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 Formulary Chapter 13: Skin - Full Chapter
13.01  Management of skin conditions
13.01.01  Vehicles
13.01.02  Suitable quantities for prescribing
 note 

Area of body     

Face and neck

Both hands

Scalp

Both arms

Both legs

Trunk

Groins and genitalia

Creams and Ointments

15 to 30 g

15 to 30 g

15 to 30 g

15 to 30 g

100 g

100 g

15 to 30 g

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

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

MHRA/CHM advice (updated December 2018): Emollients: new information about risk of severe and fatal burns with paraffin-containing and paraffin-free emollients

Note:

Emollients should be applied immediately after washing or bathing to maximise the effect of skin hydration.

Emollient bath additives should be added to bath water; hydration can be improved by soaking in the bath for 10–20 minutes. Some bath emollients can be applied to wet skin undiluted and rinsed off.

Emollient preparations contained in 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 hair growth to reduce the risk of folliculitis.

13.02.01  Emollients
 note 

Emollients should be applied immediately after washing or bathing to maximise the effect of skin hydration.

Liquid and White Soft Paraffin Ointment (50:50)

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Formulary
Green

Very Greasy

Pack size 250g, 500g

Self Care Self Care Medicine-Available OTC self care.

 
   
Emollin®spray

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Formulary
Green

Very Greasy

Restriction: Under specialist advice only

Pack size 150ml, 240ml

 
   
Hydromol ®ointment

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Formulary
Green

Greasy (equivalent to Epaderm® Ointment)

1st line

Pack size 125g, 500g

 
   
Cetraben®ointment

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Formulary
Green

Greasy (equivalent to Epaderm® Ointment)

2nd Line

Pack size 125g, 450g

Self Care Self Care Medicine-Available OTC for self care.

 

 

 
   
Epimax®Isomol Gel

(Formerly known as Isomol Gel)
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Formulary
Green

Rich Cream (equivalent to Doublebase®)

1st line

Pack size 100g, 500g

 
   
Myribase®gel

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Formulary
Green

Rich Cream (equivalent to Doublebase®)

2nd Line

Pack size 100g, 500g

 
   
Epimax ®Original Cream

(Formerly known as Epimax Cream)
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Formulary
Green

Creamy (equivalent to Epaderm® Cream)

1st line

Pack size 100g, 500g

Self Care Self Care Medicine-Available OTC for self care.

 

 
   
Cetraben®cream

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Formulary
Green

Creamy (equivalent to Epaderm® Cream)

2nd Line

Pack size 150g, 500g 

Self Care Self Care Medicine-Avilable OTC self care.

 

 
   
Diprobase ®cream

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Formulary
Green

Creamy (equivalent to Epaderm® Cream)

3rd Line

Pack size 50g, 500g

Self Care Self Care Medicine-Available OTC for self care.

 

 
   
Dermol®cream

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Formulary
Green

Creamy with Antimicrobial Effect

Pack size 100g, 500g

Self Care Self Care Medicine-Available OTC for self care.

 

 
   
E45®cream
(Hospital only)
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Formulary
Green

Light (low paraffin)

Pack size 50g, 125g, 500g

 
   
Exocream®

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Formulary
Green

Light (low paraffin)

Pack size 50g, 500g

 
   
ZeroAQS®cream

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Formulary
Green

Light (low paraffin)

Can also be used as a soap substitute

Pack size 500g

 
   
Dermol®500 lotion

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Formulary
Green

Light with Antimicrobial Effect

Pack size 500ml

Self Care Self Care Medicine-Available OTC self care.

 

 
   
13.02.01  Emollients - preparations containing urea
Aquadrate®cream
(Urea 10%)
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Formulary
Green

Creamy with Urea Content

Pack size 100g

Self Care Self Care Medicine-Available OTC for self care.

 

 

 
   
Balneum®cream
(Urea 5%)
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Formulary
Green

Creamy with Urea Content

Pack size 50g, 500g

 
   
Balneum®Plus cream
(Urea 5% + lauromacrogol 3%)
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Formulary
Green

Creamy with Urea Content

Restricted for pruritus

Pack size 100g, 500g

 
   
Flexitol ®heel balm
(Urea 25%)
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Formulary
Green

Creamy with Urea Content

For severe hyperkeratosis

Pack size 40g, 75g

 
   
13.02.01  Emollients - with antimicrobials
13.02.01.01  Emollient bath and shower preparations
 note 

Emollient bath additives should be added to bath water; hydration can be improved by soaking in the bath for 10–20 minutes. Some bath emollients can be applied to wet skin undiluted and rinsed off.

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

Aqueous cream  
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First Choice
Green

1st Line

Use only as a soap substitute

Pack size 100g, 500g

Self Care Self Care Medicine-Available OTC for self care.

 
Dermalo®bath emollient

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Second Choice
Green

2nd Line

Pack size 500ml

NHS England has identified this product as an item that should not be routinely prescribed in primary care (Ver. 2, June 2019)

 

NHS England: Items which should not be routinely prescribed in primary care: Guidance for CCGs

 

 
   
Hydromol ® bath and shower

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Third Choice
Green

3rd Line

Pack size 350ml, 500ml

NHS England has identified this product as an item that should not be routinely prescribed in primary care (Ver. 2, June 2019)

NHS England: Items which should not be routinely prescribed in primary care: Guidance for CCGs

Self Care Self Care Medicine-Available OTC for self care.

