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13.0 Skin

13.0 Skin
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 Care.  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. 
 Infantile Haemangiomas
 There is evidence for the use of oral propranolol for those haemangiomas with a potential to impair function or cause permanent
 disfigurement [off licence use]
 AMBER   Propranolol oral solution

Severe [refractory] Pyoderma Gangrenosum
 See attachment [British Association of Dermatologists]
 RED     Infliximab [including biosimilars]
 Hailey Hailey Disease: Treatment with low dose naltrexone [off-label use]
 RED     Low dose Naltrexone