Greater Glasgow and Clyde Medicines
Key to symbols The medicine should be initiated by, or on the advice of a specialist, but is suitable for continuation by a GP The medicine should only be used and prescribed by a specialist Indicates the preferred choice within a class or group of medicines
The medicine should be initiated by, or on the advice of a specialist, but is suitable for continuation by a GP
The medicine should only be used and prescribed by a specialist
Indicates the preferred choice within a class or group of medicines
13. Skin

13.5. Preparations for eczema and psoriasis

13.5.1. Preparations for eczema

Preferred List
ZINC PASTE AND ICHTHAMMOL BANDAGE BP
ICHTHAMMOL 1% (SPECIAL OINTMENT)
Total Formulary
Specialist Only
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.

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13.5.2. Preparations for psoriasis

Preferred List
PSORIDERM (cream)
Total Formulary
DITHRANOL (DITHROCREAM) (CREAM)

Prescribing Notes:

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

BNF Link

CALCIPOTRIOL (ointment)
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"

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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"

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SALICYLIC ACID IN AQUEOUS CREAM 10%

Prescribing Notes:

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

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COAL TAR AND SALICYLIC ACID (OINTMENT)
SALICYLIC ACID IN AQUEOUS CREAM 5%

Prescribing Notes:

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

BNF Link

Specialist Only
ACITRETIN

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

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SALICYLIC ACID
COAL TAR (EXOREX) (lotion)
CALCITRIOL (OINTMENT)
CALCIPOTRIOL AND BETAMETHASONE

Prescribing Notes:

Calcipotriol and betamethasone can be supplied as individual preparations, calcipotriol 50microgram/g ointment plus betamethasone 0.05% (Diprosone®) ointment, 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.

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13.5.3. Drugs affecting the immune response

Preferred List
Specialist and GP
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

Specialist and GP
METHOTREXATE (2.5MG TABLETS)

Restrictions:

Restricted to use under specialist dermatological supervision.

Prescribing Notes:

Near Patient Testing (NPT) arrangements for GPs may be in place for this medicine.  See the relevant section in the Prescribing Resources page for current information.

BNF Link

Total Formulary
Specialist Only
TILDRAKIZUMAB (ILUMETRI) (injection)

Restrictions:

Restricted to specialist use in the treatment of moderate to severe plaque psoriasis in accordance with local guidelines in patients who have failed to respond to conventional systemic therapies (including ciclosporin, methotrexate and phototherapy), are intolerant to, or have contra-indications to these treatments.

BNF Link

Specialist Only
RISANKIZUMAB (SKYRIZI) (injection)

Restrictions:

Restricted to specialist use in the treatment of moderate to severe plaque psoriasis in accordance with local guidelines in patients who have failed to respond to conventional systemic therapies (including ciclosporin, methotrexate and phototherapy), are intolerant to, or have contra-indications to these treatments.

BNF Link

Specialist Only
GUSELKUMAB (TREMFYA) (injection)

Restrictions:

Restricted to specialist use in accordance with local guidelines in patients with moderate to severe plaque psoriasis who have failed to respond to conventional systemic therapies (including ciclosporin, methotrexate and phototherapy), are intolerant to, or have a contra-indication to these treatments.

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Specialist Only
CERTOLIZUMAB PEGOL (CIMZIA) (injection)

Restrictions:

Restricted to specialist use in accordance with local guidelines in patients with moderate to severe plaque psoriasis 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.

Prescribing Notes:

For uses in rheumatology, see section 10.1.3

BNF Link

Specialist Only
BRODALUMAB (KYNTHEUM) (injection)

Restrictions:

Restricted to specialist use in accordance with local guidelines in patients with moderate to severe plaque psoriasis who have failed to repond to standard systemic therapies (including ciclosporin, methotrexate and phototherapy), are intolerant to, or have a contra-indication to these medicines.

BNF Link

Specialist Only
DUPILUMAB (injection)

Restrictions:

The use in the treatment of moderate-to-severe atopic dermatitis in adults is restricted to use in accordance with local guidelines in patients who have had an inadequate response to existing systemic immunosuppressants such as ciclosporin, or in whom such treatment is considered unsuitable.

BNF Link

Specialist Only
DIMETHYL FUMARATE (SKILARENCE) (tablets)

Restrictions:

Restricted to specialist use only in patients in whom other non-biologic systemic treatments (methotrexate, ciclosporin and acitretin) are not appropriate, or have failed and who are considered unsuitable for biologic therapy given they current disease state or personal preference,

BNF Link

Specialist Only
IXEKIZUMAB (injection)

Restrictions:

Restricted to specialist use in patients with moderate to severe plaque psoriasis 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

Prescribing Notes:

For use in psoriatic arthritis, see section 10.1.3

BNF Link

Specialist Only
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.

BNF Link

Specialist Only
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

BNF Link

Specialist Only
ADALIMUMAB (injection)

Restrictions:

Restrictions apply as per prescribing notes below.

Prescribing Notes:

Adalimumab should be prescribed by brand name. Amgevita® is the preferred biosimilar.

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, 11.8 and 10.1.3.

BNF Link

Specialist Only
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. Remsima® is the preferred biosimilar.

BNF Link

Specialist Only
USTEKINUMAB (STELARA) (sub-cutaneous 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 and for use in Crohn's disease see section 1.5.3

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Specialist Only
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.

Prescribing Notes:

Etanercept should be prescribed by brand name. Benepali® is the preferred biosimilar.

BNF Link

Specialist and GP
TACROLIMUS (OINTMENT)

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

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Specialist and GP
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

Specialist Only
METHOTREXATE (Metoject) (PRE-FILLED SYRINGE)

Restrictions:

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

Prescribing Notes:

Near Patient Testing (NPT) arrangements for GPs may be in place for this medicine.  See the relevant section in the Prescribing Resources page for current information.

BNF Link