 

 
   
Dermol®600 bath emollient

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Fourth Choice
Green

Emollient bath and shower preparations with antimicrobial effect

4th Line

Pack size 600ml

NHS England has identified this product as an item that should not be routinely prescribed in primary care (Ver. 2, June 2019)

NHS England: Items which should not be routinely prescribed in primary care: Guidance for CCGs

 

 
   
13.02.02  Barrier preparations to top
Conotrane®cream

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Formulary
Green

Pack size 100g (now discontinued), 500g

 
   
13.03  Topical local anaesthetics and antipruritics
Eurax®cream
(Crotamiton 10%)
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Formulary
Green

Pack size 30g, 100g

 

Self Care Self Care Medicine-Available OTC for self care.

 
   
13.04  Topical corticosteriods.
Fluocinolone acetonide 0.0025%
(Synalar®1 in 10 Dilution cream)
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Formulary
Green

Mild potency

Pack size 30g, 100g

 
   
Hydrocortisone  (0.5% & 1%)
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Formulary
Green

Mild potency

Hydrocortisone 0.5% cream 15g, 30g
Hydrocortisone 0.5% ointment 15g, 30g
Hydrocortisone 1% cream 15g, 30g
Hydrocortisone 1% ointment 15g, 30g

Hydrocortisone 1% cream Self Care Self Care Medicine-Available OTC for self care (Please note exceptions may apply)

 
   
Betamethasone (as valerate) 0.025%
(Betnovate-RD®)
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Formulary
Green

Moderate potency

Betnovate-RD®cream 100g
Betnovate-RD®ointment 100g

 
   
Fludroxycortide 4micrograms/square cm tape 7.5cm
(Haelan®tape)
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Formulary
Green

Moderate potency

Pack size 20cm

For chronic localised recalcitrant dermatoses (but not acute or weeping)

 
   
Clobetasone butyrate 0.05%
(Eumovate®)
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Formulary
Green

Moderate potency

Eumovate®cream 30g, 100g
Eumovate®ointment 30g, 100g

 

 
   
Fluocinolone acetonide 0.00625%
(Synalar®1 in 4 Dilution )
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Formulary
Green

Moderate potency

Synalar®1 in 4 Dilution cream 50g
Synalar®1 in 4 Dilution ointment 50g

 
   
Fluocinolone acetonide 0.025%
(Synalar®)
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Formulary
Green

Potent

Synalar®cream 50g
Synalar®ointment 50g

 
   
Betamethasone (as valerate) 0.1%

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Formulary
Green

Potent

Betamethasone valerate 0.1% cream 30g, 100g
Betamethasone valerate 0.1% ointment 30g, 100g

 
   
Hydrocortisone butyrate 0.1%
(Locoid®)
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Formulary
Green

Potent

Locoid®cream 30g, 100g
Locoid®ointment 30g, 100g

 

 
   
Clobetasol propionate 0.05%
(Dermovate®)
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Formulary
Green

Very potent

Dermovate®cream 30g, 100g
Dermovate®ointment 30g, 100g

 
   
Diflucortolone valerate 0.3%
(Nerisone®Forte )
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Formulary
Green

Very potent

Nerisone®Forte ointment 15g
Nerisone®Forte oily cream 15g

 
   
Betamethasone (as dipropionate) 0.05% with salicylic acid 3%
(Diprosalic®)
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Formulary
Green

Topical corticosteroids with salicylic acid

Potent

Diprosalic®ointment 30g, 100g

 
   
Hydrocortisone 1% with clotrimazole 1%
(Canesten®HC)
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Formulary
Green

Topical corticosteroids with antimicrobials

Mild potency

Canesten HC®cream 30g

Limit duration of treatment with steroid/antimicrobial combinations; usually twice daily for 1 week.

 
   
Hydrocortisone 1% with miconazole nitrate 2%
(Daktacort®)
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Formulary
Green

Topical corticosteroids with antimicrobials

Mild potency

Daktacort®cream 30g
Daktacort®ointment 30g

Limit duration of treatment with steroid/antimicrobial combinations; usually twice daily for 1 week.

 
   
Hydrocortisone acetate 1% with fusidic acid 2%
(Fucidin®H)
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Formulary
Green

Topical corticosteroids with antimicrobials

Mild potency

Fucidin®H cream 30g
Fucidin®H ointment 30g

Limit duration of treatment with steroid/antimicrobial combinations; usually twice daily for 1 week.

 
   
Clobetasone butyrate 0.05% with oxytetracycline 3% and nystatin 100,000 units/g
(Trimovate®)
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Formulary
Green

Topical corticosteroids with antimicrobials

Moderate potency

Trimovate®cream 25g, 30g

Limit duration of treatment with steroid/antimicrobial combinations; usually twice daily for 1 week.

 
   
Betamethasone (as valerate) 0.1% with clioquinol 3%

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Formulary
Green

Topical corticosteroids with antimicrobials

Potent

Betamethasone valerate 0.1% & clioquinol 3% cream 30g
Betamethasone valerate 0.1% & clioquinol 3% ointment 30g

Limit duration of treatment with steroid/antimicrobial combinations; usually twice daily for 1 week.

 

 
   
Betamethasone (as Valerate) 0.1% with fucidic acid 2%
(Fucibet®)
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Formulary
Green

Topical corticosteroids with antimicrobials

Potent

Fucibet®cream 30g

Limit duration of treatment with steroid/antimicrobial combinations; usually twice daily for 1 week.

