Dermatology

Dermatology Specialist formulary list

**Other indications for particular drugs may be included on completion of further specialist lists**

For information on use of unlicensed medicines or medicines used 'off-label' - click here

The following medicines are approved for prescribing by or on the recommendation of a Consultant Dermatologist or Dermatological Surgeon for the treatment of adults:

TAF SECTION	MEDICINE	SUMMARY OF RESTRICTED INDICATION	CATEGORY	PROTOCOL
13.3	Ranitidine tablets	Chronic Urticaria (unlicensed use ‘off-label’) after H1 antihistamines		1. Guidelines for evaluation and management of urticaria in adults and children
13.3	Montelukast 10mg tablets	Chronic Urticaria (unlicensed use ‘off-label’) after ranitidine
13.3	Lidocaine 4% cream (LMX 4^®)	Reserved for patients with a latex allergy who require minor surgery (unlicensed use ‘off-label’)
13.4	Pigmanorm^®cream (hydroquinone, tretinoin, hydrocortisone) (unlicensed)	Melanin hyperpigmentation		Pigmanorm^® SPC and Pigmanorm^® PIL available on request from IDIS
13.5.1 13.5.3	Tacrolimus ointment	Moderate to severe atopic eczema (dermatitis). See Shared Care Agreement.		See SIGN 125 Management of atopic eczema in primary care Tacrolimus Ointment Shared Care Agreement (Staffnet intranet link only)
13.5.1	Alitretinoin capsules	Severe chronic hand eczema unresponsive to treatment with potent topical corticosteroids		To be dispensed by a hospital pharmacy only. Monitoring is undertaken by the Dermatology Clinic.
13.5.2	8-Methoxypsoralen 10mg tablets (unlicensed)	Skin conditions requiring PUVA light therapy (e.g. whole body psoriasis)		2. Calculation of 8MOP dose according to BSA in PUVA treatment
	5-Methoxypsoralen 20mg tablets (unlicensed)	Skin conditions requiring PUVA light therapy (e.g. whole body psoriasis), where nausea or gastrointestinal adverse effects with 8-Methoxypsoralen.		Photonet: Oral PUVA. Patient Information Leaflet. Photonet: Treatment Protocols. http://www.photonet.scot.nhs.uk/
	8-Methoxypsoralen 0.005% gel (unlicensed)	Skin conditions requiring PUVA light therapy (topical treatment for localised areas).		3. Guidelines for topical PUVA
	8-Methoxypsoralen 1.2% Bath Lotion (unlicensed)	Skin conditions requiring PUVA light therapy (topical treatment for localised areas)		3. Guidelines for topical PUVA
13.5.2	Acitretin (Neotigason^®) capsules	Psoriasis – severe or refractory Severe congenital ichthyosis Severe Darier's disease (keratosis follicularis) Hidradenitis suppurativa (unlicensed use 'off-label') Severe refractory eczema (unlicensed use ‘off-label’)		4. Guidelines on the efficacy and use of acitretin in dermatology
	Fumaric Acid Esters (Fumaderm^®) (unlicensed)	Psoriasis – severe or refractory in patients not suitable or not responded to other systemic therapies		See SIGN 121 Diagnosis and management of psoriasis and psoriatic arthritis in adults Fumaderm^® SPC and Fumaderm^® PIL available on request from IDIS.
	Hydroxycarbamide (Hydroxyurea) 500mg capsules	Psoriasis - severe or refractory in patients not suitable or not responded to other systemic therapies (unlicensed use ‘off-label’)		See SIGN 121 Diagnosis and management of psoriasis and psoriatic arthritis in adults
13.5.3	Azathioprine tablets	Systemic lupus erythematosus Dermatomyositis and polymyositis Pemphigus vulgaris Autoimmune bullous disorders (unlicensed use ‘off-label’) Severe refractory eczema (unlicensed use ‘off-label’)		SCA under development 5. Guidelines for the safe and effective prescribing of azathioprine BSR guideline for disease-modifying anti-rheumatic drug (DMARD) therapy in consultation with the British Association of Dermatologists 6. Guidelines for the management of bullous pemphigoid 7. Guidelines for the management of contact dermatitis 8. Guidelines for the management of pemphigus vulgaris
	Chloroquine phosphate tablets (low dose)	Porphyria Cutanea Tarda (unlicensed use ‘off-label’)		9. The cutaneous porphyrias
