Formulary Chapter 13: Skin - Full Chapter
|
Notes: |
Specials Recommended by the British Association of Dermatologists for Skin Disease
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... |
13.10 |
Anti-infective skin preparations |
|
|
13.10.01 |
Antibacterial preparations |
|
|
13.10.01.01 |
Antibacterial preparations only used topically |
|
|
Mupirocin 2% Ointment (Bactroban®)
|
Formulary
|
|
|
Silver Sulfadiazine 1% cream (Flamazine®)
|
Formulary
|
|
|
Potassium Iodide capsules
|
Restricted
|
- Unlicensed
- Potassium Iodide 60mg and 300mg capsules
- Approved for neutrophilic dermatoses (Sweet syndrome and pyoderma gangrenosum) and panniculitis (including erythema nodosum and nodular vasculitis)
- Dermatology only
|
|
Nitrofurazone 0.2% Ointment
|
Unlicensed
|
- For limited use in burns/plastic surgery patients only.
|
|
13.10.01.02 |
Antibacterial preparations also used systemically |
|
|
Fusidic Acid 2%
|
Formulary
|
|
|
Metronidazole 0.75%
|
Formulary
|
Cream & gel
|
|
13.10.02 |
Antifungal preparations |
|
|
Clotrimazole 1% cream
|
Alternatives
|
|
|
Ketoconazole
|
Alternatives
|
|
|
Miconazole 2% cream
|
Alternatives
|
|
MHRA Drug Safety Update (June 2016): Topical miconazole, including oral gel: reminder of potential for serious interactions with warfarin
|
Terbinafine 1% cream
|
Alternatives
|
|
|
13.10.03 |
Antiviral preparations |
|
|
Aciclovir 5% cream
|
Formulary
|
|
|
13.10.04 |
Parasiticidal preparations |
|
|
13.10.04 |
Scabies |
|
|
Ivermectin
|
Formulary
|
- 3mg tablets
- Approved for the treatment of scabies in accordance with DHSC Medicine Supply Notification
- Note: The licensed preparation is currenly only avialable from Alliance.
|
DHSC Medicine Supply Notification - Permethrin 5% w/w cream
|
Permethrin 5% (Lyclear® Dermal Cream)
|
Formulary
|
|
|
13.10.04 |
Head lice |
|
|
Dimeticone 4% lotion (Hedrin®)
|
First Choice
|
|
|
Malathion 0.5% solution (aqueous)
|
Second Choice
|
|
|
Permethrin 1% (Lyclear® Creme Rinse)
|
Formulary
|
|
|
|
13.10.04 |
Crab lice |
|
|
Permethrin 5% (Lyclear® Dermal Cream)
|
Formulary
|
|
|
13.10.04 |
Benzyl benzonate |
|
|
13.10.04 |
Carbaryl |
|
|
13.10.04 |
Dimeticone |
|
|
13.10.04 |
Malathion |
|
|
13.10.04 |
Permethrin |
|
|
13.10.04 |
Phenothrin |
|
|
13.10.05 |
Preparations for minor cuts and abrasions |
|
|
Bismuth Subnitrate and Iodoform (B.I.P.P.) Paste
|
Formulary
|
- For use in ENT surgery & epistaxis
1.25cm x 100cm & 2.5cm x 100cm impregnated gauze
|
|
Drapolene® cream
|
Formulary
|
|
|
Enbucrilate
|
Formulary
|
- See 13.10.05 skin tissue adhesives (Liquiband®, Liquiband Optima®, IndermilX-Fine, Histoacryl Blue®)
|
|
Lanolin Cream
|
Formulary
|
|
|
Magnesium Sulphate Paste BP
|
Formulary
|
|
|
13.10.05 |
Collodion |
|
|
Collodion Flexible BP
|
Formulary
|
- 2.5% castor oil & colophony 2.5% in a collodion base.
|
|
13.10.05 |
Skin tissue adhesive |
|
|
Fibrin sealant (Artiss®)
|
Formulary
|
- 2ml, 4ml & 10ml prefilled syringe.
- For use in plastic surgery to close dead spaces, adhere skin graft, close simple wounds and stabilise bone grafts.
|
|
Fibrin sealant (Bioglue®)
|
Formulary
|
- For use in neurosurgery and vascular surgery.
|
|
Fibrin sealant (Evicel® Human Fibrin Glue)
|
Formulary
|
2ml and 5ml kit
|
|
Fibrin sealant (Floseal® Matrix sealant)
|
Formulary
|
|
|
Fibrin sealant (Tisseel Lyo® Fibrin Glue)
|
Formulary
|
- 2ml, 4ml & 10ml kit
- Also approved for use in the treatment of mesh fixation in hernia repair.
|
|
Histoacryl Blue®
|
Formulary
|
|
|
Indermil X-Fine®
|
Formulary
|
|
|
LiquiBand Optima®
|
Formulary
|
|
|
LiquiBand®
|
Formulary
|
|
|
TachoSil®
|
Formulary
|
- 4.8 & 9.5 cm 2 Haemostatic (collagen sponge coated with fibrinogen and thrombin) - for use in liver and renal surgery.
|
|
.... |
Non Formulary Items |
Amorolfine 5% nail lacquer cream (Loceryl®)
|
Non Formulary
|
|
|
|
Key |
|
|
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. |
|
|
|