 
   
Fluocinolone acetonide 0.025% with clioquinol 3%
(Synalar®C)
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Formulary
Green

Topical corticosteroids with antimicrobials

Potent

Synalar®C cream 15g
Synalar®C ointment 15g

 
   
Fluocinolone acetonide 0.025% with neomycin sulfate 0.5%
(Synalar®N)
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Formulary
Green

Topical corticosteroids with antimicrobials

Potent

Synalar®N cream 30g
Synalar®N ointment 30g

 
   
Clobetasol propionate 500microgram/neomycin sulfate 5mg/ and nystatin 100,000unit/g

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Formulary
Green

Topical corticosteroids with antimicrobials

Very potent

Clobetasol propionate 500microgram/neomycin sulfate 5mg/ and nystatin 100,000unit/g cream 30g
Clobetasol propionate 500microgram/neomycin sulfate 5mg/ and nystatin 100,000unit/g ointment 30g

HCDGeneric expensive. Dermovate NN is no longer available as the brand

 

 
   
Betamethasone valerate 0.1% scalp application
(Betacap®)
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Formulary
Green

Scalp applications

Potent

Betacap®scalp application 100ml

 
   
Betamethasone (as dipropionate) 0.05% with salicylic acid 2% scalp application
(Diprosalic®)
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Formulary
Green

Scalp applications

Potent

Diprosalic®scalp application 100ml

 
   
Fluocinolone acetonide 0.025% gel
(Synalar®)
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Formulary
Green

Scalp applications

Potent

Synalar®gel 30g

 
   
Clobetasol propionate 0.05% scalp application
(Dermovate®)
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Formulary
Green

Scalp applications

Very potent

Dermovate®scalp application 30ml, 100ml

 
   
13.04  Topical corticosteriod preparation potencies
 note 

Topical corticosteroid preparation potencies

Potency of a topical corticosteroid preparation is a result of the formulation as well as the corticosteroid. Therefore, proprietary names are shown below. 

          Mild

  • Hydrocortisone 0.1; 2.5% (Dioderm, Mildison, Synalar 1 in 10 dilution)
  • Mild with antimicrobials: Canesten HC, Daktacort, Econacort, Fucidin H, Nystaform-HC, Timodine
  • Mild with crotamiton: Eurax-Hydrocortisone 

    Moderate
  • Betnovate-RD, Eumovate, Haelan, Modrasone, Synalar 1 in 4 Dilution, Ultralanum Plain
  • Moderate with antimicrobials: Trimovate
  • Moderate with urea: Alphaderm, Calmurid HC, Hydromol HC Intensive.

    Potent
  • Beclometasone dipropionate 0.025%, Betamethasone valerate 0.1%, Betacap, Betesil, Bettamousse, Betnovate, Cutivate, Diprosone, Elocon, Hydrocortisone butyrate, Locoid, Locoid Crelo, Metosyn, Nerisone, Synalar
  • Potent with antimicrobials: Aureocort, Betnovate-C, Betnovate-N, Fucibet, Lotriderm, Synalar C, Synalar N
  • Potent with salicylic acid: Diprosalic 

    Very potent
  • Clarelux, Dermovate, Etrivex, Nerisone Forte
  • Very potent with antimicrobials: Clobetasol with neomycin and nystatin

 

13.05  Preparations for eczema and psoriasis
13.05.01  Preparations for eczema to top
Alitretinoin (Toctino®)
(oral)
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Formulary
Red
High Cost Medicine
BlueTeq

Restriction: In line with NICE Guidance

Alitretinoin is teratogenic and must not be given to women of child-bearing potential unless they practise effective contraception and then only after detailed assessment and explanation by the physician.

 
Link  NICE TA177: Alitretinoin for the treatment of severe chronic hand eczema
   
13.05.02  Preparations for psoriasis
5-Methoxypsoralen (20mg tablets)
(oral)
 Track Changes
Unlicensed Drug Unlicensed
Red

Unlicensed preparation

Restriction: To be initiated by a dermatology consultant

 
   
8-Methoxypsoralen 
(Topical gel & lotion)
 Track Changes
Unlicensed Drug Unlicensed
Red

Unlicensed preparation

Restriction: To be initiated by a dermatology consultant

 
   
8-Methoxypsoralen (10mg tablets, capsules)
(oral)
 Track Changes
Unlicensed Drug Unlicensed
Red

Unlicensed preparation

Restriction: To be initiated by a dermatology consultant

 
   
13.05.02  Topical preparations for psoriasis
Calcipotriol 
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Formulary
Green

Calcipotriol 50microgram/g ointment 30g, 60g, 120g

 
   
Calcipotriol 50micrograms/g with Betamethasone 0.05%
(Dovobet®)
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Formulary
Green

Restriction: See APC/NMC Advice

Dovobet®ointment 30g,60g,120g
Dovobet®gel 60g,120g

Dovobet gel: Usual duration of therapy for scalp psoriasis is 4 weeks and for mild to moderate plaque psoriasis for 8 weeks; may be continued or repeated on the advice of a specialist

Dovobet ointment: Indicated for once daily treatment of stable plaque psoriasis for 4 weeks; if necessary treatment may be continued beyond 4 weeks or repeated on the advice of a specialist. 

 

APC/NMC Advice: Betamethasone 0.05% / calcipotriol 50micrograms per gram (May 2017).
Dovobet® & Enstilar® are included in the NSJF as a second line agent for the treatment of psoriasis when patients are unable to comply with the individual preparations i.e. betamethasone applied mane and calcipotriol applied nocte. (Green status on the NSJF)

 
   
Calcipotriol 50micrograms/g with Betamethasone 0.05%
(Enstilar®)
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Formulary
Green

Restriction: See APC/NMC Advice

Enstilar®cutaneous foam 60g, 120g

The foam presentation may be preferred to the gel or ointment presentations, depending on the site of the psoriasis and patient preference. The recommended duration of therapy is 4 weeks.

