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 Formulary Chapter 13: Skin - Full Chapter
Notes:

This chapter of the formulary is under continual development, please let the team know if you have any comments about the contents: mlcsu.lscformulary@nhs.net. 

For more information about the formulary development process, please see: https://www.lancsmmg.nhs.uk/lancashire-and-south-cumbria-icb-formulary-development/

 Details...
13.01  Management of skin conditions
Birch bark extract (Filsuvez Gel®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
NHS England

Gel 100mg/1g

 
Link  NICE: Birch bark extract for treating epidermolysis bullosa
 
HidraWear
View adult BNF View SPC online View childrens BNF
Formulary
Green

 Hidradenitis Suppurativa 

 
Link  LSCMMG HidraWear Position Statement
 
13.01.01  Vehicles
13.01.02  Suitable quantities for prescribing
13.01.03  Excipients and sensitisation
13.02  Emollient and barrier preparations to top
 note  Please noter that the 'Zero' range of emollients are cheaper in primary care. These are to be advised on the GP referal letters
13.02.01  Emollients
 note 

MHRA December 2018:

Emollients: new information about risk of severe and fatal burns with paraffin-containing and paraffin-free emollients

Warnings about the risk of severe and fatal burns are being extended to all paraffin-based emollients regardless of paraffin concentration. Data suggest there is also a risk for paraffin-free emollients. Advise patients who use these products not to smoke or go near naked flames, and warn about the easy ignition of clothing, bedding, dressings, and other fabric that have dried residue of an emollient product on them.

Emulsifying Ointment BP
View adult BNF View SPC online View childrens BNF
Formulary
Green
500g

NB: fire hazard - see BNF 
 
Epimax ®
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream 100g, 500g 
 
Epimax ® ointment
View adult BNF View SPC online View childrens BNF
Formulary
Green

Ointment

MHRA Drug Safety Update, July 2024: Epimax Ointment and Epimax Paraffin-Free Ointment: reports of ocular surface toxicity and ocular chemical injury

 
Link  MHRA: Epimax Ointment and Epimax Paraffin-Free Ointment: reports of ocular surface toxicity and ocular chemical injury
 
Epimax Oatmeal®
View adult BNF View SPC online View childrens BNF
Formulary
Green

Cream 100g, 500g

 
 
ExCetra®
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Formulary
Green

Liquid paraffin light 105 mg per 1 gram, White soft paraffin 132 mg per 1 gram

Cream 100g, 500g

 
 
Imuderm® emollient
View adult BNF View SPC online View childrens BNF
Formulary
Green

emollient 500g

(Contains urea 5%)

 
 
Isomol gel ®
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Formulary
Green
100g, 500g 
 
Liquid and White Soft Paraffin Ointment (50:50)
View adult BNF View SPC online View childrens BNF
Formulary
Green
500g

NB: fire hazard - see BNF 
 
Oilatum®
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream 50g, 500g 
 
ZeroAQS® (Emollient preparation)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Cream 500g,

Similar to aqueous cream but contains no sodium lauryl sulfate.

 
 
13.02.01  Emollients - with antimicrobials
Dermol®
View adult BNF View SPC online View childrens BNF
Formulary
Green

Cream 500g

Lotion 500mL

Also contains antimicrobials

 
 
13.02.01  Preparations containing urea
Emollient preparation containing Urea 25% (Flexitol®)
View adult BNF View SPC online View childrens BNF
Formulary
Green Restricted

Heel balm 75g

Specific use only for diabetic patients

 
Link  LSCMMG: Over the Counter Items that Should not be Routinely Prescribed in Primary Care Policy
 
Flexitol® Cream, Hydromol® Intensive
(urea 10%)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Flexitol is lower cost then Hydromol

 
 
13.02.01.01  Emollient bath and shower preparations
 note  Emollient bath and shower preparations are no longer recommended. Most emollients can be used as a soap substitute.
13.02.02  Barrier preparations to top
Conotrane®
(Barrier preparation)
View adult BNF View SPC online View childrens BNF
Formulary
Green

For community use only

 
 
Medi Derma-S
View adult BNF View SPC online View childrens BNF
Formulary
Green

Spray barrier film

For community use only

 
 
Medihoney®
View adult BNF View SPC online View childrens BNF
Formulary
Green

Second choice

Cream and sachet

For community use only

 
 
Metanium® (Barrier preparation)
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Formulary
Green

Ointment
For paediatric use only

Tissue Viability Nurse authorisation required for use in adult patients

 
 
Proshield Plus®
(For excoriated skin)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Skin protectant ointment 115g
 
