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 Formulary Chapter 13: Skin - Full Chapter
Notes:

Review date: September 2021

Non-formulary drugs - any drug or formulation not listed in the formulary is deemed to be non-formulary.

Off-label use: Drugs are included in the formulary for their licensed indications – where inclusion of off-label use is considered to be included in the formulary this is specifically stated in the formulary entry for the drug N.B. also see Paediatrics note below.

Paediatrics: Drugs are included in the formulary for paediatric use for their BNF for Children recommended indications (indicated by symbol View childrens BNF) which may be off-label, unless otherwise stated. All drugs are deemed to have the same RAG status as they have for adults unless stated otherwise.

NHS England Specialised Commissioning
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.

NHSE NHS England Specialised Commissioning: Key documents

NHSE NHS England Specialised Commissioning: National programmes of care and clinical reference groups





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13.01  Management of skin conditions
13.01.01  Vehicles
13.01.02  Suitable quantities for prescribing
 note 

Suitable quantities of dermatological preparations to be prescribed for specific areas of the body:

Area of the body

Creams and Ointments

Lotions

Face

15 - 30 g

100 mL

Both hands

25 – 50 g

200 mL

Scalp

50 – 100 g

200 mL

Both arms or both legs

100 – 200 g

200 mL

Trunk

400 g

500 mL

Groins and genitalia

15 – 25 g

100 mL

These amounts are usually suitable for an adult for twice daily application for 1 week. The recommendations do not apply to corticosteroid preparations – for suitable quantities of corticosteroid preparations, see section 13.4.

13.01.03  Excipients and sensitisation
13.02  Emollient and barrier preparations to top
13.02.01  Emollients
 note 

Emollients soothe, smooth and hydrate the skin and are indicated for all dry or scaling disorders. Their effects are short-lived and they should be applied frequently even after improvement occurs. They are useful in dry and eczematous disorders, and to a lesser extent psoriasis. The choice of an appropriate emollient will depend on the severity of the condition, patient preference, and the site of application. Emollient preparations contained in the tubs should be removed with a clean spoon or spatula to reduce bacterial contamination of the emollient. Emollients should be applied in the direction of the hair growth to reduce the risk of folliculitis. Ointments may exacerbate acne and folliculitis. Some ingredients rarely cause sensitisation and this should be suspected if an eczematous reaction occurs. The use of aqueous cream as a leave-on emollient may increase the risk of skin reaction, particularly in eczema, see MHRA safety warning.

Fire Risk with paraffin-based skin emollients on dressings or clothing: Smoking or a naked flame could cause patients’ dressings or clothing to catch fire when being treated with paraffin-based emollient that is in contact with the dressing or clothing. Patients’ clothing and bedding should be changed regularly – preferably daily – because the risk is greater when these preparations are applied to large areas of the body, and clothing or dressings become soaked with emollient. Advise patients not to: smoke; use naked flames (or be near people who are smoking or using naked flames); or go near anything that may cause a fire while emollients are in contact with their medical dressings or clothing.

MHRA safety warning

Emollients creams and ointments, paraffin-containing

Pan Mersey APC (2019). PARAFFIN-BASED EMOLLIENTS: fire risk

Preparations such as aqueous cream and emulsifying ointment can be used as soap substitutes for hand washing and in the bath; the preparation is rubbed on the skin before rinsing off completely.

Preparations containing an antibacterial (section 13.10) should be avoided unless infection is present or is a frequent complication.

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.

For further information Atopic eczema in children: Management of atopic eczema in children from birth up to the age of 12years consult NICE CG 57

AproDerm®
View adult BNF View SPC online View childrens BNF
Formulary
Green

Emollient cream; 50 g tube; 500 g pump pack

Colloidal oat cream; 500mL pump pack: Paraffin-free (suitable for those on oxygen or smokers)

Medium

 
   
Aquamax®
View adult BNF View SPC online View childrens BNF
Formulary
Green

Cream; 100g tube; 500g tub

Medium

 
   
Aveeno®
View adult BNF View SPC online View childrens BNF
Formulary
Green
Lotion; 500 mL; Cream; 100ml, 300ml pump pack

For ACBS approved indication only: endogenous and exogenous eczema, xeroderma, ichthyosis, and senile pruritus (pruritus of the elderly) associated with dry skin.

Cream = Medium
Lotion = Light 
   
Cetraben®
View adult BNF View SPC online View childrens BNF
Formulary
Green

Ointment; 450 g tub

Very Greasy

 
   
Cetraben®
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream; 500 g pump pack

Medium
 
   
Diprobase®
View adult BNF View SPC online View childrens BNF
Formulary
Green

Cream; 500 g pump pack

Medium

Ointment; 500g tub

Greasy

 
   
DoubleBase®
View adult BNF View SPC online View childrens BNF
Formulary
Green

Gel; 500 g

Dayleave Gel; 100g; 500g pump pack

Greasy

 
   
E45®
View adult BNF View SPC online View childrens BNF
Formulary
Green
Lotion; 200 mL, 500 mL pump pack

Light
 
   
Emulsifying Ointment BP
View adult BNF View SPC online View childrens BNF
Formulary
Green
Ointment; 500 g tub

Very Greasy
 
   
Epimax®
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream 100 g tube, 500 g pump
(same as Aqueous Cream but SLS free. Use as emollient and soap substitute)

Light
 
   
Hydromol®
View adult BNF View SPC online View childrens BNF
Formulary
Green
Ointment only (not cream); 500 g, 1 kg tub

Very Greasy
 
   
Oilatum®
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream; 150 g, 500 mL pump pack, 1.05 litre pump pack

Medium
 
   
White Soft Paraffin 50% / Liquid Paraffin 50%
View adult BNF View SPC online View childrens BNF
Formulary
Green
Ointment; 500 g tub

Very Greasy
 
   
Whitesoft paraffin
View adult BNF View SPC online View childrens BNF
Formulary
Green
Ointment; 500 g tub

Very Greasy
 
   
ZeroAQS®
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream; 500 g tub

Light
 
   
Zerobase®
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream; 500 g pump pack

Medium
 
   
Zerocream®
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream; 500 g pump pack

Medium
 
   
Zeroderm®
View adult BNF View SPC online View childrens BNF
Formulary
Green
Ointment; 500 g tub

Very Greasy
 
   
Zerodouble®
View adult BNF View SPC online View childrens BNF
Formulary
Green
Gel; 475g squeeze bottle

Greasy
 
   
Zeroguent®
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream; 500 g tub

Greasy
 
   
13.02.01  Preparations containing urea
Balneum®
View adult BNF View SPC online View childrens BNF
First Choice
Green
Urea 5%, ceramide 0.1% Cream; 500 g

Medium
 
ImuDerm Emollient®
View adult BNF View SPC online View childrens BNF
First Choice
Green

Urea 5%, glycerol 5%, Cream; 500 g pump

Medium

 
Balneum Plus®
View adult BNF View SPC online View childrens BNF
Second Choice
Green
Urea 5%, lauromacrogols 3% Cream; 500 g pump pack

Medium
 
   
Flexitol 10% urea cream®
View adult BNF View SPC online View childrens BNF
Formulary
Green

Urea 10%, Cream; 500 g

Medium

 
   
Hydromol Intensive®
View adult BNF View SPC online View childrens BNF
Formulary
Green

Urea 10%; Cream; 30 g; 100 g

Medium

 
   
Nutraplus®
View adult BNF View SPC online View childrens BNF
Formulary
Green

Urea 10%, Cream; 100 g

Medium

 
   
13.02.01  With antimicrobials
Dermol®
View adult BNF View SPC online View childrens BNF
Formulary
Green

Cream; 500 g pump pack (used as emollient and soap substitute)

Medium

 
   
Dermol® 500
View adult BNF View SPC online View childrens BNF
Formulary
Green

Lotion; 500 mL pump pack (used as emollient and soap substitute)

Light

 
   
13.02.01.01  Emollient bath and shower preparations
 note 

Emollient bath and shower additives – Not recommended. No evidence of clinical benefit shown from including emollient bath additives in the standard management of eczema in children. The evidence is for leave-on emollients and soap substitutes only.