 

APC/NMC Advice: Betamethasone 0.05% / calcipotriol 50micrograms per gram (May 2017).
Dovobet® & Enstilar® are included in the NSJF as a second line agent for the treatment of psoriasis when patients are unable to comply with the individual preparations i.e. betamethasone applied mane and calcipotriol applied nocte. (Green status on the NSJF)

 
   
Coal Tar  
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Formulary
Green

As per skin department formulary

Coal tar bath emulsion (Psoriderm 40% bath additive) 200ml
Coal tar cream (Psoriderm cream) 225ml
Coal tar emollient (Polytar 2.5% solution) 500ml
Coal tar lotion (Exorex 5%) 100ml, 250ml
Coal tar scalp ointment (Sebco 12%, Cocois) 40g, 100g

Self Care  Most of these preparations are available for purchase over the counter in pharmacies.

MHRA/CHM advice (updated December 2018): Emollients: new information about risk of severe and fatal burns with paraffin-containing and paraffin-free emollients

 

 
   
Dithranol (Dithrocream®)
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Formulary
Green

Dithrocream®0.1% cream 50g
Dithrocream®0.25% cream 50g
Dithrocream®0.5% cream 50g
Dithrocream®1% cream 50g
Dithrocream®2% cream 50g

Dithranol should not be used in people with acute or pustular psoriasis or inflamed psoriasis. Avoid using dithranol on the face.

Self Care Prescription only medicine if dithranol content more than 1%, otherwise may be sold to the public. 

 
   
Salicylic acid  
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Formulary
Green

Salicylic acid 2% ointment BP

For the treatment of hyperkeratotic and scaling conditions such as psoriasis.

 
   
13.05.02  Oral retinoids for psoriasis
 note 

MHRA advice (June 2019) - Oral retinoid medicines▼: revised and simplified pregnancy prevention educational materials for healthcare professionals and women

 

Acitretin 
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Formulary
Red

Acitretin 10mg capsules
Acitretin 25mg capsules

Restriction: Initiation on specialist dermatological advice

 

 

 
   
13.05.03  Drugs affecting the immune response
Pimecrolimus (Elidel®)
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Formulary
Green

Elidel®1% cream 30g, 60g, 100g

Restriction: Initiation only by physicians with a special interest and experience in dermatology

 

 
Link  NICE TA82: Pimecrolimus and tacrolimus for atopic dermatitis (eczema)
   
Tacrolimus (Protopic®)
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Formulary
Green

Protopic®0.03% ointment 30g,60g
Protopic®0.1% ointment 30g,60g

Restriction: Initiation only by physicians with a special interest and experience in dermatology

 

 
Link  NICE TA82: Pimecrolimus and tacrolimus for atopic dermatitis (eczema)
   
Cytotoxic Drug Azathioprine 
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Formulary
Amber E

For the treatment of Inflammatory Skin Disease [unlicensed indication]

Azathioprine 25mg tablets
Azathioprine 50mg tablets

Link to ESCA

 
   
Cytotoxic Drug Methotrexate 
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Formulary
Amber E

For the treatment of Inflammatory Skin Disease (licensed for severe skin psoriasis)

[unlicensed use in other inflammatory and autoimmune skin conditions i.e. atopic eczema, sarcoidosis, bullous pemphigoid, morphoea etc]

Methotrexate 2.5mg tablets

Prescribe WEEKLY (on the same day each week); orally as multiples of 2.5mg strength tablets.

Link to ESCA

MHRA/CHM advice: Methotrexate once-weekly for autoimmune diseases: new measures to reduce risk of fatal overdose due to inadvertent daily instead of weekly dosing (September 2020)

 
   
Apremilast (Otezla®)
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Formulary
Red
High Cost Medicine
CCG
BlueTeq

Restriction: In line with NICE Guidance only

 
Link  NICE TA419: Apremilast for treating moderate to severe plaque psoriasis
   
Ciclosporin 
(Prescribe by brand)
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Formulary
Red

Restriction: Initiation on specialist dermatological advice

Brand must be stated

MHRA/CHM advice: ciclosporin must be prescribed and dispensed by brand name (December 2009)

 
   
Dimethyl Fumarate  (Skilarence®)
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Formulary
Red
High Cost Medicine
CCG
BlueTeq

Skilarence® 30mg G/R tablets
Skilarence® 120mg G/R tablets

Restriction: In line with NICE Guidance only

 
Link  NICE TA475: Dimethyl fumarate for treating moderate to severe plaque psoriasis
   
Cytotoxic Drug Methotrexate injection

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Formulary
Red

Methotrexate injection (as pre-filled syringes/ pens/ injectors)- brands include Nordimet®, Zlatal®, Methofill® and Metoject PEN®

Prescribe WEEKLY (on the same day each week)

Restriction: Initiation on specialist dermatological advice

 

 
   
Tildrakizumab (Ilumetri®)Black Triangle
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Formulary
Red
High Cost Medicine
CCG
BlueTeq

Restriction: In line with NICE Guidance only

 
Link  NICE TA575: Tildrakizumab for treating moderate to severe plaque psoriasis
   
Adalimumab (Hyrimoz®, Amgevita®, Imraldi®, Hulio®, Humira®)
(Prescribe by brand)
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Formulary
Red
High Cost Medicine
NHS England
CCG
BlueTeq

Restriction: In line with NICE Guidance only

Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people is commissioned by NHS England for patients treated in specialised dermatology centres and CCGs for treatments in non-specialist centres where commissioned.

