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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...
13.06  Expand sub section  Acne and rosacea
 note 

Please refer to BSW Acne Prescribing Guidance for recommended treatment pathway in primary care

Metronidazole 0.75% (Cream)
View adult BNF View SPC online
First Choice
traffic lightGreen
  • Cream 0.75% 30g, 40g
  • Treatment of pustules and erythema of rosacea
  • Notes: Topical metronidazole preparations are licensed for different indications: rosacea (Rozex®) and malodorous tumours and skin ulcers (Anabact®). Therefore, it is important to prescribe the appropriate branded product.

 

 
Ivermectin
(Cream)
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Second Choice
traffic lightGreen
  • Cream 1% 30g
  • Treatment of moderate to severe inflammatory lesions of rosacea
  • Second line to metronidazole

 

 
 
Azelaic Acid
(Topical gel)
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Formulary
traffic lightGreen
  • Non-antibiotic treatment option for rosacea (adults only) and mild to moderate papular-pustular acne of the facial area (age 12 upwards).
  • Gel 15% 30g
  • Apply twice daily discontinue if no improvement  after 1 month (acne) or 2 months (rosacea) 

 

 
Link  BSW Acne Prescribing Guidelines
 
13.06.01  Expand sub section  Topical preparations for acne
13.06.01  Expand sub section  Benzoyl peroxide and azelaic acid
Benzoyl Peroxide
(Topical)
View adult BNF View SPC online
Formulary
traffic lightSelf
  • Aqueous gel 5% 
 
Link  BSW Acne Prescribing Guidelines
Link  NHS patient information benozyl peroxide
 
Benzoyl Peroxide 5% with Clindamycin 1%
(Topical gel)
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Formulary
traffic lightGreen
  • Gel benzoyl peroxide 5%, clindamycin 1% 25g, 50g
  • Apply once daily in the evening.

 

 
Link  BSW Acne Prescribing Guideline
 
13.06.01  Expand sub section  Topical antibacterials for acne
Clindamycin 1%
(Aqueous solution)
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Formulary
traffic lightGreen
  • 10% aqueous Solution
  • Topical antibiotics should not be used in isolation; use in combination with retinoids or benzoyl peroxide topically if possible.
  • Resistance is more likely with topical antibiotics and topical clindamycin can cause resistance to oral erythromycin. Only use topical clindamycin if retinoids/BPO aren't tolerated and the patient does not want to take an oral antibiotic (or has contra-indications).
 
Link  BSW Acne Prescribing Guidelines
 
Clindamycin/ tretinoin (Gel)
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Formulary
traffic lightGreen
  • Gel Tretinoin 0.025% and Clindamycin 1% 30g
 
Link  BSW Acne Prescribing Guidelines
 
Erythromycin 40mg with Zinc Acetate 12mg/mL
(Topical lotion)
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Formulary
traffic lightGreen
  • Topical lotion, powder for reconstitution, erythromycin 40mg/ml, Zinc acetate 12mg/ml 30ml, 90ml
  • Apply twice daily
  • Note that this product is not in local acne guidance due to high resistance levels. It was on the 3Ts and SFT formularies for children under 12 with acne only.

 

 
 
13.06.01  Expand sub section  Topical retinoids and related preparations for acne to top
Adapalene
(Topical)
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First Choice
traffic lightGreen
  • Cream 0.1% 45g
  • Gel 0.1% 45g
  • For the prevention of relapse.

 

 
Adapalene + Benzoyl peroxide
(Topical gel)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Gel Adapalene 0.1% and Benzoyl Peroxide 2.5% 45g 
  • Gel Adapalene 0.3% and Benzoyl Peroxide 2.5% 45g 
 
Link  BSW Acne Prescribing Guidelines
 
13.06.01  Expand sub section  Other topical preparations for acne
13.06.02  Expand sub section  Oral preparations for acne
 note 
  • Always combine systemic antibiotic with a topical anti-acne agent such as a retinoid or Benzoyl peroxide to reduce resistance and improve outcome

  • The need for continued antibiotic treatment should be reviewed at 3 months due to risk of resistance.

  • Erythromycin is best reserved for patients in whom other antibiotics are unsuitable as resistance is common

  • Tetracyclines can cause photosensitivity.
13.06.02  Expand sub section  Oral antibiotics for acne
Doxycycline
(Capsule)
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Formulary
traffic lightGreen
  • Capsules 100mg
  • 100mg once a day for 3 months then review
 
Link  BSW Acne Prescribing Guidelines
 
Lymecycline
(Capsule)
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Formulary
traffic lightGreen
  • Capsules 408mg
  • 408mg once a day for 3 months then review
  • Better compliance due to once daily dose.
 