See Emollient bath additives for the treatment of childhood eczema. BMJ 2018;361:k1332

Aqueous Cream BP
View adult BNF View SPC online View childrens BNF
Formulary
Green

Cream 100g, 500 g (not recommended as an emollient as contains SLS)

Soap substitute only

 
   
13.02.01.01  With antimicrobials to top
Dermol® 200
View adult BNF View SPC online View childrens BNF
Formulary
Green

Shower emollient; 200 mL

Can be used as a soap substitute

 
   
13.02.02  Barrier preparations
 note 

Prescqipp B181 : Barrier products : April 2017

Conotrane®
View adult BNF View SPC online View childrens BNF
First Choice
Green
Cream; 100 g, 500 g

 
Cavilon
View adult BNF View SPC online
Second Choice
Green

Durable Barrier Cream; 28 g, 92 g;

No-Sting Barrier Film, spray; 28 mL

Does not affect the absorbency of continence pads

Paediatrics: No BNFc entry, seek specialist advice 

 
   
Proshield Plus Skin Protectant®
View adult BNF View SPC online
Second Choice
Green

115g 

Continence pads can be applied directly over the protected area.

No BNFc entry; Paediatrics, seek specialist advice

 
   
MediDerma-S®
View adult BNF View SPC online View childrens BNF
Second Choice
Green

Barrier cream, 28 g, 90g 

Non-sting Medical barrier film, pump spray, 30ml

Continence pads can be applied directly over the protected area.

 
   
Metanium®
View adult BNF View SPC online View childrens BNF
Formulary
Green

Ointment; 30 g

For nappy rash only

 
   
13.03  Topical local anaesthetics and antipruritics
Crotamiton
View adult BNF View SPC online View childrens BNF
Formulary
Green

10% Cream (Eurax®); 100g

 
   
Levomenthol Cream, BP (Menthol in aqueous cream)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Cream; 1%, 100 g, 500 g pump pack & 2%, 500 g pump pack.
Some brands are sodium lauuryl sulphate free e.g. Dermacool®, Menthoderm®

 
   
13.04  Topical corticosteriods.
 note 

Suitable quantities of corticosteroid preparations to be prescribed for specific areas of the body.

 

Creams and Ointments

Face and neck

15 - 30 g

Both hands

15 – 30 g

Scalp

15 – 30 g

Both arms

30 – 60 g

Both legs

100 g

Trunk

100 g

Groins and genitalia

15 – 30 g

These amounts are usually suitable for an adult for a single daily application for 2 weeks.

Please note corticosteroids should be prescribed in line with NICE TA 81 - Frequency of application of topical corticosteroids for atopic eczema.

In order to minimise the side-effects of a topical corticosteroid, it is important to apply it thinly to affected areas only, no more frequently than twice daily, and to use the least potent formulation which is fully effective.

Psoriasis: The use of potent or very potent corticosteroids in psoriasis can result in rebound relapse, development of generalised pustular psoriasis, and local and systemic toxicity. Do NOT use very potent corticosteroids continuously at any site for longer than 4 weeks.

Do NOT use potent corticosteroids continuously at any site for longer than 8 weeks.

Corticosteroids with Antimicrobials
Only where inflammatory skin conditions are associated with bacterial or fungal infection, such as infected eczema.  The antimicrobial drug should be chosen according to the sensitivity of the infecting organism and used regularly for a short period (typically twice daily for 1 week).  Longer use increases the likelihood of resistance and of sensitisation.

Hydrocortisone
View adult BNF View SPC online View childrens BNF
Formulary
Green
First Choice
0.5%, 1.0% Cream; Ointment; 15 g, 30 g

Mild 
   
Fluocinolone Acetonide
View adult BNF View SPC online View childrens BNF
Formulary
Green

Second choice

0.0025% (Synalar 1 in 10 dilution®) Cream (for those intolerant to hydrocortisone); 50 g

Mild

 
   
Betamethasone Valerate
View adult BNF View SPC online View childrens BNF
Formulary
Green

First Choice

0.025% (Betnovate-RD®) Cream; Ointment; 100 g

Moderately potent

Amber Recommended Paediatrics

 
   
Clobetasone Butyrate
View adult BNF View SPC online View childrens BNF
Formulary
Green
First Choice

0.05% (Eumovate®) Cream; Ointment; 30 g, 100 g

Moderately potent
 
   
Fludroxycortide
View adult BNF View SPC online View childrens BNF
Formulary
Green

Second choice

4micrograms / cm2 (Haelan®) Tape; 7.5 cm x 20 cm
 
Moderately potent

Amber Recommended Paediatrics

 
   
Fluocinolone Acetonide
View adult BNF View SPC online View childrens BNF
Formulary
Green

Second choice

0.00625% (Synalar 1 in 4 dilution®) Cream; Ointment; 50 g

Moderately potent

Amber Recommended Paediatrics

 
   
Betamethasone Dipropionate
View adult BNF View SPC online View childrens BNF
Formulary
Green

First Choice

0.05% (Diprosone®) Cream; Ointment; 30 g, 100 g

Potent

Amber Recommended Paediatrics

 
   
Betamethasone Valerate
View adult BNF View SPC online View childrens BNF
Formulary
Green

First Choice

0.1% (Betnovate®) Cream; Ointment; 30 g, 100 g
Scalp application; 100 mL

Potent

Amber Recommended Paediatrics

 
   
Diflucortolone Valerate
View adult BNF View SPC online View childrens BNF
Formulary
Green

First choice

0.1% (Nerisone Oily®) cream 30 g

Potent

Amber Recommended Paediatrics

 
   
Fluocinolone Acetonide
View adult BNF View SPC online View childrens BNF
Formulary
Green

Second choice

0.025% (Synalar®) Cream; Ointment; 30g, 100g
Gel; 30 g, 60 g

Potent

Amber Recommended Paediatrics

 
   
Hydrocortisone Butyrate
View adult BNF View SPC online View childrens BNF
Formulary
Green

Second choice 0.1% (Locoid®) Cream; Lipocream; Ointment; 30 g, 100 g

Potent

Amber Recommended Paediatrics

 
   
Mometasone Furoate
View adult BNF View SPC online View childrens BNF
Formulary
Green

Second choice

0.1% (Elocon®) Cream; Ointment; 30 g, 100 g

Potent

Amber Recommended Paediatrics

 
   
Clobetasol Propionate
View adult BNF View SPC online View childrens BNF
Formulary
Green

First choice

0.05% (Dermovate®) Cream; Ointment; 30 g, 100 g
0.05% foam scalp application (Clarelux®); 100 g (for use in adults only)

Very potent

Amber Recommended Paediatrics

 
   
Diflucortolone Valerate
View adult BNF View SPC online View childrens BNF
Formulary
Green

Second choice

0.3% (Nerisone Forte®) Oily cream; 15 g

Very Potent

Amber Recommended Paediatrics

 
   
Hydrocortisone 1%, Clotrimazole 1%
View adult BNF View SPC online View childrens BNF
Formulary
Green
(Canestan HC®) Cream; 30 g

Mild with antifungal 
   
Hydrocortisone 1%, Miconazole Nitrate 2%
View adult BNF View SPC online View childrens BNF
Formulary
Green
(Daktacort®) Cream; ointment; 30 g

Mild with antifungal 
   
Hydrocortisone Acetate 1%, Fusidic Acid 2%
View adult BNF View SPC online View childrens BNF
Formulary
Green
(Fucidin H®) Cream; 30 g, 60 g