Clinicians must ensure the biosimilar brand for their region is prescribed first-line.
(Hyrimoz is the first line biosimilar in West Midlands region; Amgevita is used in patients intolerant to citrate content i.e injection site reactions)

 

 
Link  NICE TA146: Adalimumab for the treatment of adults with psoriasis
Link  NICE TA455: Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people
   
Brodalumab (Kyntheum®)Black Triangle
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
High Cost Medicine
CCG
BlueTeq

Restriction: In line with NICE Guidance only

 
Link  NICE TA511: Brodalumab for treating moderate to severe plaque psoriasis
   
Dupilumab (Dupixent®)Black Triangle
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
High Cost Medicine
CCG
BlueTeq

Restriction: In line with NICE Guidance only

 
Link  NICE TA534: Dupilumab for treating moderate to severe atopic dermatitis
   
Etanercept (Enbrel®, Benepali®, Erelzi®)Black Triangle
(Prescribe by brand)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
High Cost Medicine
CCG
BlueTeq

Restriction: In line with NICE Guidance only

 

 
Link  NICE TA103: 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 (Tremfya®)Black Triangle
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
High Cost Medicine
CCG
BlueTeq

Restriction: In line with NICE Guidance only

 
Link  NICE TA521 : Guselkumab for treating moderate to severe plaque psoriasis
   
Infliximab (Flixabi®, Inflectra®, Remicade®, Remsima®)
(Prescribe by brand)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
High Cost Medicine
CCG
BlueTeq

Restriction: In line with NICE Guidance only

 
Link  NICE TA134: Infliximab for the treatment of adults with psoriasis
   
Ixekizumab (Taltz® )Black Triangle
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
High Cost Medicine
CCG
BlueTeq

Restriction: In line with NICE Guidance only

 
Link  NICE TA442: Ixekizumab for treating moderate to severe plaque psoriasis
   
Risankizumab (Skyrizi®)Black Triangle
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
High Cost Medicine
CCG
BlueTeq

Restriction: In line with NICE guidance only

 
Link  
Link  NICE TA596:Risankizumab for treating moderate to severe plaque psoriasis
   
Secukinumab (Cosentyx®)Black Triangle
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
High Cost Medicine
CCG
BlueTeq

Restriction: In line with NICE Guidance only

 
Link  NICE TA350: Secukinumab for treating moderate to severe plaque psoriasis
   
Ustekinumab (Stelara®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
High Cost Medicine
CCG
BlueTeq

Restriction: In line with NICE Guidance only

 

 
Link  MHRA Guidance on Ustekinumab (Stelara): risk of exfoliative dermatitis
Link  NICE TA180: Ustekinumab for the treatment of adults with moderate to severe psoriasis
Link  NICE TA340: Ustekinumab for treating active psoriatic arthritis
Link  NICE TA455 : Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people
   
13.06  Acne and rosacea to top
Metronidazole  (Rozex®)
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice
Green

1st line treatment for papulopustular rosacea

Metronidazole 0.75% cream or gel 

Acea®, Anabact®, Rozex® brands are more cost-effective. 

 
Ivermectin  (Soolantra®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Soolantra®10mg/g cream

Restriction: 2nd line treatment for papulopustular rosacea if treatment with topical metronidazole has failed

Provide a 4 month course initially and review after 3 months. The course may be repeated if required.

 
   
Adalimumab (Hyrimoz®, Amgevita®, Imraldi®, Hulio®, Humira®)
(Prescribe by brand)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
High Cost Medicine
NHS England

For Acne inversa

Restriction: In line with NICE Guidance

Clinicians must ensure the biosimilar brand for their region is prescribed first-line.
(Hyrimoz is the first line biosimilar in West Midlands region; Amgevita is used in patients intolerant to citrate content i.e injection site reactions)

 

 
Link  NICE TA392: Adalimumab for treating moderate to severe hidradenitis suppurativa
   
13.06.01  Topical preparations for acne
13.06.01  Benzoyl peroxide and azelaic acid
Azelaic acid (Skinoren®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Skinoren®- Azelaic acid 20% cream 30g

Do not confuse with Azelaic Acid 15% (Finacea) which is licensed for rosacea

 
   
Benzoyl peroxide 
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Acnecide® - Benzoyl peroxide 5% gel 30g,60g
Acnecide®Wash - Benzoyl peroxide 5% gel wash 50g

Panoxyl Aquagel® - Benzoyl peroxide 2.5%, 5% or 10% gel, 40g

 

 

 
   
Benzoyl peroxide with clindamycin
(Duac® Once Daily)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Benzoyl peroxide with Antibacterial

Duac®Once Daily gel (3% and 1%) 30g,60g
Duac®Once Daily gel (5% and 1%) 30g,60g

For mild papular/pustular acne where an antimicrobial is indicated.

 
   
13.06.01  Topical antibacterials for acne
13.06.01  Topical retinoids and related preparations for acne
 note 

MHRA advice (June 2019) - Oral retinoid medicines▼: revised and simplified pregnancy prevention educational materials for healthcare professionals and women

 

Adapalene (Differin®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Differin®Adapalene 0.1% cream 45g
Differin®Adapalene 0.1% gel 45g

 
   
Isotretinoin (Isotrex® )
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Isotrex®- Isotretinoin 0.05% gel 

Discontinued 

Prescribers to consider alternative topical preparations within the drug class.

