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Other - Cost: £652,109,405.62 Empagliflozin (Jardiance) - Cost: £7,788,101.39 Edoxaban (Lixiana) - Cost: £8,056,980.75 Influenza vaccine (Fluad) - Cost: £13,930,057.90 Beclometasone / Formoterol MDI (Fostair) - Cost: £17,160,087.08 Rivaroxaban (Xarelto) - Cost: £20,491,468.20 Apixaban (Eliquis) - Cost: £33,811,997.20
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Notes for: Skin
Last edited [16/11/2021 14:55:40]


NHS Kernow emollient prescribing guideline September 2021

NHS Kernow moisture associated skin damage pathway September 2021

Fire risk with paraffin-containing products


Management of skin conditions

    With skin disease it is extremely important to consider patient acceptability of a product to maximise patient compliance. There is a wide range of products available and patient acceptance of individual products is very variable.
    Where a consultant or GP with specialist interest asks a GP to prescribe a non-formulary agent they should check that formulary agents have been tried and not tolerated by the patient

    Greasy preparations (ointments) are often preferable to creams in most circumstances because:

    • They contain fewer skin sensitisers
    • They are more hydrating (ie water retaining)
    • There is better penetration of active ingredients

    However, patient preference or activity may necessitate a combination of ointments and creams, for example, patients may prefer to apply creams during the day and use ointments at night, or different preparations on different parts of the body.

    Application technique: It is important to educate patients with the correct application technique. Ointments and creams should be applied down the direction of hair growth. They should also be smeared on and not rubbed in.

    Pot Hygiene: When supplying patients with pots of emollient, it is important to educate them about the hygiene required. Patients should be advised to decant from the pot onto plate/bowl etc. using a spoon or a spatula. Hands should not be put into the pot as this will lead to the introduction of foreign particles.

    In many cases generic prescribing will be difficult because products contain a combination of active ingredients. In this chapter brand names are used for products which should not be prescribed generically.

    Extemporaneous preparations: A product should only be extemporaneously prepared when there is no product with a marketing authorisation available. Depending on the formulation this may be done in a pharmacy, or by a specials manufacturer, usually depending on the formulation. Where a specials manufacturer prepares the product, additional charges will be incurred. The cost can, and usually does, exceed £100 for a cream. The cost is usually the same whether 500 g or 50 g of a product is ordered. Specials all have a very short shelf life with an expiry date of a maximum of 28 days from manufacture.

    A range (but not all) of specials preferred by the British Association of Dermatologists has been approved for use within Cornwall & IoS mainly for prescribing by secondary care. The website also lists various clinical guidelines.



     

    Cornwall Joint Formulary Recommended Choices     (...Top)
    Displaying 20 Drugs

    Key:
    First Line Drugs First Line Drugs
    Second Line Drugs Second Line Drugs
    Specialist Initiated Drugs Specialist Initiated Drugs
    Hospital Only Drugs Hospital Only Drugs
    Discouraged Discouraged
    No comment available No comment available
    Antibiotics Antibiotics

