| 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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| Chapter Links... |
 South East London Dermatology Guidelines for primary care |
| 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 and salicylic acid cutaneous solution (Actikerall®)
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Formulary
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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)
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APC recommendation: Actikerall® cutaneous solution for the topical treatment of actinic keratosis (grade I/II) in immunocompetent adult patients
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Fluorouracil cream 5% (Efudix®)
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Formulary
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Approved for licensed indications
 for actinic keratosis and Bowen's disease
 for use in basal cell carcinoma of the skin
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Imiquimod 5% cream (Aldara® - basal cell carcinoma and actinic keratosis)
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Formulary
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Approved for use (as a second line option to fluoruracil 5% cream) in:
Superficial basal cell carcinoma
Actinic keratosis
Refer to APC recommendations for further information
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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
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® - currently unavailable)
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Formulary
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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
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 MHRA Feb 20 - Ingenol mebutate gel (Picato▼): suspension of the licence due to risk of skin malignancy
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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 recommended for prescribing 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) (not approved)
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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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