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 Formulary Chapter 13: Skin - Full Chapter
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13.06.01  Expand sub section  Topical preparations for acne
13.06.01  Expand sub section  Benzoyl peroxide
13.06.01  Expand sub section  Topical antibacterials for acne
13.06.01  Expand sub section  Topical retinoids and related preparations for acne
13.06.01  Expand sub section  Other Topicals for Acne and Rosacea to top
 note 

Acne Vulgaris

Azelaic acid is mildly effective as a comedolytic, antibacterial and anti-inflammatory agent

It is recommended as second line in several guidelines

Some people may prefer azelaic acid to benzoyl peroxide as it is less likely to cause skin irritation.

Acne Rosacea

Metronidazole can be used for 6-9 weeks for mild to moderate rosacea

Azelaic acid may be more effective especially in people without sensitive skin.

Metronidazole 0.75%
(Gel or Cream)
View adult BNF View SPC online View childrens BNF
First Choice
Green

For Rosacea:

Use for 6-9 weeks

Cream may be preferred for sensitive skin

 
Azelaic Acid
(Skinoren®; Finacae®)
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Formulary
Green

Third line in acne vulgaris

Alternative to metronidazole in rosacea for people without sensitive skin

Discontinue if no improvement

Finacae licensed for papulopustular rosacea

 
Brimonidine gel
(Mirvaso®)
(rosacea)
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Formulary
Yellow

Persistant facial erythema in rosacea.

 

MHRA/CHM advice: Brimonidine gel (Mirvaso®): risk of systemic cardiovascular effects (June 2017)

Systemic cardiovascular effects including bradycardia, hypotension, and dizziness have been reported after application of brimonidine gel. To minimise the possibility of systemic absorption, it is important to avoid application to irritated or damaged skin, including after laser therapy.

 
Ivermectin cream
(Soolantra®)
(Rosacea)
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Formulary
Yellow

Papulopustular rosacea

Apply daily for upto 4 months

Discontinue if no improvement after 3 months

 
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Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Green

Drugs that may be initiated, stabilised and maintained by primary, secondary or tertiary care Secondary and tertiary care prescribing may be continued by primary care. [this does not indicate first/second line choice]  

Green Hospital

Items used by the Hospital but would not normally be continued into primary care. Primary care prescribers can change to GREEN first or second.   

Green plus

Initiation of drugs by primary care following written advice from secondary/ tertiary care advice.  

Yellow

Drugs that may be continued in primary care following initiation and stabilisation in secondary/tertiary care  

Amber

Items requiring a shared care agreement. These items should be initiated and stabilised by secondary or tertiary care. The GP should only be asked to take over prescribing through a formal shared care agreement. Secondary care will be expected to continue prescribing until the agreement is made.  

Red

Hospital/ Trust ONLY. These are items the secondary and tertiary care are responsible for prescribing and will need to continue to prescribe for long term maintenance. These items will NOT be prescribed in primary care. But primary care should be informed the patient is receiving these items. This will include NHSE funded items requiring repatriation.  

GP - Black

Items covered by NHSE ‘Should not prescribe in primary care list’ – See CCG policy on Drugs of limited clinical value  

GP - Grey

Grey List: Items covered by NHSE ‘Should not prescribe in primary care list’ that are not to be routinely prescribed but may be suitable in a defined population – See CCG policy on Drugs of limited clinical value  

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