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Guy's and St Thomas' NHS Foundation Trust
Kings College Hospital NHS Foundation Trust
Lewisham and Greenwich NHS Trust
 
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 Formulary Chapter 13: Skin - Full Chapter
Notes:

Where a formulary entry does not detail a medicine’s indications for use, the medicine can be assumed to be approved for all licensed indications.

Formulary approved "off-label" use is detailed separately.

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 Details...
13.01  Management of skin conditions
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
13.02.01  Emollients (can be used as a soap substitute in the bath or shower)
Liquid and White Soft Paraffin Ointment (50:50)
View adult BNF
First Choice
Green

First line choice if a very greasy emollient is required

 
Emulsifying Ointment BP
View adult BNF View SPC online
First Choice
Green

First line choice if a greasy emollient is required

 
Epimax® cream
View adult BNF
First Choice
Green

First line option if a cream or gel type emollient is required

 
Isomol® gel
View adult BNF
First Choice
Green

First line option if a cream or gel type emollient is required

 
ZeroAQS® cream
View adult BNF
First Choice
Green

First line option if a cream or gel type emollient is required

 
QV® lotion
View adult BNF
First Choice
Green

First line choice where a lotion type emollient is required

 
Aproderm® ointment
View adult BNF
Second Choice
Green

Second line option where a greasy emollient is required

 
   
Epimax® ointment
View adult BNF
Second Choice
Green

Second line option where a greasy emollient is required

 
   
Hydromol® ointment
View adult BNF
Second Choice
Green

Second line option where a greasy emollient is required

 
   
Zeroderm® ointment
View adult BNF
Second Choice
Green

Second line option where a greasy emollient is required

 
   
Aproderm® cream or gel
View adult BNF
Second Choice
Green

Second line option if a cream or gel type emollient is required

 
   
Aquamax® cream
View adult BNF
Second Choice
Green

Second line option if a cream or gel type emollient is required

 
   
ExCetra® cream
View adult BNF
Second Choice
Green

Second line option if a cream or gel type emollient is required

 
   
Zerobase® cream
View adult BNF
Second Choice
Green

Second line option if a cream or gel type emollient is required

 
   
Zerocream® cream
View adult BNF
Second Choice
Green

Second line option if a cream or gel type emollient is required

 
   
E45® lotion
View adult BNF
Second Choice
Green

Second line choice where a lotion type emollient is required

 
   
Zerodouble® gel
View adult BNF
Third Choice
Green

Third line option if a cream or gel type emollient is required

 
   
Emollin® spray
View adult BNF
Restricted Drug Restricted
Amber 1

For very painful/fragile skin where there is difficulty with ‘hands-on’ application of creams and ointments only

 
   
Propylene glycol 20% w/w in aqueous cream (100g)
Unlicensed Drug Unlicensed
Amber 2

BAD/APC approved Special

As a moisturiser, to use on very dry skin conditions.

 
   
13.02.01  Emollients - preparations containing urea
 note  Useful where a keratolytic is required, e.g. hyperkeratosis, ichthyosis, extremely dry and/or fissured skin on hands and feet
Balneum® cream (5% urea)
View adult BNF View SPC online
First Choice
Amber 1

First line choice if a urea containing emollient is required

 
Flexitol® cream (10% or 25% urea)
View adult BNF
Second Choice
Amber 1

Second choice if a urea containing emollient is required

 
   
Nutraplus® cream (10% urea)
View adult BNF View SPC online
Restricted Drug Restricted
Green

Restricted to use in patients where paraffin-free cream is specifically indicated

 
   
13.02.01  Emollients - with antimicrobials
 note  Can be used as a soap substitute in the bath or shower.  Short term use to wash and/or as a leave on skin emollient during infection only
Dermol® 500 lotion
View adult BNF View SPC online
First Choice
Amber 1

First line emollient with antibacterial

 
Dermol® cream
View adult BNF View SPC online
Second Choice
Amber 1

Second line emollient with antibacterial

 
   
Eczmol® cream
View adult BNF View SPC online
Third Choice
Amber 1

Third line emollient with antibacterial

 
   
13.02.01.01  Emollient bath and shower preparations
 note  Use any cream or ointment as a soap substitute in the bath or shower except for preparations containing urea. The following should only be prescribed as a soap substitute where other emollients are unsuitable or not tolerated.
Note: Risk of slipping in bath

LPL 63.4%
View adult BNF
First Choice
Amber 1

First line bath/shower emollient

 
Hydromol® bath and shower emollient
View adult BNF
Second Choice
Amber 1

Second line line bath/shower emollient

 
   
Dermol® 600 bath emollient
View adult BNF View SPC online
Formulary
Amber 1

Contains an antimicrobial

 
   
13.02.02  Barriers creams to top
 note 

Barriers creams provided by hosptial pharmacy; other preparations may be available locally outside of hospital pharmacy supply

Drapolene® cream
View adult BNF
Formulary  
   
Metanium® ointment
View adult BNF View SPC online
Formulary  
   
Sprilon® spray
View adult BNF
Formulary  
   
Sudocrem® cream
View adult BNF View SPC online
Formulary  
   
Zinc and caster oil ointment BP
View adult BNF View SPC online
Formulary

 
   
13.03  Topical local anaesthetics and antipruritics
Calamine lotion
View adult BNF View SPC online
Formulary  
   
Crotamiton cream
View adult BNF View SPC online
Formulary  
   
Doxepin cream 5%
View adult BNF
Formulary  
   
Levomenthol in aqueous cream 1%, 2%
View adult BNF
Formulary Itchy skin including pruritus of pregnancy and in the lderly, if adequate emollient alone has been unhelpful. Start with 1% and increase to 2% if tolerated 
   
Pliazon® cream
Formulary
Red

Hospital supply only

For skin reactions associated with Epidermal Growth Factor Receptor (EGFR) targeted therapies for patients with metastatic colorectal cancer

 
   
Tetracaine cream
View adult BNF
Formulary  
   
13.04  Topical corticosteriods.
Hydrocortisone cream, ointment, 0.5%, 1%
View adult BNF View SPC online
Formulary Steroid potency = mild 
   
Alclometasone dipropionate cream, ointment 0.05%
View adult BNF View SPC online
Formulary Steroid potency = moderate 
   
Betamethasone valerate cream, ointment 0.025%
View adult BNF View SPC online
Formulary Steroid potency = moderate
 
   
Clobetasone butyrate cream, ointment 0.05%
View adult BNF View SPC online
Formulary Steroid potency = moderate 
   
Betamethasone dipropionate 0.05% and salicylic acid 3% ointment
View adult BNF View SPC online
Formulary

Steroid potency = potent

Specialist advice only when initiated in secondary care

 
   
Betamethasone valerate cream, ointment 0.1%
View adult BNF View SPC online
Formulary

Steroid potency = potent 

Specialist advice only when initiated in secondary care

 
   
Betamethasone valerate lotion 0.1%
View adult BNF View SPC online
Formulary

Steroid potency = potent 

Specialist advice only when initiated in secondary care

 
   
Diflucortolone valerate oily cream and ointment 0.1%
View adult BNF View SPC online
Formulary

Steroid potency = potent 

Specialist advice only when initiated in secondary care

 
   
Hydrocortisone butyrate cream 0.1%
View adult BNF View SPC online
Formulary

Steroid potency = potent 

Specialist advice only when initiated in secondary care

 
   
Hydrocortisone butyrate lipocream, lotion 0.1%
View adult BNF View SPC online
Formulary

Steroid potency = potent 

Specialist advice only when initiated in secondary care

 
   
Mometasone furoate cream, ointment 0.1%
View adult BNF View SPC online
Formulary

Steroid potency = potent 

Specialist advice only when initiated in secondary care

 
   
Clobetasol propionate cream, ointment 0.05%
View adult BNF View SPC online
Formulary

Steroid potency = very potent

Specialist advice only when initiated in secondary care

 
   
Diflucortolone valerate oily cream 0.3%
View adult BNF View SPC online
Formulary

Steroid potency = very potent 

Specialist advice only when initiated in secondary care

 
   
