NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Prescribing
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13 Skin

13.5 Preparations for eczema and psoriasis

13.5.1 Preparations for eczema

Preferred list
ICHTHAMMOL 1% (SPECIAL OINTMENT)

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/5965.htm#_5965

ZINC PASTE AND ICHTHAMMOL BANDAGE BP

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/5967.htm

Total Formulary
ALITRETINOIN

Restrictions: Only to be prescribed via dermatology clinics.

Prescribing Notes:

A treatment dose of 30mg once daily is recommended and should only be reduced to 10mg once daily if not tolerated.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/201617.htm

13.5.2 Preparations for psoriasis

Preferred list
Total Formulary
SALICYLIC ACID IN AQUEOUS CREAM 10%

Prescribing Notes:

This is not available as a licensed proprietary preparation, but is routinely available as a "special"

SALICYLIC ACID IN AQUEOUS CREAM 5%

Prescribing Notes:

This is not available as a licensed proprietary preparation, but is routinely available as a "special"

DITHRANOL (DITHROCREAM) (CREAM)

Prescribing Notes:

Available in 0.1%, 0.25%, 0.5%, 1% and 2% strengths.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/5984.htm#_5984

SALICYLIC ACID IN YELLOW SOFT PARAFFIN 10%

Prescribing Notes:

This is not available as a licensed proprietary preparation, but is routinely available as a "special"

SALICYLIC ACID IN YELLOW SOFT PARAFFIN 5%

Prescribing Notes:

This is not available as a licensed proprietary preparation, but is routinely available as a "special"

ACITRETIN

Restrictions: Restricted to specialist use only. Restricted to hospital use under specialist dermatological supervision.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/5995.htm

COAL TAR AND SALICYLIC ACID (OINTMENT)

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/5943.htm#_5943

CALCIPOTRIOL AND BETAMETHASONE

Prescribing Notes:

Calcipotriol and betamethasone can be supplied as individual preparations at a significantly reduced cost. A suggested regimen of the separate preparations may be calcipotriol applied in the morning with application of betamethasone at night.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/106478.htm

13.5.3 Drugs affecting the immune response

Preferred list
CICLOSPORIN

Restrictions: Restricted to use under specialist dermatological supervision

Prescribing Notes:

Can be used for severe atopic dermatitis or severe psoriasis when conventional therapy has failed.

Prescribe by brand name.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4783.htm

METHOTREXATE (2.5MG TABLETS)

Restrictions: Restricted to use under specialist dermatological supervision.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/6002.htm

Total Formulary
PIMECROLIMUS (CREAM)

Restrictions: Restricted to initiation by physicians experienced in the management of eczema. It is restricted to the management of moderate eczema on the face and neck of children aged between 2 years and 16 years that has not been controlled by topical steroids or where there is serious risk of important adverse effects from further topical steroid use, particularly irreversible skin atrophy.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/119691.htm

TACROLIMUS (OINTMENT)

Restrictions: Topical tacrolimus is restricted to initiation and review by a dermatologist.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/119635.htm

INFLIXIMAB

Restrictions: Restricted to specialist use only. Treatment of severe plaque psoriasis in adults is restricted to specialist use in patients who failed to respond to, or who have a contraindication to, or are intolerant of other systemic therapy including ciclosporin, methotrexate or psoralen ultraviolet A (PUVA) and in accordance with the local approved protocol.

Prescribing Notes:

Infliximab should be prescribed by brand name

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/201653.htm

ADALIMUMAB (injection)

Restrictions: Restrictions apply as per prescribing notes below.

Prescribing Notes:

Formulary indications:

  • Treatment of chronic plaque psoriasis is restricted to specialist use only in patients with severe disease as defined by a total Psoriasis Area Severity Index (PASI) score of >10 and a Dermatology Life Quality Index (DLQI) of >10.
  • Treatment of moderate to severe hidradenitis suppurativa (HS) in adult patients with an inadequate response to conventional systemic HS therapy is restricted to specialist use only.

 

For use in other indications, see sections 1.5.3 and 10.1.3

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/128230.htm

APREMILAST (tablets)

Restrictions: The treatment of moderate to severe chronic plaque psoriasis in adults patients who failed to respond to or who have a contraindication to, or are intolerant to other systemic therapy including ciclosporin, methotrexate or psoralen and ultraviolet-A light (PUVA) is restricted to specialist use only.

Prescribing Notes:

For other indications please see chapter 10.1.3

ETANERCEPT

Restrictions:

Restricted to specialist use only.

  • Use for adults with psoriasis is restricted to initiation and supervision only by specialist physicians in accordance with NICE Technology Appraisal 103. 
  • Use for the treatment of chronic severe plaque psoriasis in children and adolescents is restricted to specialist use in patients where the disease:
    • is severe as defined by a total Psoriasis Area Severity Index (PASI) of 10 or more and a Dermatology Life Quality Index (DLQI) of more than 10,
    • has failed to respond to standard systemic therapies or the patient is intolerant to, or has a contraindication to these treatments,
  • Etanercept should be discontinued in patients whose psoriasis has not responded adequately at 12 weeks.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/201652.htm

IXEKIZUMAB (injection)

Restrictions:

Restricted to specialist use in patients who have failed to respond to standard systemic therapies (including ciclosporin, methotrexate and phototherapy), are intolerant to, or have a contra-indication to these treatments

METHOTREXATE (Metoject) (PRE-FILLED SYRINGE)

Restrictions: Restricted to specialist use only. Restricted to use under specialist dermatological supervision.

BNF Link: http://bnf.org/bnf/bnf/current/6002.htm

SECUKINUMAB

Restrictions: Use for moderate to severe plaque psoriasis in adults is restricted to specialist use in patients who have failed to respond to standard systemic therapies (including ciclosporin, methotrexate and phototherapy), are intolerant to or have contraindications to these treatments.

USTEKINUMAB (STELARA) (injection)

Restrictions:

Restricted to specialist use in accordance with the prescribing notes below.

Prescribing Notes:

Psoriasis in adults:

  • The treatment of moderate to severe plaque psoriasis in adults who failed to respond to, or who have a contraindication to, or are intolerant to other systematic therapies including ciclosporin, methotrexate and psoralen and UVA treatment (PUVA) is restricted to specialist use. Continued treatment should be restricted to patients who achieve a PASI 75% response within 16 weeks.

Psoriasis in adolescents:

  • The treatment of moderate to severe plaque psoriasis in adolescent patients from the age of 12 years and older, who are inadequately controlled by, or are intolerant to, other systemic therapies or phototherapies is restricted to specialist use.  Continued treatment should be restricted to patients who achieve at least 75% improvement in their Psoriasis Area and Severity Index (PASI 75) within 16 weeks.

For use in psoriatic arthritis see section 10.1.3

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/PHP7789-ustekinumab.htm?q=ustekinumab&t=search&ss=text&p=1#_hit