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NHS Bath and North East Somerset, Swindon and Wiltshire CCG
Royal United Hospitals Bath NHS Foundation Trust
Great Western Hospitals NHS Foundation Trust
Salisbury NHS Foundation Trust
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 Formulary Chapter 13: Skin - Full Chapter
Notes:

Only high cost medicines to be supplied within our health economy are listed on BSW Formulary, but patients may also have access to more specialised, high cost medicines via other specialist centres, if eligible.

Dermatology-related Prescribing Guidance

Please see our Prescribing Guidelines page for all prescribing guidance relating to this chapter.

Dermatology-related Shared Care Agreements

Please see our Shared Care Agreements page for all shared care agreements (SCAs) relating to this chapter.

Self-care

Many of the products in this chapter are available for purchase over-the-counter, and patients are encouraged to self-care, with the support of their community pharmacist, in the first instance.

For further information on self-care & the NHS, please refer to https://www.england.nhs.uk/medicines/conditions-for-which-over-the-counter-items-should-not-routinely-be-prescribed/

Dermatology Specials Approved List: see section 13.14

Please note that any specials listed in the BAD list are deemed to be RED on this formulary, so that specialists can prescribe them only.

 

 

 Details...
13.05.02  Expand sub section  Preparations for psoriasis
13.05.02  Expand sub section  Topical preparations for psoriasis
Calcipotriol 50mcg/g
(Topical)
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First Choice
Green
  • Scalp solution, calcipotriol 50 micrograms/ml
  • Ointment 50micrograms/g: Note this is not licensed in under 18 years
  • First Line Calcipotriol Ointment 50mcg/g 30g Dovonex®
  • Apply Calcipotriol thickly twice a day maximum of 100g per week
  • Second Line - If very itchy or inflamed consider adding in a steroid as a separate product e.g Eumovate or Betnovate RD:
  • Calcipotriol Ointment 50mcg/g 30g Dovonex® PLUS Eumovate Cream OR
  • Calcipotriol Ointment 50mcg/g 30g Dovonex® PLUS Betnovate RD Cream
  • Apply calcipotriol in the mornings thickly and steroid in the evenings thinly.
  • Gradually reduce the steroid and increase the calcipotriol to twice daily
  •  Note: When preparations used together, maximum total calcipotriol 5mg in any one week (eg. scalp solution 60ml with cream/ointment 30g OR cream/ointment 60g with scalp solution 30ml)
 
Calcipotriol 50micrograms/g with Betamethasone 0.05%
(Dovobet)
(Ointment)
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Formulary
Green
  • Ointment Calcipotriol 50mcg/g betamethasone diproprionate 500mcg/g 120g  
  • Contains a potent steroid which may destabilise psoriasis and increase its severity due to rebound pustulation and inflammation.
  • Usual max duration of treatment is 4 weeks. 
  • Max 15g daily to no more than 30% of body surface area; max 100g weekly; 75g weekly (child >12 yrs)
 
   
Calcipotriol and betamethasone 50 microgram/g + 0.5 mg/g
(Dovobet)
(Gel)
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Formulary
Green
  • Indications: Topical treatment of scalp psoriasis in adults. Topical treatment of mild to moderate “non-scalp” plaque psoriasis vulgaris in adults.
  • Contains a potent steroid which may destabilise psoriasis and increase its severity due to rebound pustulation and inflammation.
  • The recommended treatment period is 4 weeks for scalp areas and 8 weeks for “non-scalp” areas. If it is necessary to continue or restart treatment after this period, treatment should be continued after medical review and under regular medical supervision.
  • The maximum daily dose should not exceed 15 g. The body surface area treated with calcipotriol containing medicinal products should not exceed 30 %
 
   
Calcipotriol and Betamethasone cutaneous foam
(Enstilar®)
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Formulary
Green
  • One gram of cutaneous foam contains 50 micrograms of calcipotriol (as monohydrate) and 0.5 mg of betamethasone (as dipropionate).
  • Contains a potent steroid which may destabilise psoriasis and increase its severity due to rebound pustulation and inflammation.
  • Usual max duration of treatment is 4 weeks. 
  • Max 15g daily to no more than 30% of body surface area; max 100g weekly; 75g weekly (child >12 yrs)
 
   
Calcitriol 3micrograms/g
(Silkis®)
(Topical)
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Formulary
Green
  • Can be used on the face (with caution) and flexures unlike Dovonex.
  • It is recommended that not more than 35% of the body surface be exposed to daily treatment. Not more than 30 g of ointment should be used per day. There is limited clinical experience available for the use of this dosage regimen of more than 6 weeks.
 
