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NHS Castle Point and Rochford CCG / NHS Southend CCG

Integrated Dermatology Service South East Essex May 2020, updated July 2021

BNF CHAPTER 13:

SKIN

• Some of the emollients listed in this chapter are classed as appliances and are listed in part IXA of the Drug Tariff

(DT) e.g. Epimax® cream, Hydromol® ointment and products from the Zeroderma range (list not exhaustive). Please

prescribe only preparation listed in the DT or licensed as medicinal product (http://www.medicines.org.uk/emc/ )

• Warning: Paraffin-based emollients are flammable. Dressings and clothing that have contact with paraffin-based

products are easily ignited by a naked flame. Advise patients to keep them away from fire or flames and not smoke

when using them. The risk of fire should be considered when using large quantities of any paraffin-based emollient.

• Products should be applied in direction of hair growth to prevent folliculitis

• Ensure that the indication is a documented dermatological condition. Prescribing of emollients for non-clinical

cosmetic purposes such as dry skin in the absence of a diagnosed dry skin condition such as eczema or psoriasis is not

supported and should be stopped.

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NHS Castle Point and Rochford CCG

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May 2020, updated July 2021

13.1 MANAGEMENT OF SKIN CONDITIONS

• Prescribe pump dispensers to minimize the risk of bacterial contamination, when they are available for the patient’s

selected emollient. For Preparations that come in pots, using a clean spoon or spatula (rather than fingers) to remove

the emollient helps to minimize contamination.

• Use licensed medicines whenever they are likely to be of benefit. Prescribe Dermatology Specials only from the

BAD list

BNF 13.2 EMOLLIENT AND BARRIER PREPARATIONS

Suitable quantities of Emollients to be prescribed for specific areas of the body:

Area of the body Cream / ointment Lotion

One week supply One month supply One week supply One month supply

Face and neck 15 – 30g 60-120g 100ml 400ml

Both hands 25 – 50g 100-200g 200ml 800ml

Scalp 50 – 100g 200-400g 200ml 800ml

Both arms or both legs 100 - 200g 400-800g 200ml 800ml

Trunk 400g 1600g 500ml 2000ml

Groins and genitalia 15 – 25g 60-100g 100ml 400ml

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May 2020, updated July 2021

These amounts are usually suitable for an adult for twice daily application.

• Generally the greasier the product the more effective it is as emollient, as it is able to trap more moisture in the skin.

However, greasier emollients can be less acceptable or tolerable.

• Products listed in the tables below follow cost criteria in ascending order.

EMOLLIENT LOTIONS

First Choice

Product Name Potential Sensitisers

E45 Lotion Lanolin/Derivatives

Hydroxybenzoates (Parabens)

Benzyl Alcohol

Alternatives

Product Name Sensitisers

QV skin lotion Cetyl/Cetostearyl/Stearyl Alcohol

Hydroxybenzoates (Parabens)

Cetraben Lotion Cetyl/Cetostearyl/Stearyl Alcohol

Phenoxyethanol

• Lotions have a higher water content than creams, which makes them easier to spread but less effective as emollients.

They may be preferred for very mildly dry skin, as well as for hairy areas of skin.

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NHS Castle Point and Rochford CCG

NHS Southend CCG

May 2020, updated July 2021

EMOLLIENT CREAMS

First Choice

Product Name Potential Sensitisers

Epimax® Cream – Easy Squeeze – Flexi dispenser Cetyl/Cetostearyl/Stearyl Alcohol

Phenoxyethanol

Alternatives

Product Name Potential Sensitisers

Epimax® ExCetra Cream - Easy Squeeze – Flexi dispenser Cetyl/Cetostearyl/Stearyl Alcohol/ Phenoxyethanol

Epimax oat® Cream - Easy Squeeze – Flexi dispenser Cetyl/Cetostearyl/Stearyl Alcohol

Chlorocresol/Benzyl alcohol/Phenoxyethanol/ Isopropyl palmitate

Zerocream® - Pump Cetyl/Cetostearyl/Stearyl Alcohol/ Lanolin/Derivatives/

Phenoxyethanol

Zerobase® Cream - Pump Cetyl/Cetostearyl/Stearyl Alcohol

Chlorocresol

Zeroveen® Cream – Pump

Cetyl/Myristyl/Stearyl Alcohol

Isopropyl palmitate

Benzyl alcohol

EMOLLIENT GELS

First Choice

Product Name Potential Sensitisers

Epimax® Isomol Gel – “Easy Squeeze” flexi dispenser Triethanolamine

Phenoxyethano

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May 2020, updated July 2021

Isopropyl mysristate

Alternatives

Product Name Potential Sensitisers

Zerodouble® Gel – Top down bottle

Triethanolamine

Phenoxyethano

Isopropyl mysristate

• Creams and gels are emulsions of oil and water and their less greasy consistency often makes them more cosmetically

acceptable.