13.04.01  Topical corticosteroid scalp applications
Betamethasone dipropionate 0.05% and salicylic acid 2% scalp application (Diprosalic®)
View adult BNF View SPC online
Formulary

Steroid potency = potent 

Specialist advice only when initiated in secondary care

 
   
Betamethasone dipropionate scalp lotion 0.05%
View adult BNF View SPC online
Formulary

Steroid potency = potent 

Specialist advice only when initiated in secondary care

 
   
Betamethasone valerate scalp application, cutaneous foam 0.1%
View adult BNF View SPC online
Formulary

Steroid potency = potent 

Specialist advice only when initiated in secondary care

 
   
Mometasone furoate scalp lotion 0.1%
View adult BNF View SPC online
Formulary

Steroid potency = potent 

Specialist advice only when initiated in secondary care

 
   
Clobetasol priopionate scalp application, shampoo, foam 0.05%
View adult BNF View SPC online
Formulary

Steroid potency = very potent 

Specialist advice only when initiated in secondary care

 
   
13.04.02  Topical corticosteroids - for use under specialist supervision only
Beclometasone dipropionate 0.025% cream, ointment
View adult BNF View SPC online
Formulary  
   
Betamethasone dipropionate 0.05% cream, ointment
View adult BNF View SPC online
Formulary

 
   
Fludroxycortide tape 4micrograms/cm2
View adult BNF View SPC online
Formulary

 
   
Fluocinolone acetonide 0.025% cream, gel
View adult BNF View SPC online
Formulary  
   
Hydrocortisone 0.25% and crotamiton 10% (Eurax-Hydrocortisone®)
View adult BNF View SPC online
Formulary  
   
Hydrocortisone 1% and urea 10% cream (Alphaderm®)
View adult BNF View SPC online
Formulary

 
   
Hydrocortisone 2.5% cream, ointment
View adult BNF View SPC online
Formulary  
   
13.04.03  Topical corticosteroids - unlicensed specials to top
Beclometasone dipropionate in WSP 0.0025% (Propaderm® 1:10)
Unlicensed Drug Unlicensed
Amber 2

APC approved Special

For eczema wet wraps in pediatrics only.

 
   
Coal tar solution BP 10% w/w in betamethasone valerate 0.025% w/w ointment
Unlicensed Drug Unlicensed
Amber 2

APC approved Special

For moderate to severe psoriasis of the trunk and limbs when other treatments such as vitamin D analogues have been ineffective.

 
   
Coal tar solution BP 3.3% w/w and propylene glycol 20% w/w/ in Synalar® gel
View adult BNF View SPC online
Unlicensed Drug Unlicensed
Amber 2

BAD/APC approved Special

For very inflamed hyperkeratotic scalp psoriasis.

 
   
Coal tar solution BP 5% w/w in betamethasone valerate 0.025% w/w ointment
View adult BNF View SPC online
Unlicensed Drug Unlicensed
Amber 2

BAD/APC approved Special

For moderate to severe psoriasis of the trunk and limbs when other treatments such as vitamin D analogues have been ineffective.

 
   
Dermovate® in propylene glycol cream 40%
Unlicensed Drug Unlicensed
Amber 2

BAD/APC approved Special

For severe inflammatory disease without hyperkeratosis, or at sensitive skin sites e.g. the vulva

 
   
Salicylic acid 5% w/w / propylene glycol 47.5% w/w in Dermovate®cream
View adult BNF View SPC online
Unlicensed Drug Unlicensed
Amber 2

BAD/APC approved Special

For use on the palms and/or soles for hyperkeratotic eczema, palmoplantar pustulosis and psoriasis which has not responded to Dermovate and emollients alone.

 
   
13.04.04  Topical corticosteroids and anti-infective preparations
Clotrimazole 1% and hydrocortisone 1% cream (Canesten HC®)
View adult BNF View SPC online
Formulary Steroid potency = mild 
   
Hydrocortisone 1% and miconazole nitrate 2% cream, ointment (Daktacort®)
View adult BNF View SPC online
Formulary Steroid potency = mild 
   
Hydrocortisone 0.5%, nystatin 100 000 units/g and benzalkonium chloride 0.2% cream (Timodine®)
View adult BNF View SPC online
Formulary Steroid potency = mild 
   
Hydrocortisone 1% and fusidic acid 2% cream (Fucidin H®)
View adult BNF View SPC online
Formulary Steroid potency = mild 
   
Clobetasone butyrate 0.05%, oxytetracycline 3% and nystatin 100 000 units/g cream (Trimovate®)
View adult BNF View SPC online
Formulary Steroid potency = moderate 
   
Betamethasone dipropionate 0.064% and clotrimazole 1% cream (Lotriderm®)
View adult BNF View SPC online
Formulary

Steroid potency = potent 

Specialist advice only when initiated in secondary care

 
   
Betamethasone valerate 0.1% and clioquinol 3% cream, ointment
View adult BNF View SPC online
Formulary

Steroid potency = potent 

Specialist advice only when initiated in secondary care

 
   
Betamethasone valerate 0.1% and fusidic acid 2% cream (Fucibet®)
View adult BNF View SPC online
Formulary

Steroid potency = potent 

Specialist advice only when initiated in secondary care

 
   
Betamethasone valerate 0.1% and neomycin sulphate 0.5% cream, ointment
View adult BNF View SPC online
Formulary

Steroid potency = potent 

Specialist advice only when initiated in secondary care

 
   
Clobetasol propionate 0.05%, neomycin sulphate 0.5% and nystatin 100 000 units/g cream, ointment (Dermovate-NN®)
View adult BNF View SPC online
Formulary

Steroid potency = potent 

Specialist advice only when initiated in secondary care

 
   
Triamcinolone acetonide 0.1% and chlortetracycline 3% ointment (Aureocort®)
View adult BNF View SPC online
Formulary

Steroid potency = potent 

Specialist advice only when initiated in secondary care

 
   
Hydrocortisone 1% and oxytetracycline 3% ointment (Terra-Cortril®)
View adult BNF View SPC online
Formulary
Red

Approved off-label indication:

Treatment of over-granulating wounds Restricted to Plastic and Reconstructive Surgery use only

Steroid potency = mild

 
   
13.05  Preparations for eczema and psoriasis
13.05.01  Preparations for eczema
Alitretinoin caps
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
 
Link  NICE TA177: Eczema (chronic) - alitretinoin
   
Zinc paste and ichthammol bandage BP (Ichthopaste®)
View adult BNF View SPC online
Formulary  
   
Zinc paste bandage BP (Viscopaste PB7®)
View adult BNF View SPC online
Formulary  
   
Beclometasone dipropionate in WSP ointment 0.0025% (Propaderm® 1:10)
View adult BNF View SPC online
Unlicensed Drug Unlicensed
Amber 2

BAD/APC Approved Special

For eczema wet wraps in paediatrics only.

 
   
Ichthammol 1% w/w and zinc oxide 15% w/w in YSP
View adult BNF View SPC online
Unlicensed Drug Unlicensed
Amber 2

BAD/APC Approved Special

For acutely inflamed atopic eczema.

 
   
13.05.02  Preparations for psoriasis
Clindamycin caps
View adult BNF View SPC online
Formulary
Amber 2

Approved off-label indication:

Used in combination with rifampicin in the treatment of hidradenitis suppurativa (HS)

Use in accordance with the local guideline at GSTFT

 
   
Rifampicin caps
View adult BNF View SPC online
Formulary
Amber 2

Approved off-label indication:

Used in combination with clindamycin in the treatment of hidradenitis suppurativa (HS)


Use in accordance with the local guideline at GSTFT

 
   
5-methoxypsoralen tabs
Unlicensed Drug Unlicensed

Used in PUVA treatment for psoriasis and vitiligo.

Dose is dependent upon the patient’s surface area.

Dose ~ 50 mg/m2

 
   
8-methoxypsoralen injection 20 micrograms/mL
Unlicensed Drug Unlicensed

Used in extracorpeal photopheresis to treat CTCL.