 
Sorbaderm®
View adult BNF View SPC online View childrens BNF
Formulary
Green
Available from stores - not supplied from UHMB pharmacy 
 
Sudocrem® (Barrier preparation)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Cream 60g

For paediatric use only

 
 
13.03  Topical local anaesthetics and antipruritics
Crotamiton 10% (Eurax®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream 30g 
 
Difelikefalin Black Triangle (Kapruvia®)
View adult BNF View SPC online View SMC online View childrens BNF
Formulary
Red
NHS England

Solution for injection 50micrograms/mL

NICE TA890 Difelikefalin for treating pruritus in people having haemodialysis

 
Link  NICE TA890: Difelikefalin for treating pruritus in people having haemodialysis
 
Levomenthol 0.5%, 1%, 5% cream
View adult BNF View SPC online View childrens BNF
Formulary
Green

Cream 500g

 
 
13.04  Topical corticosteriods.
Betamethasone 0.1%
View adult BNF View SPC online View childrens BNF
Formulary
Green
Scalp application 100mL 
 
Betamethasone 0.1% (Bettamousse®)
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Formulary
Green
Foam 100g 
 
Betamethasone Dipropionate 0.05% with Salicylic Acid 2% (Diprosalic®)
(Potency = potent)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Scalp application 100mL 
 
Betamethasone Dipropionate 0.05% with Salicylic Acid 3% (Diprosalic®)
(Potency = potent)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Ointment 100g
 
 
Betamethasone Dipropionate 0.064% with Clotrimazole 1% (Lotriderm®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream 30g 
 
Betamethasone Valerate 0.025% (Betnovate-RD®)
(Potency = moderate)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream 100g
Ointment 100g 
 
Betamethasone Valerate 0.1% (Betnovate®)
(Potency = potent)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream 30g, 100g
Ointment 30g, 100g  
 
Betamethasone Valerate 0.1% with Fucidic Acid 2% (Fucibet®)
(Potency = potent)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream 30g


Preparations containing fusidic acid should not be used in secondary care for in-patients 
 
Clobetasol propionate  (Etrivex®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber 0

Shampoo, clobetasol propionate 0.05% 125mL

 
 
Clobetasol propionate 0.05% (Clarelux®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Scalp application and shampoo 
 
Clobetasol Propionate 0.05% (Dermovate®)
(Potency = very potent)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream 30g, 100g
Ointment 30g, 100g 
 
Clobetasone 0.05%/Nystatin 100,000u/g/Oxytetracycline 3% (Trimovate®)
(Potency - moderate)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream 30g 
 
Clobetasone Butyrate 0.05% (Eumovate®)
(Potency = moderate)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream 30g
Ointment 30g 
 
Flucinolone Acetonide 0.025% (Synalar®)
(Potency = potent)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Gel 30g

For scalp use only 
 
Fludroxycortide  (Haelan®)
(Potency = Moderate)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Tape 4 micrograms/cm2 7.5cm x 50cm x 200cm

Amber 0 In East Lancashire

 
 
fluocinolone acetonide 0.025% with clioquinol 3% (Synalar C®)
(potent corticosteroid with antimicrobials)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Cream & Ointment

Replaces Betnovate C cream & ointment

 
 
Hydrocortisone 0.5%/ nystatin 100,000units/g /benzalkonium chloride 0.2%/ dimeticone '350' 10%  (Timodine®)
(Potency = mild)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream 30g 
 
Hydrocortisone 1%
(potency = mild)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream 15g
Ointment 15g 
 
Hydrocortisone 1% with Clotrimazole 1% (Canesten HC®)
(Potency = mild)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream 30g 
 
Hydrocortisone Acetate 1% with Fusidic Acid 2% (Fucidin H®)
(Potency = mild)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream 30g, 60g

Preparations containing fusidic acid should not be used in secondary care for in-patients 
 
Mometasone Furoate 0.1% (Elocon®)
(Potency = potent)
View adult BNF View SPC online View childrens BNF
Formulary
Amber 0

Cream 30g
Ointment 30g

 
 
13.04  Topical corticosteriod preparation potencies
 note  Topical corticosteroids are classified according to their potency. Potency is a result of the formulation as well as the corticosteroid.
For guidance on quantities to prescribe see BNF.
13.04  Topical corticosteroids (Potency: Mild)
13.04  Topical corticosteroids (Potency: Moderate) to top
13.04  Topical corticosteroids (Potency: Potent)
13.04  Topical corticosteroids (Potency: Very Potent)
13.04.01  Topical corticosteroids – Compound preparations – with antimicrobials
13.04.01  Topical corticosteroids – Compound preparations – with salicyclic acid
13.05  Preparations for eczema and psoriasis to top
13.05.01  Preparations for eczema
Ichthammol with Zinc oxide  ( Ichthopaste bandage®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
7.5cm x 6m 
 