    NameTariffBNF Sub Paragraph
    Calcipotriol Ointment (Dovonex / Calcipotriol)
    50 mcg/g ointment (30g tube) Pack of 30
    £5.78PCT FORMULARY STATUS: First Line Drugs Preparations For PsoriasisView BNF Article on 'Calcipotriol Ointment'View SPC on 'Calcipotriol Ointment'View PIL on 'Calcipotriol Ointment'
    Cocois Scalp Ointment
    40 g Unit Pack of 40
    £6.22PCT FORMULARY STATUS: First Line Drugs Preparations For Psoriasis
    View BNF Article on 'Cocois Scalp Ointment'View SPC on 'Cocois Scalp Ointment'View PIL on 'Cocois Scalp Ointment'
    Coal Tar Lotion (Exorex)
    5 % Lotion in emollient Pack of 100
    £8.11PCT FORMULARY STATUS: First Line Drugs Preparations For PsoriasisView BNF Article on 'Coal Tar Lotion'View SPC on 'Coal Tar Lotion'View PIL on 'Coal Tar Lotion'
    Calcitriol ointment (Silkis)
    3 mcg/g 100g Pack of 100
    £18.06PCT FORMULARY STATUS: First Line Drugs Preparations For PsoriasisView BNF Article on 'Calcitriol ointment'View SPC on 'Calcitriol ointment'View PIL on 'Calcitriol ointment'
    Calcipotriol / Betamethasone (Enstilar)
    60 gm 50 mcg & 0.5mg / g foam Pack of 60
    £39.68PCT FORMULARY STATUS: First Line Drugs [Notes:] Enstilar foam is accepted onto the formulary as another formulation of calcipotriol and betamethasone dipropionate for patients with non-scalp psoriasis. The recommended treatment period for foam (and Dovobet ointment) is 4 weeks. If it is necessary to continue or restart treatment after this period, treatment should be continued after medical review and under regular medical supervision. General measures such as the frequent use of emollients are important in the management of psoriasis. If using other topical products containing calcipotriol in addition to Enstilar, the total dose of all calcipotriol containing products should not exceed 15 g per day. Preparations For PsoriasisView BNF Article on 'Calcipotriol / Betamethasone'View SPC on 'Calcipotriol / Betamethasone'View PIL on 'Calcipotriol / Betamethasone'
    Enstilar foam is accepted onto the formulary as another formulation of calcipotriol and betamethasone dipropionate for patients with non-scalp psoriasis. The recommended treatment period for foam (and Dovobet ointment) is 4 weeks. If it is necessary to continue or restart treatment after this period, treatment should be continued after medical review and under regular medical supervision. General measures such as the frequent use of emollients are important in the management of psoriasis. If using other topical products containing calcipotriol in addition to Enstilar, the total dose of all calcipotriol containing products should not exceed 15 g per day.
    Calcipotriol
    50 mcg / ml scalp solution Pack of 60
    £70.46PCT FORMULARY STATUS: First Line Drugs [Notes:] Scalp psoriasis, apply scalp solution twice daily; maximum 60mL weekly Preparations For PsoriasisView BNF Article on 'Calcipotriol'View SPC on 'Calcipotriol'View PIL on 'Calcipotriol'
    Scalp psoriasis, apply scalp solution twice daily; maximum 60mL weekly
    Coal Tar / Hydrocortisone Cream (Alphosyl HC)
    100 g Cream Pack of 100
    £3.10PCT FORMULARY STATUS: Second Line Drugs Preparations For PsoriasisView BNF Article on 'Coal Tar / Hydrocortisone Cream'View SPC on 'Coal Tar / Hydrocortisone Cream'View PIL on 'Coal Tar / Hydrocortisone Cream'
    Dithranol (Dithrocream)
    0.1 % cream Pack of 50
    £3.77PCT FORMULARY STATUS: Second Line Drugs Preparations For PsoriasisView BNF Article on 'Dithranol'View SPC on 'Dithranol'View PIL on 'Dithranol'
    Dithranol (Dithrocream)
    1 % HP cream Pack of 50
    £3.77PCT FORMULARY STATUS: Second Line Drugs Preparations For PsoriasisView BNF Article on 'Dithranol'View SPC on 'Dithranol'View PIL on 'Dithranol'
    Dithranol (Dithrocream)
    0.25 % cream Pack of 50
    £4.04PCT FORMULARY STATUS: Second Line Drugs Preparations For PsoriasisView BNF Article on 'Dithranol'View SPC on 'Dithranol'View PIL on 'Dithranol'
    Dithranol (Dithrocream)
    0.5 % forte cream Pack of 50
    £4.66PCT FORMULARY STATUS: Second Line Drugs Preparations For PsoriasisView BNF Article on 'Dithranol'View SPC on 'Dithranol'View PIL on 'Dithranol'
    Coal Tar Scalp Ointment (Sebco)
    12 % solution Pack of 40
    £6.20PCT FORMULARY STATUS: Second Line Drugs Preparations For PsoriasisView BNF Article on 'Coal Tar Scalp Ointment'View SPC on 'Coal Tar Scalp Ointment'View PIL on 'Coal Tar Scalp Ointment'
    Dithranol (Dithrocream)
    2 % cream Pack of 50
    £6.79PCT FORMULARY STATUS: Second Line Drugs Preparations For PsoriasisView BNF Article on 'Dithranol'View SPC on 'Dithranol'View PIL on 'Dithranol'
    Calcipotriol / Betamethasone (Dovobet)
    60 gm 50 mcg & 0.5mg / g gel Pack of 1
    £37.21PCT FORMULARY STATUS: Second Line Drugs [Notes:] Recommended treatment period of  4 weeks for Dovobet gel on scalp and 8 weeks for Dovobet gel on body. If necessary treatment may be continued or repeated after this initial period on the advice of a specialist. Preparations For PsoriasisView BNF Article on 'Calcipotriol / Betamethasone'View SPC on 'Calcipotriol / Betamethasone'View PIL on 'Calcipotriol / Betamethasone'
    Recommended treatment period of 4 weeks for Dovobet gel on scalp and 8 weeks for Dovobet gel on body. If necessary treatment may be continued or repeated after this initial period on the advice of a specialist.
    5-methoxypsoralen
    20 mg tablets Pack of 28
    - PCT FORMULARY STATUS: Hospital Only Drugs Preparations For PsoriasisView BNF Article on '5-methoxypsoralen'View SPC on '5-methoxypsoralen'View PIL on '5-methoxypsoralen'
    8-methoxypsoralen
    10 mg tablets Pack of 28
    - PCT FORMULARY STATUS: Hospital Only Drugs Preparations For PsoriasisView BNF Article on '8-methoxypsoralen'View SPC on '8-methoxypsoralen'View PIL on '8-methoxypsoralen'
    Puvasoralen
    1.2 % Bath Lotion Pack of 1
    - PCT FORMULARY STATUS: Hospital Only Drugs Preparations For PsoriasisView BNF Article on 'Puvasoralen'View SPC on 'Puvasoralen'View PIL on 'Puvasoralen'
    Puvasoralen
    8 emulsion 0.15% 50mL Pack of 1
    - PCT FORMULARY STATUS: Hospital Only Drugs Preparations For PsoriasisView BNF Article on 'Puvasoralen'View SPC on 'Puvasoralen'View PIL on 'Puvasoralen'
    Acitretin Capsule (Neotigason)
    10 mg cap Pack of 60
    - PCT FORMULARY STATUS: Hospital Only Drugs Preparations For PsoriasisView BNF Article on 'Acitretin Capsule'View SPC on 'Acitretin Capsule'View PIL on 'Acitretin Capsule'
    Acitretin Capsule (Neotigason)
    25 mg cap Pack of 60
    - PCT FORMULARY STATUS: Hospital Only Drugs Preparations For PsoriasisView BNF Article on 'Acitretin Capsule'View SPC on 'Acitretin Capsule'View PIL on 'Acitretin Capsule'

     
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