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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...
13.08.01  Expand sub section  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  Expand sub section  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 gradeI/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 for further details (link below)

 
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

Green for actinic keratosis

Red for use in basal cell carcinoma of the skin

Apply once or twice a day

 
   
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:

RedSuperficial basal cell carcinoma

GreenActinic 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.

 
   
 ....
 Non Formulary Items
Imiquimod 3.75% cream  (Zyclara®)

View adult BNF View SPC online
Non Formulary

Not approved 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)
 
  
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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