Alitretinoin (Toctino®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
BlueTeq

Capsules 10mg, 30mg

Consultant dermatologist or specialist only

Pregnancy must be excluded before initiation and before each repeat prescription.
prescriptions for women are limited to 28 days treatment

REQUIRES BLUETEQ APPROVAL

 
Link  MHRA: Oral retinoid medicines▼: revised and simplified pregnancy prevention educational materials for healthcare professionals and women
Link  NICE TA177: Alitretinoin for the treatment of severe chronic hand eczema
 
Zinc oxide 15% and Ichthammol 1% in yellow soft paraffin (Special ointment No1)
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Ointment

 
 
13.05.01  Topical preparations for eczema
Viscopaste® bandages
View adult BNF View SPC online View childrens BNF
Formulary
Green

 Bandage 7.5cm x 6m

For community use only

 
 
13.05.02  Preparations for psoriasis
Dimethyl Fumarate (Skilarence®)
(moderate/severe plaque psoriasis)
View adult BNF View SPC online View childrens BNF
Formulary
Red
BlueTeq

Tablets 30mg, 120mg

 
Link  NICE TA475: Dimethyl fumarate for treating moderate to severe plaque psoriasis
 
Ixekizumab  (Taltz®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
ICB
BlueTeq

80mg/1mL pre-filled pen

 
Link  NICE TA442: Ixekizumab for treating moderate to severe plaque psoriasis
Link  NICE TA537: Ixekizumab for treating active psoriatic arthritis after inadequate response to DMARDs
 
Methoxypsoralen
Unlicensed Drug Unlicensed
Red
Bath lotion 1.2%
Gel 0.005%
Tablets 10mg 
 
13.05.02  Topical preparations for psoriasis
Calcipotriol
View adult BNF View SPC online View childrens BNF
Formulary
Green
Ointment 120g
 
 
Calcipotriol 50micrograms/g with Betamethasone 0.05% (Dovobet®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Gel 60g 
 
Calcipotriol 50micrograms/g with Betamethasone 0.5mg/g (Enstilar®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cutaneous foam  
 
Coal tar 1% with salicylic acid 2% and precipitated sulfur 4% (Sebco®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Scalp ointment 40g 
 
Coal tar lotion 5% (Exorex®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Lotion 100mL 
 
salicylic acid in emulsifying ointment 2%, 5%, 10%
View adult BNF View childrens BNF
Formulary
Red
Ointment 2%, 5%, 10% 
 
Tacalcitol 4micrograms/g (Curatoderm®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Ointment 100g 
 
Zinc and Salicylic Acid Paste BP
(Lassars Paste)
View adult BNF View SPC online View childrens BNF
Formulary
Amber 0

Zinc oxide 24% / salicylic acid 2% / starch 24% / white soft paraffin 50%

 
 
Coal Tar 2% and Salicylic Acid Ointment 2% BP (Sloppy Tar)
(For scalp use only)
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Amber 0

Not all coal tar products are routinely stocked by the pharmacy departments. If the product has to be obtained from a specials manufacturing unit there may be a delay of up to 4 weeks

 
 
Coal tar in emulsifying ointment
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Amber 0

1%, 2%, 5%, 10%, 15%, 20%, 25%, 30% 100g
Not all coal tar products are routinely stocked by the pharmacy departments. If the product has to be obtained from a specials manufacturing unit there may be a delay of up to 4 weeks.

 
 
Dithranol in Lassar’s Paste
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Amber 0

10%
(0.1%, 0.25%, 0.5%, 1%, 2%, 4%, 6%, 8% dilutions available from pharmacy)
Not all dithranol products are routinely stocked by the pharmacy departments. If the product has to be obtained from a specials manufacturing unit there may be a delay for up to 4 weeks.