EMOLLIENT OINTMENTS

First Choice

Product Name Potential Sensitisers

Epimax® ointment Cetyl/Cetostearyl/Stearyl Alcohol

Alternatives

Product Name Potential Sensitisers

White soft paraffin None

Zeroderm® ointment Cetyl/Cetostearyl/Stearyl Alcohol

Emulsifying ointment SPC: Cetostearyl alcohol

Phenoxyethanol

50:50 White soft and liquid paraffin ointment None

Hydromol® ointment Cetyl/Cetostearyl/Stearyl Alcohol

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May 2020, updated July 2021

• Ointments are the greasiest preparations, being made up of oils or fats. They do not usually contain preservatives and

may be more suitable for those with sensitivities. However, they can exacerbate acne, can cause folliculitis when

overused and they should not be used where infection is present.

• Emollients should be applied in the direction of hair growth to reduce the risk of folliculitis.

EMOLLIENTS WITH ANTIMICROBIALS

First Choice

Product Name Potential Sensitisers

Dermol 500® lotion

(for weeping infected skin)

Cetyl/Cetostearyl/Stearyl Alcohol

Phenoxyethanol

Benzalkonium chloride

Dermol® cream

(for dry infected skin)

Cetostearyl Alcohol; Cetomacrogol; Phenoxyethanol; Disodium

Phosphate Dodecahydrate; Sodium Dihydrogen Phosphate

Dihydrate; Benzalkonium chloride

• Antiseptic products are more likely to cause skin sensitisation reactions and may cause bacterial resistance

• Preparations containing an antibacterial (e.g. Dermol) should be avoided unless infection is present or is a

frequent complication.

• Use should be targeted and short term.

EMOLLIENTS CONTAINING UREA

First Choice

Product Name Potential Sensitisers

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NHS Castle Point and Rochford CCG

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Imuderm® Urea Emollient

Cetyl/Cetostearyl/Stearyl Alcohol

Benzalkonium Chloride; Phenethyl Alcohol

Cetrimonium Bromide

• Emollient products containing urea are not all interchangeable. The urea content of products varies widely and some

contain additional active ingredients such as salicylic acid or lactic acid (keratolytic properties), or lauromacrogols

(reputed to reduce itch). Ensure that product(s) selected are indicated for the intended use.

• It is reasonable to target use of emollients containing urea (a keratin softener and hydrating agent) to specific

groups, e.g. those with scaling skin, or those who have tried other emollients without success.

BATH AND SHOWER EMOLLIENTS AND SOAP SUBSTITUTES

Evidence around the use of bath and shower preparations is limited. Many standard emollients can be used as a soap

substitute. Any ointment (except 50:50) can be dissolved in some hot water and added to the bath water as a bath additive.

Bath additives and shower gels are not recommended for prescribing – please see emollients, bath oils, soap

substitutes and shower gels position statement.

It is recommend to use a standard emollient as a soap substitute (e.g. by applying it to the skin before bathing/showering

then rinsing it off), as they believe this provides better moisturisation of the skin.

Regardless of the type of product the person uses to wash with, it should not replace the regular use of a leave-on emollient.

Please, advise people to continue using standard emollients in addition to any bath/shower product or soap substitute used.

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BNF 13.4 TOPICAL CORTICOSTEROIDS

Fingertip units of topical corticosteroid cream or ointment to apply to specific areas

Number of fingertip units

Age Face & neck One arm & hand One leg & foot Trunk (front) Trunk (back) inc.

buttocks

Adult 2.5 4 8 7 7

3-6 month old child 1 1 1.5 1 1.5

1-2 month old child 1.5 1.5 2 2 3

3-5 month old child 1.5 2 3 3 3.5

6-10 month old child 2 2.5 4.5 3.5 5

Suitable quantities of corticosteroid preparations to be prescribed for specific areas of the body - These amounts are

usually suitable for an adult for a single daily application for 2 weeks.

