| Formulary Chapter 13: Skin - Full Chapter
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| Chapter Links... |
 LSCMMG: Guidelines for the Management of Psoriasis in Primary Care |
| LSCMMG: Position Statement: Prescribing of Medical Camouflaging Products |
| LSCMMG: Psoriasis in adults: LSCMMG Biologic and High Cost Drug Commissioning Pathway |
| NICE CG153: Psoriasis: assessment and management |
| NICE CG57: Atopic eczema in under 12s: diagnosis and management |
| NICE NG12: Suspected cancer: recognition and referral |
| NICE NG14: Melanoma: assessment and management |
| NICE NG198: Acne vulgaris: management |
| Details... |
| 13.04 |
Topical corticosteroids. |
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In the BNF publications topical corticosteroids for the skin are categorised as ‘mild’, ‘moderately potent’, ‘potent’ or ‘very potent’; the least potent preparation which is effective should be chosen but dilution should be avoided whenever possible.
Potency of a topical corticosteroid preparation (including compound preparations) is based solely on the corticosteroid component, irrespective of the formulation and strength.
The potency of each topical corticosteroid should be included on the label with the directions for use. The label should be attached to the container (for example, the tube) rather than the outer packaging.
For guidance on quantities to prescribe see BNF:
https://bnf.nice.org.uk/treatment-summaries/topical-corticosteroids/ |
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Hydrocortisone
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Formulary
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Cream 1%
Ointment 1%
Consider OTC/Self care.
Mild corticosteroid.
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Hydrocortisone with clotrimazole (Canesten HC®)
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Formulary
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Cream hydrocortisone 1%, clotrimazole 1%
Consider OTC/Self care.
Mild corticosteroid.
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Hydrocortisone with fusidic acid (Fucidin H®)
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Formulary
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Cream hydrocortisone acetate 1%, fusidic Acid 2%
Preparations containing fusidic acid should not be used in secondary care for in-patients.
Mild corticosteroid.
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Hydrocortisone with benzalkonium chloride, dimeticone and nystatin (Timodine®)
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Formulary
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Cream hydrocortisone 0.5%, nystatin 100000 unit per 1 g, benzalkonium chloride 0.2%, dimeticone '350' 10%
Mild corticosteroid.
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Hydrocortisone butyrate (Locoid®)
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Formulary
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Lipocream 0.1%
Lichen sclerosus in women when betamethasone cream is ineffective.
Moderate corticosteroid.
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Clobetasone Butyrate
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Formulary
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Cream 0.05% (Eumovate®)
Ointment 0.05%
Moderate corticosteroid.
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Clobetasone butyrate with nystatin and oxytetracycline (Trimovate®)
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Formulary
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Cream clobetasone 0.05%, nystatin 100000 unit per 1 gram, oxytetracycline 3%
Moderate corticosteroid.
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Betamethasone Valerate
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Formulary
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Cream 0.025%, 0.1%
Ointment 0.025%, 0.1%
Scalp application 0.1%
Foam 0.1% (Bettamousse®)
Potent corticosteroid.
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Betamethasone dipropionate with salicylic acid (Diprosalic®)
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Formulary
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Ointment betamethasone 0.05%, salicylic acid 3%
Scalp application betamethasone 0.05%, salicylic acid 2%
Potent corticosteroid.
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Betamethasone valerate with fusidic acid
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Formulary
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Cream betamethasone 0.1%, fusidic acid 2%
Preparations containing fusidic acid should not be used in secondary care for in-patients.
Potent corticosteroid.
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Betamethasone dipropionate with clotrimazole (Lotriderm®)
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Formulary
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Cream betamethasone 0.064% , clotrimazole 1%
Potent corticosteroid.
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Flucinolone Acetonide
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Formulary
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Gel 0.025% (Synalar®)
For scalp use only.
Potent corticosteroid.
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Fludroxycortide
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Formulary
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Tape 4micrograms/square cm, 7.5cm
Potent corticosteroid.
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Mometasone Furoate
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Formulary
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Cream 0.1%
Ointment 0.1%
Potent corticosteroid.
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Clobetasol Propionate
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Formulary
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Cream 0.05%, Ointment 0.05%
Cutaneous foam 0.05% (Clarelux®)
Shampoo 0.05% (Etrivex®)
Very potent corticosteroid.
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Betamethasone dipropionate (Diprosone®)
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Formulary
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Cream 0.05%
For use post urology surgery.