 
 
13.05.02  Oral retinoids for psoriasis to top
Acitretin (Neotigason®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Capsules 10mg, 25mg

Consultant dermatologist or specialist initiation only

Pregnancy must be excluded before initiation and before each repeat prescription.
Prescriptions for women are limited to 28 days treatment

 
Link  MHRA: Oral retinoid medicines▼: revised and simplified pregnancy prevention educational materials for healthcare professionals and women
 
13.05.03  Drugs affecting the immune response
AbrocitinibBlack Triangle (Cibinqo ®)
View adult BNF View SPC online View SMC online View childrens BNF
Formulary
Red
ICB
BlueTeq

Tablets 50mg - for treating moderate to severe atopic dermatitis

Tablets 100mg - for treating moderate to severe atopic dermatitis

Tablets 200mg - for treating moderate to severe atopic dermatitis

 
Link  NICE TA814: Abrocitinib, tralokinumab or upadacitinib for treating moderate to severe atopic dermatitis
 
Adalimumab (Biosimilars avaliable)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
Homecare
BlueTeq

S/C injection 40mg pre-filled syringe, pre-filled pen

Consultant dermatologist or specilaist initiation only

Tertiary centre only for hidradenitis suppurativa

Usually supplied to patients by a home delivery company

REQUIRES BLUETEQ APPROVAL

 
Link  MHRA: Tumour necrosis factor alpha inhibitors
Link  NICE TA392: Adalimumab for treating moderate to severe hidradenitis suppurativa
Link  NICE TA455: Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people
Link  NIE TA146: Adalimumab for the treatment of adults with psoriasis
 
Apremilast (Otezla®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
Homecare
BlueTeq

Tablets 10mg, 20mg, 30mg

Usually supplied to patients by a home delivery company

REQUIRES BLUETEQ APPROVAL

 
Link  MHRA: Apremilast (Otezla ▼): risk of suicidal thoughts and behaviour
Link  NICE TA419: Apremilast for treating moderate to severe plaque psoriasis
Link  NICE TA433: Apremilast for treating active psoriatic arthritis
 
Cytotoxic Drug Azathioprine
View adult BNF View SPC online View childrens BNF
Formulary
Amber 2

Tablets 25mg, 50mg
Unlicensed indication
Consultant dermatologist or specilaist initiation only
See section 10.1.3

 
Link  LSCMMG: Shared care guideline - Azathioprine
 
Baricitinib
View adult BNF View SPC online View childrens BNF
Formulary

Film-coated tablets 2mg, 4mg

Red Treatment of atopic dermatitis

Do Not Prescribe Treatment of alopecia areata

 
Link  NICE TA681: Baricitinib for treating moderate to severe atopic dermatitis
Link  NICE TA926: Baricitinib for treating severe alopecia areata
 
BimekizumabBlack Triangle (Bimzelx ®)
View adult BNF View SPC online View SMC online View childrens BNF
Formulary
Red
NHS England
Homecare

Pre-filled pen/syringe 160mg

Usually supplied to patients via a homecare delivery company

 
Link  NICE TA723: Bimekizumab for treating moderate to severe plaque psoriasis
 
BrodalumabBlack Triangle (Kyntheum®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
ICB
BlueTeq

Solution for injection pre-filled syringes 210mg/1.5ml 

 
Link  NICE TA511: Brodalumab for treating moderate to severe plaque psoriasis
 
Ciclosporin
View adult BNF View SPC online View childrens BNF
Formulary
Amber 2

Consultant dermatologist or specilaist initiation only

To be prescribed generically for dermatology patients

See section 10.1.3

 
Link  LSCMMG: Shared care guideline - Ciclosporin
 
Deucravacitinib (SOTYKTU )
View adult BNF View SPC online View childrens BNF
Formulary
Red
ICB
BlueTeq

Film coated tablets 6mg

 

Red NICE TA907: Deucravacitinib for treating moderate to severe plaque psoriasis

 

 

 
Link  NICE TA907: Deucravacitinib for treating moderate to severe plaque psoriasis
 
DupilumabBlack Triangle (Dupixent®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
Homecare
BlueTeq

Pre-filled syringe 300mg/2ml solution for injection

Do Not Prescribe NICE TA648: Dupilumab for treating chronic rhinosinusitis with nasal polyps (terminated appraisal)

Do Not Prescribe NICE TA955: Dupilumab for treating moderate to severe prurigo nodularis

 
Link  MHRA: Dupilumab (Dupixent▼): risk of ocular adverse reactions and need for prompt management
Link  NICE TA534: Dupilumab for treating moderate to severe atopic dermatitis
Link  NICE TA955: Dupilumab for treating moderate to severe prurigo nodularis
 
Etanercept (Biosimilars avaliable)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
Homecare
BlueTeq

S/C injection 50mg pre-filled syringe, pre-filled pen

Consultant dermatologist or specilaist initiation only
Usually supplied to patients by a home delivery company

REQUIRES BLUETEQ APPROVAL

 
Link  MHRA: Tumour necrosis factor alpha inhibitors
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®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
ICB
Homecare
BlueTeq

Solution for injection in pre-filled pen 100mg/1ml

 
Link  NICE TA521: Guselkumab for treating moderate to severe plaque psoriasis
 
Infliximab (Biosimilars avaliable)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
BlueTeq

