North East and North Cumbria
ICS Formulary
 
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13 Skin

Specials Recommended by the British Association of Dermatologists for Skin Disease

Most prescribing uses licensed medicines whose safety and efficacy are assured. For many common dermatological diseases including psoriasis and eczema, the range of licensed medicines is limited. As a result, Dermatology prescribing may rely significantly on unlicensed creams and ointments (known as ‘Specials’) containing tars, dithranol, salicylic acid, steroids and other active constituents in a range of concentrations and bases. This is of particular concern in primary care where lack of effective price controls and a mechanism to ensure independent scrutiny of product quality has increased costs and concern about standards. To address these concerns, and help optimise quality of care, adherence to the revised British Association of Dermatologists (BAD) list of preferred Specials (2018) is encouraged.

13-05-03 Drugs affecting the immune response

Abrocitinib Cibinqo®
Formulary
  • Approved for the treatment of moderate to severe atopic dermatitis in line with NICE
Link  MHRA Drug Safety Update (April 2023): Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality
Link  NICE TA814: Abrocitinib, tralokinumab or upadacitinib for treating moderate to severe atopic dermatitis

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Adalimumab
Formulary
  • Approved for psoriasis in line with NICE.
  • Approved for the treatment of moderate to severe hidradenitis suppurativa in line with NICE and NHS England Commissioning Policy
  • Approved for the treatment of plaque psoriasis in children and young people in line with NICE 

Biosimilars are available – note that indications can differ between different products – prescribe by brand. Consult with individual trust pharmacy department for details of
preferred biosimilar brand.
Link  NICE TA146 Adalimumab for the treatment of adults with psoriasis
Link  NICE TA392: Adalimumab for treating moderate to severe hidradenitis suppurativa
Link  NICE TA455 Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people

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Apremilast Otezla®
Formulary
  • 10mg, 20mg & 30mg tablets
  • To be used in accordance with NICE guidance
Link  MHRA Drug Safety Update (Jan 2017): Apremilast (Otezla ): risk of suicidal thoughts and behaviour
Link  NICE TA419: Apremilast for treating moderate to severe plaque psoriasis

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Baricitinib Olumiant®
Formulary
  • Approved for treating moderate to severe atopic dermatitis in adults in line with NICE.
Link   NICE TA681: Baricitinib for treating moderate to severe atopic dermatitis
Link  MHRA Drug Safety Update (April 2023): Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality
Link  MHRA Drug Safety Update (Aug 2020): Baricitinib (Olumiant▼): increased risk of diverticulitis, particularly in patients with risk factors
Link  MHRA Drug Safety Update (Mar 2020): Baricitinib (Olumiant▼): risk of venous thromboembolism

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Bimekizumab  Bimzelx®
Formulary
  • 160mg/ml solution pre-filled pen/syringe
  • Approved for the treatment of moderate to severe plaque psoriasis in line with NICE

 
Link  NICE TA723: Bimekizumab for treating moderate to severe plaque psoriasis

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Brodalumab Kyntheum®
Formulary
  • 210mg/1.5ml solution for injection in pre-filled syringes.
  • Approved for the treatment of moderate to severe plaque psoriasis in line with NICE 



 
Link  NICE TA511: Brodalumab for treating moderate to severe plaque psoriasis

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Certolizumab pegol 
Formulary
Link  NICE TA574: Certolizumab pegol for treating moderate to severe plaque psoriasis

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Ciclosporin
Formulary
  • Capsules & SF Solution 
    See section 8.2.2
Link  County Durham and Darlington Shared Care Guideline: Ciclosporin
Link  Tees Valley Shared Care Guideline: Ciclosporin

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Deucravacitinib Sotyktu
Formulary
  • 6mg tablets
  • Approved for the treatment of moderate to severe plaque psoriasis in line with NICE
Link  NICE TA907: Deucravacitinib for treating moderate to severe plaque psoriasis

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Dimethyl fumarate Skilarence®
Formulary
  • 120mg tablets
  • Approved for the treatment of moderate to severe plaque psoriasis in line with NICE
Link  NICE TA475 Dimethyl fumarate for treating moderate to severe plaque psoriasis

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Dupilumab Dupixent®
Formulary
  • 200mg/1.14ml & 300mg/2ml solution for injection
  • Approved for treating moderate to severe atopic dermatitis in adults in line with NICE
Link  MHRA Drug Safety Upate (Nov 2022): Dupilumab (Dupixent▼): risk of ocular adverse reactions and need for prompt management
Link  NICE TA534: Dupilumab for treating moderate to severe atopic dermatitis

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Etanercept Enbrel®, Benapali® & Erelzi®
Formulary
  • Approved for psoriasis in line with NICE
  • Approved for the treatment of plaque psoriasis in children and young people in line with NICE

 

Biosimilars are available – note that indications can differ between different products – prescribe by brand. Consult with individual trust pharmacy department for details of
preferred biosimilar brand.
Link  NICE TA103: Psoriasis - efalizumab and etanercept
Link  NICE TA455 Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people

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Guselkumab Tremfya®
Formulary
  • 100mg/1mL solution for injection
  • Approved for the treatment of moderate to severe plaque psoriasis in line with NICE

 
Link  NICE TA521: Guselkumab for treating moderate to severe plaque psoriasis

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Hydroxychloroquine
Formulary
Link  MHRA Drug Safety Update (Feb 2022): Hydroxychloroquine, chloroquine: increased risk of cardiovascular events when used with macrolide antibiotics; reminder of psychiatric reactions
Link  NENC Shared Care Protocol - Hydroxychloroquine for patients within adult services