Area of body Creams and Ointments

Face and neck 15 – 30g

Both Hands 15 – 30g

Scalp 15 – 30g

Both Arms 30 – 60g

Both Legs 100g

Trunk 100g

Groins and genitalia 15 – 30g

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NHS Castle Point and Rochford CCG

NHS Southend CCG

May 2020, updated July 2021

• Topical corticosteroids should be spread thinly on the skin but in sufficient quantity to cover the affected areas. The

length of cream or ointment expelled from a tube can be measured in terms of a fingertip unit (the distance from

the tip of the adult index finger to the first crease, equivalent of approximately 500mg).

• Match the potency of topical corticosteroid to the severity of the condition, taking into account the patient’s age

and site of application.

• Use topical corticosteroids short term or intermittently wherever possible. Regular emollient use and strategies such

as treating frequently flaring atopic eczema with topical corticosteroid for two days a week, or the use of non-steroid

based treatments in between topical corticosteroid courses in psoriasis can support this.

• Use the more potent topical corticosteroids with appropriate caution. Potent or very potent topical corticosteroids

may be contraindicated or restricted to use under specialist supervision depending on the age of the person, the

condition being treated and the site of application.

• Topical corticosteroids are contraindicated in acne, rosacea, perioral dermatitis and untreated bacterial, fungal,

or viral skin lesions. They should not be used for the routine treatment of urticaria or pruritis of unknown cause,

and they may worsen ulcerated lesions.

Small packs of hydrocortisone 1% (alone or combined with other ingredients) and clobetasone butyrate 0.05% are

available over the counter (OTC) for short-term use (maximum seven days) in skin conditions such as mild to moderate

eczema, dermatitis and insect bites. The licence of OTC products is more restrictive, but when appropriate patients can be

directed to purchase items for self care.

Products listed below are generally with the generic name first, except where a brand is available at a lower price to the

Drug Tariff price, where brand name is listed first.

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NHS Castle Point and Rochford CCG

NHS Southend CCG

May 2020, updated July 2021

The list of excipients listed below correspond to the brand names as generic products contain different excipients

depending on their manufacturer

MILD TOPICAL CORTICOSTEROIDS – cost less than £0.20 per gram or ml - £6 per 30g or 30ml

First Choice

Hydrocortisone 1% cream

Alternatives

Synalar 1 in 10 Dilution® (fluocinolone acetonide 0.0025% cream)

MODERATE TOPICAL CORTICOSTEROIDS – cost less than £0.10 per gram or ml - £3 per 30g or 30ml

First Choice

Audavate RD® 0.025% cream/ointment (betamethasone valerate)

Alternatives

Clobavate® 0.05% ointment (clobetasone butyrate)

Modrasone® 0.5% cream (alclometasone dipropionate)

Haelan® (fludroxycortide 0.0125% cream/ointment)

Ultralanum Plain® cream (fluocortolone pivalate 0.25%, fluocortolone hexanoate 0.25%)

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NHS Castle Point and Rochford CCG

NHS Southend CCG

May 2020, updated July 2021

Ultralanum Plain® ointment (fluocortolone monohydrate 0.25%, fluocortolone hexanoate 0.25%)

Eumovate® (clobetasone butyrate 0.05% cream)

Alphaderm® (hydrocortisone 1%, urea 10% cream)

Synalar 1 in 4 Dilution® (fluocinolone acetonide 0.00625% cream/ointment)

POTENT TOPICAL CORTICOSTEROIDS – cost less than £0.10 per gram or ml - £3 per 30g or 30ml

First Choice

Audavate® 0.1% ointment (betamethasone valerate)

Betnovate® (betamethasone valerate 0.1% lotion)

Alternatives

Betnovate® 0.1% cream/ointment (betamethasone valerate)

Locoid® (hydrocortisone butyrate 0.1% cream/ointment)

Locoid 0.1% Lipocream® (hydrocortisone butyrate)

Locoid Crelo® 0.1% emolsion (hydrocortisone butyrate)

VERY POTENT TOPICAL CORTICOSTEROIDS – cost less than £0.10 per gram or ml - £3 per 30g or 30ml

First Choice

Clobaderm® 0.05% cream/ointment (clobetasol propionate)

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NHS Castle Point and Rochford CCG

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May 2020, updated July 2021

Alternatives

Dermovate® (clobetasol propionate 0.05% cream/ointment)

PRODUCTS CONTAINING ANTIMICROBIALS OR ANTIFUNGALS

• The benefit of including antibacterials or antifungals with a topical corticosteroid is uncertain. NICE advise that use

of topical antibiotics in children with atopic eczema, including those combined with topical corticosteroids, should be

reserved for cases of clinical infection in localised areas and limited to a maximum of two weeks treatment. Longer

use increases the risk of resistance and sensitization.