Intravenous infusion 100mg

Consultant dermatologist or specilaist initiation only

REQUIRES BLUETEQ APPROVAL

 
Link  MHRA: Tumour necrosis factor alpha inhibitors
Link  NICE TA134: Infliximab for the treatment of adults with psoriasis
 
Cytotoxic Drug Methotrexate
View adult BNF View SPC online View childrens BNF
Formulary
Amber 2

Consultant dermatologist or specialist initiation only


Methotrexate should be prescribed once weekly as a single dose on the same day each week. If oral methotrexate is prescribed only use the 2.5 mg strength

 
Link  LSCMMG: Shared care guideline - Methotrexate
 
Pimecrolimus 1% (Elidel®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber 0

Cream 30g, 60g, 100g

 
Link  NICE TA82: Tacrolimus and pimecrolimus for atopic eczema
 
RisankizumabBlack Triangle (Skyrizi®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
ICB
BlueTeq

solution for injection pre-filled syringes, solution for injection pre-filled pen 150mg/mL

Red BlueTeqNICE TA888 Risankizumab for previously treated moderately to severely active Crohn's disease - see link below

 
Link  NICE TA596: Risankizumab for treating moderate to severe plaque psoriasis
Link  NICE TA803: Risankizumab for treating active psoriatic arthritis after inadequate response to DMARDs
 
SecukinumabBlack Triangle (Cosentyx®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
Homecare
BlueTeq

150mg pre-filled syringe

Usually supplied to patients by a home delivery company

REQUIRES BLUETEQ APPROVAL

Approved as Red Traffic Light  for palmoplantar psoriasis - off-label use

 
Link  NICE TA350: Secukinumab for treating moderate to severe plaque psoriasis
Link  NICE TA445: Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs
Link  NICE TA734: Secukinumab for treating moderate to severe plaque psoriasis in children and young people
 
Tacrolimus  (Protopic®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber 0

Ointment 0.03%, 0.1% 30g, 60g

Consultant dermatologist or specilaist initiation only

 
Link  MHRA: Tacrolimus ointment (Protopic): possible risk of malignancies including lymphomas and skin cancers
Link  NICE TA82: Tacrolimus and pimecrolimus for atopic eczema
 
TildrakizumabBlack Triangle (Ilumetri®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
ICB
BlueTeq

Solution for injection pre-filled syringes 100mg/1ml

 
Link  NICE TA575: Tildrakizumab for treating moderate to severe plaque psoriasis
 
TralokinumabBlack Triangle (Adtralza ®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
ICB

Pre-filled syringe 150 mg solution for injection - for treating moderate to severe atopic dermatitis - see link below

 
Link  NICE TA814: Abrocitinib, tralokinumab or upadacitinib for treating moderate to severe atopic dermatitis
 
Upadacitinib Black Triangle (Rinvoq ®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
ICB
Homecare
BlueTeq

Prolonged release tablets 15mg

 

 
Link  MHRA: Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality
Link  NICE TA814: Abrocitinib, tralokinumab or upadacitinib for treating moderate to severe atopic dermatitis
Link  NICE768: Upadacitinib for treating active psoriatic arthritis after inadequate response to DMARDs
 
Ustekinumab (Stelara®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
Homecare
BlueTeq

Injection 45mg, 90mg pre-filled syringe

Consultant dermatologist or specilaist initiation only
Usually supplied to patients by a home delivery company

REQUIRES BLUETEQ APPROVAL

 
Link  NICE TA180: Ustekinumab for the treatment of adults with moderate to severe psoriasis
Link  NICE TA455: Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people
 
13.06  Acne and rosacea
Brimonidine Gel (Mirvaso® )
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Green Restricted

3mg/g gel brimonidine tartrate

 (Only for use in patients with moderate to severe, persistent facial erythema of rosacea)

 
 
Ivermectin cream 1% (Soolantra®)
(Rosacea)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream 
Link  NICE: Inflammatory lesions of papulopustular rosacea: ivermectin 10 mg/g cream
 
Trifarotene 0.05% CreamBlack Triangle (Aklief®)
View adult BNF View SPC online View childrens BNF
Formulary
Green

For acne

 
 
13.06.01  Topical preparations for acne
 note 

Patients should be referred to their community pharmacist or GP for advice/prescription of topical preparations for acne.