	Ciclosporin capsules (specify brand name on prescription)	Short-term treatment of severe atopic dermatitis where conventional therapy ineffective or inappropriate Autoimmune bullous disorders (unlicensed use ‘off-label’) Severe psoriasis		SCA under development BSR guideline for disease-modifying anti-rheumatic drug (DMARD) therapy in consultation with the British Association of Dermatologists 7. Guidelines for the management of contact dermatitis 6. Guidelines for the management of bullous pemphigoid See SIGN 121 Diagnosis and management of psoriasis and psoriatic arthritis in adults
	Dapsone tablets	Dermatitis Herpetiformis and other dermatoses Autoimmune bullous disorders (unlicensed use ‘off-label’) Hidradenitis Suppurativa (unlicensed use ‘off-label’) Neutrophilic vasculitides (unlicensed use ‘off-label’) Other indications – see Shared Care Agreement		Dapsone Shared Care Agreement 6. Guidelines for the management of bullous pemphigoid 10 Hidrandenitis suppurativa: a review of cause and treatment
	Hydroxychloroquine sulphate tablets	Systemic and Discoid Lupus Erythematosus Dermatological conditions caused or aggravated by sunlight Other cutaneous lupus erythematosus (unlicensed use ‘off-label’) Skin manifestations of dermatomyositis (unlicensed use ‘off-label’)		SCA under development BSR guideline for disease-modifying anti-rheumatic drug (DMARD) therapy in consultation with the British Association of Dermatologists Hydroxychloroquine and Ocular Toxicity Recommendations on Screening 2009
13.5.3 13.6	Lymecycline capsules	Autoimmune bullous disorders (unlicensed use ‘off-label’) Pyoderma gangrenosum (unlicensed use ‘off-label’) Hidradenitis suppurativa (unlicensed use ‘off-label’) Severe atopic eczema (unlicensed use ‘off-label’)		6. Guidelines for the management of bullous pemphigoid 10 Hidrandenitis suppurativa: a review of cause and treatment
13.5.3	Mepacrine hydrochloride 100mg tablets (unlicensed)	Discoid Lupus Erythematosus		2^nd line to hydroxychloroquine or in combination with hydroxychloroquine
	Mycophenolate mofetil tablets	Autoimmune bullous disorders (unlicensed use ‘off-label’) Severe refractory eczema in those unresponsive to or intolerant of other immunosuppressants (unlicensed use ‘off-label’) Systemic lupus erythematosus (unlicensed use ‘off-label’) Dermatomyositis and polymyositis (unlicensed use ‘off-label’)		SCA under development BSR guideline for disease-modifying anti-rheumatic drug (DMARD) therapy in consultation with the British Association of Dermatologists 6. Guidelines for the management of bullous pemphigoid
	Methotrexate (oral) - 2.5mg tablets ONCE WEEKLY	Psoriasis – severe or refractory Severe atopic eczema (unlicensed use ‘off-label’)		SCA under development See SIGN 121 Diagnosis and management of psoriasis and psoriatic arthritis in adults BSR guideline for disease-modifying anti-rheumatic drug (DMARD) therapy in consultation with the British Association of Dermatologists.
	Methotrexate (parenteral) - 50mg/mL solution for injection (Metoject^®) ONCE WEEKLY	Psoriasis – severe or refractory Severe psoriatic arthritis
		Severe atopic eczema (unlicensed use ‘off-label’)	Note: May be administered in primary care.
13.5.3	Adalimumab (Humira^®▼) injection	Severe psoriasis according to criteria (see local guidelines)		Guidelines on the Biological Treatment of Severe Psoriasis (NHS Tayside Staffnet intranet link only) See SIGN 121 Diagnosis and management of psoriasis and psoriatic arthritis in adults Ustekinumab has a PAS agreement
	Etanercept (Enbrel^®▼) injection
	Infliximab (Remicade^®) intravenous infusion
	Ustekinumab (Stelara^®▼) injection
13.6	Minocycline tablets	Pyoderma gangrenosum (unlicensed use ‘off-label’) Hidradenitis suppurativa (unlicensed use ‘off-label’)		10 Hidrandenitis suppurativa: a review of cause and treatment
	Trimethoprim tablets	Acne resistant to other antibacterials (unlicensed use ‘off-label’)