Also, for psoriasis and vitiligo unresponsive to topical treatment

 
   
8-methoxypsoralen tabs
Unlicensed Drug Unlicensed

Used in PUVA treatment for psoriasis and vitiligo.

Dose is dependent upon the patient’s surface area.

Dose ~ 25 mg/m2

 
   
Fumaric acid tablets (Fumaderm® )
Unlicensed Drug Unlicensed

Use in accordance with the local guideline at GSTFT

Treatment of severe, relapsing, chronic plaque psoriasis

 
   
13.05.02  Topical preparations for psoriasis to top
Calamine and Coal Tar ointment BP
View adult BNF View SPC online
Formulary  
   
Calcipotriol 50micrograms/g and betametasone 0.05% ointment, gel
View adult BNF View SPC online
Formulary  
   
Calcipotriol 50micrograms/g with betamethasone 0.05% cutaneous foam (Enstilar®)
View adult BNF View SPC online
Formulary
Green
 
Link  SE London APC recommendation: Enstilar (calcipotriol and betametasone) cutaneous foam
   
Calcipotriol cream, ointment 50micrograms/g
View adult BNF View SPC online
Formulary  
   
Calcitriol 3 micrograms/g ointment
View adult BNF View SPC online
Formulary  
   
Coal tar 6% and Lecithin 0.4% cream (Psoriderm®)
View adult BNF View SPC online
Formulary  
   
Coal Tar Paste BP
View adult BNF View SPC online
Formulary  
   
Coal tar solution 5% in an emollient basis (Exorex®)
View adult BNF View SPC online
Formulary

 
   
Dithranol cream 0.1%, 0.25%, 0.5%, 1%, 2%
View adult BNF View SPC online
Formulary

  • 0.1–0.5% suitable for overnight treatment
  • 1–2% for max 1hr (consult Dithocream product literature)
 
   
Polytar Emollient® bath additive
View adult BNF View SPC online
Formulary  
   
Tacalcitol ointment, lotion 4micrograms/g
View adult BNF View SPC online
Formulary  
   
Tazarotene gel 0.05%, 0.1%
View adult BNF View SPC online
Formulary  
   
Zinc and Salicylic Acid Paste BP (Lassar's Paste)
View adult BNF View SPC online
Formulary  
   
8-methoxypsoralen bath lotion 1.2%
Unlicensed Drug Unlicensed

Used in bath PUVA treatments for various skin conditions.

130 mL bottle is used per bath

 
   
8-methoxypsoralen gel 0.005%
Unlicensed Drug Unlicensed

Applied topically in PUVA treatment, for psoriasis, vitiligo and alopecia.

A thin layer is appled to the affected area

 
   
8-methoxypsoralen paint 0.15%
Unlicensed Drug Unlicensed

Applied topically in PUVA treatment, for psoriasis, vitiligo and alopecia.

A thin layer is appled to the affected area

 
   
Coal tar (crude) in YSP ointment 1%, 20%, 30%
View adult BNF View SPC online
Unlicensed Drug Unlicensed
Amber 2

APC approved Special

For moderate to severe chronic psoriasis when vitamin D analogues and commercial tar treatments have been ineffective or unsuitable.

 
   
Coal tar (crude) in YSP ointment 2%, 5%, 10%
Unlicensed Drug Unlicensed
Amber 2

BAD/APC approved Special

For moderate to severe chronic psoriasis when vitamin D analogues and commercial tar treatments have been ineffective or unsuitable.

 
   
Coal tar solution BP 6% w/w and salicylic acid 6% w/w in Ung. Merck
View adult BNF View SPC online
Unlicensed Drug Unlicensed
Amber 2

BAD/APC approved Special

For moderate to severe chronic psoriasis when vitamin D analogues and commercial tar treatments have been ineffective or unsuitable.

 
   
Dithranol in Lassar's paste 0.1%, 0.5%, 1%, 2%, 4%, 6%, 8%, 10%, 15% w/w
Unlicensed Drug Unlicensed
Amber 2

BAD/APC approved Special

For moderate to severe chronic plaque psoriasis when other topical treatments including vitamin D analogues, commercial tar preparations and commercial dithranol preparations have been ineffective or unsuitable

 
   
Lactic acid in Diprobase® cream 10%
Unlicensed Drug Unlicensed
Amber 2

APC approved Special

For hyperkeratotic disorders (congenital ichthyosis) only.

 
   
Salicylic acid in emulsifying ointment 1%, 3%, 30%, 50%, 70%
View adult BNF View SPC online
Unlicensed Drug Unlicensed
Amber 2

APC approved Special

For hyperkeratotic psoriasis, hyperkeratotic eczema, viral warts, lichen simplex, ichthyosis, keratodermas, callus, keratosis pilaris and other hyperkeratotic conditions where emollients and commercial preparations are ineffective only.

 
   
Salicylic acid in emulsifying ointment 2%, 5%, 10%, 20%
Unlicensed Drug Unlicensed
Amber 2

BAD/APC approved Special

For hyperkeratotic psoriasis, hyperkeratotic eczema, viral warts, lichen simplex, ichthyosis, keratodermas, callus, keratosis pilaris and other hyperkeratotic conditions where emollients and commercial preparations are ineffective only.

 
   
Urea in WSP ointment 40%
Unlicensed Drug Unlicensed
Red

APC approved Special


To be initiated and used under the supervision of a Dermatologist only

 
   
Zinc and salicylic acid paste (Lassar’s Paste) half-strength
Unlicensed Drug Unlicensed
Amber 2

BAD/APC approved Special

For prevention and treatment of irritant and/or flexural dermatitis where other barrier preparations have been ineffective.

 
   
13.05.02  Oral retinoids for psoriasis
Acitretin caps
View adult BNF View SPC online
Formulary
Red
 
   
Acitretin caps
View adult BNF View SPC online
Formulary
Red

Approved off-label indication:

Non-melanoma skin cancer in organ transplant patients

Dose: 10 - 30 mg daily. Initiate on 10 mg daily and titrate dose down to 10 mg on alternate days or up to a maximum dose of 30 mg daily, based upon side effect profile and response

 
   
13.05.02.01  Psoriasis - topical preparations for the scalp
 note 
Alphosyl 2 in 1® shampoo  (alcoholic coal tar extract 5%)
View adult BNF View SPC online
Formulary  
   
Calcipotriol scalp solution 50 micrograms/mL
View adult BNF View SPC online
Formulary  
   
Ceanel Concentrate® shampoo (cetrimide 10% + undecenoic acid 1% + phenylethyl alcohol 7.5%)
View adult BNF View SPC online
Formulary  
   
Coal tar 1% + coconut oil 1% + salicylic acid 0.5% shampoo  (Capasal®)
View adult BNF View SPC online
Formulary  
   
Coal tar 2.5% and Lecithin 0.3% scalp lotion (Psoriderm®)
View adult BNF View SPC online
Formulary  
   
Coal tar solution 12% + salicylic acid 2% + sulphur 4% scalp ointment (Sebco® or Cocois®)
View adult BNF View SPC online
Formulary  
   
Polytar® liquid
View adult BNF View SPC online
Formulary  
   
Selsun® shampoo (selenium sulphide 2.5%)
View adult BNF View SPC online
Formulary  
   
T/Gel® shampoo (coal tar extract 2%)
View adult BNF View SPC online
Formulary  
   
Cade oil 12% w/w and salicylic acid 6% w/w/ in emulsifying ointment
Unlicensed Drug Unlicensed
Amber 2

BAD/APC approved Special

For moderate to severe scalp psoriasis when vitamin D analogues and commercial tar treatments have been ineffective or unsuitable.

 
   
Coal tar scalp pomade (coal tar solution BP 6% w/w / salicylic acid 2% w/w in emulsifying ointment)
Unlicensed Drug Unlicensed
Amber 2

BAD/APC approved Special

For moderate to severe scalp psoriasis when vitamin D analogues and commercial tar treatments have been ineffective or unsuitable.

 
   
Coconut oil 25% w/w in emulsifying ointment
View adult BNF View SPC online
Unlicensed Drug Unlicensed
Amber 2

BAD/APC approved Special

For scalp psoriasis where commercial preparations have been ineffective.

