13.3 Inflammatory skin conditions

13.3.1 Eczema and Psoriasis

Antracen Derivatives

Recommended:

Dithranol in Lassar’s paste 0.1 to 2% (TLS Red)

• Only on prescription by a Clinician experienced in skin disease (TLS Red)
• Dithranol in Lassar’s Paste are only available as ‘special’ preparations (i.e. not proprietary products). These preparations are not cost-effective in primary care and there may be a significant delay in obtaining such preparations
• Arachis oil (TLS Green) should be prescribed to remove the Dithranol in Lassar’s Paste. Arachis oil contains peanuts

Bacteriostatics

Zinc paste bandages (Ichthopaste^®, Viscopaste^®, Zipzoc^®) (TLS Green)

Calcineurin Inhibitors and Related Drugs

Pimecrolimus 1% cream (Elidel^®) (TLS Amber)

• Only on prescription by a Clinician experienced in skin disease
• Short term treatment of mild to moderate atopic eczema (including flares) when topical corticosteroids cannot be used
• Outside of SPC indication, this is TLS RED

Tacrolimus 0.03% ointment (Protopic^®) (TLS Green)

• Only on prescription by a Clinician experienced in skin disease
• For use in moderate to severe atopic dermatitis unresponsive to conventional therapies. Within SPC use only, in accordance with NICE TA82

Tacrolimus 0.1% ointment (Protopic^®) (TLS Amber Specialist Recommended)

Corticosteroids

Mild

Hydrocortisone 0.5, 1% cream/ointment (TLS Green)

Hydrocortisone 1% / Miconazole nitrate 2% cream / ointment (Daktacort^®) (TLS Green)

Hydrocortisone 1% / Clotrimazole 1% cream (Canesten HC) (TLS Green)

Moderate

Clobetasone butyrate 0.05% cream / ointment (Eumovate^®) (TLS Green)

Betamethasone 0.025% cream / ointment (Betnovate RD^®) (TLS Green)

Clobetasone butyrate 0.05% / Oxytetracycline 3% / Nystatin 100,000 units/g cream (Trimovate^®) (TLS Green)

Fluocinolone 0.00625% (Synalar^® 1 in 4) ointment and cream (TLS Blue)

• As per licensed indications

Potent

Betamethasone 0.1% cream / ointment/lotion (Betnovate^®) (TLS Green)

Betamethasone 0.05% / Salicylic acid 3% ointment (Diprosalic^®) (TLS Green)

Mometasone furoate 0.1% cream / ointment (Elocon^®) (TLS Green)

Fludroxycortide tape (Haelan^®) (TLS Green)

Synalar (Fluocinolone 0.025%) gel / ointment / cream (TLS Blue)

Very Potent 

Clobetasol propionate 0.05% cream / ointment (Dermovate^®) (TLS Amber Specialist Recommended)

Clobetasol propionate 0.05% / Neomycin sulphate 0.5% / Nystatin 100,000 units/g cream / ointment (TLS Amber Specialist Recommended)

Other Preparations

Hydroquinone 5% / Hydrocortisone 1% / Tretinoin 0.1% cream (Pigmanorm^®) (TLS Red)

• For Consultant Dermatologist use only, subject to the Cosmetic Surgery or Treatment Individual Funding Request Policy.
• See Cosmetic skin treatments page on Remedy.

Specific indication:

Dermovate^® with 40% Propylene glycol (TLS Red)

• Specialist Consultant use only for the treatment of Severe hyperkeratotic psoriasis and eczema of the palms and/or soles for 4 weeks (Unlicensed)

Retinoid and Related Drugs

Recommended:

Acitretin (TLS Red)

• Specialist use only

Alitretinoin (TLS Red)

• NICE TA177 For severe chronic hand eczema

Tars

Recommended:

Exorex^® lotion (TLS Green)

Sebco^® scalp ointment (TLS Green)

Coal tar / Salicylic acid ointment (TLS Green)

• Coal Tar and Salicylic Acid ointments are only available as ‘special’ preparations (i.e. not proprietary products). These preparations are not cost-effective in primary care and there may be a significant delay in obtaining such preparations.

Vitamin D and Analogues

Recommended:

Calcipotriol / Betamethasone 0.05% (Dovobet^®) (TLS Green)

Calcipotriol ointment (TLS Green)

Drugs Affecting the Immune Response

Azathioprine (oral) (TLS Red)

Ciclosporin (oral) (TLS Red)

Methotrexate - weekly dose (TLS Amber 1 month) (SCP click here)

Mycophenolate (oral) (TLS Red)

• N.B. unlicensed for eczema and skin conditions
• Used only by specialists

Cytokine Modulators

• As per NICE’s biosimilar position statement, if the originator biologic product is on the BNSSG joint formulary, the new biosimilar product will also be included on the formulary in accordance with its UK licence when it becomes commercially available

Recommended: (TLS Red)

Abrocitinib (oral)

• NICE TA814 Abrocitinib or upadacitinib for treating moderate to severe atopic dermatitis in young people 12 years and over

Adalimumab (parenteral)

• NICE TA455 Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people
• As per NICE TA146
• NICE TA392 For severe hidradenitis suppurativa. Commissioned by NHS England

Dupilumab (parenteral)

• NICE TA534 Dupilumab for treating moderate to severe atopic dermatitis

Etanercept (parenteral)

• NICE TA455 Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people
• As per NICE TA103

Infliximab (parenteral)

• As per NICE TA134

Secukinumab (parenteral)

• As per NICE TA350
• NICE TA734 Secukinumab for treating severe plaque psoriasis in children and young people

Ustekinumab (parenteral)

• NICE TA455 Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people
• As per NICE TA180
• Please refer to NPSA guidance on reducing the risks of oral methotrexate. Patients should have patient held records while they are receiving treatment with any DMARD requiring regular monitoring (record cards and GP protocol advice available from rheumatology)
• Tacrolimus ointment is classified TLS green when used within the SPC and red when used outside of the SPC
• Please refer to Chapter 8 for systemic preparations

Upadacitinib (oral)

• NICE TA814 Abrocitinib or upadacitinib for treating moderate to severe atopic dermatitis in young people 12 years and over