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...

13.11

Skin cleansers, antiseptics, and desloughing agents

Gigasept PA
(Solution)

Formulary

Lubricating jelly

Formulary

Plaster remover

Formulary

13.11.01

Alcohols and saline

Alcohol hand rub gel

Formulary

Alcohol impregnated wipes

Formulary

Containing 70% isopropyl alcohol or methylated spirit (e.g. Clini-wipes®, Alcowipes®)

Industrial Methylated Spirit BP
(Solution & spray)

Formulary

70% liquid & 70% spray

Isopropyl alcohol 70% Skin Preparation Swabs (Sterets^®)

Formulary

Sodium Chloride 0.9%

Formulary

Sterile solution – bottles
25ml & 100ml sachets(Normasol®)

Water for Irrigation
(Sterile)

Formulary

13.11.02

Chlorhexidine salts

In June 2014 information was published highlighting the risk of severe chemical injuries associated with the use of both alcohol-based and water-based chlorhexidine solutions for skin disinfection in premature infants. This was based on Yellow Card reports and reports identified in the literature. A European review has since considered the MHRA evidence together with additional information from spontaneous reporting and published
literature The risk appears to be higher in infants born before 32 weeks of gestation than in full term infants and in the first 2 weeks of life than in later life.

Advice for healthcare professionals:

 When using alcohol-based or water-based chlorhexidine solutions on premature infants, bear in mind the risk of severe chemical injuries.
 Use the minimum amount of chlorhexidine solution required and do not allow the solution to pool. Remove any excess solution and any soaked materials, drapes, or gowns from the skin.
 Use single-use containers where possible. There is a danger of accidentally using too much solution from a multiple-use container.
 Monitor patients frequently to detect and manage cutaneous side effects at an early stage.
 Please report any adverse events through the Yellow Card Scheme:www.mhra.gov.uk/yellowcard

Chlorhexidine 0.015% with Cetrimide 0.15%
(Solution)

Formulary

Chlorhexidine Gluconate

Formulary

0.05% solutions, 25ml & 100ml sachets
0.5% solution in 70% methylated spirit (pink, colourless & red staining)
2.5% in 70% methylated spirit wipes
0.5% hand rub (contains 70% isopropyl alcohol + emollients)
4% surgical scrub
2% in 70% isopropyl alcohol wipes (Clinell®)
Skin swabs & skin cleanser
3ml & 10.5ml applicators (Chloraprep®)
1% Obstetric cream

MHRA Drug Safety Update (November 2012): Chlorhexidine: reminder of potential for hypersensitivity

Prontosan

Formulary

Solution containing Betaine 0.1% (surfactant) and Polyhexanide 0.1% (a chlorhexidine polymer). Mainly for use from 40ml plastic ampoules.
Also available as a gel.
To be prescribed/used only on the advice of tissue viability specialists.

MHRA Drug Safety Update (November 2012): Chlorhexidine: reminder of potential for hypersensitivity

13.11.03

Cationic surfactants and soaps

Infacare Baby Bath Additive

Formulary

Secondary care use only

Mediscrub^®

Formulary

Octenisan^® wash

Formulary

Used in some trusts as an alternative to chlorhexidine scrub and Triclosan skin cleanser in MRSA prophylaxis/eradication on secondary care advice.

13.11.04

Iodine and Chlorine

Povidone-Iodine

Formulary

2.5% dry powder spray
10% alcoholic solution
7.5% surgical scrub
10% antiseptic solution (aqueous)
0.35% sterile aqueous solution
- approved for use in the prevention of surgical site infection in arthroplasty.

Sodium Hypochlorite Solution 1%

Unlicensed

1% sterilising solution.

13.11.05

Phenolics

13.11.06

Oxidisers, and dyes

Hydrogen Peroxide Solution BP

Formulary

10 volume (3%) & 20 volume (6%) solutions.

Potassium Permanganate

Formulary

5% solution unlicensed
400mg tablets

Potassium permanganate not to be issued on repeat prescription

Inadvertent oral administration of potassium permanganate

Silver nitrate 0.5% Solution
(UNDER REVIEW)

Formulary

Bonney's Blue Paint
(Brilliant green & crystal violet)

Unlicensed

For limited use in some operating theatres only.

Crystal Violet 0.5% Paint

Unlicensed

For limited use in some operating theatres/critical care areas only.

Magenta Paint BPC (Castellani's paint)
(UNDER REVIEW)

Unlicensed

Paint containing magenta 0.4%, boric acid 0.8%, phenol 0.004%, resorcinol 8%, acetone and alcohol (or industrial methylated spirit).

13.11.07

Desloughing agents

13.11.07

Growth factor

....

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.