 
   
Dithranol pomade 0.4% w/w
Unlicensed Drug Unlicensed
Amber 2

BAD/APC approved Special

For moderate to severe scalp psoriasis when vitamin D analogues and commercial tar treatments and commercial commercial dithranol preparations have been ineffective or unsuitable.

 
   
Synalar® gel mix
Unlicensed Drug Unlicensed
Red

APC approved Special

Scalp psoriasis/eczema – dry scaly skin

 
   
13.05.03  Drugs affecting the immune response
Cytotoxic Drug Azathioprine tabs (dermatology indications, including off-label use)
View adult BNF View SPC online
Formulary
Amber 3

Refer to SE London immunomodulatory shared care guidance for list of indications (link below)

 
   
Ciclosporin caps, oral solution (dermatology indications, including off-label use)
View adult BNF View SPC online
Formulary
Amber 3

Refer to SE London immunomodulatory shared care guidance for list of indications (link below)

 
   
Hydroxychloroquine tabs (dermatology indications, including off-label use)
View adult BNF View SPC online
Formulary
Amber 3

Refer to SE London immunomodulatory shared care guidance for list of indications (link below)

 
   
Leflunomide tabs (dermatology indications, including off-label use)
View adult BNF View SPC online
Formulary
Amber 3

Refer to SE London immunomodulatory shared care guidance for list of indications (link below)

 
   
Cytotoxic Drug Methotrexate tabs, subcutaneous injection (dermatology indications, including off-label use)
View adult BNF View SPC online
Formulary
Amber 3

Refer to SE London immunomodulatory shared care guidance for list of indications (link below)

 
   
Mycophenolate mofetil tabs, caps, suspension (dermatology indications, including off-label use)
View adult BNF View SPC online
Formulary
Amber 3

Refer to SE London immunomodulatory shared care guidance for list of indications (link below)

 
   
Mycophenolate sodium tabs (dermatology indications, including off-label use)
View adult BNF View SPC online
Formulary
Amber 3

Refer to SE London immunomodulatory shared care guidance for list of indications (link below)

  • Restricted to use where there is intolerance to mycophenolate mofetil.
  • Refer to APC recommendation (link below)
 
Link  APC recommendation: Mycophenolate sodium (mycophenolic acid) 360mg tablets for autoimmune rheumatic and dermatological conditions in patients unable to tolerate mycophenolate mofetil
   
Sulfasalazine tabs, oral suspension (dermatology indications, including off-label use)
View adult BNF View SPC online
Formulary
Amber 3

Refer to SE London immunomodulatory shared care guidance for list of indications (link below)

 
   
Pimecrolimus cream 1% (eczema)
View adult BNF View SPC online
Formulary
Amber 2

Use under specialist supervision only

For moderate atopic eczema

 
Link  NICE TA82: Pimecrolimus and tacrolimus for atopic dermatitis (eczema)
   
Pimecrolimus cream 1% (psoriasis - off-label)
View adult BNF View SPC online
Formulary
Amber 2

Approved off-label indication:

Psoriasis of the face, flexures and genitals

Use under specialist supervision only

 
   
Tacrolimus ointment 0.03%, 0.1% (eczema)
View adult BNF View SPC online
Formulary
Amber 2

Use under specialist supervision only For moderate to severe atopic eczema

 
Link  NICE TA82: Tacrolimus and pimecrolimus for atopic eczema
   
Tacrolimus ointment 0.03%, 0.1% (psoriasis - off-label)
View adult BNF View SPC online
Formulary
Amber 2

Approved off-label indication:

Psoriasis of the face, flexures and genitals

Use under specialist supervision only

 
   
Thalidomide caps (dermatology indications - off-label)
View adult BNF View SPC online
Restricted Drug Restricted
Red

Approved for the following off-label dermatology indications (dermatology specialist use only):

  • Actinic prurigo (after failure of topical therapy, oral steroids and phototherapy)
  • Nodular prurigo (after failure of topical therapy, phototherapy and methotrexate)
  • Cutaneous Lupus Erythematosus (after failure of topical therapy, oral steroids, hydroxychloroquine and mepacrine)

Follow internal guideline at GSTFT

 
   
Dupilumab injection
View adult BNF View SPC online
Formulary
Red
High Cost Medicine

Approved for treating moderate to severe atopic dermatitis as per NICE technology appraisal guidance (see link below)

 
Link  NICE TA534: Dupilumab for treating moderate to severe atopic dermatitis
   
Adalimumab injection (Hidradenitis suppurativa)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
BlueTeq

Approved for hidradenitis suppurativa as per NICE technology appraisal guidance

 
Link  NICE TA392: Adalimumab for treating moderate to severe hidradenitis suppurativa
   
Adalimumab injection (psoriasis)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine

Approved as per detail in SE London APC Psoriasis Biological Drug Treatment Pathway (link below)

In inadequate primary response, the following dose increase is also approved:

  • Dose increase from 40 mg every other week to 40 mg every week (category B* form required)

See SE London APC Psoriasis Biological Drug Treatment Pathway (link below)

 
Link  NICE TA146: Adalimumab for the treatment of adults with psoriasis
   
Apremilast tabs
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
Approved for use (as per criteria in NICE guidance) in:
  • Severe to moderate plaque psoriasis (TA419)
  • Active psoriatic arthritis (TA433)

     
  • Link  MHRA Jan 2017: 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
       
    Brodalumab injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved as per detail in SE London APC Psoriasis Biological Drug Treatment Pathway (link below)

     
    Link  NICE TA511: Brodalumab for treating moderate to severe plaque psoriasis
       
    Certolizumab pegol injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved for use as per NICE technology appraisal guidance (see links below)

     
    Link  NICE TA574: Certolizumab pegol for treating moderate to severe plaque psoriasis
       
    Dimethyl fumarate tablets (Skilarence - psoriasis)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Approved for use in psoriasis as per NICE Technology Appraisal guidance 
    Link  NICE TA475: Dimethyl fumarate for treating moderate to severe plaque psoriasis
       
    Etanercept injection (psoriasis)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved as per detail in SE London APC Psoriasis Biological Drug Treatment Pathway (link below)

    In inadequate primary response, the following dose increase is also approved:

    • Dose increase from 50 mg every week to 50 mg twice a week

    See SE London APC Psoriasis Biological Drug Treatment Pathway (link below)

    Biosimilar products available, to be prescribed by brand name.

    Contact pharmacy department for advice on brand for routine prescribing if unsure

     
    Link  NICE TA103: Etanercept and efalizumab for the treatment of adults with psoriasis
       
    Guselkumab injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved as per detail in SE London APC Psoriasis Biological Drug Treatment Pathway (link below)

     
    Link  NICE TA521: Guselkumab for treating moderate to severe plaque psoriasis
       
    Cytotoxic Drug Hydroxycarbamide caps (psoriasis - off-label)
    View adult BNF View SPC online
    Formulary
    Red

    Approved off-label indication:

    Severe refractory psoriasis

     
       
    Infliximab injection (hidradenitis suppurativa - off-label)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved off-label indication:

    Last line treatment for severe hidradenitis suppurativa

    Use in accordance with the local guideline at GSTFT.

    Requires individual funding application for exceptional cases, currently not recommended for routine commissioning

    Biosimilar products available, to be prescribed by brand name.

    Contact pharmacy department for advice on brand for routine prescribing if unsure

     
    Link  SE London APC position statement: Biosimilar infliximab
       
    Infliximab injection (psoriasis)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved as per detail in SE London APC Psoriasis Biological Drug Treatment Pathway (link below)

    In inadequate primary response, the following off-label dose increase is also approved:

    • Dose increase from 5 mg/kg every 8 weeks to 5 mg/kg every 6 weeks (category B* form required)

    See SE London APC Psoriasis Biological Drug Treatment Pathway (link below)

    Biosimilar products available, to be prescribed by brand name.