 
   
Adapalene with benzoyl peroxide
(Epiduo®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Topical retinoids and related preparations with benzoyl peroxide

Epiduo®- Adapalene 0.1% and benzoyl peroxide 2.5% gel 45g

 
   
Isotretinoin with erythromycin
(Isotrexin®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Topical retinoids and related preparations with antibacterial

Isotrexin®- Isotretinoin 0.05% and erythromycin 2.0% gel 30g

 
   
Tretinoin with clindamycin phosphate
(Treclin®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Topical retinoids and related preparations with antibacterial

Treclin®- Clindamycin phosphate 1% and tretinoin 0.025% gel 30g

 
   
Tretinoin with erythromycin
(Aknemycin® Plus)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Topical retinoids and related preparations with antibacterial

Aknemycin®Plus - Tretinoin 0.025% and erythromycin 4.0% solution, 25ml

 
   
13.06.01  Other topical preparations for acne to top
13.06.02  Oral preparations for acne
13.06.02  Oral antibiotics for acne
Doxycycline 
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice
Green

Doxycycline 50mg capsules
Doxycycline 100mg capsules
Doxycycline 100mg dispersible tablets
Efracea® - Doxycycline 40mg MR capsules (for papulopustular facial rosacea, without ocular involvement)

1st line choice. Counsel on need to minimise sun exposure due to photosensitivity

 
Lymecycline 
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Lymecycline 408mg capsules

Alternative choice to patients experiencing side-effects with doxycycline.

 
   
Clarithromycin 
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Clarithromycin 250mg tablets
Clarithromycin 500mg tablets

 
   
Oxytetracycline 
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Oxytetracycline 250mg tablets

Alternative to doxycycline.

 
   
Erythromycin 
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Erythromycin GR 250mg tablets
Erythromycin stearate 500mg tablets
Erythormycin ethyl succinate 125mg/5ml oral suspension
Erythormycin ethyl succinate 250mg/5ml oral suspension
Erythormycin ethyl succinate 500mg/5ml oral suspension

For use in pregnancy, under 12’s and patients with contraindications/intolerance to tetracyclines.

 
   
13.06.02  Hormone treatment for acne
Combined Oral Contraceptive

View adult BNF View SPC online View childrens BNF  Track Changes
First Choice
Green

1st line

 
Co-Cyprindiol (cyproterone acetate 2mg with ethinylestradiol 35micrograms)
(Dianette®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

2nd line

Prescribe generically.

CSM Advice: Co-cyprindiol is licensed for use in women with severe acne which 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 Guidance on Co-Cyprindiol: balance of benefits and risks remains positive
   
Cyproterone acetate

View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red

Cyproterone acetate 50mg tablets
Cyproterone acetate 100mg tablets

Restriction: Initiation on specialist dermatological advice

 

 
Link  Restrictions in use of cyproterone acetate due to risk of meningioma
   
13.06.02  Oral retinoid for acne
 note 

MHRA advice (June 2019) - Oral retinoid medicines▼: revised and simplified pregnancy prevention educational materials for healthcare professionals and women

 

Isotretinoin (Roaccutane®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red

Restriction: Initiation on specialist dermatological advice

Contraindicated in pregnancy.

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.

MHRA/CHM advice: Isotretinoin (Roaccutane®): rare reports of erectile dysfunction and decreased libido (October 2017)

MHRA/CHM advice: Oral retinoid medicines: revised and simplified pregnancy prevention educational materials for healthcare professionals and women (June 2019)

MHRA/CHM advice: Isotretinoin (Roaccutane®): reminder of important risks and precautions (August 2020)

 
   
13.07  Preparations for warts and calluses to top
Salicylic acid 
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Salatac® - Salicylic Acid 12% Gel
Salactol® - Salicylic Acid 16.7% with Lactic Acid 16.7% 
Verrugon® complete - Salicylic Acid Ointment 50% ointment 6g
Occlusal® - Salicylic Acid 26% solution 10ml

Self Care  Self Care Medicine. Available OTC for self care

 

 

 
   
Formaldehyde (Veracur®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Formaldehyde (as formaldehyde solution BP) 0.75% w/w gel, 15g

Self Care  Self Care Medicine. Available OTC for self care

 
   
Silver nitrate  (Avoca®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red

Avoca®Silver nitrate 40% pencils
Avoca®Silver nitrate 75% applicators
Avoca®Silver nitrate 95% pencils
Avoca®Silver nitrate 95% applicators

 
   
13.07  Anogenital warts
Imiquimod  
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Amber

Aldara® 5% cream 250mg sachets (12 sachets)
Bascellex® 50mg/g cream 250mg sachets (12 sachets)

Restriction: Initiation by specialist for anogenital warts


Should be rubbed in and allowed to stay on the treated area for 6–10 hours for warts, then washed off with mild soap and water (uncircumcised males treating warts under foreskin should wash the area daily). The cream should be washed off before sexual contact. Maximum 16 weeks course length. 

 

 
   
Podophyllotoxin 
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Amber

Warticon® 0.15% cream 5g
Condyline® 0.5% solution 3.5ml
Warticon® 0.5% solution 3ml

A total of four 3-day treatment courses for Warticon® cream and solution, or five 3-day treatment courses for Condyline®. Direct medical supervision is required for lesions greater than 4 cm2.

 

 
   
13.08  Sunscreens and camouflagers
 note 
  • Sunscreen preparations are regarded as drugs when prescribed for skin protection against ultraviolet radiation in abnormal cutaneous photosensitivity resulting from genetic disorders or photodermatoses, including vitiligo, those resulting from radiotherapy and chronic or recurrent herpes simplex labialis.
  • Prescriptions used in this way should be marked "ACBS" (Advisory Committee on Borderline Substances).
13.08.01  Sunscreen preparations
SpectraBan®
(UVB)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Green

Prescriptions in primary care must be endorsed ‘ACBS’

SpectraBan®sunscreen 20g

Not recommended for prescribing as not listed in the ACBS section of NHS Drug Tariff.

Self Care Self Care Medicine. Available OTC for self care

 
   
RoC Sante Soleil®
(UVB)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Prescriptions in primary care must be endorsed ‘ACBS’

RoC Sante Soleil®sun lotion SPF50 125ml

Not recommended for prescribing as not listed in the ACBS section of NHS Drug Tariff.

