Lancashire and South Cumbria
Formulary
 
back
13 Skin

Dermatology prescribing may require use of expensive unlicensed
creams and ointments (known as ‘Specials’). Please consult the revised British Association of Dermatologists (BAD) list of preferred Specials (2018) for advice on appropriate product choice.

Specials Recommended by the British Association of Dermatologists for Skin Disease

Several medicines in the skin chapter are available for purchase over the counter and may be appropriate for self care. Please consult the local OTC policy for more details.

LSCMMG: Over The Counter (OTC) Items That Should Not Be Routinely Prescribed In Primary Care Policy 

13-05-03 Drugs affecting the immune response

Consultant dermatologist or specialist initiation only.
To be prescribed in accordance with local and NICE guidance.

Medicines are commissioned by NHS England for paediatric indications where an adult NICE TA is in place.


Abrocitinib Cibinqo®
Formulary

Tablets 50mg, 100mg, 200mg

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

Red View adult BNF  View SPC online  View childrens BNF
Adalimumab
Formulary

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

Tertiary centre only for hidradenitis suppurativa.

Commissioned in accordance with LSCMMG biologics pathways.
NHSE commissioned for some indications.
Consult chapter links for more details.

Link  MHRA: Tumour necrosis factor alpha inhibitors
Link  NICE TA199: Etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis
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

Red View adult BNF  View SPC online  View childrens BNF
Apremilast Otezla®
Formulary

Tablets 10mg, 20mg, 30mg

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

Red View adult BNF  View SPC online  View childrens BNF
Azathioprine
Formulary

Tablets 25mg, 50mg

Some indications are unlicensed unlicensed. Please consult product literature for licensing information.

Consultant dermatologist or specialist initiation only.

Link  LSCMMG: Azathioprine and Mercaptopurine shared care guideline
Link  MHRA: Thiopurines and intrahepatic cholestasis of pregnancy

Cytotoxic Drug  Amber 2 View adult BNF  View SPC online  View childrens BNF
Baricitinib
Formulary

Film-coated tablets 2mg, 4mg

Red Treatment of atopic dermatitis

Do Not Prescribe Treatment of alopecia areata

Link  MHRA: Baricitinib (Olumiant▼): increased risk of diverticulitis, particularly in patients with risk factors
Link  MHRA: Baricitinib (Olumiant▼): risk of venous thromboembolism
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 TA681: Baricitinib for treating moderate to severe atopic dermatitis
Link  NICE TA926: Baricitinib for treating severe alopecia areata

View adult BNF  View SPC online  View childrens BNF
Bimekizumab Bimzelx®
Formulary

Solution for injection pre-filled pen 160mg/1ml, 320mg/2ml
Solution for injection pre-filled syringe 160mg/1ml, 320mg/2ml

Link  NICE TA723: Bimekizumab for treating moderate to severe plaque psoriasis
Link  NICE TA916: Bimekizumab for treating active psoriatic arthritis

Red View adult BNF  View SPC online  View childrens BNF
Brodalumab Kyntheum®
Formulary

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

Link  NICE TA511: Brodalumab for treating moderate to severe plaque psoriasis

Red View adult BNF  View SPC online  View childrens BNF
Certolizumab pegol Cimzia®
Formulary

Solution for injection pre-filled pens 200mg/1ml
Solution for injection pre-filled syringes 200mg/1ml
Solution for injection in a dose-dispenser cartridge 200mg/1ml

Commissioned in accordance with LSCMMG biologics pathways.
Consult chapter links for more details.

Link  MHRA: Tumour necrosis factor alpha inhibitors
Link  NICE TA445: Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs
Link  NICE TA574: Certolizumab pegol for treating moderate to severe plaque psoriasis

Red View adult BNF  View SPC online  View childrens BNF
Ciclosporin
Formulary

Capsules 10mg, 25mg, 50mg, 100mg
Oral solution 100mg/ml

Consultant dermatologist or specilaist initiation only.

Patients should be stabilised on a particular brand of oral ciclosporin because switching between formulations without close monitoring may lead to clinically important changes in blood-ciclosporin concentration.

Link  LSCMMG: Ciclosporin shared care guideline

Amber 2 View adult BNF  View SPC online  View childrens BNF
Deucravacitinib Sotyktu®
Formulary

Film coated tablets 6mg

It is not known whether deucravacitinib, an inhibitor of tyrosine kinase 2 (TYK2), is associated with the adverse reactions of Janus kinase (JAK) inhibition. Risks that have been identified as a class effect of JAK inhibitors include major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality.  

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

Red View adult BNF  View SPC online  View childrens BNF
Dupilumab Dupixent®
Formulary

Solution for injection pre-filled pens 300mg/2ml, 200mg/1.14ml
Solution for injection pre-filled syringes 300mg/2ml, 200mg/1.14ml

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

Red View adult BNF  View SPC online  View childrens BNF
Etanercept
Formulary

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

Link  MHRA: Tumour necrosis factor alpha inhibitors
Link  NICE TA103: Etanercept and efalizumab for the treatment of adults with psoriasis
Link  NICE TA199: Etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis
Link  NICE TA455: Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people

Red View adult BNF  View SPC online  View childrens BNF
Guselkumab Tremfya®
Formulary

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

Link  NICE TA521: Guselkumab for treating moderate to severe plaque psoriasis
Link  NICE TA815: Guselkumab for treating active psoriatic arthritis after inadequate response to DMARDs

Red View adult BNF  View SPC online  View childrens BNF
Infliximab
Formulary

Solution for injection pre-filled pen 120 mg/1ml 

Adequate resuscitation facilities must be available when infliximab is used.