    Contact pharmacy department for advice on brand for routine prescribing if unsure

     
    Link  NICE TA134: Infliximab for the treatment of adults with psoriasis
    Link  SE London APC position statement: Biosimilar infliximab
       
    Ixekizumab injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved as per detail in SE London APC Psoriasis Biological Drug Treatment Pathway (link below)

     
    Link  NICE TA442: Ixekizumab for treating moderate to severe plaque psoriasis
       
    Risankizumab injection
    View adult BNF View SPC online
    Formulary
    Red

    Approved for use as per NICE technology appraisal guidance (see links below)

     
    Link  NICE TA596: Risankizumab for treating moderate to severe plaque psoriasis
       
    Rituximab injection (dermatology indications)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

    Approved off-label indication:

    Severe immunobullous disease

    • Pemphigus
    • Pemphigoid
    • Epidermolysis bullosa acquisita (EBA)

    Use in accordance with the local guideline at GSTFT, and NHSE Policy (see link below)

    Biosimilar products available, to be prescribed by brand name.

    Contact pharmacy department for advice on brand for routine prescribing if unsure

     
    Link  NHSE Clinical Commissioning Policy 16035/P: Rituximab for Immunobullous Disease
       
    Secukinumab injection (psoriasis)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved as per detail in SE London APC Psoriasis Biological Drug Treatment Pathway (link below)

     
    Link  NICE TA350: Secukinumab for treating moderate to severe plaque psoriasis
       
    Tildrakizumab injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved for use as per NICE technology appraisal guidance (see links below)

     
    Link  NICE TA575: Tildrakizumab for treating moderate to severe plaque psoriasis
       
    Ustekinumab injection (psoriasis)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Approved as per detail in SE London APC Psoriasis Biological Drug Treatment Pathway (link below)

    In inadequate primary response, the following off-label dose increases are also approved:

    • Dose increase from 45mg every 12 weeks to 90mg every 12 weeks in those <100kg
    • Dose increase from 90 mg every 12 weeks to to 90 mg every 8 weeks (category B* form required)
     
    Link  NICE TA180: Ustekinumab for the treatment of adults with moderate to severe psoriasis
       
    13.06  Acne and rosacea
    Ivermectin 1% cream  (Soolantra® - papulopustular rosacea)
    View adult BNF View SPC online
    First Choice
    Green

    First line topical choice for papulopustular rosacea

    See APC recommendation and SE London rosacea treatment pathway for further information (links below)

     
    Azelaic acid 15% gel (papulopustular rosacea )
    View adult BNF View SPC online
    Second Choice
    Green

    Second line topical treatment for papulopustular rosacea

    Refer to SE London papulopustular rosacea treatment pathway for further information (link below)

     
       
    Clonidine tablets (rosacea off-label)
    View adult BNF View SPC online
    Formulary
    Green

    Approved off-label indication:

    Rosacea with flushing and fixed erythema 

    Dose = 25-50mg BD, starting as 25mg OD and titrate up if tolerated

     
       
    Lymecycline caps (papulopustular rosacea off-label)
    View adult BNF View SPC online
    Restricted Drug Restricted
    Green

    For use in severe papulopustular rosacea

    Restricted to use as a 2nd line oral antibiotic where there is intolerance (e.g. abdominal pain, nausea) to the first line oral antibiotic choice (either oxytetracyline or doxycycline 100mg)

    Refer to APC recommendation and SE London rosacea treatment pathway for further information (links below)

     
    Link  APC recommendation: Lymecycline for the treatment of severe papulopustular rosacea and severe ocular rosacea
       
    Oxytetracycline tabs (papulopustular rosacea )
    View adult BNF View SPC online
    Formulary
    Green

    First line oral antibiotic option for severe papulopustular rosacea

    Refer to SE London APC rosacea treatment pathway for further information (link below)

     
       
    Propranolol tablets (rosacea off-label)
    View adult BNF View SPC online
    Formulary
    Green

    Approved off-label indication:

    Rosacea with flushing and fixed erythema, especially if triggered by anxiety 

    Dose = 10-20mg BD

     
       
    Doxycycline caps (papulopustular rosacea - off-label)
    View adult BNF View SPC online
    Formulary
    Green

    First line oral antibiotic option for severe papulopustular rosacea

    Refer to SE London rosacea treatment pathway for further information (link below)

     
       
    Doxycyline 40mg m/r capsules (Efracea® - papulopustular rosacea)
    View adult BNF View SPC online
    Restricted Drug Restricted
    Green

    For use in severe papulopustular rosacea

    Restricted to use as a 2nd line oral antibiotic where there is intolerance (e.g. abdominal pain, nausea) to the first line oral antibiotic choice (either oxytetracyline or doxycycline 100mg)

    Refer to APC recommendation and SE London rosacea treatment pathway for further information (links below)

     
    Link  APC recommendation: Doxycycline 40mg m/r caps for rosacea
       
    13.06.01  Topical preparations for acne to top
    13.06.01  Benzoyl peroxide and azelaic acid
    Azelaic acid cream 20% (acne)
    View adult BNF View SPC online
    Formulary

     
       
    Benzoyl peroxide 3% with clindamycin 1% gel
    View adult BNF View SPC online
    Formulary  
       
    Benzoyl peroxide 5% with clindamycin 1% gel
    View adult BNF View SPC online
    Formulary  
       
    Benzoyl peroxide cream 4%, 5%, 10%
    View adult BNF View SPC online
    Formulary  
       
    Benzoyl peroxide gel 5%
    View adult BNF View SPC online
    Formulary  
       
    13.06.01  Topical antibacterials for acne
    Clindamycin lotion 1%, topical solution 1%, gel 1%
    View adult BNF View SPC online
    Formulary  
       
    Erythromycin 40mg with zinc acetate 12mg/mL (Zineryt®)
    View adult BNF View SPC online
    Formulary USE ON SPECIALIST ADVICE 
       
    Erythromycin solution 2%
    View adult BNF View SPC online
    Formulary  
       
    13.06.01  Topical retinoids and related preparations for acne
    Adapalene 0.1%, with benzoyl peroxide 2.5% gel
    View adult BNF View SPC online
    Formulary  
       
    Adapalene cream, gel 0.1%
    View adult BNF View SPC online
    Formulary  
       
    Isotretinoin 0.05% with erythromycin 2% gel
    View adult BNF View SPC online
    Formulary  
       
    Tretinoin 0.025% with erythromycin 4% solution
    View adult BNF View SPC online
    Formulary  
       
    13.06.01  Other topical preparations for acne
    Salicylic acid 2% w/w and sulphur 2% w/w in aqueous cream
    Unlicensed Drug Unlicensed
    Amber 2

    BAD/APC approved Special

    For scaly, inflamed conditions of the face or scalp, such as treatment of seborrhoeic dermatitis.

     
       
    13.06.02  Oral preparations for acne to top
    13.06.02  Oral antibiotics for acne
    Doxycycline caps
    View adult BNF View SPC online
    Formulary
    Green

     
       
    Erythromycin tabs, suspension
    View adult BNF View SPC online
    Formulary
    Green

     
       
    Lymecycline caps
    View adult BNF View SPC online
    Formulary
    Green

    Approved for licensed use (acne) and the following off-label indications:

    • Severe papulopustular rosacea, and severe ocular rosacea, restricted to use in patients experiencing intolerance or inefficacy with oxytetracycline and doxycycline capsules.  See APC recommendation (link below) for further information.
     
