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...

13.05.02

Preparations for psoriasis

5-Methoxypsoralen 20mg tablets

Unlicensed

8-Methoxypsoralen 10mg tablets

Unlicensed

Methoxypsoralen 1.2% bath additive

Unlicensed

NICE CG153: Psoriasis: assessment and management

13.05.02

Topical preparations for psoriasis

Calcipotriol 50mcg/g (Dovonex^®)

Formulary

0.005% Cream and ointment

Calcipotriol with Betamethasone

Formulary

Calcipotriol 50mcg/1g and betamethasone (as betamethasone dipropionate) 500mcg/1g
- Gel and ointment (Dovobet®)
  - approved for the treatment of scalp and mild to moderate non scalp plaque psoriasis vulgaris in adults.
- 60g cutaneous spray (Enstilar®)
  - Approved for the treatment of plaque psoriasis
- Cream (Wynzora®)

Coal tar 2% and salicylic acid 2% ointment

Formulary

Coal tar in emulsifying ointment solution

Formulary

1% unlicensed
2% unlicensed
5% unlicensed

Coal tar lotion 1% (Exorex^®)

Formulary

Cocois^®
(Scalp application)

Formulary

Diprosalic ointment

Formulary

0.05%/3%

Dithranol pomade

Formulary

0.2%, 0.4% & 0.6% unlicensed

Sebco^® scalp ointment

Formulary

Shampoos (T/Gel®)

Formulary

Dithranol in Full Strength Lassar's Paste BP

Unlicensed

0.1%, 0.2%, 0.4%, 0.6%, 0.8%, 1%, 2%, 4%, 6% & 8%.

Dithranol with salycyclic acid 0.5%

Unlicensed

0.1%, 0.2%, 0.4%, 0.6%, 0.8%, 1%, 2%, 4%, 6%, 8% & 16%in emulsifying base.

Salicylic Acid in emulsifying ointment

Unlicensed

2%, 5%, 10% and 20%.

Tar Pomade (6% coal tar solution & 2% salycylic acid in emulsifying ointment)

Unlicensed

Zinc and Coal Tar Paste (White's Tar Paste)

Unlicensed

Zinc and Salicylic Acid Compound Paste (Half Strength Lassar's Paste)

Unlicensed

13.05.02

Oral retinoids for psoriasis

Acitretin (Neotigason^®)

Unlicensed

10mg and 25mg capsules

MHRA Drug Safety Update (July 2021): Oral retinoid medicines (isotretinoin▼, alitretinoin▼, and acitretin▼): temporary monitoring advice during coronavirus (COVID-19) pandemic

MHRA Drug Safety Update (Jun 2019): Oral retinoid medicines▼: revised and simplified pregnancy prevention educational materials for healthcare professionals and women

Fumaric acid esters

Unlicensed

30mg & 120mg tablets

13.05.02.01

Topical preparations for the scalp

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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.