13.06.01  Benzoyl peroxide and azelaic acid
Azelaic Acid 15% (Finacae®)
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Formulary
Green
Gel 30g 
 
Azelaic Acid 20% (Skinoren®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream  
 
Benzoyl Peroxide 5% (Acnecide®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Gel

 
 
Benzoyl Peroxide 5% with Clindamycin 1% (Duac® Once Daily)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Gel 30g, 60g 
 
13.06.01  Topical antibacterials for acne to top
Erythromycin 40mg with Zinc Acetate 12mg/mL (Zineryt®)
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Formulary
Green

Lotion 30mL, 90mL

 
 
Clindamycin 1% (Dalacin T®)
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Formulary
Green

Lotion 30mL, 60mL

 
 
Clindamycin 1% gel
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Formulary
Red

Gel 1%

For oncology patients only

 
 
13.06.01  Topical retinoids and related preparations for acne
Adapalene 0.1% (Differin®)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Cream 45g

 
 
Adapalene 0.1% / Benzoyl Peroxide 2.5% (Epiduo®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Gel 45g

 
 
Clindamycin 1%/ tretinoin 0.025% (Treclin®)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Gel 

 
 
13.06.01  Other topical preparations for acne
13.06.02  Oral preparations for acne
13.06.02  Oral antibiotics for acne
Doxycycline
View adult BNF View SPC online View childrens BNF
Formulary
Green
Capsules 100mg 
 
Erythromycin
View adult BNF View SPC online View childrens BNF
Formulary
Green
Tablets 250mg 
 
Lymecycline
View adult BNF View SPC online View childrens BNF
Formulary
Green
Capsules 408mg 
 
Oxytetracycline
View adult BNF View SPC online View childrens BNF
Formulary
Green
Tablets 250mg 
 
13.06.02  Hormone treatment for acne to top
Co-Cyprindiol
View adult BNF View SPC online View childrens BNF
Formulary
Green
Tablets cyproterone 2mg / ethinylestradiol 35 micrograms

CSM advice: VTE risk - see BNF 
Link  MHRA: Cyproterone acetate with ethinylestradiol (co-cyprindiol): balance of benefits and risks remains positive
 
13.06.02  Oral retinoid for acne
Isotretinoin
View adult BNF View SPC online View childrens BNF
Formulary
Red
Capsules 5mg, 20mg

Consultant dermatologist or specialist only

Pregnancy must be excluded before initiation and before each repeat prescription.
Prescriptions for women are limited to 28 days treatment 
Link  MHRA: Isotretinoin (Roaccutane▼): introduction of new safety measures, including additional oversight of the initiation of treatment for patients under 18 years of age
Link  MHRA: Isotretinoin: risk of serious skin reactions
Link  MHRA: Oral retinoid medicines▼: revised and simplified pregnancy prevention educational materials for healthcare professionals and women
 
13.06.03  Topical preparations for rosacea
13.07  Preparations for warts and calluses
Salicylic Acid 16.7% with Lactic Acid 16.7% (Salactol®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Paint 10mL 
 
Glutarol 10% solution
View adult BNF View SPC online View childrens BNF
Formulary
Green

Cutaneous solution 10%

For Primary care use only

 
 
Salicylic Acid 26% (Occlusal®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Solution 
 
Silver Nitrate 75%  (AVOCA®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
Caustic applicator  
 
13.07  Anogenital warts
Imiquimod 5% (Aldara®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber 0

Cream

External genital warts and actinic keratosis

 
 
Podophyllotoxin 0.015% (Warticon®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream 5g 
 
13.08  Sunscreens and camouflagers to top
Aminolevulinic acid  (Ameluz®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

gel 78mg/g

 
 
13.08.01  Sunscreen preparations
Sunsense® Ultra
View adult BNF View SPC online View childrens BNF
Formulary
Green

Factor 50 lotion 50mL

Green for ACBS conditions only, otherwise self care

 
 
13.08.01  Photodamage
5-aminolevulinic acid (Alacare ®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Medicated plaster 8mg - Each medicated plaster of 4 cm2 contains 8 mg 5-aminolevulinic acid, 2 mg per cm2

Alacare plasters are only recommended for single-use treatment of mild actinic keratoses lesions with a maximum diameter of 1.8cm on the face and scalp (hairless areas)

 
 
Diclofenac 3% (Solaraze®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Gel 25g 
 
Cytotoxic Drug Fluorouracil 5% (Efudix®)
View adult BNF View SPC online View childrens BNF
Formulary

Cream 40g


 Green for actinic keratosis

 Red  for the treatment of small superficial basal-cell carcinomas in adults

Green treatment of superficial pre-malignant skin lesions

 

 
 
Imiquimod (Aldara®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Cream 5%

Red for treatment of small superficial basal cell carcinoma in adults

 
 
Methyl-5-Aminolevulinate (Metvix®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
Cream 2g 
 
TirbanibulinBlack Triangle (Klisyri ®)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Ointment 10 mg/g

Each sachet contains 2.5 mg of tirbanibulin in 250 mg ointment.