Mild with antimicrobials 
   
Clobetasone butyrate 0.05%, oxytetracycline 3.0% and nystatin 100,000 units/g
View adult BNF View SPC online View childrens BNF
Formulary
Green

Cream 30g (Trimovate®)

Moderate with antimicrobial + antifungal 

 
   
Hydrocortisone 1% with oxytetracycline
View adult BNF View SPC online View childrens BNF
Formulary
Green

Terra-Cortril® ointment 30 g

 

Mild with antimicrobials 

 
   
Hydrocortisone 1%, Nystatin 100,000 units/g, Chlorhexidine Hydrochloride 1%
View adult BNF View SPC online View childrens BNF
Formulary
Green

Ointment; 30 g

Mild with antimicrobials

 
   
Hydrocortisone 0.5%, Nystatin 100,000 units/g, Benzalkonium chloride solution 0.2%, dimeticone '350' 10%
View adult BNF View SPC online View childrens BNF
Formulary
Green
(Timodine®) Cream; 30 g

Mild with antimicrobials 
   
Betamethasone (as dipropionate) 0.064% (≡ betamethasone 0.05%), clotrimazole 1%
View adult BNF View SPC online View childrens BNF
Formulary
Green

(Lotriderm®) cream; 30 g

Potent with antifungal

Amber Recommended Paediatrics

 
   
Betamethasone (as Valerate) 0.1%, Fucidic Acid 2%
View adult BNF View SPC online View childrens BNF
Formulary
Green

(Fucibet®) Cream; 30 g, 60 g

Potent with antimicrobials

 Amber Recommended Paediatrics

 
   
Fluocinolone acetonide 0.025%, Clioquinol 3%
View adult BNF View SPC online View childrens BNF
Formulary
Green

Synalar C Cream; Ointment; 15 g

Potent with antimicrobials

Amber Recommended Paediatrics

 
   
Betamethasone (as Dipropionate) 0.05% with Salicylic Acid
View adult BNF View SPC online View childrens BNF
Formulary
Green

Diprosalic® Ointment contains salicylic acid 3%; 30 g, 100 g

Diprosalic® Scalp Application contains salicylic acid 2%; 100 mL

Potent with salicylic acid
Amber Recommended Paediatrics


The keratolytic effect of salicylic acid facilitates the absorption of topical corticosteroids; however, excessive and prolonged topical use may result in symptoms of salicylism.
Manufacturer recommends that Diprosalic preparations are prescribed for two weeks, and that treatment is reviewed at that time. The maximum weekly dose should not exceed 60g. Application in children should be limited to 5 days.

 
   
Clobetasol Propionate 0.05%, Neomycin 0.5%, Nystatin 100,000 units/g
View adult BNF View SPC online View childrens BNF
Formulary
Green

Cream; Ointment; 30g

Very potent with antimicrobials

Amber Recommended Paediatrics

 
   
13.05  Preparations for eczema and psoriasis
Viscose stockinette garments (Clinifast®, Comfifast Easywrap®, Skinnies Viscose®, Tubifast 2-way Stretch®)
Formulary
Amber Recommended

Elasticated viscose stockinette - in a range of garments, e.g. body suits, vests, leggings and gloves, and in a variety of sizes.

 
Link  Pan Mersey APC (2018). Elasticated Viscose Stockinette (’Viscose’) Garments
   
Silk garments (Dermasilk®, Dreamskin®, Skinnies Silk®)
Formulary
Black

eye masks, socks, gloves, vests, pyjamas, body suits etc.

 
Link  Pan Mersey APC (2018). SILK garments (Dermasilk®, Dreamskin®, Skinnies Silk®)
   
13.05.01  Preparations for eczema to top
 note 

For further information on the Atopic eczema in children: Management of atopic eczema in children from birth up to the age of 12 years consult NICE CG 57

13.05.01  Topical preparations for eczema
Zinc paste bandage
View adult BNF View SPC online View childrens BNF
Formulary
Green

Viscopaste®; 6 m x 7.5 cm

 
   
Zinc Paste (6%) and Ichthammol (2%) Bandage, BP 1993
View adult BNF View SPC online View childrens BNF
Formulary
Green
Ichthopaste® (6/2%); 6 m x 7.5 cm 
   
13.05.01  Oral retinoid for eczema
Alitretinoin
View adult BNF View SPC online
Formulary
Red

Capsules 10 mg, 30 mg
In line with NICE TA 177 - Alitretinoin for the treatment of severe chronic hand eczema

No BNFc entry: Paediatrics seek specialist advice 

Pregnancy prevention
In women of child-bearing potential, exclude pregnancy 1 month before treatment, up to 3 days before treatment, 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 alitretinoin should be limited to a supply of up to 30 days' treatment and dispensed within 7 days of the date stated on the prescription. 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

 
Link  NICE TA177 Alitretinoin for the treatment of severe chronic hand eczema
   
13.05.02  Preparations for psoriasis
 note 

Consult NICE CG 153 - Psoriasis: Assessment and management of psoriasis

Summary: Management of Psoriasis - taken from NICE CG 153:

  • First line – Topical therapy – e.g. corticosteroids, vitamin D, vitamin D analogues, dithranol and tar preparations
  • Second line – broad- or narrow-band UVB light and psoralen plus UVA light (PUVA) and systemic non-biologics e.g. ciclosporin, methotrexate or acitretin
  • Third line – systemic biologics; Anti-TNFs – adalimumab, etanercept and infliximab and mono-clonal antibody ustekinumab which targets IL-12 and IL-23.

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.
Calcipotriol and tacalcitol are analogues of vitamin D that affect cell division and differentiation. Calcitriol is an active form of vitamin D. Vitamin D and its analogues are used first-line for the long-term treatment of plaque psoriasis; they do not smell or stain and they may be more acceptable than tar or dithranol products. Of the vitamin D analogues, calcitriol is less likely to irritate.

Dimethyl fumarate
View adult BNF View SPC online
Formulary
Red

Tablets 30mg, 120mg

No BNFc entry; Paediatrics, seek specialist advice 

 
Link  NICE TA475: Dimethyl fumarate for treating moderate to severe plaque psoriasis
   
13.05.02  Topical preparations for psoriasis
 note 

British Association of Dermatologists (BAD) preferred choice of products

Calcipotriol
View adult BNF View SPC online View childrens BNF
First Choice
Green

50 micrograms/g (Dovonex®) Ointment;
(not for face or flexures) 30 g

For chronic plaque psoriasis in adult and child 6-18 years
For Body

Amber Recommended Paediatrics < 6 years

 
Calcitriol
View adult BNF View SPC online View childrens BNF
First Choice
Green

3micrograms/g (Silkis®) Ointment; 100g

For chronic plaque psoriasis in adult and child over 12 years
For Body

 

Amber Recommended Paediatrics < 12 years

 
Betamethasone diproprionate 0.05%, calcipotriol 50 micrograms/g
View adult BNF View SPC online View childrens BNF
Second Choice
Green

(Dovobet®) Gel; 60g

(Enstilar®) Cutaneous Foam; 60g
 
For chronic plaque psoriasis
For body and scalp (Dovobet) or body (Enstilar)
Off label use in children 12-18 years (specialist use only)

Amber Recommended Paediatrics

 
Link  PAN MERSEY AREA PRESCRIBING COMMITTEE PRESCRIBING POLICY STATEMENT; CALCIPOTRIOL and BETAMETHASONE cutaneous foam (Enstilar®)
   
Dithranol
View adult BNF View SPC online View childrens BNF
Third Choice
Green

0.1%, 0.25%, 0.5%, 1%, 2% (Dithrocream®) Cream; 50 g

For chronic plaque psoriasis
For Body and Scalp

Consider short-contact dithranol only in treatment resistant trunk and limb psoriasis with educational support for self-use or ensure treatment is given in a specialist setting:

