 0.05% cream Mupirocin 2% Ointment Appendix ii
RAJAH PENDISPENSAN UBAT DERMATOLOGI TOPIKAL
Nama: MRN: Tarikh:
SENARAI UBAT SAPU / LIST OF TOPICAL MEDICATION
(adapted from: My Skin Diary (Jan 2015), Projek Inovasi Jabatan Farmasi Hospital Serdang) NOTA:. 

Scene 10

38
ITEM 
CODE 
ITEM 
CODE 
ITEM 
CODE 
Aqueous Cream 
  
Clobetasol Propionate 0.05%  
Ointment  
  
Magnesium Sulphate 45% Paste 
  
Adapalene 0.1% Cream/Gel 
  
Castellani's Paint 
  
Neomycin 0.5% Cream 
  
Amorolﬁne 5% Nail Lacquer  
  
Coal Tar 20% Solu�on 
  
Nysta�n 100,000 units/g Cream 
  
Benzoic Acid Compound Ointment 
  
Coal Tar 1% with Vaseline 
  
Paraﬃn, White so� 
  
Benzyl Benzoate Emulsion 12.5 % 
(Child) / 25% (Adult) 
  
Coal Tar 3% with Vaseline 
  
Permethrin 5% w/v Lo�on 
  
Benzoyl Peroxide 5% Gel  
  
Coal Tar 6% with Vaseline 
  
Podophyllum 10% Paint 
  
BVC 0.01% (1:10) 
  
Clotrimazole 1% Cream  
  
Pot. Permanganat 0.1% Solu�on 
  
BVC 0.05% (1:2) 
  
Emulsifying Ointment 
  
Pot. Permanganat 5% Solu�on 
  
BVC 0.025% (1:4) 
  
Fusidic acid 2% Ointment 
  
Salicylic acid 2% Ointment  
  
BVC 0.1% 
  
Fusidic acid 2% in BVC 0.1%  
  
Salicylic acid 5% Ointment  
  
BVO 0.1%  
  
Gamma Benzene Hexa 1% Lo�on 
  
Salicylic acid 10% Ointment  
  
BVO 0.05% (1:2) 
  
Gentamicin 0.1% Cream 
  
Salicylic acid 20% Ointment  
  
BVO 0.25% (1:4) 
  
Glycerin 25% in Aqueous Cream 
  
Salicylic acid 2% in BVO 0.025%(1:4)  
  
Calamine + 6% Sulphur Lo�on 
  
Glycerin 50% in Aqueous Cream 
  
Selenium Sulphide 2.5%   Shampoo 
  
Calamine with 0.5% Menthol Lo�on 
  
Hydrocor�sone 1% Cream 
  
Silver Nitrate 0.5% Lo�on 
  
Calcipotriol 50mcg/g Cream  
  
Hydrocor�sone 1% Ointment 
  
Sod. Chloride 0.9% (For Irriga�on) 
  
Calcipotriol 50mcg/g + Betamet. 
0.5mg/g Gel (Xamiol) 
  
Hydroquinone Comb 
Depigmenta�on Cream 
  
Sulfacetamide 15% Solu�on 
  
Calcipotriol 50mcg/g + Betamet. 
0.5mg/g Ointment (Daivobet) 
  
Ketoconazole 2% Shampoo 
  
Tar, Coal Tar, and Salicylic Acid Liquid 
(Sebitar) 
  
Carbamide (urea) 10% Cream  
  
Methoxsalen 0.01% Ointment 
  
Tre�noin 0.05% Cream / Gel 
  
Cetrimide 2% Lo�on 
  
Methoxsalen 0.05% Ointment 
  
Zinc Oxide Cream 
  
Clobetasone Butyrate 0.05% Cream 
  
Miconazole cream 
  
  
  
Clobetasone Butyrate 0.05%   
Ointment  
  
Mometasone Furoate 0.1% Cream 
  
  
  
Clobetasol Propionate 0.05% cream 
  
Mupirocin 2% Ointment 
  
  
  
 
Appendix ii
RAJAH PENDISPENSAN UBAT DERMATOLOGI TOPIKAL
Nama:   
 
 
 
MRN: 
Tarikh:
SENARAI UBAT SAPU / LIST OF TOPICAL MEDICATION
(adapted from: My Skin Diary (Jan 2015), Projek Inovasi Jabatan Farmasi Hospital Serdang)
 
NOTA:

Cara Mengisi Rajah Pendispensan Ubat Dermatologi Topikal i. Ubat yang dipreskrib diberikan Kod pada Senarai Ubat Sapu. (kod ditentukan oleh pegawai yang memberikan kaunseling) Contoh: Hydrocortisone Ointment = A Aqueous Cream = B
ii. Labelkan pada label ubat kod yang telah ditentukan. iii. Tandakan Kod tersebut pada nama ubat disenaraikan dalam RAJAH PENDISPENSAN UBAT DERMATOLOGI TOPIKAL iv. Jika terdapat maklumat tambahan, sila isikan di ruang nota yang disediakan.
v. Berikan RAJAH PENDISPENSAN UBAT DERMATOLOGI TOPIKAL kepada pesakit untuk rujukan.
vi. Sekiranya ubat pesakit tidak tersenarai dalam jadual ubat tersebut, mohon tambah pada ruang kosong yang ada.
39. 