Self Care Self Care Medicine. Available OTC for self care

 
   
Uvistat ®
(UVB)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Prescriptions in primary care must be endorsed ‘ACBS’

Uvistat® suncream SPF 30 and 50 125ml
Uvistat® lipscreen SPF 50

Self Care  Self Care Medicine. Available OTC for self care

 
   
13.08.01  Photodamage
Solaraze®
(Diclofenac sodium in sodium hyaluronate gel)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Solaraze®- Diclofenac 3% Gel 50g, 100g

For the treatment of actinic keratosis

Do not prescribe for longer than 3 months. Should not be confused with diclofenac 1% gel which is indicated for pain and inflammation.

 
   
Cytotoxic Drug Efudix® (Fluorouracil 5% cream)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Amber

Efudix®- Fluorouracil 5% cream 40g

For the treatment of actinic keratosis

1st line for superficial basal cell carcinoma

Restriction: Initiation by a consultant dermatologist or GP with a special interest

 

 
   
Aldara® (Imiquimod 5% cream)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Amber

Aldara®- Imiquimod 5% cream 250mg sachets (12 sachets)

2nd line for superficial basal cell carcinoma

Restriction: Initiation by a consultant dermatologist or GP with a special interest

 

 
   
Picato® (Ingenol mebutate 150 or 500microgram/g gel)Black Triangle
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Amber

Picato®150microgram/g gel 1.41g
Picato®500microgram/g gel 0.94g

For the treatment of non-hyperkeratotic, non-hypertrophic actinic keratosis in adults

Restriction: Patients with actinic keratosis affecting an area of skin of up to 25cm2

MHRA advice (Oct 2019): Ingenol mebutate gel (Picato▼)- increased incidence of skin tumours seen in some clinical studies

MHRA advice (Feb 2020): Ingenol mebutate gel (Picato▼): suspension of the licence due to risk of skin malignancy. Clinicians should stop prescribing Picato and consider other treatment options for actinic keratosis as appropriate. The licence of ingenol mebutate (Picato) has been suspended as a precautionary measure while the European Medicines Agency (EMA) continues to investigate concerns about a possible increased risk of skin malignancy.

 
   
Aldara® (Imiquimod 5% cream)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red

Aldara®- Imiquimod 5% cream 250mg sachets (12 sachets)

For Bowen’s Disease [unlicensed indication]

Restriction: To be initiated by a dermatology consultant

 

 

 
   
Actikerall®
(Fluorouracil 0.5% and salicylic acid 10% cutaneous solution)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red

Actikerall 5mg/g / 100mg/g cutaneous solution

For low or moderately thick hyperkeratotic actinic keratoses

 
   
Metvix® (Methyl-5-aminolevulinate cream)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red

Metvix 160mg/g cream

 
   
13.08.02  Camouflagers to top
13.09  Shampoos and other preparations for scalp and hair conditions
Alphosyl 2 in 1®
(Coal Tar Extract 5% alcoholic )
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Alphosyl 2 in 1®- Coal Tar Extract 5% alcoholic shampoo 250ml

Self Care Self Care Medicine. Available OTC for self care

 
   
Cocois® 
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Cocois®ointment 40g, 100g

Self Care  Self Care Medicine. Available OTC for self care

 
   
Ketoconazole 
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Ketoconazole 2% shampoo 120ml

Self Care  Self Care Medicine. Available OTC for self care

 
   
Polytar®

View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Polytar®scalp shampoo 150ml

Contains peanut oil.

Self Care Self Care Medicine. Available OTC for self care

 
   
Selsun® (Selenium sulfide 2.5%)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Selsun®- Selenium sulfide 2.5% shampoo 50ml,100ml,150ml

Self Care  Self Care Medicine. Available OTC for self care

 
   
13.10  Anti-infective skin preparations
13.10.01  Antibacterial preparations
13.10.01.01  Antibacterial preparations only used topically
Mupirocin 2% (Bactroban®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Bactroban®- Mupirocin 2% cream 15g
Bactroban®- Mupirocin 2% ointment 15g

Restriction: On specialist advice for the treatment of MRSA minor skin infection

 

 
   
Silver sulfadiazine
(Flamazine®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Flamazine®1% cream 20g,50g,250g,500g

This product is licensed for prophylaxis and treatment of Burn wounds.
Also licensed for short-term treatment of infection in Pressure sores and Leg ulcers

 
   
13.10.01.02  Antibacterial preparations also used systemically to top
Fusidic acid (sodium fusidate)
(Fucidin®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Fusidic acid cream 15g
Fusidic acid ointment 15g

Restriction: For acute impetigo, minor infections only

 

 
   
Metronidazole (gel/ cream)
(rosacea)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Metronidazole 0.75% gel
Metronidazole 0.75% cream (more cost effective)

Acea®, Anabact®, Rozex® brands are more cost-effective. 

 

 

 
   
13.10.02  Antifungal preparations
Clotrimazole (Canesten®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Clotrimazole 1% (cream, powder, solution)

Self Care Self Care Medicine. Available OTC for self care

 
   
Ketoconazole (Nizoral®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Nizoral® - Ketoconazole 2% cream 30g

Restriction: For treatment of seborrhoeic dermatitis and pityriasis versicolor only (primary care prescriptions should be endorsed ‘SLS’ i.e Nizoral® cream)

 

 

 
   
Miconazole (Daktarin®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Daktarin®- Miconazole 2% cream 30g

Self Care Self Care Medicine. Generic product is available to purchase from the pharmacy.

 
   
Nystatin (cream)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Nystatin cream discontinued in UK 2008

An alternative product is Nystatin 100,000 units/g with Chlorhexidine Hydrochloride 1%, 30g or a similar product within the drug class.

