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Specialist Skin Formulary

Specialist Skin Formulary


Wherever possible the use of licensed medicines is encouraged to assure safety and 
efficacy. 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 to optimise quality of care Dermatology 'Specials' should only be prescribed 
from the document: 
 'Specials Recommended by the British Association of Dermatologists for Skin Disease'
The prescribing of such products may be continued in Primary Care.
When a product is required that is not included in the 'BAD' list then the prescribing of
such will remain with the Consultant/Prescriber and may not be continued in Primary 

Where a preparation is required that is not listed in the BAD document then there is a 
requirement to submit a request to East Lancashire Medicines Management Board 
(ELMMB) for the product to be considered for inclusion in the formulary.








Prescribing guidance and volumes

 Emollients and Barriers
 Propylene glycol 20% w/w in aqueous cream                                                     ¦   100g
 As a moisturiser, to use on very dry skin conditions. Works well as a barrier, enhances 
 penetration of other treatments like topical steroids. Use when urea-based preparations, 
 e.g.Eucerin® and Aquadrate®, are ineffective, unsuitable or not tolerated.
 Steroid Combinations
 Salicylic acid 5% w/w /propylene glycol 47.5% w/w in Dermovate® cream    ¦   100g
 Very potent steroid: propylene glycol increases penetration of Dermovate®.
 To use on the palms and/or soles for hyperkeratoic eczema, palmoplantar pustulosis and 
 psoriasis where it is persistent, severe and not responding to Dermovate® and emollients
 alone. It can be used once daily under occlusion for short periods (a maximum of 2 weeks)
 and then without occlusion for a few weeks more. Keep the frequency of application to a
 minimum to reduce the risk of atrophy and tachyphylaxis. Please see NICE guidelines on
 psoriasis (all ages) and atopic eczema (children and young people) for advice on safe 
 appropriate use of corticosteroids. https://guidance.nice.org.uk