Scene 11

Cara Mengisi Rajah Pendispensan Ubat Dermatologi Topikal   
i. Ubat yang dipreskrib diberikan Kod pada Senarai Ubat Sapu. (kod ditentukan oleh 
pegawai yang memberikan kaunseling)
 
Contoh:
 
 
Hydrocortisone Ointment = A
 
 
Aqueous Cream = B
ii. Labelkan pada label ubat kod yang telah ditentukan. 
iii. Tandakan Kod tersebut pada nama ubat disenaraikan dalam RAJAH   
PENDISPENSAN UBAT DERMATOLOGI TOPIKAL  
iv. Jika terdapat maklumat tambahan, sila isikan di ruang nota yang disediakan.
v. Berikan RAJAH PENDISPENSAN UBAT DERMATOLOGI TOPIKAL kepada 
pesakit untuk rujukan.
vi. Sekiranya ubat pesakit tidak tersenarai dalam jadual ubat tersebut, mohon 
tambah pada ruang kosong yang ada.
39

General Counselling Points for Topical Dermatology Products
• Ensure that the patient knows which product to apply to which part of the body; and the difference in potencies.
• If both emollient & topical corticosteroid to be use at the same area, apply emollient first and wait for several minutes before applying topical corticosteroid. • Always apply cream based preparation prior to ointment based preparation.
• Do not scratch the affected area as it will worsened the condition.
• Remind Patient to practice hand hygiene before & after applying topical preparation and to Cut nails as short as possible. • Provide information on storage.
• Always apply ‘wet the dry’’and ‘dry the wet’ concept when counselling patient. ‘wet the dry’ – use emollient to moisten the dry area ‘dry the wet’ – use KMNO4 on weepy area
40
Appendix iii. 

Scene 12

General 
Counselling 
Points 
for 
Topical 
Dermatology Products
• Ensure that the patient knows which product to apply to which part of the body; 
and the difference in potencies.
• If both emollient & topical corticosteroid to be use at the same area, apply 
emollient first and wait for several minutes before applying topical 
corticosteroid. 
• Always apply cream based preparation prior to ointment based preparation.
• Do not scratch the affected area as it will worsened the condition.
• Remind Patient to practice hand hygiene before & after applying topical 
preparation and to Cut nails as short as possible. 
• Provide information on storage.
• Always apply ‘wet the dry’’and ‘dry the wet’ concept when counselling patient.
 
 ‘wet the dry’ – use emollient to moisten the dry area
 
 ‘dry the wet’ – use KMNO4 on weepy area
40
Appendix iii

Index
2% Fucidic acid cream 4
2% Mupirocin ointment 4
6% Sulphur ini Calamine/ Petrolatum 8, 9
Adapalene, Tretinoin 32
Azelaic acid 20% cream 32
Benzyl peroxide 5%; 10% 32
Cetrimide 1%, 2% solution 32
Crotamitone 10% 8, 9
Dithranol (Anthralin) 30
Emollients 21, 22, 24, 28 Aqueous cream 21, 28 Emulsifying ointment 21, 28 Liquid paraffin 21, 28 Glycerin 25% - 50% in Aqueous cream 21, 28 White/ Yellow soft paraffin 18, 21, 28 Urea cream 21
Emulsion Benzoyl Benzoate (EBB) 12.5% 8
Emulsion Benzoyl Benzoate (EBB) 25% 8
Gamma Benzene Hexachloride (GBH) 0.1% lotion 10
Imiquimod 5% cream 18
Ketoconazole shampoo 14
Nystatin cream 16
Permethrin 1% lotion 10
Permethrin 5% lotion 8, 9
Podophyllum 10 – 20% 18
Potassium Permanganate 5% 5, 6
Salicylic acid 1 – 20% 18
Selenium Sulphide (2.5%) lotion or shampoo 14
Tar-based preparation 29
Topical corticosteroids 21, 22, 23, 24, 30
Topical Calcineurin Inhibitors (TCIS) 26
Tacrolimus 0.03% & 0.1% ointment 26
Silver Nitrate 0.5%, 2%, 5% & 10% solution 26
Topical Imidazole (Miconazole cream/ powder, Clotrimazole cream) 13, 15, 16
Vitamin D analogues 1, 30
Whitfield ointment 17
41. 

Scene 13

Index
2% Fucidic acid cream  4
2% Mupirocin ointment  4
6% Sulphur ini Calamine/ Petrolatum  8, 9
Adapalene, Tretinoin  32
Azelaic acid 20% cream  32
Benzyl peroxide 5%; 10%  32
Cetrimide 1%, 2% solution  32
Crotamitone 10%  8, 9
Dithranol (Anthralin)  30
Emollients  21, 22, 24, 28
 
 
Aqueous cream  21, 28
 
 
Emulsifying ointment  21, 28
 
 
Liquid paraffin  21, 28
 
 
Glycerin 25% - 50% in Aqueous cream  21, 28
 
 
White/ Yellow soft paraffin  18, 21, 28
 
 
Urea cream  21
Emulsion Benzoyl Benzoate (EBB)  12.5%  8
Emulsion Benzoyl Benzoate (EBB)  25%  8
Gamma Benzene Hexachloride (GBH) 0.1% lotion  10
Imiquimod 5% cream  18
Ketoconazole shampoo  14
Nystatin cream  16
Permethrin 1% lotion  10
Permethrin 5% lotion  8, 9
Podophyllum 10 – 20%  18
Potassium Permanganate 5%  5, 6
Salicylic acid 1 – 20%  18
Selenium Sulphide (2.5%) lotion or shampoo  14
Tar-based preparation  29
Topical corticosteroids  21, 22, 23, 24, 30
Topical Calcineurin Inhibitors (TCIS)  26
Tacrolimus 0.03% & 0.1% ointment  26
Silver Nitrate 0.5%, 2%, 5% & 10% solution  26
Topical Imidazole (Miconazole cream/ powder, Clotrimazole cream)  13, 15, 16
Vitamin D analogues  1, 30
Whitfield ointment  17
41

Topical Preparation Counselling Guide (3.8.2019) (7) 1edit part 2