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Infliximab Remsima®, Inflectra®, Remicade®
Formulary

  • Approved for psoriasis in line with NICE.
Link  NICE TA134: Infliximab for psoriasis

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Ixekizumab Taltz®
Formulary
  • Approved for the treatment of moderate to severe plaque psoriasis in adults in line with NICE

 
Link  NICE TA442 Ixekizumab for treating moderate to severe plaque psoriasis

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Lebrikizumab Ebglyss®
Formulary
  • Approved for treating moderate to severe atopic dermatitis in people 12 years and over in line with NICE
Link  NICE TA986: Lebrikizumab for treating moderate to severe atopic dermatitis in people 12 years and over

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Methotrexate
Formulary

 
Link  County Durham and Darlington Shared Care Guideline: Methotrexate
Link  MHRA Drug Safety Update (August 2023): Methotrexate: advise patients to take precautions in the sun to avoid photosensitivity reactions
Link  MHRA Drug Safety Update (Sept 2020): Methotrexate once-weekly for autoimmune diseases: new measures to reduce risk of fatal overdose due to inadvertent daily instead of weekly dosing
Link  Tees Valley Shared Care Guideline: Methotrexate

Cytotoxic Drug  Amber View adult BNF  View SPC online  View childrens BNF
Pimecrolimus cream Elidel®
Formulary
  • 1% cream
    • Approved of moderate atopic eczema on the face and neck in children between 2 and 16 years in line NICE.
    • Can be initiated by prescribers (including general practitioners) with a special interest and experience in dermatology and only after careful discussion with the patient about the potential risks and benefits of all appropriate second-line treatment options.
Link  NICE TA82: Pimecrolimus and tacrolimus for atopic dermatitis (eczema)

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Risankizumab Skyrizi®
Formulary

  • Approved for the treatment of moderate to severe plaque psoriasis in line with NICE
Link  NICE TA596: Risankizumab for treating moderate to severe plaque psoriasis

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Ritlecitinib Litfulo®
Formulary
  • 50mg hard capsules
  • Recommended as an option for treating severe alopecia areata in people 12 years and over in line with NICE 

 
Link  NICE TA958: Ritlecitinib for treating severe alopecia areata in people 12 years and over

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Secukinumab Cosentyx®
Formulary
  • Approved for the treatment of plaque psoriasis in line with NICE.
  • Approved for the treatment of moderate to severe plaque psoriasis in children and young people in line with NICE
  • Approved for treating moderate to severe hidradenitis suppurativa in  line with NICE
Link  NICE TA350: Secukinumab for treating moderate to severe plaque psoriasis
Link  NICE TA734: Secukinumab for treating moderate to severe plaque psoriasis in children and young people
Link  NICE TA935: Secukinumab for treating moderate to severe hidradenitis suppurativa

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Tacrolimus ointment Protopic®
Formulary
  • 0.03% & 0.1% ointment
    • Approved for moderate to severe atopic eczema in patients over 2 years in line with NICE.
    • Can be initiated by prescribers (including general practitioners) with a special interest and experience in dermatology and only after careful discussion with the patient about the potential risks and benefits of all appropriate second-line treatment options
Link  NICE TA82: Pimecrolimus and tacrolimus for atopic dermatitis (eczema)

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Tildrakizumab Ilumetri®
Formulary
  • 100 mg solution for injection in pre-filled syringe
  • Approved for the treatment of moderate to severe plaque psoriasis in line with NICE
Link  NICE TA575: Tildrakizumab for treating moderate to severe plaque psoriasis

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Tralokinumab Adtralza®
Formulary
  • Approved for the treatment of moderate to severe atopic dermatitis in line with NICE
Link  MHRA Drug Safety Update (April 2023): Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality
Link  NICE TA814: Abrocitinib, tralokinumab or upadacitinib for treating moderate to severe atopic dermatitis

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Upadacitinib Rinvoq®
Formulary
  • Approved for the treatment of moderate to severe atopic dermatitis in line with NICE
Link  MHRA: Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality
Link  NICE TA814: Abrocitinib, tralokinumab or upadacitinib for treating moderate to severe atopic dermatitis

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Ustekinumab Stelara®
Formulary
  • 45mg & 90mg SC injections approved for psoriasis in line with NICE.
  • Approved for the treatment of plaque psoriasis in children and young people in line with NICE
Link  MHRA Drug Safety Update (Jan 2015): Ustekinumab (Stelara): risk of exfoliative dermatitis
Link  NICE TA180: Psoriasis - ustekinumab (Updated March 2017)
Link  NICE TA455 Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people

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Baricitinib Olumiant®
Non Formulary
  • Not approved for the treatment of severe alopecia areata
Link  NICE TA926: Baricitinib for treating severe alopecia areata

Not Recomended View adult BNF  View SPC online  View childrens BNF
Dupilumab Dupixent®
Non Formulary
  • Not approved for treating moderate to severe prurigo nodularis in adults when systemic treatment is suitable 
Link  MHRA Drug Safety Upate (Nov 2022): Dupilumab (Dupixent▼): risk of ocular adverse reactions and need for prompt management
Link  NICE TA955: Dupilumab for treating moderate to severe prurigo nodularis

Not Recomended View adult BNF  View SPC online  View childrens BNF  HCD