North East and North Cumbria Formulary


	North East and North Cumbria ICS Formulary

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Formulary Chapter 13: Skin - Full Chapter

Notes:

Most prescribing uses licensed medicines whose safety and efficacy are assured. For many common dermatological diseases including psoriasis and eczema, the range of licensed medicines is limited. As a result, Dermatology prescribing may rely significantly on unlicensed creams and ointments (known as ‘Specials’) containing tars, dithranol, salicylic acid, steroids and other active constituents in a range of concentrations and bases. This is of particular concern in primary care where lack of effective price controls and a mechanism to ensure independent scrutiny of product quality has increased costs and concern about standards. To address these concerns, and help optimise quality of care, adherence to the revised British Association of Dermatologists (BAD) list of preferred Specials (2018) is encouraged.

Details...

13.09

Shampoos and other preparations for scalp and hair conditions

Betamethasone 0.05%, salicylic acid 2% (Diprosalic ^® )
(Scalp application)

Formulary

Betamethasone 0.1%
(Scalp application)

Formulary

Capasal^®

Formulary

Clobetasol 0.05%
(Scalp application)

Formulary

Coal Tar Extract 5% shampoo (Alphosyl 2 in 1^®)
(Alcoholic)

Formulary

Eucerin 5% Dry Scalp Shampoo

Formulary

Ketoconazole 2% shampoo (Nizoral^®)

Formulary

Oilatum shampoo

Formulary

Selenium Sulphide 2.5% shampoo (Selsun^®)

Formulary

Shampoo Cetrimide with undecanoic acid Ceanel Concentrate®

Formulary

Shampoos (Dermax^®)

Formulary

Simple shampoo
(Gentle/frequent)

Formulary

13.09

Hirsutism

Co-Cyprindiol 2000/35
(Cyproterone Acetate 2mg with Ethinylestradiol 35micrograms)

Formulary

Tablets containing cyproterone acetate 2mg & ethinylestradiol 35 micrograms.
Note: generic co-cyprindiol is much cheaper than Dianette®

Eflornithine 11.5% cream (Vaniqa^®)

Formulary

**UNDER REVIEW**
Approved for use as a second-line treatment of facial hirsutism in patients where co-cyprindiol is ineffective, contra-indicated or considered inappropriate. Treatment should be initiated by or on the specific advice of an appropriate specialist - endocrinologist (or gynaecologist).

13.09

Androgenetic alopecia

13.09

Dandruff, psoriasis, seborrhoeic dermatitis of the scalp

13.09

Hirsutism-Postmenstrual women

....

Non Formulary Items

Minoxidil

Non Formulary

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

	Cytotoxic Drug
	Controlled Drug
	High Cost Medicine
	NHS England
	Homecare
	CCG

Traffic Light Status Information

Status	Description
	Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment. In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances. For all RED drugs automatically added to the formulary in response to a positive NICE TA: Prescribers need to ensure that local Trust new drug governance procedures and pharmacy processes are followed before any prescribing.
	Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber. If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care.
	Drugs normally recommended or initiated by a specialist (hospital or GP with an extended role https://www.rcgp.org.uk/gpwer), but can be safely maintained in primary care with very little or no monitoring required. In some cases there may be a further restriction for use outlined - these will be defined in each case. Provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by GPs.
	Drugs where prescribing by GPs is appropriate. Can be initiated and prescribed in all care settings, and if appropriate, discontinued without recourse to secondary care.
	NOT APPROVED: Drugs that have been considered by NTAG or the NENC ICB Medicines Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria.
	UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review.
	NOT REVIEWED: Drugs that haven not been reviewed yet. This usually means that an application is in progress. These drugs are not normally considered appropriate for prescribing in the North East and North Cumbria until such time that a decision is taken on their formulary status.