 
   
Coal Tar solution 12%, salicylic acid 2%, precipitated sulphur 4%
View adult BNF View SPC online View childrens BNF
Formulary
Green

in a coconut oil emollient basis (Sebco®); Ointment, 100 g

For scalp

Amber Recommended Paediatrics < 6 years

 
   
Coal tar solution 5% in emollient base
View adult BNF View SPC online View childrens BNF
Formulary
Green
(Exorex®) Lotion; 100 mL, 250 mL

For scalp 
   
Coal tar 5% solution in 0.025% strength betnovate ointment
View adult BNF View childrens BNF
Unlicensed Drug Unlicensed
Amber Initiated

Ointment; 100 g Topical steroid For psoriasis, this unlicensed special may be considered

 
   
Coal tar 6% solution with salicylic acid 2% in emulsifying ointment
View adult BNF View childrens BNF
Unlicensed Drug Unlicensed
Amber Initiated

Ointment; 100 g Tar For psoriasis, this unlicensed special may be considered

 
   
Salicylic acid 2% w/w in emulsifying ointment
View adult BNF View childrens BNF
Unlicensed Drug Unlicensed
Amber Initiated

Ointment; 100 g Keratolytic For psoriasis, this unlicensed special may be considered

 
   
Salicylic acid 5% w/w in emulsifying ointment
View adult BNF View childrens BNF
Unlicensed Drug Unlicensed
Amber Initiated

Ointment; 100 g Keratolytic For psoriasis, this unlicensed special may be considered

 
   
Salicylic acid 10% w/w in emulsifying ointment
View adult BNF View childrens BNF
Unlicensed Drug Unlicensed
Amber Initiated

Ointment; 100 g Keratolytic For psoriasis, this unlicensed special may be considered

 
   
Zinc and salicylic acid paste (Lassar’s Paste) half-strength
View adult BNF View childrens BNF
Unlicensed Drug Unlicensed
Amber Initiated

Paste; 100 g Keratolytic For psoriasis, this unlicensed special may be considered

 
   
13.05.02  Oral retinoids for psoriasis to top
Acitretin
View adult BNF View SPC online View childrens BNF
Formulary
Red
Capsules; 10 mg, 25 mg

Pregnancy prevention
In women of child-bearing potential (including those with a history of infertility), exclude pregnancy up to 3 days before treatment, every month during treatment, and every 1–3 months for 3 years after stopping treatment. Treatment should be started on day 2 or 3 of menstrual cycle. Women must practise effective contraception for at least 1 month before starting treatment, during treatment, and for at least 3 years 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 acitretin should be limited to a supply of up to 30 days' treatment and dispensed within 7 days of the date stated on the prescription. Women should be advised to seek medical attention immediately if they become pregnant during treatment or within 3 years of stopping treatment. They should also be advised to avoid alcohol during treatment and for 2 months after stopping treatment

Oral retinoids for psoriasis 
   
13.05.03  Drugs affecting the immune response
 note 

 

Pimecrolimus
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated

1% (Elidel®) Cream; 30 g, 60 g, 100 g In line with NICE TA 82 - Tacrolimus and pimecrolimus for atopic eczema (see also NICE CG 153 –Psoriasis - off label indication) Topical preparations

 
Link  NICE CG 153 –Psoriasis
Link  NICE TA82: Pimecrolimus and tacrolimus for atopic dermatitis (eczema)
   
Tacrolimus
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated

0.03%, 0.1% (Protopic®) Ointment; 30g, 60g In line with NICE TA 82 - Tacrolimus and pimecrolimus for atopic eczema (see also NICE CG 153 –Psoriasis - off label indication) Topical preparation

 
Link  NICE CG 153 –Psoriasis - off label indication
Link  NICE TA82: Pimecrolimus and tacrolimus for atopic dermatitis (eczema)
   
Azathioprine
View adult BNF View SPC online View childrens BNF
Formulary
Purple

Tablets 25 mg, 50 mg Oral preparation Off label

Red Paediatrics

 
Link  Pan Mersey Shared Care Framework for Azathioprine
Link  St Helen’s & Knowsley Hospitals’ Shared Care Framework
   
Ciclosporin
View adult BNF View SPC online View childrens BNF
Formulary
Purple

Capsules 10 mg, 25 mg, 50 mg, 100 mg (Deximune®, Neoral®, Capimune®)

Pan Mersey first line recommended brand is Capimune®

Oral solution 100 mg/mL (Neoral®); 50mL

NB Ciclosporin must be prescribed by brand.

Red Paediatrics

 
Link  Pan Mersey Shared Care Framework for Ciclosporin
Link  St Helen’s & Knowsley Hospitals’ Shared Care Framework
   
Methotrexate
View adult BNF View SPC online View childrens BNF
Formulary
Purple

Tablets 2.5 mg

Metoject® PEN solution for injection in prefilled pens available in a range of doses for subcutaneous administration.

Black 10mg tablets. Do not prescribe – see link below

Red Paediatrics

Red Oral solution sugar-free 2mg/ml paediatrics only

 
Link  Pan Mersey APC (2018). METHOTREXATE: safe prescribing and dispensing
Link  Pan Mersey Shared Care Framework for Methotrexate
Link  St Helen’s & Knowsley Hospitals’ Shared Care Framework
   
Mycophenolate mofetil
View adult BNF View SPC online View childrens BNF
Formulary
Purple

Capsules 250 mg: Tablets 500 mg
Oral suspension 1 g/5 mL

Expert opinion locally is that mycophenolate does not require brand prescribing – significant cost savings are available with generic prescribing Oral preparation Off label

Red Paediatrics

 
Link  MHRA advice: Mycophenolate mofetil, mycophenolic acid: updated contraception advice for male patients
Link  MHRA drug safety alert - risk of hypogammaglobulinaemia and risk of bronchiectasis.
Link  Pan Mersey Shared Care Framework for Mycophenolate mofetil
Link  St Helen’s & Knowsley Hospitals’ Shared Care Framework
   
Adalimumab
View adult BNF View SPC online View childrens BNF
Formulary
Red

Injection 40 mg prefilled pen or prefilled syringe
In line with NICE TA 146 – Adalimumab for the treatment of adults with psoriasis

NHS NHSE commissioned drug for Paediatric indications (in line with NICE TA 455) - see Specialised Commissioning: Key documents

NHS NHSE for treatment of hidradenitis suppurativa
 
NHS NHSE IFR for treatment of uveitis

Cytokine modulator

Amgevita® biosimilar brand

Hulio® biosimilar brand

Hyrimoz® biosimilar brand

Imraldi® biosimilar brand

Humira® originator brand  

Prescribe by brand name

 
Link  NICE (2008) Adalimumab for the treatment of adults with psoriasis [TA146]
Link  NICE (2016). Adalimumab for treating moderate to severe hidradenitis suppurativa [TA392]
Link  NICE (2017). Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people [TA455]
   
Brodalumab
View adult BNF View SPC online View SMC online View childrens BNF
Formulary
Red

210mg solution for injection (pre-filled syringe)

For treatment of plaque psoriasis

 
Link  BRODALUMAB solution for injection (Kyntheum®▼) for plaque psoriasis: Pan Mersey Area Prescribing Committee Policy Statement
Link  NICE TA511: Brodalumab for treating moderate to severe plaque psoriasis
   
Certolizumab pegol
View adult BNF View SPC online View childrens BNF
Formulary
Red

Subcutaneous injection 200mg (pre-filled syringe, pre-filled pen)

In line with NICE TA574: Certolizumab pegol for treating moderate to severe plaque psoriasis

 
Link  Pan Mersey APC (2019): Certolizumab pegol solution for injection (Cimzia®) for plaque psoriasis
Link  NICE TA574: Certolizumab pegol for treating moderate to severe plaque psoriasis
   
Dupilumab
View adult BNF View SPC online View childrens BNF
Formulary
Red

solution for injection 300mg; pre-filled pen

Treatment of atopic dermatitis

NHS NHS England commissioned for paediatrics (aged 12-17); must be treated within a specialised treatment centre and meet the criteria within NICE TA534 for adults.

