North East and North Cumbria Formulary


	North East and North Cumbria ICS Formulary

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Formulary Chapter 13: Skin - Full Chapter

Notes:

Most prescribing uses licensed medicines whose safety and efficacy are assured. For many common dermatological diseases including psoriasis and eczema, the range of licensed medicines is limited. As a result, Dermatology prescribing may rely significantly on unlicensed creams and ointments (known as ‘Specials’) containing tars, dithranol, salicylic acid, steroids and other active constituents in a range of concentrations and bases. This is of particular concern in primary care where lack of effective price controls and a mechanism to ensure independent scrutiny of product quality has increased costs and concern about standards. To address these concerns, and help optimise quality of care, adherence to the revised British Association of Dermatologists (BAD) list of preferred Specials (2018) is encouraged.

Details...

13.04

Topical corticosteriods.

MHRA Drug Safety Update (Aug 2017): Corticosteroids: rare risk of central serous chorioretinopathy with local as well as systemic administration

MHRA Drug Safety Update (Sep 2021): Topical corticosteroids: information on the risk of topical steroid withdrawal reactions

NICE TA81: Frequency of application of topical corticosteroids for atopic eczema

13.04

Topical corticosteriod preparation potencies

13.04

Mild

Hydrocortisone 0.5%, 1% & 2.5%

Formulary

Cream and ointment

Hydrocortisone 1% with Clotrimazole 1% (Canesten HC^®)

Formulary

Cream 30g
15g available Over the Counter.

Hydrocortisone 1% with Miconazole Nitrate 2% (Daktacort^®)

Formulary

Cream 30g (15g available Over the Counter) and Ointment 30g

Hydrocortisone 1%, Oxytetracycline 3% (Terra-Cortril ®)

Formulary

Hydrocortisone Acetate 1% with Fusidic Acid 2% (Fucidin H^®)

Formulary

Nystaform-HC^®

Formulary

Cream and ointment

Timodine^®

Formulary

Cream

13.04

Moderate

Betamethasone (as Valerate) 0.025% (Betnovate-RD^®)

Formulary

Cream and ointment

Clobetasone Butyrate 0.05% (Eumovate^®)

Formulary

Cream, ointment & scalp application

Clobetasone butyrate with nystatin and oxytetracycline (Trimovate^®)

Formulary

Clobetasone butyrate 500mcg/1g, nystatin 100000iu/1g, oxytetracycline (as oxytetracycline calcium) 30mg/1g

Fludroxycortide (Haelan^®)
(Tape)

Formulary

13.04

Potent

Betamethasone (as Dipropionate) 0.05% with Salicylic Acid 3% (Diprosalic^®)

Formulary

Ointment

Betamethasone (as Valerate) 0.1%

Formulary

Cream, ointment & scalp application

Betamethasone (as Valerate) 0.1% with Clioquinol 3% (Betnovate C^®)

Formulary

Cream and ointment

Betamethasone (as Valerate) 0.1% with Fucidic Acid 2% (Fucibet^®)

Formulary

Betamethasone (as valerate) medicated plasters (Betesil^®)

Formulary

2.25mg medicated plasters

Flucinolone Acetonide 0.025% with Neomycin Sulphate 0.5% (Synalar N^®)

Formulary

Fluocinolone Acetonide 0.025% (Synalar^®)

Formulary

Cream, ointment & gel

Fluocinolone acetonide 0.025% with clioquinol 3% (Synalar C^®)

Formulary

Hydrocortisone Butyrate 0.1% cream (Locoid^®)

Formulary

Mometasone Furoate 0.1% (Elocon^®)

Formulary

13.04

Very Potent

Clobetasol Propionate 0.05% (Dermovate^®)

Formulary

Cream, ointment & scalp application

Clobetasol Propionate with neomycin and nystatin (Dermovate-NN^®)

Formulary

Ointment

13.04.01

Topical corticosteroid scalp applications

Betamethasone (as Dipropionate) 0.05% with Salicylic Acid 2% (Diprosalic^®)

Formulary

Scalp application

13.04.02

Topical corticosteroids - for use under specialist supervision only

13.04.03

Topical corticosteroids - unlicensed specials

13.04.04

Topical corticosteroids and anti-infective preparations

13.04.04

Very Potent

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Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to children's BNF
	Link to SPCs

	Cytotoxic Drug
	Controlled Drug
	High Cost Medicine
	NHS England
	Homecare
	CCG

Traffic Light Status Information

Status	Description
	Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment. In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances. For all RED drugs automatically added to the formulary in response to a positive NICE TA: Prescribers need to ensure that local Trust new drug governance procedures and pharmacy processes are followed before any prescribing.
	Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber. If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care.
	Drugs normally recommended or initiated by a specialist (hospital or GP with an extended role https://www.rcgp.org.uk/gpwer), but can be safely maintained in primary care with very little or no monitoring required. In some cases there may be a further restriction for use outlined - these will be defined in each case. Provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by GPs.
	Drugs where prescribing by GPs is appropriate. Can be initiated and prescribed in all care settings, and if appropriate, discontinued without recourse to secondary care.
	NOT APPROVED: Drugs that have been considered by NTAG or the NENC ICB Medicines Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria.
	UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review.
	NOT REVIEWED: Drugs that haven not been reviewed yet. This usually means that an application is in progress. These drugs are not normally considered appropriate for prescribing in the North East and North Cumbria until such time that a decision is taken on their formulary status.