    Link  SE London APC Recomendation: Lymecycline for the treatment of severe papulopustular rosacea and severe ocular rosacea
       
    Minocycline m/r caps, tabs
    View adult BNF View SPC online
    Formulary
    Red

    Specialist prescribing only

    Last line tetracycline option for skin infections where the others have failed, are contraindicated or not tolerated

    Use limited to exceptional circumstances due to risk of serious ADRs (see BNF)

     
    Link  SE London APC position statement: Minocycline for the treatment of acne
       
    Oxytetracycline tabs
    View adult BNF View SPC online
    Formulary  
       
    Trimethoprim tabs
    View adult BNF View SPC online
    Formulary

    Approved off-label indication:

    Moderate to severe resistant acne where topical treatment and other systemic antibiotic therapy are ineffective or inappropriate

     
       
    13.06.02  Hormone treatment for acne
    Co-cyprindiol 2000/35 tabs (Dianette®)
    View adult BNF View SPC online
    Formulary Refer to BNF for CSM advice (increased risk for thromboembolism) 
       
    Cyproterone acetate tabs
    View adult BNF View SPC online
    Formulary Approved off-label indication:
    Treatment of women with severe treament resistant acne only
    Specialist initiation only 
       
    13.06.02  Oral retinoid for acne
    Isotretinoin caps (acne)
    View adult BNF View SPC online
    Formulary
    Red

     
    Link  MHRA Aug 20: Isotretinoin (Roaccutane▼): reminder of important risks and precautions
    Link  MHRA Oct 17: Isotretinoin (Roaccutane): rare reports of erectile dysfunction and decreased libido
       
    Isotretinoin caps (dermatology off-label indications)
    View adult BNF View SPC online
    Formulary
    Red

     Approved off label indications:

    1. Hidradenitis suppurativa - prior to biologic treatment

    2. Folliculitis Decalvans - after failure of other conventional treatment e.g topical antibiotics, systemic antibiotics (clindamycin and rifampicin again) and other systemic therapy, such as oral dapsone.

     
    Link  MHRA Aug 20: Isotretinoin (Roaccutane▼): reminder of important risks and precautions
       
    13.07  Preparations for warts and calluses
    Occlusal® application (salicylic acid 26%)
    View adult BNF View SPC online
    Formulary  
       
    Salactol® paint (salicylic acid 16.7%, lactic acid 16.7%)
    View adult BNF View SPC online
    Formulary

     
       
    Salatac® gel (salicylic acid 12.0%, lactic acid 4.0%)
    View adult BNF View SPC online
    Formulary  
       
    Silver nitrate caustic pencil
    View adult BNF View SPC online
    Formulary  
       
    Diphenylcyclopropenone in acetone 0.00001-6.0% w/v
    Unlicensed Drug Unlicensed
    Amber 2

    BAD/APC approved Special

    For alopecia areata and resistant viral warts as topical immunotherapy.

     
       
    Formaldehyde solution 4%
    Unlicensed Drug Unlicensed

    For warts

    Use daily as a soak diluted 1 part with 3 parts of water to prepare a 1% formaldehyde solution

     
       
    Salicylic acid in WSP 5%
    Unlicensed Drug Unlicensed May be used on an ad-hoc basis for
    any skin condition for its keratolytic
    effect 
       
    Formaldehyde solution 10%
    Unlicensed Drug Unlicensed  
       
    13.07  Anogenital warts to top
    Imiquimod cream 5% (Aldara® - genital warts)
    View adult BNF View SPC online
    Formulary

    Specialist initiation only

    Second-line to podophyllotoxin and cryotherapy for the treatment of genital warts

     
       
    Imiquimod cream 5% (Aldara® - off-label uses)
    View adult BNF View SPC online
    Formulary

    Approved off-label indications:

    • Multifocal vulvar intraepithelial neoplasia (VIN) and extensive extramammary Paget disease (EMPD)
    • Treatment of molluscum contagiosum in accordance with BASHH guidelines

    Specialist initiation only

     
       
    Podophyllotoxin solution 0.5% (Warticon® licensed uses)
    View adult BNF View SPC online
    Formulary

     
       
    Podophyllotoxin cream 0.15% (Warticon®)
    View adult BNF View SPC online
    Formulary  
       
    Podophyllotoxin Paint, Compound, BP
    View adult BNF View SPC online
    Formulary  
       
    Podophyllotoxin solution 0.5% (Warticon® for molluscum contagiosum - off-label)
    View adult BNF View SPC online
    Formulary

    Approved off-label indication:

    Treatment of molluscum contagiosum in accordance with BASHH guidelines

     
       
    Podophyllotoxin paint 25% in bezoin compound tincture
    Unlicensed Drug Unlicensed For anogenital wards
    To be applied once a week 
       
    13.08  Sunscreens and camouflagers
    13.08.01  Sunscreen preparations
    Anthelios XL® melt in cream (Sunscreen SPF 50+)
    (ACBS)
    View adult BNF
    Formulary

    Approved for prescribing for (ACBS):

    Protection from UV radiation in abnormal cutaneous photosensitivity resulting from genetic disorders or photodermatoses, including vitiligo, and those resulting from radiotherapy; chronic or recurrent herpes simplex labialis

     
       
    Sunsense® Ultra (Sunscreen SPF 50+)
    (ACBS)
    View adult BNF
    Formulary

    Approved for prescribing for (ACBS):

    Protection from UV radiation in abnormal cutaneous photosensitivity resulting from genetic disorders or photodermatoses, including vitiligo, and those resulting from radiotherapy; chronic or recurrent herpes simplex labialis

     
       
    Reflective (Dundee) sunscreens - coffee, coral, pink, beige
    Unlicensed Drug Unlicensed
    Amber 2

    BAD/APC approved Special

    For photosensitivity disorders where the patient is sensitive to visible light, most commonly solar urticaria and porphyrias, particularly erythropoietic protoporphyria.

     
       
    13.08.01  Photodamage
    5-aminolevulinate gel (Ameluz®)
    View adult BNF View SPC online
    Formulary
    Red

    USE UNDER SPECIALIST SUPERVISION ONLY

    Treatment of actinic keratoses, superficial or nodular basal cell carcinoma 

     
       
    Diclofenac sodium gel 3% (Solaraze®)
    View adult BNF View SPC online
    Formulary
    Green

     
       
    Cytotoxic Drug Fluorouracil and salicylic acid cutaneous solution (Actikerall®)
    View adult BNF View SPC online
    Formulary
    Green

    Approved as a 2nd line for grade I/II actinic keratosis where there are discrete, localised lesions with a thin base AND cryotherapy is not available or where topical therapy is preferred.

    See APC recommendation and SEL APC dermatology guidance for further details (link below and above)

     
    Link  APC recommendation: Actikerall® cutaneous solution for the topical treatment of actinic keratosis (grade I/II) in immunocompetent adult patients
       
    Cytotoxic Drug Fluorouracil cream 5% (Efudix®)
    View adult BNF View SPC online
    Formulary

    Approved for licensed indications

    Green for actinic keratosis and Bowen's disease

    Red for use in basal cell carcinoma of the skin

     
       
    Imiquimod 5% cream  (Aldara® - basal cell carcinoma and actinic keratosis)
    View adult BNF View SPC online
    Formulary

    Approved for use (as a second line option to fluoruracil 5% cream)  in:

    Red Superficial basal cell carcinoma

    Green Actinic keratosis

    Refer to APC recommendations for further information

     
    Link  SE London APC recommendation: Imiquimod 5% cream (Aldara®) for the topical treatment of non- hyperkeratotic, non-hypertrophic actinic keratosis (AK) on the face or scalp in immunocompetent adult patients
    Link  SE London APC recommendation: Imiquimod 5% cream (Aldara™) for the treatment of superficial basal cell carcinoma in adults
       
    Ingenol mebutate 150 micrograms/g, 500 micrograms/g (Picato® - currently unavailable)
    View adult BNF View SPC online
    Formulary

    Unavailable as Market Authorisation suspended whilst the European Medicines Agency reviews possible link between ingenol and skin cancer

    • Healthcare professionals should stop prescribing ingenol and consider different treatment options, while authorities review the data.
    • Patients should no longer use ingenol gel to treat actinic keratosis
    • Patients should look out for any unusual skin changes or growths and seek medical advice promptly if any occur

    The link to the EMA website notification is here

     
    Link  MHRA Feb 20 - Ingenol mebutate gel (Picato▼): suspension of the licence due to risk of skin malignancy
       
    Methyl-5-aminolevulinate cream (Metvix®)
    View adult BNF View SPC online
    Formulary
    Red

    USE UNDER SPECIALIST SUPERVISION ONLY

    Treatment of actinic keratoses, superficial or nodular basal cell carcinoma and Bowen's Disease.