 
 
13.08.02  Camouflagers
13.09  Shampoos and other preparations for scalp and hair conditions
Capasal®
View adult BNF View SPC online View childrens BNF
Formulary
Green
Shampoo 250mL 
 
Coal Tar Shampoo
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
Link  LSCMMG: Over the Counter Items that Should not be Routinely Prescribed in Primary Care Policy
 
Ketoconazole 2%
View adult BNF View SPC online View childrens BNF
Formulary
Green
Shampoo 120mL 
Link  LSCMMG: Over the Counter Items that Should not be Routinely Prescribed in Primary Care Policy
 
13.09  Hirsutism to top
13.09  Androgenetic alopecia
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
Formulary
Green
Cream 15g 
 
Silver Sulfadiazine 1% (Flamazine®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream 50g 
 
13.10.01.02  Antibacterial preparations also used systemically to top
Fusidic Acid 2%
View adult BNF View SPC online View childrens BNF
Formulary
Green

Cream 15g
Ointment 15g

 
 
Metronidazole 0.75% gel
View adult BNF View SPC online View childrens BNF
Formulary
Green

Gel 30g

 
 
13.10.02  Antifungal preparations
Clotrimazole 1%
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream 20g 
 
Miconazole 2%
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream 30g 
Link  MHRA: Topical miconazole, including oral gel: reminder of potential for serious interactions with warfarin
 
Terbinafine 1% cream
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream 15g 
 
13.10.03  Antiviral preparations
Aciclovir 5%
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream 2g, 10g 
 
13.10.04  Parasiticidal preparations
Ivermectin
View adult BNF View SPC online View childrens BNF
Formulary
Amber 0

Tablets 3mg

For hyperkeratotic (crusted or Norwegian) scabies unresponsive to topical treatment alone.

 
 
13.10.04  Scabies
13.10.04  Head lice to top
13.10.04  Crab lice
13.10.04  Benzyl benzonate
13.10.04  Carbaryl
13.10.04  Dimeticone
Dimeticone (Hedrin®)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Lotion 4%

 
Link  LSCMMG: Over the Counter Items that Should not be Routinely Prescribed in Primary Care Policy
 
13.10.04  Malathion to top
Malathion 0.5% (Derbac-M®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Liquid in an aqueous basis 50mL, 200mL 
 
13.10.04  Permethrin
Permethrin 5% (Lyclear® Dermal Cream)
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Formulary
Green
Dermal cream 30g 
 
13.10.04  Phenothrin
13.10.05  Preparations for minor cuts and abrasions
Magnesium Sulphate Paste BP
View adult BNF View SPC online View childrens BNF
Formulary
Green
50g 
 
13.10.05  Collodion
13.10.05  Skin tissue adhesive to top
13.11  Skin cleansers, antiseptics, and desloughing agents
 note  Skin cleansers and antiseptics listed in BNF sections 13.11.1 - 13.11.5 are obtained from stores
Octenisan®
(Antimicrobial wash)
View adult BNF View SPC online View childrens BNF
Formulary  
 
13.11.01  Alcohols and saline
13.11.02  Chlorhexidine salts
Chlorhexidine gluconate 4% (Hibiscrub®)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Cleansing solution, 250mL, 500mL
For use by dermatologists only

 
 
Chlorhexidine Gluconate Cream (Hibitane Obstetric®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Cream 5%

 
 
13.11.03  Cationic surfactants and soaps
13.11.04  Iodine and Chlorine to top
13.11.05  Phenolics
13.11.06  Oxidisers, and dyes
Hydrogen Peroxide 1% (Crystacide®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Cream 25g 
 
Potassium Permanganate (Permitabs®)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Solution tablets 400mg

Primary Care :  Potassium permanganate should always be prescribed for a named patient by a primary care prescriber, experienced in the treatment of dermatological conditions and use of potassium permanganate.
 
Secondary Care:- Potassium permanganate concentrate should always be prescribed for a named patient by a specialist in dermatology, a clinician working under the guidance of a dermatologist, or specialist tissue viability staff only.
 
Note:  A risk assessment must be completed if potassium permanganate is to be used in a patient's home
 
Link  BAD and NHS England & NHS Improvement guidance on the safe use of potassium permanganate soaks
Link  NHS Central alerting system
 
13.11.07  Desloughing agents
Sterile Larvae (Maggots) (LarvE®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
Available to order for named patients 
 
13.11.07  Desloughing agents
13.11.07  Growth factor to top
13.12  Antiperspirants
Botulinum toxin type A
View adult BNF View SPC online View childrens BNF
Formulary
Red

For treatment of primary idiopathic hyperhidrosis and secondary hyperhidrosis.