 
Link  Pan Mersey APC (2018): DUPILUMAB injection (Dupixent®▼) for atopic dermatitis
Link  NICE TA534 (2018): Dupilumab for treating moderate to severe atopic dermatitis
   
Etanercept
View adult BNF View SPC online View childrens BNF
Formulary
Red

Injection 25 mg, 50 mg
In line with NICE TA 103 – Etanercept for the treatment of adults with psoriasis

Cytokine modulator

Benepali®,biosimilar brand

Erelzi®,biosimilar brand 
Enbrel®, originator brand
Prescribe by brand

NHS NHSE commissioned drug for Paediatric indications (in line with NICE TA 455) - see Specialised Commissioning: Key documents

 

 
Link  NICE TA 103 – Etanercept and efalizumab for the treatment of adults with psoriasis
Link  NICE TA455: Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people
   
Guselkumab
View adult BNF View SPC online View SMC online View childrens BNF
Formulary
Red

solution for injection 100mg; pre-filled syringe (Tremfya®)

For treatment of psoriasis

 
Link  NICE (2018). Guselkumab for treating moderate to severe plaque psoriasis
Link  Pan Mersey APC (2018). GUSELKUMAB solution for injection (Tremfya®▼) for Plaque Psoriasis
   
Infliximab
View adult BNF View SPC online
Formulary
Red

Injection 100 mg
Remicade® - Originator Brand
Flixabi ®, Inflectra®, Remsima® - Biosimilar Brands

Prescribe by brand

In line with NICE TA 134 – Infliximab for the treatment of adults with psoriasis

Cytokine modulator

No BNFc entry; Paediatrics, seek specialist advice 

NHS NHSE commissioned drug for Paediatric indications (where Adult TA available) - see Specialised Commissioning: Key documents

 
Link  NICE TA 134 – Infliximab for the treatment of adults with psoriasis
Link  MHRA Drug Safety Update - Biosimilar Products
Link  London Medicines Evaluation Network - Answers to commonly asked questions about biosimilar versions of ifliximab
   
Ixekizumab
View adult BNF View SPC online
Formulary
Red

80mg solution for injection (Taltz®) prefilled syringe; prefilled pen

No BNFc entry; Paediatrics, seek specialist advice 

 
Link  IXEKIZUMAB solution for injection (Taltz®▼) for Plaque Psoriasis Pan Mersey Area Prescribing Committee Policy Statement
Link  NICE TA442: Ixekizumab for treating moderate to severe plaque psoriasis
   
RisankizumabBlack Triangle
View adult BNF View SPC online
Formulary
Red

75mg solution for injection (Skyrizi®) pre-filled syringe

In line with NICE TA596: Risankizumab for treating moderate to severe plaque psorias

 
Link  Pan Mersey APC (2019): RISANKIZUMAB solution for injection (Skyrizi®▼) for plaque psoriasis
Link  NICE TA596 (2019): Risankizumab for treating moderate to severe plaque psoriasis
   
Secukinumab
View adult BNF View SPC online
Formulary
Red
High Cost Medicine

150mg solution for injection (Cosentyx®) prefilled syringe; prefilled pen.

In line with NICE TA350: Secukinumab for treating moderate to severe plaque psoriasis

No BNFc entry; Paediatrics, seek specialist advice 

 
Link  NICE TA350 - Secukinumab for treating moderate to severe plaque psoriasis
   
TildrakizumabBlack Triangle
View adult BNF View SPC online View childrens BNF
Formulary
Red

100mg solution for injection (Ilumetri®) pre-filled syringe

In line with NICE TA575: Tildrakizumab for treating moderate to severe plaque psorias

 
Link  Pan Mersey APC (2019). TILDRAKIZUMAB solution for injection (Ilumetri®▼) for Plaque Psoriasis
Link  NICE TA575: Tildrakizumab for treating moderate to severe plaque psoriasis
   
Ustekinumab
View adult BNF View SPC online
Formulary
Red

Injection 45 mg, 90mg
In line with NICE TA 180 - Ustekinumab for the treatment of adults with moderate to severe psoriasis

Cytokine modulator

No BNFc entry; Paediatrics, seek specialist advice 

NHS NHSE commissioned drug for Paediatric indications (in line with NICE TA 455) - see Specialised Commissioning: Key documents

 
Link  NICE TA 180 - Ustekinumab for the treatment of adults with moderate to severe psoriasis
Link  NICE TA455: Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people
   
Apremilast
View adult BNF View SPC online
Formulary
Red

Tablet 10 mg, 20mg, 30mg (Otezla®)

 

In line with NICE TA419 - Apremilast for treating moderate to severe plaque psoriasis

No BNFc entry; Paediatrics, seek specialist advice 

 
Link  MHRA alert: Apremilast (Otezla ¥): risk of suicidal thoughts and behaviour
Link  NICE TA419: Apremilast for treating moderate to severe plaque psoriasis (replaces TA368)
   
13.06  Acne and rosacea
13.06.01  Topical preparations for acne
13.06.01  Benzoyl peroxide and azelaic acid
Benzoyl Peroxide
View adult BNF View SPC online View childrens BNF
Formulary
Green

5% aqueous gel 30g, 60g,

4%  cream 50g

 
   
Benzoyl Peroxide 3% with Clindamycin 1%
View adult BNF View SPC online View childrens BNF
Formulary
Green

Aqueous gel (Duac® Once Daily); 30 g, 60g

 
   
Benzoyl Peroxide 5% with Clindamycin 1%
View adult BNF View SPC online View childrens BNF
Formulary
Green

Aqueous gel (Duac® Once Daily); 30 g, 60 g

 
   
Azelaic Acid
View adult BNF View SPC online View childrens BNF
Formulary
Green
15% (Finacea®) Gel; 30 g
20% (Skinoren®) Cream; 30 g (acne vulgaris only)

Topical preparation for rosacea 
   
13.06.01  Topical antibacterials for acne to top
Clindamycin
View adult BNF View SPC online View childrens BNF
Formulary
Green

1% (Dalacin T®) top[ical lotion(aqueous base); 30 mL, 60 mL
1% topical solution(aqueous alcoholic base); 30 mL, 50 mL

 
   
Erythromycin 40mg with Zinc Acetate 12mg/mL
View adult BNF View SPC online View childrens BNF
Formulary
Green

lotion (Zineryt®) (for pregnant women); 30 mL, 90 mL

 
   
13.06.01  Topical retinoids and related preparations for acne
Adapalene
View adult BNF View SPC online View childrens BNF
Formulary
Green
0.1% (Differin®) Cream, Gel; 45 g 
   
Adapalene 0.1%, benzoyl peroxide 2.5%
View adult BNF View SPC online View childrens BNF
Formulary
Green
(Epiduo®) Gel; 45 g 
   
Isotretinoin 0.05%, erythromycin 2%
View adult BNF View SPC online View childrens BNF
Formulary
Green

(Isotrexin®) Gel; 30 g

 

Amber Recommended Paediatrics - for neonatal and infantile acne

 
   
Tretinoin 0.025%, clindamycin1%
View adult BNF View SPC online View childrens BNF
Formulary
Green

(Treclin®) Gel, 30g

Amber Recommended Paediatrics - for neonatal and infantile acne

 
   
13.06.01  Other topical preparations for acne
Aknicare®
Formulary
Black
 
   
13.06.02  Oral preparations for acne
13.06.02  Oral antibiotics for acne
 note 

For the initial management of acne follow the local antibiotic guideline which can be found within Chapter 5.
Other antibiotics may be recommended by specialists and are Amber Recommended in these circumstances.