   
Capasal ®
(Shampoo)
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Formulary
Self
  • Coal tar distilled 10 mg per 1 gram
  • Coconut oil 10 mg per 1 gram
  • Salicylic acid 5 mg per 1 gram
  • 250ml

 

 
   
Coal Tar Extract 5% (Alcoholic)
(Shampoo)
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Formulary
Self
  • Alphosyl 2 in 1®
  • 250ml
 
   
Coal tar lotion 5% (Exorex®)
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Formulary
Self
  • Coal Tar solution 5% emulsion 100ml, 250ml
  • Useful for guttate psoriasis. Dilute with water to form an emulsion. Apply a thin layer twice or three times a day. Also useful applied to scaly scalps overnight.

 

 
   
Cocois® 
(Ointment)
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Formulary
Self
  • Coal tar solution 120 mg per 1 gram
  • Salicylic acid 20 mg per 1 gram
  • Sulfur precipitated 40 mg per 1 gram
  • 40g,100g

 

 
   
Polytar®  
(Scalp shampoo)
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Formulary
Self
  • Coal tar solution 2.5%, arachis (peanut) oil extract of coal tar 7.5%, tar 7.5%, cade oil 7.5%, light liquid paraffin 35%
  • 150ml bottle
 
   
Sebco ® 
(Ointment)
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Formulary
Self
  •  Scalp ointment, coal tar solution 12%, salicylic acid 2%, precipitated sulphur 4%, in a coconut oil emollient basis 40g, 100g
 
   
Tars (Psoriderm®)
(Cream)
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Formulary
Self
  • Distilled Coal Tar 6.0% w/w
  • 225ml jar
 
   
Tars - bath preparations
(Psoriderm®)
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Formulary
Self
  • Psoriderm Emulsion 40% bath additive
  • Coal tar distilled 400 mg per 1 ml, 200ml
 
   
Dithranol 
(cream)
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Formulary
  • SelfCream: 0.1% 50g  0.25% 50g  , 0.5% 50g (Dithrocream Forte)  , 1% 50g (Dithrocream HP)
  • Green 2% 50g (Dithrocream 2%) (Prescription only)
  • For psoriasis. Increase strength gradually. Stains clothes
 
   
Dithranol  
View adult BNF View SPC online
Unlicensed Drug Unlicensed
Red
  • Restricted: Specialist Prescribing Only. Various forms as per BAD specials list.
  • See section 13.14 for BAD specials information

 

 

 
   
13.05.02  Expand sub section  Oral retinoids for psoriasis
 ....
 Non Formulary Items
Alphosyl HC ® cream


View adult BNF View SPC online
Non Formulary
 
Tacalcitol (Curatoderm®)

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Non Formulary
 
Tars (Clinitar®)

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Non Formulary
 
Tars (Cocois®)

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Non Formulary
 
Tars - bath preparations
(Pinetarsol®)

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Non Formulary
 
Tazarotene 0.05% (Zorac®)

View adult BNF View SPC online
Non Formulary
 
Zinc and Salicylic Acid Paste BP


View adult BNF View SPC online
Non Formulary
 
  
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 SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Red

RED - Hospital only – to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.  

Amber

Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.  

Amber with Shared Care

Shared Care - these medicines require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.  

Green

These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.  

Self

Suitable for patient to be directed to buy themselves  

Grey

Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.   

Black

Not currently used. We intend to include this TLS in future to highlight where a decision has been made by either or both the local or national NHS not to routinely commission this preparation for its licensed indications. Do not prescribe.  

Red Specialist Centre

Not currently used. We intend to include this TLS in future to highlight where this medicine and indication is ONLY available through a Specialist Centre according to a NICE Highly Specialised Technology or NHSE Specialised Commission Circular / Policy.  

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