- as an option for the management of severe primary idiopathic hyperhidrosis of the axillae, which does not respond to self-care strategies and topical treatment, and where the cause is NOT due to social anxiety.

- as an option for the management of severe secondary hyperhidrosis of the axillae, which does not respond to self-care strategies and topical treatment, where the cause is NOT due to social anxiety and where the primary condition has been optimally managed as far as reasonable to alleviate the hyperhidrosis.

In order to reduce the potential for antibody formation which reduces the effectiveness of treatment, inject the lowest effective dose at the longest clinically indicated interval

 
Link  LSCMMG: Botulinum Toxin Type A
 
13.13  Topical circulatory preparations
13.14  dermatology specials
 ....
 Non Formulary Items
  
Key
Restricted Drug Restricted Drug
Unlicensed Drug Unlicensed
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
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
ICB
ICB
Green Low Carbon

Low carbon footprint

Amber Medium Carbon

Medium carbon footprint

Red High carbon footprint

High carbon footprint

Status Description

Green

Green: Appropriate for initiation and ongoing prescribing in both primary and secondary care. Generally, little or no routine drug monitoring is required.  

Green Restricted

Green (Restricted): Appropriate for initiation and ongoing prescribing in both primary and secondary care provided: Additional criteria specific to the medicine or device are met, or The medicine or device is used following the failure of other therapies as defined by the relevant LSCMMG pathway. Generally, little or no routine drug monitoring is required.   

Red

Red medicines: Medicine is supplied by the hospital for the duration of the treatment course. Primary care initiation or continuation of treatment is not recommended unless exceptional circumstances such as specialist GP. Red medicines are those where primary care prescribing is not recommended. These treatments should be initiated by specialists only and prescribing retained within secondary care. They require specialist knowledge, intensive monitoring, specific dose adjustments or further evaluation in use. If however, a primary care prescriber has particular specialist knowledge or experience of prescribing a particular drug for a particular patient it would not always be appropriate for them to expect to transfer that prescribing responsibility back to secondary care. There should be a specific reason and a specific risk agreement, protocol and service set up to support this. Primary care prescribers may prescribe RED medicines in exceptional circumstances to patients to ensure continuity of supply while arrangements are made to obtain ongoing supplies from secondary care.  

Amber 0

Amber level 0: Suitable for prescribing in primary care following recommendation or initiation by a specialist. Little or no specific monitoring required. Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care. Brief prescribing document or information sheet may be required. Primary care prescribers must be familiar with the drug to take on prescribing responsibility or must get the required information. When recommending or handing over care, specialists should ask primary care prescribers to take over prescribing responsibility, and should give enough information about the indication, dose, monitoring requirements, use outside product licence and any necessary dose adjustments to allow them to confidently prescribe.  

Amber 1

Amber level 1 (with shared care): Suitable for prescribing in primary care following recommendation or initiation by a specialist. Minimal monitoring required. Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care. Full prior agreement about patient’s on-going care must be reached under the shared care agreement. Primary care prescribers are advised not to take on prescribing of these medicines unless they have been adequately informed by letter of their responsibilities with regards monitoring, side effects and interactions and are happy to take on the prescribing responsibility. A copy of locally approved shared care guidelines should accompany this letter which outlines these responsibilities. Primary care prescribers should then tell secondary care of their intentions as soon as possible by letter so that arrangements can be made for the transfer of care.  

Amber 2

Amber level 2 (with shared care and enhanced service): Initiated by specialist and transferred to primary care following a successful initiation period. Significant monitoring required on an on-going basis. Full prior agreement about patient’s on-going care must be reached under the shared care agreement. Suitable for enhanced service. These medicines are considered suitable for GP prescribing following specialist initiation of therapy, as per shared care document which will be sent out with the request to prescribe, with on-going communication between the primary care prescriber and specialist. Amber Level 2 medicines require significant monitoring for which an enhanced service may be suitable. (Subject to local commissioning agreements).  

Do Not Prescribe

Do not prescribe: NOT recommended for use by the NHS in Lancashire and South Cumbria. Includes medicines that NICE has not recommended for use and terminated technology appraisals, unless there is a local need.  

Grey

Grey medicines: Medicines which have not yet been reviewed or are under the review process. GPs and specialists are recommended not to prescribe these drugs. This category includes drugs where funding has not yet been agreed.   

Multiple

Refer to local guidance and local commissioning arrangements  

netFormulary