Link  MHRA: Tumour necrosis factor alpha inhibitors
Link  NICE TA134: Infliximab for the treatment of adults with psoriasis
Link  NICE TA199: Etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis

Red View adult BNF  View SPC online  View childrens BNF
Lebrikizumab Ebglyss®
Formulary

Solution for injection pre-filled pens 250mg/2ml
Solution for injection pre-filled syringes 250mg/2ml

The MHRA has reviewed the risk of dry eye and serious ocular side-effects associated with dupilumab, an inhibitor of interleukin-4 and interleukin-13 signalling. Lebrikizumab, which similarly inhibits interleukin-13, is also associated with ocular side-effects.

Link  MHRA: Dupilumab (Dupixent▼): risk of ocular adverse reactions and need for prompt management
Link  NICE TA986: Lebrikizumab for treating moderate to severe atopic dermatitis in people 12 years and over

Red View adult BNF  View SPC online  View childrens BNF
Methotrexate
Formulary

Tablets 2.5mg
Prefilled syringes and pens (various strengths)

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.
See hospital policy for prescribing and supply of oral methotrexate.

Methotrexate subcutaneous injection may be supplied through a homecare arrangement.

Link  LSCMMG: Methotrexate shared care guideline
Link  MHRA: Methotrexate once-weekly for autoimmune diseases: new measures to reduce risk of fatal overdose due to inadvertent daily instead of weekly dosing
Link  MHRA: Methotrexate: advise patients to take precautions in the sun to avoid photosensitivity reactions

Cytotoxic Drug  Amber 2 View adult BNF  View SPC online  View childrens BNF
Nemolizumab Nemluvio®
Formulary

30 mg powder and solvent for solution for injection in pre-filled pen

Link  NICE TA1077: Nemolizumab for treating moderate to severe atopic dermatitis in people 12 years and over

Red View adult BNF  View SPC online  View childrens BNF
Omalizumab Xolair®
Formulary

Solution for injection pre-filled pens 75mg/0.5ml, 150mg/1ml, 300mg/2ml
Solution for injection pre-filled syringes 75mg/0.5ml, 150mg/1ml, 300mg/2ml

unlicensed Unlicensed use of omalizumab for severe chronic inducible urticarias.

Link  LSCMMG: Commissioning statement Unlicensed use of omalizumab for severe chronic inducible urticarias
Link  MHRA: Omalizumab: potential risk of arterial thrombotic events
Link  NICE TA339: Omalizumab for previously treated chronic spontaneous urticaria

Red View adult BNF  View SPC online  View childrens BNF
Pimecrolimus Elidel®
Formulary

Cream 1% 

Consultant dermatologist or specilaist initiation only.

Link  NICE TA82: Tacrolimus and pimecrolimus for atopic eczema

Amber 0 View adult BNF  View SPC online  View childrens BNF
Risankizumab Skyrizi®
Formulary

Solution for injection pre-filled syringes 150mg/mL
Solution for injection pre-filled pen 150mg/mL
Solution for injection cartridges 180mg/1.2ml, 360mg/2.4ml

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

Red View adult BNF  View SPC online  View childrens BNF
Ritlecitinib Litfulo®
Formulary

Capsules 50mg

Link  BAD: Professional guidance supplementary to NICE TA958
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 TA958: Ritlecitinib for treating severe alopecia areata in people 12 years and over

Red View adult BNF  View SPC online  View childrens BNF
Secukinumab Cosentyx®
Formulary

Solution for injection pre-filled pens 150mg/1ml, 300mg/2ml
Solution for injection pre-filled syringes 75mg/0.5ml, 150mg/1ml

NHSE NHSE commissioned for some indications.

Approved by LSCMMG for palmoplantar psoriasis unlicensed

Link  LSCMMG: Secukinumab (Cosentyx▼) NMR
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
Link  NICE TA935: Secukinumab for treating moderate to severe hidradenitis suppurativa

Red View adult BNF  View SPC online  View childrens BNF
Tacrolimus
Formulary

Ointment 0.03%, 0.1%

Psoriasis.

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

Amber 0 View adult BNF  View SPC online  View childrens BNF
Tildrakizumab Ilumetri®
Formulary

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

Link  NICE TA575: Tildrakizumab for treating moderate to severe plaque psoriasis

Red View adult BNF  View SPC online  View childrens BNF
Tralokinumab Adtralza®
Formulary

Solution for injection pre-filled syringes 150mg/1ml
Solution for injection pre-filled pens 300mg/2ml

The MHRA has reviewed the risk of dry eye and serious ocular side-effects associated with dupilumab, an inhibitor of interleukin-4 and interleukin-13 signalling. Tralokinumab, which similarly inhibits interleukin-13, is also associated with ocular side-effects.

Link  MHRA: Dupilumab (Dupixent▼): risk of ocular adverse reactions and need for prompt management
Link  NICE TA814: Abrocitinib, tralokinumab or upadacitinib for treating moderate to severe atopic dermatitis

Red View adult BNF  View SPC online  View childrens BNF
Upadacitinib  Rinvoq®
Formulary

Prolonged release tablets 15mg, 30mg, 45mg

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

Red View adult BNF  View SPC online  View childrens BNF
Ustekinumab
Formulary

Solution for injection pre-filled syringes 45mg/0.5ml, 90mg/1ml

Consultant dermatologist or specialist initiation only.

Link  MHRA: Ustekinumab (Stelara): risk of exfoliative dermatitis
Link  NICE TA180: Ustekinumab for the treatment of adults with moderate to severe psoriasis
Link  NICE TA340: Ustekinumab for treating active psoriatic arthritis
Link  NICE TA455: Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people

Red View adult BNF  View SPC online  View childrens BNF