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...

13.10

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

Cream and ointment

Metronidazole 0.75%

Formulary

Cream & gel

13.10.02

Antifungal preparations

Clotrimazole 1% cream

Alternatives

Ketoconazole

Alternatives

2% cream
shampoo

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

MHRA Drug Safety Update (March 2018): Head lice eradication products: risk of serious burns if treated hair is exposed to open flames or other sources of ignition, eg, cigarettes

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

	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.