 
   
13.10.03  Antiviral preparations
Aciclovir 
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Aciclovir 5% cream 2g,10g

Cold sores resolve after 7–10days without treatment.

Self Care Self Care Medicine. Available OTC for self care. (Please note exceptions may apply)

 
   
13.10.04  Parasiticidal preparations
 note 
Suitable quantities of parasiticidal preparations:
 

Area of body

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.

Malathion (Derbac-M®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Derbac-M® - Malathion 0.5% liquid 50ml,100ml

Self Care Self Care Medicine. Available OTC for self care

 

 
Link  UKMI Q&A: How should head lice be treated in a breastfeeding mother?
   
Permethrin 
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Permethrin 5% cream 30g

BNF designates Lyclear®1% creme rinse as less suitable for prescribing, thus do not prescribe.

Self Care Self Care Medicine. Available OTC for self care

 

 
Link  UKMI Q&A: How should head lice be treated in a breastfeeding mother?
   
Phenothrin 
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Full Marks® - Phenothrin 0.2% lotion (alcohol)
Full Marks® - Phenothrin 0.5% liquid (aqueous)
Full Marks® - Phenothrin 0.5% mousse (alcohol)

 

Self Care Self Care Medicine-Available OTC for self-care

 

 

 
Link  UKMI Q&A: How should head lice be treated in a breastfeeding mother?
   
13.10.05  Preparations for minor cuts and abrasions
13.11  Skin cleansers, antiseptics, and desloughing agents to top
13.11.01  Alcohols and saline
Sodium chloride 0.9%

 Track Changes
Formulary
Green

Sodium chloride 0.9% 10mL Ampoules
Sodium chloride 0.9% 20mL Ampoules
Sodium chloride 0.9% 25mL Sachet (Normasol®)
Sodium chloride 0.9% 100mL Sachet (Normasol®)
Sodium chloride 0.9% Irrigation 1L

 

 
   
13.11.02  Chlorhexidine salts
Chlorhexidine gluconate
(preparations)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Chlorhexidine gluconate 0.05% Sachets 25mL
Chlorhexidine gluconate 0.05% Sachets 100mL (Brands include Unisept®)

Chlorhexidine 0.015% with Cetrimide 0.15% (Tisept®) 

Chlorhexidine 4% solution (Brands include Hydrex® surgical scrub and Hibiscrub® cleansing solution). Can be purchased over the counter.

 
   
13.11.03  Cationic surfactants and soaps
13.11.04  Iodine and Chlorine
Iodine 
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Weak iodine solution and povidone-iodine

Povidone-Iodine 10% antiseptic solution, 500ml
Povidone-Iodine 2.5% dry powder spray, 100ml

Alternative for patients with chlorhexidine intolerance/allergy 

 
   
13.11.05  Phenolics to top
Triclosan  
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red

Triclosan 1% surgical scrub
Triclosan 2% (Ster-Zac Bath Concentrate®), 500ml

AQUASEPT DISCONTINUED

 
   
13.11.06  Oxidisers, and dyes
Hydrogen peroxide  
View adult BNF View childrens BNF  Track Changes
Formulary
Red

Hydrogen peroxide 3% solution (10vols) 200ml
Hydrogen peroxide 6% solution (20vols) 200ml

Restriction: On specialist advice only

 

 
   
Potassium permanganate
(Permitabs®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Potassium permanganate 400mg tablets for cutaneous solution 30 tablets

Caution - Not for Oral use and can be fatal if ingested orally.

1 tablet dissolved in 4 litres of water provides a 0.01% (1 in 10,000) solution for external use only.

 
Link  NHS England Patient Safety Alert: Risk of death or serious harm from accidental ingestion of potassium permanganate preparations
   
13.11.07  Desloughing agents
13.12  Antiperspirants
Aluminium chloride hexahydrate
(antiperspirant)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Anhydrol Forte® 20% solution, 60ml
Driclor® 20% solution 20ml,75ml

Self Care Self Care Medicine. Available to purchase over the counter for hyperhidrosis

 
   
13.13  Topical circulatory preparations
Heparinoid  (Hirudoid®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red

Hirudoid® 0.3% cream 50g
Hirudoid® 0.3% gel, 50g

 
   
 ....
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
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Link to adult BNF
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Link to children's BNF
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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
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Red

Medicines that can only be prescribed within Secondary Care. Examples of medicines which fall into this category are: Certain new medicines and new indications for older medicines where there is at present no experience of use in Primary Care. Medicines or dressings not available or prescribable in Primary Care. Where a medicine has been classified as Amber E, but an approved shared-care guideline is not yet available   

Amber

Medicines which can be prescribed within Secondary Care, but are only suitable for prescribing in Primary Care after specialist referral. There is no need for approved shared care guidelines for medicines in this category. This replaces Amber 2 on the North Staffs Formulary.   

Amber E

Medicines which can be prescribed within Secondary Care, but are only considered suitable for prescribing in Primary Care under an approved shared-care agreement (ESCA) or Rationale for Initiation, Continuation and Discontinuation (RICaD). This replaces Amber 1 on the North Staffs Formulary  

Green

Medicines which can be prescribed in either Primary or Secondary Care.  

Grey

These medicines have been reviewed by the New Medicines Committee and the Area Prescribing Committee and found not to be suitable for inclusion in the Joint Formulary. Inadequate or weak evidence for efficacy No clearly defined local need Lack of long term safety data No perceived benefit over established formulary alternatives Prescribers can consider these medicines where formulary alternatives are unsuitable, ineffective or not tolerated.  

netFormulary