• Limiting use to a maximum of two weeks for adults and children

• Only issuing these items as acute issues and reviewing any currently prescribed as repeats

Potency of corticosteroid: Mild

Product Active Ingredients

Canesten HC – 30gr hydrocortisone 1%, clotrimazole 1%

Daktacort® cream/ ointment - 30gr hydrocortisone 1%, miconazole nitrate 2%

Timodine cream Hydrocortisone 0.5%, Benzalkonium chloride 0.20%,

nystatin 100 000 units/g

Terra-Cortril® ointment - 30gr hydrocortisone 1%, oxytetracycline (as hydrochloride) 3%

Fucidin H® cream - 30gr hydrocortisone acetate 1%, fusidic acid 2%

Potency of corticosteroid: Potent

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NHS Castle Point and Rochford CCG

NHS Southend CCG

May 2020, updated July 2021

Product Active Ingredients

Synalar N® cream/ ointment – 30gr fluocinolone acetonide 0.025%, neomycin sulfate 0.5%

Fucibet® cream/lipid cream - 30gr betamethasone (as valerate) 0.1%, fusidic acid 2%

Lotriderm® cream - 30gr betamethasone dipropionate 0.064%, clotrimazole 1%

TAPES AND PLASTERS

The use of these products should be short term but it can be intermittent and under the supervision of a specialist:

• Haelan® tape is polythene adhesive film impregnated with fludroxycortide 4 micrograms/cm2

• Betesil® medicated plasters contain betamethasone (as valerate) 2.25 mg

BNF 13.5.2 PREPARATIONS FOR PSORIASIS – please refer to psoriasis topical treatment pathway

(MSEMOC).

BNF 13.5.3 DRUGS AFFECTING THE IMMUNE RESPONSE

There are topical and systemic drugs affecting the immune response which are used for eczema or psoriasis; please use them

only under specialist supervision.

BNF 13.6 ACNE AND ROSACEA

ACNE

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NHS Castle Point and Rochford CCG

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May 2020, updated July 2021

Antibacterial resistance of Propionibacterium acnes is increasing; there is cross-resistance between erythromycin and

clindamycin. To avoid development of resistance:

• when possible use non-antibiotic antimicrobials (such as benzoyl peroxide or azelaic acid);

• avoid concomitant treatment with different oral and topical antibacterials;

• if a particular antibacterial is effective, use it for repeat courses if needed (short intervening courses of benzoyl

peroxide may eliminate any resistant propionibacteria);

• do not continue treatment for longer than necessary (however, treatment with a topical preparation should be

continued for at least 6 months).

Mild to moderate acne – Topical preparations

• Start with a lower strength and increase the concentration of benzoyl peroxide gradually (Over The Counter).

• Topical antibacterials are probably best reserved for patients who wish to avoid oral antibacterials or who cannot

tolerate them.

• Topical retinoids

Moderate to severe acne – Oral antibiotics. For women only - co-cyprindiol

Severe acne – Refer to dermatologist

• Isotretinoin is a Red Traffic Light drug that should be prescribed only by a Secondary Care.

Benzoyl peroxide and azelaic acid

First Choice Alternative

Benzoyl peroxide 2.5-5-10% 40g (Over the Counter) Skinoren® - Azelaic acid 20% cream-30g

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May 2020, updated July 2021

Topical antibacterials

First Choice

Dalacin T®

Topical solution, clindamycin 1% (as phosphate), in an aqueous alcoholic basis-30mL

Lotion, clindamycin 1% (as phosphate) in an aqueous basis-30mL

Prescribing benzoyl peroxide (Over the Counter) and Dalacin T® (clindamycin 1%) separately is more cost effective than combined

products. If two separate products are used, they should be applied 12 hours apart. Typically, benzoyl peroxide is applied at night and

the topical antibiotic in the morning.

Topical retinoids

First Choice

Isotrexin® - Gel, isotretinoin 0.05%, erythromycin 2% in ethanolic basis-30g

Oral antibacterials

Topical benzoyl peroxide may also be required.

