Immunosuppressants - Skin

Drugs in this section must be initiated and supervised by specialist dermatology services and should be used according to relevant NICE TAs and guidance where they exist.

See the guidance page for skin for relevant guidance.

The following drugs also fall into this category but they are primarily listed in other parts of the formulary:-

• Ciclosporin can be used for severe psoriasis and severe eczema. See shared care guidance.
• Azathioprine, leflunomide, hydroxychloroquine and mycophenolate may be used to treat psoriasis (unlicensed indication). See shared care guidelines.
• Apremilast may be used to treat adults with moderate-severe plaque psoriasis in line with NICE TA419
• Certolizumab pegol may be used for treating moderate-severe plaque psoriasis in adults in line with NICE TA574
• Secukinumab is an option for treating active moderate to severe hidradenitis suppurativa (acne inversa) in adults as per NICE TA935
• Upadacitinib is a treatment option for managing moderate to severe atopic dermatitis in line with NICE TA814

In Kent and Medway, specialist dermatology services are provided by EKHUFT, and Kent Integrated Dermatology Services which has clinics at sites throughout North and West Kent.

Topical tacrolimus or pimecrolimus should only be used according to NICE TA82. They can be initiated only by physicians (including GPs) 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.