     
       
    13.08.02  Camouflagers
    13.09  Shampoos and other preparations for scalp and hair conditions to top
    Capasal® shampoo (salicylic acid 0.5%, coconut oil 1.0%, distilled coal tar 1.0%)
    View adult BNF View SPC online
    Formulary  
       
    Ketoconazole shampoo 2%
    View adult BNF View SPC online
    Formulary  
       
    13.09  Hirsutism
    13.09  Androgenetic alopecia
    13.10  Anti-infective skin preparations
    13.10.01  Antibacterial preparations
    13.10.01.01  Antibacterial preparations only used topically to top
    Graneodin® ointment (neomycin sulphate 0.25% + gramicidin 0.025%)
    View adult BNF View SPC online
    Formulary  
       
    Mupirocin ointment 2%
    View adult BNF View SPC online
    Formulary  
       
    Polyfax® ointment (polymyxin B sulphate ointment + bacitracin zinc)
    View adult BNF View SPC online
    Formulary  
       
    Silver sulfadiazine cream 1% (Flamazine®)
    View adult BNF View SPC online
    Formulary  
       
    13.10.01.02  Antibacterial preparations also used systemically
    Fusidic acid cream, ointment 2% (sodium fusidate)
    View adult BNF View SPC online
    Formulary  
       
    Metronidazole gel, cream 0.75%
    View adult BNF View SPC online
    Formulary  
       
    13.10.02  Antifungal preparations
    Amorolfine nail lacquer 5%
    View adult BNF View SPC online
    Formulary  
       
    Benzoic acid ointment, compound BP
    View adult BNF
    Formulary  
       
    Clotrimazole cream, powder 1%
    View adult BNF View SPC online
    Formulary  
       
    Clotrimazole solution 1%
    View adult BNF View SPC online
    Formulary  
       
    Econazole nitrate cream 1%
    View adult BNF View SPC online
    Formulary  
       
    Ketoconazole cream 2%, shampoo 2%
    View adult BNF View SPC online
    Formulary  
       
    Miconazole nitrate cream 2%
    View adult BNF View SPC online
    Formulary  
       
    Nystatin 100,000 units/g with chlorhexidine 10mg/g cream (Nystaform®)
    View adult BNF View SPC online
    Formulary  
       
    Terbinafine 1% cream
    View adult BNF View SPC online
    Formulary  
       
    Tioconazole nail lacquer 28%
    View adult BNF View SPC online
    Formulary  
       
    Selenium sulphide shampoo 2.5% (Selsun®)
    View adult BNF View SPC online
    Formulary

    Approved off-label indication:

    Pityriasis versicolor

     
       
    Sulfacetamide in IMS lotion 15%
    Unlicensed Drug Unlicensed
    Red

    APC approved Special

    To be initiated and used under the supervision of a Dermatologist only

     
       
    13.10.03  Antiviral preparations
    Aciclovir cream 5%
    View adult BNF View SPC online
    Formulary  
       
    13.10.04  Parasiticidal preparations
    13.10.04  Scabies to top
    Malathion aqueous liquid 0.5%
    View adult BNF View SPC online
    First Choice First-line for scabies in accordance with GUM guidelines 
    Permethrin cream rinse 1%
    View adult BNF View SPC online
    Second Choice Second-line for scabies in accordance with GUM guidelines 
       
    Permethrin cream 5%
    View adult BNF View SPC online
    Formulary  
       
    Benzyl benzoate application BP 25%
    View adult BNF View SPC online
    Formulary  
       
    13.10.04  Head lice
     note 

    Note: For inpatient treatment only.  Head lice treatments are not routinely offered in primary care as considered appropriate for self-care (OTC purchase).  See NHS England guidance.

    Bug Busting Kit
    Formulary  
       
    Dimeticone 4% cutaneous solution
    View adult BNF View SPC online
    Formulary

     
       
    Malathion aqueous liquid 0.5%
    View adult BNF View SPC online
    Formulary  
       
    Permethrin 1% creme rinse
    View adult BNF View SPC online
    Formulary

     
       
    13.10.04  Crab lice
    Malathion aqueous liquid 0.5%
    View adult BNF View SPC online
    First Choice First-line for crab lice in accordance with GUM guidelines 
    Permethrin cream 5%
    View adult BNF View SPC online
    Second Choice Second-line for crab lice in accordance with GUM guidelines 
       
    Phenothrin lotion 0.2%
    View adult BNF View SPC online
    Third Choice Third-line for crab lice in accordance with GUM guidelines 
       
    13.10.05  Preparations for minor cuts and abrasions
    Magnesium sulphate paste BP
    View adult BNF View SPC online
    Formulary  
       
    Proflavine cream, BPC
    View adult BNF View SPC online
    Formulary  
       
    13.10.05  Collodion
    Collodion Flexible BP
    View adult BNF View SPC online
    Formulary  
       
    13.10.05  Skin tissue adhesive to top
    Histoacryl®
    View adult BNF
    Formulary
    Red
     
       
    Indermil®
    View adult BNF
    Formulary
    Red
     
       
    13.11  Skin cleansers, antiseptics, and desloughing agents
    13.11.01  Alcohols and saline
    Industrial Methylated Spirit BP
    View adult BNF
    Formulary  
       
    Sodium Chloride 0.9%
    View adult BNF
    Formulary  
       
    Sodium chloride solution sachets 0.9% (Normasol®)
    View adult BNF
    Formulary  
       
    13.11.02  Chlorhexidine salts
    Chlorhexidine gluconate solution 0.5%
    View adult BNF
    Formulary  
       
    Hibiscrub® cleansing solution (chlorhexidine gluconate 4%)
    View adult BNF
    Formulary  
       
    Hibitane Obstetric® cream (chlorhexidine gluconate 1%)
    View adult BNF
    Formulary  
       
    Octenisan® lotion
    Formulary  
       
    Tisept® solution (Chlorhexidine 0.015% with Cetrimide 0.15%)
    View adult BNF
    Formulary  
       
    Unisept® solution (chlorhexidine gluconate 0.05%)
    View adult BNF
    Formulary  
       
    13.11.03  Cationic surfactants and soaps
    13.11.04  Iodine and Chlorine to top
    Povidone-iodine alcoholic tincture 10%
    View adult BNF
    Formulary  
       
    Povidone-iodine antiseptic solution 10%
    View adult BNF
    Formulary  
       
    Povidone-iodine skin cleanser solution 4%
    View adult BNF
    Formulary  
       
    Povidone-iodine surgical scrub 7.5%
    View adult BNF
    Formulary  
       
    13.11.05  Phenolics
    Aquasept® skin cleanser (triclosan 2%)
    Formulary  
       
    Ster-Zac Bath Concentrate® solution (triclosan 2%)
    Formulary  
       
    13.11.06  Oxidisers, and dyes
    Hydrogen peroxide cream 1%
    View adult BNF
    Formulary  
       
    Hydrogen peroxide solution BP
    View adult BNF
    Formulary  
       
    Permitabs® (potassium permanganate 400 mg)
    View adult BNF
    Formulary  
       
    13.11.07  Desloughing agents
    13.12  Antiperspirants
    Aluminium chloride hexahydrate 20% (Driclor®)
    View adult BNF
    Formulary  
       
    Botulinum toxin type A  (Botox® - hyperhidrosis)
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red
    High Cost Medicine

    CONSULTANT SPECIALISTS ONLY

    Severe hyperhidrosis of the axillae unresponsive to topical antiperspirant or other antihidrotic treatment

    Category B* form required

     
       
    Glycopyrronium bromide powder
    View adult BNF
    Formulary  
       
    Oxybutynin tabs (hyperhidrosis – off-label)
    View adult BNF View SPC online
    Formulary
    Green

    Approved off-label indiction:

    Hyperhidrosis where there is failure to respond to a trial of topical antiperspirants or other antihidrotic treatment.

    IR tabs dose = 2.5mg daily – 5mg three times a day

    MR dose = 5-10mg daily.


