netFormulary South East London Joint Medicines Formulary NHS
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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13.06  Expand sub section  Acne and rosacea
Ivermectin 1% cream  (Soolantra - 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 (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)

 
   
Oxytetracycline tabs (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)

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

First line oral antibiotic option for papulopustular rosacea

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

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

For use in facial 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  Expand sub section  Topical preparations for acne
13.06.01  Expand sub section  Benzoyl peroxide and azelaic acid
Azelaic acid cream 20% (acne)
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Formulary

 
   
Benzoyl peroxide 3% with clindamycin 1% gel
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Formulary  
   
Benzoyl peroxide 5% with clindamycin 1% gel
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Formulary  
   
Benzoyl peroxide cream 4%, 5%, 10%
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Formulary  
   
Benzoyl peroxide gel 5%
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Formulary  
   
13.06.01  Expand sub section  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)
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Formulary USE ON SPECIALIST ADVICE 
   
Erythromycin solution 2%
View adult BNF View SPC online
Formulary  
   
13.06.01  Expand sub section  Topical retinoids and related preparations for acne to top
Adapalene 0.1%, with benzoyl peroxide 2.5% gel
View adult BNF View SPC online
Formulary  
   
Adapalene cream, gel 0.1%
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Formulary  
   
Isotretinoin 0.05% with erythromycin 2% gel
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Formulary  
   
Tretinoin 0.025% with erythromycin 4% solution
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Formulary  
   
13.06.01  Expand sub section  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  Expand sub section  Oral preparations for acne
13.06.02  Expand sub section  Oral antibiotics for acne
Doxycycline caps
View adult BNF View SPC online
Formulary
Green

 
   
Erythromycin tabs, suspension
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Formulary
Green

 
   
Lymecycline caps
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Formulary
Green

Approved for licensed use 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
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Formulary  
   
Trimethoprim tabs
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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  Expand sub section  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
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Formulary Approved off-label indication:
Treatment of women with severe treament resistant acne only
Specialist initiation only 
   
13.06.02  Expand sub section  Oral retinoid for acne to top
Isotretinoin caps (acne)
View adult BNF View SPC online
Formulary
Red

 
Link  MHRA Oct 17: Isotretinoin (Roaccutane): rare reports of erectile dysfunction and decreased libido
   
Isotretinoin caps (dermatology off-label indications)
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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.

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

View adult BNF View SPC online
Non Formulary
Grey
Link  SE London APC recommendation: Brimonidine for facial erythema in rosacea (not recommended)
 
  
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  

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