Link  BSW Acne Prescribing Guidelines
 
Oxytetracycline
(Tablet)
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Formulary
traffic lightGreen
  • Tablets 250mg
  • 500mg twice a day for 3 months then review (two tablets twice daily)
 
Link  BSW Acne Prescribing Guidelines
 
Trimethoprim
(Tablet)
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Formulary
traffic lightAmber
  • Dermatologist recommendation only
  • 300mg Twice daily(off label)
 
 
Erythromycin
(Tablet)
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Formulary
traffic lightGreen
  • Tablets 250mg
  • First line children less than 12 years of age and in pregnant or breastfeeding women
  • 500mg twice a day for 3 months then review (two tablets twice daily)
 
Link  BSW Acne Prescribing Guidelines
Link  MHRA DSU Dec 2020 Erythromycin: caution required due to cardiac risks (QT interval prolongation); drug interaction with rivaroxaban
 
13.06.02  Expand sub section  Hormone treatment for acne
Co-Cyprindiol 2000/35
(Cyproterone Acetate 2mg with Ethinylestradiol 35micrograms)

(Tablet)
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Formulary
traffic lightGreen
  • Tablets cyproterone 2000mcg ethinyl estradiol 35mcg per tablet (prescribe generically, previous brand name Dianette)
 
Link  June 2020 - Cyproterone acetate: new advice to minimise risk of meningioma
Link  MHRA DSU APril 2008: Cyproterone acetate with ethinylestradiol (co-cyprindiol): recommended duration of use
Link  MHRA DSU Dec 2014: Cyproterone acetate with ethinylestradiol (co-cyprindiol): balance of benefits and risks remains positive
 
13.06.02  Expand sub section  Oral retinoid for acne to top
 note 

Note: Isotretinoin is a toxic drug that should only be prescribed by, or under the supervision of a consultant dermatologist.

This medicinal product is TERATOGENIC

Isotretinoin is contraindicated in women of childbearing potential unless all of the following conditions of the Pregnancy Prevention Programme are met. Further information and risk materials can be found on the Electronic Medicines Compendium website: https://www.medicines.org.uk/emc/search?q=isotretin

It is usually given for 16 weeks; repeat courses are not normally required. Side effects of isotretinoin include severe dryness of the skin and mucous membranes, nosebleeds and joint pains.

June 2019 DSU: Oral retinoid medicines▼: revised and simplified pregnancy prevention educational materials for healthcare professionals and women

Isotretinoin
(Capsule)
View adult BNF View SPC online
Formulary
traffic lightRed
  • Capsules 5mg, 10mg, 20mg
  • Women of child bearing age must be enrolled in the pregnancy prevention program.
  • Note: As a RED TLS drug, isotretinoin should be supplied by secondary care. A local exception to this is for Wiltshire patients under the care of the consultant-led integrated community dermatology service at Spa GP practice, Melksham - Cotswold Surgical Partners (CSP) and the BEMS community dermatology clinic.  Wiltshire community pharmacies can dispense FP10s for isotretinoin from CSP where it is clear that the prescription has been issued within the context of a Pregnancy Prevention Programme. Do not dispense 7 days beyond issue date of FP10. Further information on P6 of this newsletter.
 
Link  Pharmacist Checklist – Guidance for dispensing Roaccutane® (isotretinoin)
Link  June 2019 DSU: Oral retinoid medicines¥: revised and simplified pregnancy prevention educational materials for healthcare professionals and women
Link  MHRA DSU Dec 2014: Isotretinoin: risk of serious skin reactions
 
13.06.03  Expand sub section  Ocular rosacea
 ....
 Non Formulary Items
Abrasive Agents
(Brasivol®)

View adult BNF View SPC online
Non Formulary
 
Antibacterials
(Stiemycin®)

View adult BNF View SPC online
Non Formulary
 
Antibacterials
(Zindaclin®)

View adult BNF View SPC online
Non Formulary
 
Brimonidine gel
(Mirvaso®)
(rosacea)

View adult BNF View SPC online
Non Formulary
 
Corticosteroids
(Actinac®)

View adult BNF View SPC online
Non Formulary
 
Isotretinoin
(Isotrex® gel)

View adult BNF View SPC online
Non Formulary
 
Isotretinoin with antibacterial
(Isotrexin®)

View adult BNF View SPC online
Non Formulary
 
Salicylic Acid
(Acnisal®)

View adult BNF View SPC online
Non Formulary
 
Tretinoin (Retin-A®)

View adult BNF View SPC online
Non Formulary
 
Tretinoin with antibacterial
(Aknemycin® Plus)

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

Traffic LightRed

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

Traffic LightAmber

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

Traffic LightAmber 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.  

Traffic LightGreen

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

Traffic LightSelf

Suitable for patient to be directed to buy themselves  

Traffic LightGrey

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

Traffic LightBlack

(In use from Oct 2020) Used where a decision has been made by the BSW APC not to routinely commission this preparation for its licensed indications. Do not prescribe.   

Traffic LightRed 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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