North Staffordshire Joint Formulary Formulary


	North Staffordshire Joint Formulary North Staffordshire Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group

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Formulary Chapter 13: Skin - Full Chapter

13.08.01

Sunscreen preparations

13.08.01

Photodamage

Solaraze^®
(Diclofenac sodium in sodium hyaluronate gel)

Formulary

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.

Efudix^® (Fluorouracil 5% cream)

Formulary

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)

Formulary

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)

Formulary

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)

Formulary

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)

Formulary

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

For low or moderately thick hyperkeratotic actinic keratoses

Metvix^® (Methyl-5-aminolevulinate cream)

Formulary

Metvix 160mg/g cream

....

Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to children's BNF
	Link to SPCs
	Scottish Medicines Consortium

	Cytotoxic Drug
	Controlled Drug
	High Cost Medicine
	Cancer Drugs Fund
	NHS England
	Homecare
	CCG
	High Cost Drug Approval System

Traffic Light Status Information

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