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 Formulary Chapter 13: Skin - Full Chapter
Notes:

Coronavirus guidance

Guidance to support primary care prescribers and pharmacists is available from the MLCSU Coronavirus guidance resource page. Links are provided to national resources and regional documents produced by MLCSU, RDTC, and SPS for use by Pan Mersey APC, LSCMMG, and GMMMG.

The list of resources will be updated as new material becomes available so please check back regularly for updates.

The Pan Mersey APC supports the use of COVID-specific guidance issued by NICE, and NHS England and NHS Improvement. During the COVID pandemic this will supersede any APC advice.

Skin

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

 Details...
13.04  Expand sub section  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 (Trimovate®)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Cream 30g

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

 
   
 ....
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.  

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