| Formulary Chapter 13: Skin - Full Chapter
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| 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 |
Sunscreen preparations |
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Anthelios XL® melt in cream (Sunscreen SPF 50+)
(ACBS)
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Formulary
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 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
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Sunsense® Ultra (Sunscreen SPF 50+)
(ACBS)
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Formulary
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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
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Reflective (Dundee) sunscreens - coffee, coral, pink, beige
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 Unlicensed
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BAD/APC approved Special
For photosensitivity disorders where the patient is sensitive to visible light, most commonly solar urticaria and porphyrias, particularly erythropoietic protoporphyria.
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| 13.08.01 |
Photodamage |
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5-aminolevulinate gel (Ameluz®)
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Formulary
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USE UNDER SPECIALIST SUPERVISION ONLY
Treatment of actinic keratoses, superficial or nodular basal cell carcinoma
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Diclofenac sodium gel 3% (Solaraze®)
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Formulary
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Fluorouracil cream 5% (Efudix®)
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Formulary
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To treat actinic keratosis and basal cell carcinoma of the skin
Apply once or twice a day
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Imiquimod 5% cream (basal cell carcinoma)
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Formulary
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Approved for use in superficial basal cell carcinoma
2nd line topical option in patients who have unsuccessfully tried fluoruracil 5% cream or have a contraindication to it Refer to APC recommendation for further information
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 SE London APC recommendation: Imiquimod 5% cream (Aldara™) for the treatment of superficial basal cell carcinoma in adults
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Ingenol mebutate 150 micrograms/g, 500 micrograms/g (Picato®)
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Formulary
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For treating actinic keratosis with small areas of field change up to a maximum of 25cm2
GPs should not re-treat patients who have a recurrence on the same skin area - to refer to secondary care for re-evaluation due to the small risk of progression to squamous cell carcinoma.
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 MHRA October 2019: Ingenol mebutate gel (Picato▼): increased incidence of skin tumours seen in some clinical studies
SE London APC recommendation: Ingenol for non-hyperkeratotic, nonhypertrophic AK in adults.
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Methyl-5-aminolevulinate cream (Metvix®)
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Formulary
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USE UNDER SPECIALIST SUPERVISION ONLY
Treatment of actinic keratoses, superficial or nodular basal cell carcinoma and Bowen's Disease.
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| Non Formulary Items |
Imiquimod 3.75% cream (Zyclara®)
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Non Formulary
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Not approved in SE London for use in actinic keratosis (AK) |
SE London APC recommendation: Imiquimod 3.75% cream (Zyclara™) for the treatment of actinic keratosis (AK)
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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Cancer Drugs Fund
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NHS England |
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Homecare |
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CCG |
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Traffic Light Status Information
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Description |
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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.
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Treatment can be initiated in primary care after a recommendation from an appropriate specialist |
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Specialist initiation followed by maintenance prescribing in primary care |
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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 |
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Specialist and non-specialist initiation |
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Not recommended for prescribing |
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