First Choice Alternative

Oxytetracycline

Tetracycline

Doxycycline

Lymecycline

KEY LEARNING POINTS when using antibiotics

The right antimicrobial

• Benzoyl peroxide is the topical antimicrobial of first choice

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• When an antibiotic is clinically justified, combine topical⁄systemic therapy with benzoyl peroxide to combat

resistance

• Topical delivery is preferable to oral when acne is localised

For the right patient

• When topical non-antibiotic remedies have failed to bring about adequate control

• For moderate or severe acne while awaiting referral to secondary care

• For extensive inflammatory acne on the trunk

For the right time

• Keep courses of antibiotics short (preferably 3–4 months)

• Use to achieve control but not to maintain control

ROSACEA

• Topical ivermectin Gel (Soolantra®) – applied once daily for 4 months with sunscreen. Treatment can be repeated

ONCE only in 12 month period. Discontinue after 3 months if no improvement.

• The pustules and papules of rosacea respond to topical metronidazole or to topical azelaic acid

• Alternatively, oral administration of oral antibiotics, see above recommendation as for acne

• Isotretinoin is occasionally given in refractory cases. Specialist only.

• Brimonidine tartrate (Mirvaso®) gel – please refer to brimonidine tartrate position statement (MSEMOC).

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NHS Castle Point and Rochford CCG

NHS Southend CCG

May 2020, updated July 2021

13.7 PREPARATIONS FOR WARTS AND CALLUSES

Preparations of salicylic acid, formaldehyde, gluteraldehyde or silver nitrate are available OTC for purchase by the

public; they are suitable for the removal of warts on hands and feet.

Anogenital warts

The treatment of anogenital warts (condylomata acuminata) should be accompanied by screening for other sexually

transmitted infections through referral to GUM clinic

First Choice

Podophyllotoxin 0.15% cream - direct medical supervision for lesions greater than 4cm2

Podophyllotoxin 0.5% solution - direct medical supervision for lesions in the female and for lesions greater than 4cm2

Alternative

Imiquimod 5% (Aldara®) – Specialist initiation under GUM

13.8.1 SUNSCREEN PREPARATIONS – please refer to sunscreens position statement (MSEMOC).

Photodamage

• An emollient may be sufficient for mild actinic keratosis lesions

• Diclofenac gel is suitable for the treatment of superficial lesions in mild disease.

• Fluorouracil cream is effective against most types of non-hypertrophic actinic keratosis; a solution containing fluorouracil and salicylic

acid is available for the treatment of low or moderately thick hyperkeratotic actinic keratosis

• Imiquimod 3.75% (Zyclara®) and Imiquimod 5% (Aldara®) are used for lesions on the face and scalp when cryotherapy or other

topical treatments cannot be used.

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May 2020, updated July 2021

• Use of preparations containing Fluorouracil and Imiquimod will require counselling on side effects and consider referral to a specialist

if concerns about diagnosis or suitability of treatment.

First Choice

Diclofenac sodium 3% Gel

Fluorouracil 5% Cream

Fluorouracil 0.5%, salicylic acid 10%

Alternative

Imiquimod 3.75% (Zyclara®) | Imiquimod 5% (Aldara®)

13.8.2 CAMOUFLAGE CREAMS – please refer to camouflage creams position statement (MSEMOC).

13.9 SHAMPOOS AND OTHER PREPARATIONS FOR SCALP AND HAIR CONDICIONS

Psoriasis - please refer to psoriasis topical treatment pathway (MSEMOC).

Seborrhoeic dermatitis - medicated, anti-dandruff shampoos containing agents such as zinc pyrithione, selenium sulphide

or ketoconazole can be used regularly

Corticosteroids – See section 13.4

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NHS Castle Point and Rochford CCG

NHS Southend CCG

May 2020, updated July 2021

First Choice

Selenium sulfide 2.5% Shampoo (Selsun®) - 150 ml

Alternative

Ketoconazole 2% shampoo - 120 ml

Hirsutism

Weight loss can reduce hirsutism in obese women.

Women should be advised about local methods of hair removal, and in the mildest cases this may be all that is required.

• Co-cyprindiol (section 13.6.2) may be effective for moderately severe hirsutism.

• Metformin (section 6.1.2.2) is an alternative in women with polycystic ovary syndrome [unlicensed indication].

Systemic treatment is required for 6–12 months before benefit is seen.