Concomitant use of different topical and systemic antibacterial is undesirable owing to the increased likelihood of the development of bacterial resistance.

Lymecycline
View adult BNF View SPC online View childrens BNF
First Choice
Green

Capsules 408 mg

Paediatric: Avoid in < 12 years   

 
Oxytetracycline
View adult BNF View SPC online View childrens BNF
First Choice
Green

Tablets 250 mg

Paediatric: Avoid in < 12 years   

 
Clarithromycin
View adult BNF View SPC online View childrens BNF
Second Choice
Green
Tablets 250 mg
(after failure of first choice antibiotics) 
   
Doxycycline (Paediatric only)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Capsules 50mg, 100mg

Dispersible tablets 100mg

Paediatrics: Avoid in children < 12 years

 
   
Erythromycin (Paediatric only)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Tablets 250mg

Paediatric: alternative to tetracyclines for treating patients < 12 years

 
   
13.06.02  Hormone treatment for acne to top
Co-Cyprindiol
View adult BNF View SPC online View childrens BNF
Formulary
Green

Cyproterone acetate 2 mg, ethinylestradiol 35 micrograms (Dianette®) Tablets; 63 tablets.

Paediatric: only use in post menarche girls

See MHRA Drug Safety Update June 2013
Venous thromboembolism occurs more frequently in women taking co-cyprindiol than in those taking a low-dose combined oral contraceptive. Co-cyprindiol is licensed for use in women with severe acne that has not responded to oral antibacterials and for moderately severe hirsutism; it should not be used solely for contraception. It is contra-indicated in those with a personal or close family history of venous thromboembolism. Women with severe acne or hirsutism may have an inherently increased risk of cardiovascular disease.

 
Link  MHRA Drug Safety Update June 2013
   
13.06.02  Oral retinoid for acne
Isotretinoin
View adult BNF View SPC online View childrens BNF
Formulary
Red
Capsules 5mg, 10 mg, 20 mg (Roaccutane®)

Pregnancy prevention
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. 
Link  MHRA drug safety update: Isotretinoin: risk of serious skin reactions.
   
13.06.03  Topical preparations for rosacea
Brimonidine gel
View adult BNF View SPC online
Formulary
Green

0.33% gel (Mirvaso®▼) 30g

Topical preparation for erythema of rosacea

No BNFc entry; Paediatrics - seek specialist advice

 
Link  BRIMONIDINE Gel (Mirvaso®▼); PAN MERSEY AREA PRESCRIBING COMMITTEE PRESCRIBING POLICY STATEMENT
   
13.07  Preparations for warts and calluses
Salicylic acid
View adult BNF View SPC online View childrens BNF
First Choice
Green
Salicylic acid 12%, lactic acid 4% (Salatac®) Gel; 8 g
Salicylic acid 16.7%, lactic acid 16.7% (Salactol®) Paint; 10 mL
 
Salicylic acid
View adult BNF View SPC online View childrens BNF
Second Choice
Green
Salicylic acid 26% (Occlusal® ) Cutaneous solution; 10 mL 
   
Glutaraldehyde
View adult BNF View SPC online View childrens BNF
Second Choice
Green
10% (Glutarol®) Solution; 10 mL 
   
13.07  Anogenital warts
Imiquimod
View adult BNF View SPC online View childrens BNF
Formulary
Green

5% (Aldara®) Cream (12 sachet packs)

Anogenital warts, actinic keratosis.

 

  Amber Patient Retained Superficial basal cell carcinoma. Also lentigo maligna (Off label)

 
Link  NICE NG14 Melanoma: assessment and management
   
Podophyllotoxin
View adult BNF View SPC online View childrens BNF
Formulary
Green

0.5% (Condyline®) Solution; 3.5 mL 0.15% (Warticon®) Cream; 5 g

 

Amber Recommended Paediatrics < 12 years

 
   
13.08  Sunscreens and camouflagers to top
13.08.01  Sunscreen preparations
 note 

For optimum photoprotection, sunscreen preparations should be applied thickly and frequently (approximately 2 hourly). In photodermatoses, they should be used from spring to autumn. As maximum protection from sunlight is desirable, preparations with the highest SPF should be prescribed.

Borderline substances
The preparations marked ‘ACBS’ are regarded as drugs when prescribed for skin protection against ultraviolet radiation in abnormal cutaneous photosensitivity resulting from genetic disorders or photodermatoses, including vitiligo and those resulting from radiotherapy; chronic or recurrent herpes simplex labialis. Preparations with SPF less than 30 should not normally be prescribed. Warrington CCG - see CCG Self Care Policy

Anthelios XL®
View adult BNF View SPC online View childrens BNF
Formulary
Green

Cream SPF 50+ (UVA and UVB protection; UVB-SPF 50+)50ml

Non-formulary if not for ACBS approved indication

 
   
Sunsense® Ultra
View adult BNF View SPC online View childrens BNF
Formulary
Green
UVB-SPF 50+ Lotion (water resistant); 125 mL, 500 mL

Non-formulary if not for ACBS approved indication 
   
13.08.01  Photodamage
Cytotoxic Drug Fluorouracil
View adult BNF View SPC online
Formulary
Green

5% Cream (Efudix®); 40 g

0.5% + salicylic acid 10% solution (Actikerall®); 25ml

No BNFc entry; Paediatrics - seek specialist advice

 
   
Ingenol mebutate
View adult BNF View SPC online
Formulary
Green

gel 150 micrograms/g (Picato®), 3 × 0.47 g single-use tubes;
gel 500 micrograms/g (Picato®), 2 × 0.47 g single-use tubes

No BNFc entry; Paediatrics - seek specialist advice

 
   
Diclofenac sodium
View adult BNF View SPC online
Formulary
Green

3% Gel (Solaraze®); 50 g

No BNFc entry; Paediatrics - seek specialist advice

 
   
13.08.02  Camouflagers
 note 

These preparations are only regarded as drugs when prescribed for post–operative scars and other deformities and as an adjunctive therapy in the relief of emotional disturbances due to disfiguring skin diseases, such as vitiligo, as advised by the Advisory Committee on Borderline Substances (ACBS).

General Practitioners are reminded that the ACBS recommends products on the basis that they may be regarded as drugs for the management of specified conditions. Doctors should satisfy themselves that the products can safely be prescribed, that patients are adequately monitored and that, where necessary, expert hospital supervision is available.

Prescriptions for products recommended by the Committee should be endorsed “ACBS”.

Covermark®
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

Classic Foundation (various shades); 15 mL Finishing powder (various shades); 25 g

 
   
Dermacolor®
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

Camouflage crème (various shades); 30g Fixing powder (various shades); 60 g

 
   
Keromask®
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

Masking cream (various shades); 15 mL Finishing powder (various shades); 20 g

 
   
13.09  Shampoos and other preparations for scalp and hair conditions
Ketoconazole
View adult BNF View SPC online View childrens BNF
First Choice
Green
2% Shampoo; 120 mL 
Coal Tar
View adult BNF View SPC online View childrens BNF
Second Choice
Green

Alcoholic coal tar extract 5% (Alphosyl 2 in 1®); Shampoo; 250mL

 
   
Selenium Sulfide
View adult BNF View SPC online View childrens BNF
Second Choice
Green
2.5% (Selsun®) Shampoo; 100 mL, 150 mL 
   
Coal tar 1%, coconut oil 1%, salicylic acid 0.5%
View adult BNF View SPC online View childrens BNF
Second Choice
Green
(Capasal®) Shampoo; 250 mL 
   
Cetrimide 10%, Undecanoic acid 1%
View adult BNF View SPC online View childrens BNF
Second Choice
Green
(Ceanel Concentrate®) Shampoo; 150 mL, 500 mL 
   