	Isotretinoin capsules	Severe forms of acne resistant to adequate courses of standard therapy with systemic antibacterials and topical therapy Rosacea (unlicensed use ‘off-label’) Hidradenitis suppurativa (unlicensed use ‘off-label’)		Isotretinoin Patient Pathway (Staffnet intranet link only) Monitoring is undertaken by the Dermatology Clinic. Advice on the safe introduction and continued use of isotretinoin in acne in the UK 2010 11. Advice on the safe introduction and continued use of isotretinoin in acne 10 Hidrandenitis suppurativa: a review of cause and treatment
13.8	Imiquimod cream	Superficial Basal Cell Carcinoma Actinic Keratoses		Imiquimod Cream Protocol for actinic keratosis Click here
	Methyl aminolevulinate 16% cream (Metvix^®)	Skin conditions requiring photodynamic therapy including thin or non-hyperkeratotic and non-pigmented actinic keratoses on the face and scalp when other therapies are considered less appropriate, superficial and/or nodular basal cell carcinoma unsuitable for other available therapies, squamous cell carcinoma in situ (Bowen´s disease) when surgical excision is considered less appropriate.		Dermatology Department Photodynamic Therapy Patient Information Leaflet (Staffnet intranet link only) 12. Guidelines for topical photodynamic therapy
	5-Aminolevulinic Acid 20% cream (unlicensed)	Skin conditions requiring photodynamic therapy.
	5-Aminolevulinic Acid 7.8% gel (Ameluz^®)	Treatment of actinic keratosis of mild to moderate intensity on the face and scalp (Olsen grade 1 - 2).		Photodynamic Therapy Patient Information Leaflet (Staffnet intranet link only) 12. Guidelines for topical photodynamic therapy
13.12	Aluminium chloride hexahydrate 10% in 4% salicylic gel (unlicensed)	Hyperhidrosis – particularly for palmar and plantar hyperhidrosis, where commercially available aluminium chloride preparations are ineffective or not well tolerated.		Hyperhidrosis Guideline
	Aluminium chloride hexahydrate 20% in 4% salicylic gel (unlicensed) (available from Tayside Pharmaceuticals, special-order manufacturer)
	Glycopyrrolate 2% in unguentum merck (unlicensed)	Hyperhidrosis - in patients who fail to respond to a one month trial of aluminium antiperspirants, tap water and glycopyrrolate solution iontophoresis (or where iontophoresis is not appropriate).
	Glycopyrrolate 2% in aqueous solution (unlicensed) (available from NHS GG&C Western Infirmary, special-order manufacturer)
	Glycopyrrolate 0.05% solution (unlicensed) (available from Nova Laboratories Ltd)	Hyperhidrosis (iontophoresis solution) – where patients have not responded to tap water iontophoresis.
	Oxybutynin tablets	Hyperhidrosis (unlicensed use ‘off-label’) – adjunct to topical treatments
	Propiverine hydrochloride tablets
	Propranolol tablets	Hyperhidrosis (unlicensed use ‘off-label’) – where anxiety a precipitating factor
	Fluoxetine capsules, liquid	Hyperhidrosis (unlicensed use ‘off-label’) - where associated with or is likely to be exacerbated by anxiety or social phobia
	Botulinum Toxin Type A (Botox^®)	Severe hyperhidrosis of the axillae which does not respond to topical treatment with antiperspirants or antihidrotics
13.13	Pentoxifylline 400mg tablets	Chronic venous leg ulceration that has not responded to compression bandaging or those unsuitable for compression bandaging (unlicensed use ‘off-label’)		See SIGN 120 Management of chronic venous leg ulcers

	May be prescribed by Hospital Specialists only
	May be prescribed in General Practice under the direction of a Specialist

For further information refer to the Department of Dermatology website, the British Association of Dermatologists (BAD) website and the NHS Scotland Dermatology Referral and Management Pathways website.

Click here for a link to the British Association of Dermatologists (BAD) Patient Information Leaflets (PILs).

Click here for a link to the BAD ‘Specials’ list of preferred unlicensed dermatological preparations.

References: