netFormulary NHS
North East and North Cumbria
ICS Formulary
 Search
 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...
13.05.03  Expand sub section  Drugs affecting the immune response
Abrocitinib (Cibinqo®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
CCG
  • Approved for the treatment of moderate to severe atopic dermatitis in line with NICE



 
Link  MHRA Drug Safety Update (April 2023): Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality
Link  NICE TA814: Abrocitinib, tralokinumab or upadacitinib for treating moderate to severe atopic dermatitis
 
Adalimumab
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
  • Approved for psoriasis in line with NICE.
  • Approved for the treatment of moderate to severe hidradenitis suppurativa in line with NICE and NHS England Commissioning Policy
  • Approved for the treatment of plaque psoriasis in children and young people in line with NICE 

Biosimilars are available – note that indications can differ between different products – prescribe by brand. Consult with individual trust pharmacy department for details of
preferred biosimilar brand.

 
Link  NICE TA146 Adalimumab for the treatment of adults with psoriasis
Link  NICE TA392: Adalimumab for treating moderate to severe hidradenitis suppurativa
Link  NICE TA455 Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people
 
Apremilast (Otezla®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
  • 10mg, 20mg & 30mg tablets
  • To be used in accordance with NICE guidance
 
Link  MHRA Drug Safety Update (Jan 2017): Apremilast (Otezla ): risk of suicidal thoughts and behaviour
Link  NICE TA419: Apremilast for treating moderate to severe plaque psoriasis
 
Baricitinib (Olumiant®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • Approved for treating moderate to severe atopic dermatitis in adults in line with NICE.
 
Link   NICE TA681: Baricitinib for treating moderate to severe atopic dermatitis
Link  MHRA Drug Safety Update (April 2023): Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality
Link  MHRA Drug Safety Update (Aug 2020): Baricitinib (Olumiant▼): increased risk of diverticulitis, particularly in patients with risk factors
Link  MHRA Drug Safety Update (Mar 2020): Baricitinib (Olumiant▼): risk of venous thromboembolism
 
Bimekizumab  (Bimzelx®)
View adult BNF View SPC online View SMC online View childrens BNF
Formulary
Red
  • 160mg/ml solution pre-filled pen/syringe
  • Approved for the treatment of moderate to severe plaque psoriasis in line with NICE

 

 
Link  NICE TA723: Bimekizumab for treating moderate to severe plaque psoriasis
 
Brodalumab (Kyntheum® )
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
CCG
  • 210mg/1.5ml solution for injection in pre-filled syringes.
  • Approved for the treatment of moderate to severe plaque psoriasis in line with NICE 



 

 
Link  NICE TA511: Brodalumab for treating moderate to severe plaque psoriasis
 
Certolizumab pegol 
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
Link  NICE TA574: Certolizumab pegol for treating moderate to severe plaque psoriasis
 
Ciclosporin
View adult BNF View SPC online View childrens BNF
Formulary
Amber
  • Capsules & SF Solution 
    See section 8.2.2
 
Link  County Durham and Darlington Shared Care Guideline: Ciclosporin
Link  Tees Valley Shared Care Guideline: Ciclosporin
 
Deucravacitinib (Sotyktu)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
CCG
  • 6mg tablets
  • Approved for the treatment of moderate to severe plaque psoriasis in line with NICE
 
Link  NICE TA907: Deucravacitinib for treating moderate to severe plaque psoriasis
 
Dimethyl fumarate (Skilarence®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
  • 120mg tablets
  • Approved for the treatment of moderate to severe plaque psoriasis in line with NICE
 
Link  NICE TA475 Dimethyl fumarate for treating moderate to severe plaque psoriasis
 
Dupilumab (Dupixent®)
View adult BNF View SPC online View SMC online View childrens BNF
Formulary
Red
High Cost Medicine
NHS England
  • 200mg/1.14ml & 300mg/2ml solution for injection
  • Approved for treating moderate to severe atopic dermatitis in adults in line with NICE
 
Link  MHRA Drug Safety Upate (Nov 2022): Dupilumab (Dupixent▼): risk of ocular adverse reactions and need for prompt management
Link  NICE TA534: Dupilumab for treating moderate to severe atopic dermatitis
 
Etanercept (Enbrel®, Benapali® & Erelzi®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
  • Approved for psoriasis in line with NICE
  • Approved for the treatment of plaque psoriasis in children and young people in line with NICE

 

Biosimilars are available – note that indications can differ between different products – prescribe by brand. Consult with individual trust pharmacy department for details of
preferred biosimilar brand.

 
Link  NICE TA103: Psoriasis - efalizumab and etanercept
Link  NICE TA455 Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people
 
Guselkumab (Tremfya®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
CCG
  • 100mg/1mL solution for injection
  • Approved for the treatment of moderate to severe plaque psoriasis in line with NICE

 

 
Link  NICE TA521: Guselkumab for treating moderate to severe plaque psoriasis
 
Hydroxychloroquine
(Dermatology)
View adult BNF View SPC online View childrens BNF
Formulary
Amber
 
Link  County Durham and Darlington Shared Care Guideline: Hydroxychloroquine
Link  MHRA Drug Safety Update (Feb 2022): Hydroxychloroquine, chloroquine: increased risk of cardiovascular events when used with macrolide antibiotics; reminder of psychiatric reactions
Link  North of Tyne, Gateshead and North Cumbria - Hydroxychloroquine Shared Care Guidance v5 (October 2022)
 
Infliximab (Remsima®, Inflectra®, Remicade®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine

  • Approved for psoriasis in line with NICE.

 
Link  Infliximab subcutaneous injection (Remsima SC ®) - interim COVID-19 guidance
Link  NICE TA134: Infliximab for psoriasis
 
Ixekizumab (Taltz®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
  • Approved for the treatment of moderate to severe plaque psoriasis in adults in line with NICE

 

 
Link  NICE TA442 Ixekizumab for treating moderate to severe plaque psoriasis
 
Cytotoxic Drug Methotrexate
View adult BNF View SPC online View childrens BNF
Formulary
Amber

 

 
Link  County Durham and Darlington Shared Care Guideline: Methotrexate
Link  MHRA Drug Safety Update (Sept 2020): Methotrexate once-weekly for autoimmune diseases: new measures to reduce risk of fatal overdose due to inadvertent daily instead of weekly dosing
Link  Tees Valley Shared Care Guideline: Methotrexate
 
Pimecrolimus cream (Elidel®)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • Approved for moderate disease on face and neck for those between 2 and 16 years in line NICE.
 
Link  NICE TA82: Pimecrolimus and tacrolimus for atopic dermatitis (eczema)
 
Risankizumab (Skyrizi®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine

  • Approved for the treatment of moderate to severe plaque psoriasis in line with NICE

 
Link  NICE TA596: Risankizumab for treating moderate to severe plaque psoriasis
 
Secukinumab (Cosentyx®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
  • Approved for the treatment of plaque psoriasis in line with NICE.
  • Approved for the treatment of moderate to severe plaque psoriasis in children and young people in line with NICE
  • Approved for treating moderate to severe hidradenitis suppurativa in  line with NICE
 
Link  NICE TA350: Secukinumab for treating moderate to severe plaque psoriasis
Link  NICE TA734: Secukinumab for treating moderate to severe plaque psoriasis in children and young people
Link  NICE TA935: Secukinumab for treating moderate to severe hidradenitis suppurativa
 
Tacrolimus ointment (Protopic® )
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • Approved for moderate to severe disease atopic eczema in patients over 2 years in line with NICE.
 
Link  NICE TA82: Pimecrolimus and tacrolimus for atopic dermatitis (eczema)
 
Tildrakizumab (Ilumetri®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • 100 mg solution for injection in pre-filled syringe
  • Approved for the treatment of moderate to severe plaque psoriasis in line with NICE
 
Link  NICE TA575: Tildrakizumab for treating moderate to severe plaque psoriasis
 
Tralokinumab (Adtralza®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
CCG
  • Approved for the treatment of moderate to severe atopic dermatitis in line with NICE



 
Link  MHRA Drug Safety Update (April 2023): Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality
Link  NICE TA814: Abrocitinib, tralokinumab or upadacitinib for treating moderate to severe atopic dermatitis
 
Upadacitinib (Rinvoq®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
CCG
  • Approved for the treatment of moderate to severe atopic dermatitis in line with NICE
 
Link  NICE TA814: Abrocitinib, tralokinumab or upadacitinib for treating moderate to severe atopic dermatitis
 
Ustekinumab (Stelara®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
  • 45mg & 90mg SC injections approved for psoriasis in line with NICE.
  • Approved for the treatment of plaque psoriasis in children and young people in line with NICE
 
Link  MHRA Drug Safety Update (Jan 2015): Ustekinumab (Stelara): risk of exfoliative dermatitis
Link  NICE TA180: Psoriasis - ustekinumab (Updated March 2017)
Link  NICE TA455 Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people
 
13.05.03.01  Expand sub section  Cytokine modulators (biologic therapies) - eczema
13.05.03.02  Expand sub section  Cytokine modulators (biologic therapies) - psoriasis
 ....
 Non Formulary Items
Baricitinib  (Olumiant®)

View adult BNF View SPC online View childrens BNF
Non Formulary
Black
  • Not approved for the treatment of severe alopecia areata
Link  NICE TA926: Baricitinib for treating severe alopecia areata
  
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 children's BNF
click to search medicines.org.uk
Link to SPCs
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red

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.  

Amber

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.  

Green plus

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.  

Green

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.  

Black

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.   

Brown

UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review.  

Not Recomended

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.  

netFormulary