Benzalkonium chloride 0.5%
View adult BNF View SPC online View childrens BNF
Formulary
Green

Dermax® Shampoo; 250 mL

 
   
13.09  Hirsuitism to top
Co-cyprindiol
View adult BNF View SPC online
First Choice
Green

Cyproterone acetate 2 mg, ethinylestradiol 35 micrograms (Dianette®) Tablets

See MHRA Drug Safety Update June 2013

No BNFc entry: Paediatrics seek specialist advice 

 
Ethinylestradiol 30 micrograms, Drospirenone 3 mg
View adult BNF View SPC online
Second Choice
Green

(Yasmin®) Tablets
Off label

(Lucette®) Tablets are a less expensive brand
Off label

See MHRA Drug Safety Update June 2011

No BNFc entry: Paediatrics seek specialist advice 

 
Link  MHRA Drug Safety Update June 2011
   
Metformin
View adult BNF View SPC online
Second Choice
Amber Initiated

Tablets; 500 mg

Off label

No BNFc entry: Paediatrics seek specialist advice 

 
   
Spironolactone
View adult BNF View SPC online
Second Choice
Amber Initiated

Tablets; 25 mg, 50mg & 100mg

Off label

No BNFc entry: Paediatrics seek specialist advice 

 
   
Eflornithine
View adult BNF View SPC online
Formulary
Black
Cream; 11.5%

 
Link  EFLORNITHINE (Vaniqa®) cream, PAN MERSEY AREA PRESCRIBING COMMITTEE PRESCRIBING POLICY STATEMENT
   
13.10  Anti-infective skin preparations
13.10.01  Antibacterial preparations
13.10.01.01  Antibacterial preparations only used topically
 note 

Cellulitis requires systemic antibacterial treatment.

In the community, acute impetigo on small areas of the skin may be treated by short-term topical application of fusidic acid or mupirocin.  They should not be used for longer than 10 days and local microbiology advice should be sought before using it in hospital to avoid the development of resistance.

Mupirocin
View adult BNF View SPC online View childrens BNF
Formulary
Green

2% (Bactroban®) Cream; Ointment; 15 g

Should only be used to treat methicillin-resistant Staphylococcus aureus

 
   
Octenidine (Octenisan®)
View adult BNF View childrens BNF
Formulary
Green

Wash lotion 150mL, 500mL.

Hand, body and hair washing; MRSA suppression therapy (decolonisation)

 
   
Polymixin B/ Bacitracin
View adult BNF View SPC online View childrens BNF
Formulary
Green

Polyfax® ointment; 20 g

Alternative to Bactoban when there is a supply problem or if patient does not tolerate Bactroban

 
   
Silver Sulfadiazine
View adult BNF View SPC online View childrens BNF
Formulary
Green
1% (Flamazine®) Cream;
20 g, 50 g, 250 g, 500 g

Large areas: Plasma-sulfadiazine concentrations may approach therapeutic levels with side-effects and interactions as for sulfonamides if large areas of skin are treated. Owing to the association of sulfonamides with severe blood and skin disorders, treatment should be stopped immediately if blood disorders or rashes develop—but leucopenia developing 2–3 days after starting treatment of burns patients is reported usually to be self-limiting and silver sulfadiazine need not usually be discontinued provided blood counts are monitored carefully to ensure return to normality within a few days. Argyria may also occur if large areas of skin are treated (or if application is prolonged). 
   
Prontoderm®
Formulary
Black
 
   
13.10.01.02  Antibacterial preparations also used systemically
Metronidazole
View adult BNF View SPC online View childrens BNF
Formulary
Green

0.75% (Rozex®) Cream; Gel; 30 g, 40 g (Only licensed for rosacea)
0.75% (Anabact®) Gel; 15 g, 30 g (Only licensed for malodorous fungating tumours)

 
   
Sodium Fusidate
View adult BNF View SPC online View childrens BNF
Formulary
Green

2% (Fucidin®) Cream; Ointment; 15 g, 30 g

 
   
13.10.02  Antifungal preparations to top
Amorolfine
View adult BNF View SPC online View childrens BNF
Formulary
Green
5% nail lacquer (Loceryl®
   
Clotrimazole
View adult BNF View SPC online View childrens BNF
Formulary
Green
1% Cream; 20 g, 50 g
1% Solution; 20 mL
Cutaneous candidiasis - apply until 10 days after lesions healed 
   
Terbinafine hydrochloride
View adult BNF View SPC online View childrens BNF
Formulary
Green
1% Cream; 30 g 
   
Miconazole
View adult BNF View SPC online View childrens BNF
Formulary
Green

2% cream; 15 g, 30 g

 
Link  MHRA Drug Safety Alert – Topical miconazole: reminder of potential for serious interactions with warfarin (2016)
   
13.10.03  Antiviral preparations
Aciclovir
View adult BNF View SPC online View childrens BNF
Formulary
Green
5% Cream; 2g 
   
13.10.04  Parasiticidal preparations
 note 

Suitable quantities of parasiticidal preparations

 

Skin creams

Lotions

Cream rinses

Scalp (head lice)

50–100 mL

50–100 mL

Body (scabies)

30–60 g

100 mL

Body (crab lice)

30–60 g

100 mL

These amounts are usually suitable for an adult for single application.

Ivermectin
View adult BNF View SPC online View childrens BNF
Second Choice
Green

10mg/g cream; 30g (Soolantra®▼)

Topical preparation for treatment of moderate to severe rosacea (papulopustular).  Use when standard topical treatments (azelaic acid 15% gel and metronidazole 0.75% gel/cream) have failed as an alternative option before oral antibiotics.

 
Link  IVERMECTIN 10mg/g Cream (Soolantra®)
   
Dimeticone
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Formulary
Green

4% (Hedrin®) Lotion; 50 mL, 150mL

Consider for self-care. Refer to local Self Care Policy

 
   
Malathion
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Formulary
Green

0.5% (Derbac-M®) Liquid (in aqueous basis); 50 mL, 200 mL

Consider for self-care. Refer to local Self Care Policy

 
   
Permethrin
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Formulary
Green

5% Cream; 30 g

Consider for self-care. Refer to local Self Care Policy

 
   
Head lice device bug buster kit
Formulary
Green

Consider for self-care. Refer to local Self Care Policy

 
   
13.10.05  Preparations for minor cuts and abrasions
13.11  Skin cleansers, antiseptics, and desloughing agents
13.11.01  Alcohols and saline to top
Surgical Spirit
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Formulary
Green

Spirit; 200 mL

 
   
Sodium Chloride
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Formulary
Green

Irrigation solution 0.9%
25 x 20 mL

Note: Advice is to use tap water for irrigation of wounds and not sodium chloride

 
   
13.11.02  Chlorhexidine salts
Chlorhexidine gluconate
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Formulary
Green

Cleansing solution 4% (Hibiscrub®); 250 mL, 500 mL, 5 Litre


Red Traffic Light  Pink solution 0.05% (Unisept®); 25 x 25mL, 10 x 100mL sachets

2.5% solution (≡ chlorhexidine gluconate 0.5%) 600mL Hydrex®

 
   
Chlorhexidine 0.015% with Cetrimide 0.15%
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Formulary
Green
(Tisept®) Solution; 25 x 25 mL sachet, 10 x 100 mL sachet

Chlorhexidine salts with cetrimide 
   
Chlorhexidine gluconate 2% in isopropyl alcohol 70%
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Formulary
Red
ChloraPrep® 
   
13.11.03  Cationic surfactants and soaps
13.11.04  Iodine and Chlorine
Povidone-Iodine
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Formulary
Green

(Videne®) 10% antiseptic solution; 500 mL
(Videne®) 7.5% surgical scrub; 500 mL

 
   
Povidone-Iodine
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Formulary
Green

(Betadine®) 2.5% Dry powder spray, 100mL

 
   
13.11.05  Phenolics
13.11.06  Oxidisers, and dyes to top
Hydrogen Peroxide
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Formulary
Green
Solution 3% (10 vols); 200 mL
Solution 6% (20 vols); 200 mL
(Crystacide®) 1% Cream; 25 g, 40 g
 
   
Potassium Permanganate
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Formulary
Green
Solution tablets 400 mg
NB/ 1 tablet dissolved in 4 litres of water provides a 0.01 % (1 in 10 000) solution
 
Link  Patient safety alert issued December 2014 on risk of death or serious harm from accidental ingestion of potassium permanganate preparations.
   