Potent corticosteroid.
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| 13.04 |
Topical corticosteriod preparation potencies |
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| 13.04 |
Topical corticosteroids (Potency: Mild) |
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| 13.04 |
Topical corticosteroids (Potency: Moderate) |
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| 13.04 |
Topical corticosteroids (Potency: Potent) |
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| 13.04 |
Topical corticosteroids (Potency: Very Potent) |
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| 13.04.01 |
Topical corticosteroids – Compound preparations – with antimicrobials |
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| 13.04.01 |
Topical corticosteroids – Compound preparations – with salicyclic acid |
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Key |
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Restricted Drug |
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Unlicensed |
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
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Scottish Medicines Consortium |
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Cytotoxic Drug |
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Controlled Drug |
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High Cost Medicine
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Cancer Drugs Fund
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Homecare |
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ICB commissioned |
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NHS England commissioned |
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Blueteq form needed |
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Low carbon footprint |
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Medium carbon footprint |
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High carbon footprint |
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| Status |
Description |
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Green:
Appropriate for initiation and ongoing prescribing in both primary and secondary care.
Generally, little or no routine drug monitoring is required. |
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Green (Restricted):
Appropriate for initiation and ongoing prescribing in both primary and secondary care provided:
Additional criteria specific to the medicine or device are met, or
The medicine or device is used following the failure of other therapies as defined by the relevant LSCMMG pathway.
Generally, little or no routine drug monitoring is required.
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Red medicines:
Medicine is supplied by the hospital for the duration of the treatment course.
Primary care initiation or continuation of treatment is not recommended unless exceptional circumstances such as specialist GP.
Red medicines are those where primary care prescribing is not recommended. These treatments should be initiated by specialists only and prescribing retained within secondary care. They require specialist knowledge, intensive monitoring, specific dose adjustments or further evaluation in use. If however, a primary care prescriber has particular specialist knowledge or experience of prescribing a particular drug for a particular patient it would not always be appropriate for them to expect to transfer that prescribing responsibility back to secondary care. There should be a specific reason and a specific risk agreement, protocol and service set up to support this.
Primary care prescribers may prescribe RED medicines in exceptional circumstances to patients to ensure continuity of supply while arrangements are made to obtain ongoing supplies from secondary care. |
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Amber level 0:
Suitable for prescribing in primary care following recommendation or initiation by a specialist.
Little or no specific monitoring required.
Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care.
Brief prescribing document or information sheet may be required.
Primary care prescribers must be familiar with the drug to take on prescribing responsibility or must get the required information.
When recommending or handing over care, specialists should ask primary care prescribers to take over prescribing responsibility, and should give enough information about the indication, dose, monitoring requirements, use outside product licence and any necessary dose adjustments to allow them to confidently prescribe. |
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Amber level 1 (with shared care):
Suitable for prescribing in primary care following recommendation or initiation by a specialist.
Minimal monitoring required.
Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care.
Full prior agreement about patient’s on-going care must be reached under the shared care agreement.
Primary care prescribers are advised not to take on prescribing of these medicines unless they have been adequately informed by letter of their responsibilities with regards monitoring, side effects and interactions and are happy to take on the prescribing responsibility. A copy of locally approved shared care guidelines should accompany this letter which outlines these responsibilities. Primary care prescribers should then tell secondary care of their intentions as soon as possible by letter so that arrangements can be made for the transfer of care. |
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Amber level 2 (with shared care and enhanced service):
Initiated by specialist and transferred to primary care following a successful initiation period.
Significant monitoring required on an on-going basis.
Full prior agreement about patient’s on-going care must be reached under the shared care agreement.
Suitable for enhanced service.
These medicines are considered suitable for GP prescribing following specialist initiation of therapy, as per shared care document which will be sent out with the request to prescribe, with on-going communication between the primary care prescriber and specialist. Amber Level 2 medicines require significant monitoring for which an enhanced service may be suitable. (Subject to local commissioning agreements). |
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Do not prescribe: NOT recommended for use by the NHS in Lancashire and South Cumbria.
Includes medicines that NICE has not recommended for use and terminated technology appraisals, unless there is a local need. |
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Grey medicines:
Medicines which have not yet been reviewed or are under the review process.
GPs and specialists are recommended not to prescribe these drugs.
This category includes drugs where funding has not yet been agreed.
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Refer to local guidance. |
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