    Oxybutynin IR preparation 1st line followed by oxybutinin MR preparation or propantheline in case of intolerable adverse effects/inefficacy of oxybutynin IR

    Refer to APC recommendation below

     
    Link  SE London APC recommendation - propantheline & oxybutynin in hyperhidrosis in ADULTS
       
    Propantheline bromide tabs (hyperhidrosis)
    View adult BNF View SPC online
    Formulary
    Green

    Use in accordance with formulary recommendation below

    For hyperhidrosis where there is failure to respond to a trial of topical antiperspirants or other antihidrotic treatment

    Oxybutynin IR preparation 1st line followed by oxybutinin MR preparation or propantheline in case of intolerable adverse effects/inefficacy of oxybutynin IR

     
    Link  SE London APC recommendation - propantheline & oxybutynin in hyperhidrosis in ADULTS
       
    Botulinum toxin type A (Xeomin® - Frey's syndrome)
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red
    High Cost Medicine

    Approved off-label indication:

    Frey's syndrome

    Use in accordance with local guideline at GSTFT ENT consultants only

     
       
    Glycopyrrolate 0.05% w/v in water
    View adult BNF
    Unlicensed Drug Unlicensed
    Amber 2

    BAD/APC approved Special

    For hyperhidrosis with an iontophoresis machine.

     
       
    Glycopyrrolate 2% w/w in cetomacrogol cream
    View adult BNF
    Unlicensed Drug Unlicensed
    Amber 2

    BAD/APC approved Special

    For disabling facial hyperhidrosis.

     
       
    Glycopyrronium topical solution 0.1%
    View adult BNF
    Unlicensed Drug Unlicensed
    Red

    APC approved Special

    To be initiated and used under the supervision of a Dermatologist only

     
       
    13.13  Miscellaneous preparations to top
     note 
    Calcium gluconate gel
    Unlicensed Drug Unlicensed For hydrofluoric acid burns 
       
    Crystal violet paint
    Unlicensed Drug Unlicensed Antiseptic agent for candidal vulvovaginitis 
       
    Daydrop air freshener
    Unlicensed Drug Unlicensed Deodorant 
       
    Eosin solution 2% w/v
    Unlicensed Drug Unlicensed
    Amber 2

    BAD/APC approved Special

    For erosive dermatitis.

     
       
    Glycerine (sterile)
    Unlicensed Drug Unlicensed Often used as a moisturising agent in topical preparations 
       
    Glycerol
    Unlicensed Drug Unlicensed Often used as a moisturising agent in topical preparations 
       
    Hydroquinone 4% w/w in aqueous cream
    Unlicensed Drug Unlicensed
    Red

    APC approved Special

    To be initiated and used under the supervision of a Dermatologist only

     
       
    Hydroquinone 5% w/w, hydrocortisone 1% w/w and tretinoin 0.1% w/w in a non-aqueous gel 0.3% w/w
    View adult BNF View SPC online
    Unlicensed Drug Unlicensed
    Amber 2

    BAD/APC approved Special

    For treatment of melasma, in conjunction with a strong sunblock.

    A commercially available similar preparation called Piganorm® may be obtained.

     
       
    Hydroquinone 5% w/w, hydrocortisone 1% w/w cream
    Unlicensed Drug Unlicensed
    Red

    APC approved Special

    To be initiated and used under the supervision of a Dermatologist only

     
       
    Iodoform compound paint
    Unlicensed Drug Unlicensed Protective covering for wounds and to hold gauze dressings in place 
       
    Jessners solution
    Unlicensed Drug Unlicensed
    Red

    APC approved Special

    To be initiated and used under the supervision of a Dermatologist only

     
       
    Liquid paraffin (sterile)
    Unlicensed Drug Unlicensed To remove dithranol and crude coal tar from patients 
       
    Mercurochrome solution 10%
    Unlicensed Drug Unlicensed Antiseptic agent used on cuts 
       
    Monobenzylether of hydroquinine in cetomacrogol cream A 10%, 20%, 30%, 40%, 50%
    Unlicensed Drug Unlicensed
    Amber 2

    APC approved Special

    For depigmentation of skin in vitiligo only.

     
       
    Olive oil
    Unlicensed Drug Unlicensed Used to soften the scalp of patients with psoriasis and to prepare ear drops for patients 
       
    Orabase protective paste
    Unlicensed Drug Unlicensed Mouth ulcers, mucositis 
       
    Phenol 2% w/w in compound zinc paste BP
    View adult BNF View SPC online
    Unlicensed Drug Unlicensed
    Amber 2

    BAD/APC approved Special

    For intractable pruritus ani, unresponsive to moderate strength topical steroid and barrier preparations.

     
       
    Pigmanorm® cream
    Unlicensed Drug Unlicensed
    Amber 2

    Depigmenting cream, containing:

    • Hydroquinone 5%
    • Tretinoin 0.1%
    • Hydrocortisone 1%
     
       
    Sulphacetamide 15% in 50% methylated spirit
    Unlicensed Drug Unlicensed Chronic paronychia 
       
    Tacrolimus 0.1% and 0.3% w/w in Orabase® (oral dermatoses)
    Unlicensed Drug Unlicensed
    Amber 2

    BAD/APC approved Special

    For ulcerative and erosive inflammatory skin disease including around stomas.

     
       
    Triamcinolone acetonide 0.1% w/w in Orabase®
    View adult BNF View SPC online
    Unlicensed Drug Unlicensed
    Amber 2

    BAD/APC approved Special

    For ulcerative and erosive inflammatory skin disease including around stomas.

     
       
    Trichloroacetic acid solution 25%, 50%, 90%, 100% w/v
    Unlicensed Drug Unlicensed
    Red

    APC approved Special

    Used as a facial skin peel. 

    To be initiated and used under the supervision of a Dermatologist only

     
       
     ....
     Non Formulary Items
    Brimonidine gel  (Mirvaso®)

    View adult BNF View SPC online
    Non Formulary
    Grey

    Not recommended for prescribing in SE London

    Link  SE London APC recommendation: Brimonidine for facial erythema in rosacea (not recommended)
     
    Eflornithine  (Vaniqa®)

    View adult BNF View SPC online
    Non Formulary
    Grey

    Not recommended for prescribing in SE London

     
    Imiquimod 3.75% cream  (Zyclara®)

    View adult BNF View SPC online
    Non Formulary

    Not recommended for prescribing in SE London for use in actinic keratosis (AK)

    Link  SE London APC recommendation: Imiquimod 3.75% cream (Zyclara™) for the treatment of actinic keratosis (AK) (not approved)
     
    Silk garments

    View adult BNF View SPC online View SMC online
    Non Formulary
    Grey

    Not recommended for prescribing in SE London

    Link  SE London APC position statement: Silk garments for dermatological conditions (such as eczema or dermatitis) (not approved)
     
    Sodium cromoglicate 4% cutaneous emulsion  (Altoderm™)

    Non Formulary
    Grey

    Not recommended for prescribing in SE London

    Link  SE London APC recommendation: Sodium cromoglycate 4% cutaneous emulsion (Altoderm™) for the treatment of mastocytosis in children (not approved)
     
      
    Key
    note Notes
    Section Title Section Title (top level)
    Section Title Section Title (sub level)
    First Choice Item First Choice item
    Non Formulary Item Non Formulary section
    Restricted Drug
    Restricted Drug
    Unlicensed Drug
    Unlicensed
    Track Changes
    Display tracking information
    click to search medicines.org.uk
    Link to adult 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
    CCG
    CCG

    Traffic Light Status Information

    Status Description

    Red

    Specialist or hospital prescribing only. The responsibility for prescribing, monitoring, dose adjustment and review should remain with the specialist or hospital. In very exceptional circumstances a specialist may discuss individual patient need for a RED drug to be prescribed by a GP and the GP should consider informing the Medicines Management team before a decision is made to prescribe for individual patients.   

    Amber 1

    Treatment can be initiated in primary care after a recommendation from an appropriate specialist  

    Amber 2

    Specialist initiation followed by maintenance prescribing in primary care  

    Amber 3

    Specialist initiation with ongoing monitoring required. After dose stabilisation GPs can be requested to take over prescribing responsibilities using the approved APC shared care documentation  

    Green

    Specialist and non-specialist initiation  

    Grey

    Not recommended for prescribing  

    netFormulary