13.11.07  Desloughing agents
13.12  Antiperspirants
Aluminimum Chloride Hexahydrate
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First Choice
Green
20% Solution; 60 mL (with roll-on applicator) 
Oxybutynin
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Second Choice
Amber Initiated

Immediate release tablets; 2.5 mg, 5 mg;

MR Tablets 5 mg, 10mg

Oral solution 5mg in 5mL

For hyperhidrosis

Use MR tablets, oral solution and patches only if standard tablets not suitable or not tolerated.

Off label

 
   
Propantheline
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Second Choice
Amber Initiated

Tablets; 15 mg For gustatory sweating Off label

 
   
Glycopyrronium
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Third Choice
Red

tablets; 1 mg and 2 mg - off label

oral solution sugar-free; 1 mg/5 mL, 150mL - off label. For hyperhidrosis.

 
   
Botulinum toxin type A
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Formulary
Red

Botox®
Restricted use - For severe axillary hyperhidrosis only - see Pan Mersey Policy Statement

 
Link  BOTULINUM TOXIN TYPE A (Botox®) for Severe Axillary Hyperhidrosis, PAN MERSEY AREA PRESCRIBING COMMITTEE PRESCRIBING POLICY STATEMENT
   
Glycopyrrolate in cetomacrogol cream
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Unlicensed Drug Unlicensed
Amber Retained

Glycopyrrolate in cetomacrogol cream 2% Cream; 100 g  Restricted Item Restricted prescribing - For hyperhidrosis This unlicensed special may be considered in exceptional circumstances.

 
   
13.13  Miscellaneous
 note 

The following unlicensed specials, may be considered for exceptional circumstances only. They should be initiated by dermatology specialists only.

Dapsone
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Formulary
Purple

For Dermatitis Herpetiformis Tablets; 50 mg, 100 mg

 Red for new patients, current patients continue with current practice until shared care framework is adopted. 

 
Link  Pan Mersey Shared Care Framework: Dapsone
   
Deoxycholic Acid (Belkyra®)
Formulary
Grey

10 mg/ml solution for injection. For treatment of submental fat (use restricted to private clinics only)

 
Link  Pan Mersey APC (2019): Deoxycholic acid injection (Belkyra®▼) for submental fat
   
Electrical stimulating wound device (Accel-heal®)
Formulary
Black
 
   
Cycloidal vibration accessories (Vibro-pulse®)
Formulary
Black
 
   
Trichloroacetic acid
Unlicensed Drug Unlicensed
Red

For Warts

Specials:

25% Solution; 10 mL
50% Solution; 10 mL
90% Solution; 50 mL

No BNFc entry: Paediatrics seek specialist advice 

 
   
Hydroquinone, Hydrocortisone, Tretinoin
View childrens BNF
Unlicensed Drug Unlicensed
Amber Retained

(Pigmanorm cream®) Special - imported product

For Melasma. Hydroquinone 5% w/w, hydrocortisone 1% w/w and tretinoin 0.1% w/w

 
   
Tacrolimus
View adult BNF
Unlicensed Drug Unlicensed
Red

For Lichen Planus

0.1% in Orabase; Ointment; 50 g
0.3% in Orabase; Ointment; 50 g

No BNFc entry: Paediatrics seek specialist advice 

 
   
13.14  Molluscum contagiosum
Potassium hydroxide
Formulary
Black

5% topical solution
Treatment of Molluscum contagiosum

 
Link  PAN MERSEY AREA PRESCRIBING COMMITTEE PRESCRIBING POLICY STATEMENT: Potassium Hydroxide 5% Solution (MolluDab® or Molutrex®)
   
 ....
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Green

Medicines considered suitable for non-specialist prescribing in primary or secondary care.  

Amber Recommended

Requires specialist assessment to enable patient selection.  Amber Recommended medicines must meet criteria: (1) Requires specialist assessment to enable patient selection (2) Following specialist assessment, the medicine is suitable for prescribing in Primary Care.  

Amber Initiated

Amber Initiated. Requires specialist initiation of prescribing. Prescribing to be continued by the specialist until stabilisation of the dose is achieved and the patient has been reviewed. Amber Initiated medicines must meet criteria: (1) Requires specialist assessment to enable patient selection (2) Medicine is suitable for on-going prescribing in Primary Care (3) Requires short to medium term specialist prescribing and monitoring of efficacy or toxicity until the patient’s dose and condition is stable   

Amber Retained

Amber Patient Retained. Requires specialist initiation of prescribing. Prescribing to be continued by specialist until stabilisation of the dose is achieved and the patient had been reviewed. Patient remains under the care of specialist (ie not discharged) as occasional specialist input may be required. Amber Patient Retained medicines must meet criteria: (1)Requires specialist assessment to enable patient selection (2)Medicine is suitable for on-going prescribing in Primary Care (3) Requires short to medium term specialist prescribing and monitoring of efficacy or toxicity until the patient’s dose and condition is stable (4) May require occasional specialist input indefinitely and therefore the patient should not be discharged from specialist care   

Amber

Medicines recommended or initiated by specialists in primary or secondary care. Non-specialist prescribing in primary care may follow according the RAG criteria. In process of being superceded by Amber Recommended, Amber Initiated and Amber Patient Retained.  

Purple

Shared Care. Medicines are considered suitable for Primary Care prescribing and/or management, following specialist initiation of therapy, with on-going communication between the Primary Care prescriber and specialist, within the framework of a Shared Care Agreement. Medicines designated as requiring Shared Care require on-going input from both Specialist and Primary Care clinicians and patients should not be discharged from Specialist care. Where prescribing and monitoring are required under shared care, it is implicit that the responsibility for both of these tasks rests with the prescriber. A Shared Care Agreement will always be available for Shared Care medicines and this document will include a Shared Care Agreement pro-forma which will be completed by all involved clinicians. This pro-forma will record agreement to take on defined aspects of care e.g. monitoring and/or on-going prescribing for the individual patients. A policy detailing clinician responsibilities in Shared Care Agreements must be referred to in all cases of Shared Care. All drugs to be included in this category must meet Shared Care criteria 1 to 3: SC1 Requires specialist assessment to enable patient selection and also initiation, stabilisation and review of treatment and the patient`s condition. SC2 Prescribing and/or management of the drug in Primary Care with specialist support and input, within the framework of the Shared Care Agreement is safe and convenient and that there is an appropriate mechanism for individual patient access in Primary Care. SC3 Requires specific long-term monitoring (blood test or other measurement) for adverse effects and / or efficacy of the drug to be completed in Primary Care, and requires on-going specialist support for the dose changes or management of adverse effects. Monitoring is required on a regular basis (typically four times a year). Implicit in any shared care agreement is the understanding that participation is at the discretion of the Primary Care prescriber subject to their clinical confidence.   

Red

Primary care prescribing of these medicines is NOT recommended. These treatments should be initiated by specialists only; ongoing prescribing is retained within secondary care.   

Black

Not recommended for use. Deviation from the policy may be considered on an individual basis where exceptional circumstances exist.   

Grey

Not recommended for use at this time. Deviation from the policy may be considered on an individual basis where exceptional circumstances exist. Further guidance will be issued when more information or evidence is made available.  

netFormulary