• Eflornithine (as hydrochloride monohydrate) 11.5% (Vaniqa®) cream – please refer to eflornithine (Vaniqa®) cream

position statement (MSEMOC).

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NHS Castle Point and Rochford CCG

NHS Southend CCG

May 2020, updated July 2021

13.10. ANTI-INFECTIVE SKIN PREPARATIONS

For more information please refer to MSEMOC antimicrobial formulary and primary care antimicrobial guidance.

Parasiticidal preparations

These amounts are usually suitable for an adult for single application

Suitable quantities of parasiticidal preparations

Area of body Skin creams Lotions Cream rinses

Scalp (head lice) — 50–100 mL 50–100 mL

Body (scabies) 30–60 g 100 mL —

Body (crab lice) 30–60 g 100 mL —

These amounts are usually suitable for an adult for single application.

First Choice

Dimethicone 4% - Head lice only. Less active against eggs and treatment should be repeated after 7 days.

Alternative

Lyclear® dermal cream - Permethrin 5% Malathion 0.5% Liquid in an aqueous basis

• Products for head lice should be bought Over The Counter (OTC) in Community Pharmacies.

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NHS Southend CCG

May 2020, updated July 2021

13.11. SKIN CLEANSERS, ANTISEPTICS, AND DESLOUGHING AGENTS

Alcohols and saline – Sodium Chloride 0.9%

First Choice Alternative

Flowfusor® Bellows pack (120ml)

Irriclens® aerosol (240ml)

Clinipod® pod (25x20ml)

Sal-e Pods® pod (25x20ml)

The exact number of containers (ie aerosols, bellows packs, bottles, cans, pods, pour bottles or sachets) should be

prescribed

Chlorhexidine salts

First Choice Alternative

Hibiscrub® - chlorhexidine gluconate 4% Hydrex® - chlorhexidine gluconate 2.5% in denatured

ethanol 70%

Iodine

First Choice Alternative

Betadine® dry powder spray – povidone-iodine 2.5% Savlon® dry - dry powder spray – povidone-iodine 1.14%

Oxidisers and dyes

First Choice Alternative

Hydrogen peroxide 6% (20 vols) Permitabs® - Potassium Permanganate 400mg tablets

• Wound Care – Octenilin® Bottle 350ml. Refer to EPUT Wound Formulary.

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May 2020, updated July 2021

• MRSA Decolonisation - Octenisan®. Refer to Management of High Risk MRSA Colonised/Infected Adult Patients

in Nursing Homes and Primary Care Settings

13.12. ANTIPERSPIRANTS

First Choice

Aluminium chloride hexahydrate 20% in an alcoholic basis - OTC

Alternative

Antimuscarinics in tablet form

Oxybutynin 5mg BD

• Refer patients to Integrated Dermatology Services to try next step – Iontophoresis – Botulinum toxin A

• Botulinum toxin type A complex (Botox®) injections can be prescribed and administered in specialist clinics (needs

agreement)

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Formulary Chapter 13 SKIN

Date ratified by D&T Committee April 2016

1st review – update bath emollients information following position statement April 2017

Date ratified by D&T Committee April 2017

2nd review – Introduce Isomol® gel, Zeroveen®, update bath emollients information following advice

from dermatologists

Botulinum toxin type A included

September 2017

Date ratified by D&T Committee September 2017

3rd review – Epimax OAT® added. Bath additives, shower gels and bath oils remove from formulary.

Dovobet® to Enstilar® changed. Corticosteroid creams reviewed, Timodine® added. Scalp Psoriasis

reviewed. Treatment for Acne and Rosacea reviewed, Isotrex® and Stiemycin® removed as

discontinued. Treatment for Anogenital warts to be started in Secondary Care. Imiquimode 5% added

for photodamage. Refer to Dermatology Services for Iontophoresis – Botulinum toxin A.

November 2018

Date ratified by D&T Committee November 2018

Next Review Date November 2020

4th review – Logos changed

Skinoren® - Azelaic acid 20% cream-30g, OTC removed as it is a Prescription Only Medicine (POM)

January 2019

Date ratified by D&T Committee February 2019

Next Review Date February 2021

5th review –

Ingenol removed from Photodamage section as discontinued.

Epimax® range edited as names changed.

April 2020

Date ratified by D&T Committee May 2020

Next Review Date May 2022

6th review – updated in line with MSEMOC recommendations July 2021

Additions approved by MSEMOC December 2020; May 2021

Next review date July 2023