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13.6.1 Topical preparations for acne

For mild and moderate acne a topical preparation is recommended. 
Benzoyl peroxide & azelaic acid
Patients should be advised that, in some cases, 4-6 weeks of treatment may  be required before the full therapeutic effect is 
GREEN      Benzoyl peroxide (Acnecide®) gel 5%   
GREEN      Duac Once Daily®  (Benzyl peroxide 5% & clindamycin 1%) gel  
GREEN      Azelaic acid (Skinoren®) cream 20%  
Topical antibacterials for acne 
GREEN      Dalacin T® aqueous lotion (clindamycin 1%)     
GREEN      Zineryt® topical solution (erythromycin 40mg & zinc acetate 12mg/ml)   
Topical retinoids and related preparations for acne
GREEN      Adapalene (Differin®) cream 0.1%, gel 0.1% 
GREEN      Adapalene 0.1%/Benzoyl Peroxide 2.5% (Epiduo®Gel)  
GREEN      Tretinoin and clindamycin (Treclin®) 0.025%/1% gel       
Preparations for rosacea 
GREEN      Metronidazole (Rosex®) cream 0.75% 
GREEN      Ivermectin (Soolantra®) cream 

13.6.2 Oral preparations for acne 

Oral antibacterials for acne 
For moderate acne oral antibiotics are usually needed and should be prescribed alongside a topical retinoid or benzoyl peroxide. 
Oral antibiotics should be limited to the shortest possible period. 
If the patient responds it may be continued for 4-6 months. (consider reducing the antibiotic dose by half for the latter period) 
then stop completely.  
First line 
GREEN        Tetracycline tablets 250mg (dose: 500mg twice daily) 
GREEN       Oxytetracycline tablets 250mg (dose: 500mg twice daily) 
For use in cases where first line drugs are not tolerated or ineffective 
GREEN      Doxycycline capsules 100mg (dose: 100mg  daily) 
GREEN      Lymecycline capsules 408mg (dose: 408mg daily) 
GREEN      Trimethoprim tablets (dose: 300mg bd)
Hormone treatment for acne
Used as an alternative to oral antibiotics for female patients.  
Co-cyprindiol (Dianette®) - used primarily as a treatment for moderate acne or other androgenic conditions especially hirsutism 
(e.g in patients with PCOS) who also need contraception. It should be discontinued three to four months after the androgenic
condition has resolved. It may be continued/restarted, after counselling, if the androgenic condition recurs. It should not be used 
solely for contraception. 
Note: CSM advice is venous thromboembolism occurs  more frequently in women taking co-cyprindiol than those taking a low-
           dose combined oral contraceptive. See BNF for full details.
GREEN       Co-cyprindiol tablets (cyproterone 2mg & ethinylestradiol 35mcg)    (Prescribe generically, not as Dianette®) 
Oral retinoid for acne 
For severe acne which has not responded to oral antibiotics, prescribed only by or under the supervision of a consultant
RED           Isotretinoin capsules 5mg, 20mg