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13.6 Acne and Rosacea
13.6.1 Preparations for acne 
Mild to moderate acne:
This includes people who have 1 or more of the following: any number of non-inflammatory lesions (comedones); up to
34 inflammatory lesions (with or without non-inflammatory lesions); up to 2 nodules.
First line
GREEN      Adapalene 0.1%/Benzoyl Peroxide 2.5% (Epiduo®Gel) 
GREEN      Adapalene 0.3%/Benzoyl Peroxide 2.5% (Epiduo®Gel)  
Second line
GREEN      Tretinoin and clindamycin 0.025%/1% gel (Treclin®) 

GREEN      Benzyl peroxide 5% & clindamycin 1% gel (Duac Once Daily®) 

Alternative if treatment options above are contraindicated or the person wishes to avoid using a topical retinoid or an antibiotic 
(oral or topical): 
GREEN      Benzoyl peroxide 5% gel (Acnecide®) 
Moderate to severe acne:
This includes people who have either or both of the following: 35 or more inflammatory lesions (with or without non-inflammatory 
lesions); 3 or more nodules.
First line 
Consider monotherapy with one of the following products: 
GREEN      Adapalene 0.1%/Benzoyl Peroxide 2.5% gel (Epiduo®Gel)
GREEN      Adapalene 0.3%/Benzoyl Peroxide 2.5% gel (Epiduo®Gel)
GREEN      Tretinoin and clindamycin 0.025%/1% gel (Treclin®)

GREEN        Trifarotene 5% cream (Aklief®)

Alternative if treatment options above are contraindicated or the person wishes to avoid using a topical retinoid or  

an antibiotic (oral or topical):

GREEN      Benzoyl peroxide 5% gel (Acnecide®)

Second line

Combination therapy with one of the following topical products + an oral antibiotic. Please see the ELMMB antimicrobial 
formulary for further information on dosing and review recommendations. 
Topical product options (for use in combination therapy):
GREEN      Adapalene 0.1%/Benzoyl Peroxide 2.5% gel (Epiduo®Gel)
GREEN      Adapalene 0.3%/Benzoyl Peroxide 2.5% gel (Epiduo®Gel)
GREEN      Azelaic acid 20% cream (Skinoren®) 

Oral antibiotic options (for use in combination therapy):
Preferred antibiotics options:
GREEN      Lymecycline capsules 408 mg (dose: 408 mg daily)
GREEN       Doxycycline capsules 100 mg (dose: 100 mg daily)
Less preferred antibiotics options:
GREEN    Trimethoprim tablets 100 mg, 200 mg (dose: 300 mg twice daily)
GREEN      Erythromycin tablets E/C 250 mg (dose: 500 mg twice daily)
Antibiotic options that should only be used for acne upon advice of dermatologist:
GREEN      Oxytetracycline tablets 250mg (dose: 500 mg twice daily)

GREEN      Tetracycline tablets 250mg (dose: 500 mg twice daily)

Severe Acne (resistant to standard therapy with systemic antibiotics and topical therapy):
RED           Isotretinoin capsules 5 mg,10 mg, 20 mg*
*Prescribed by or under the supervision of a Consultant Dermatologist

Hormonal acne treatment for female patients:

GREEN       Co-cyprindiol tablets (cyproterone 2mg & ethinylestradiol 35 micrograms)*
*Prescribe generically, not as 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.

Additional products available for treatment of acne:

Alternative option as monotherapy for maintenance following acne treatment: 

GREEN      Adapalene 0.1% cream/gel (Differin®) 

The following products can be considered as alternative treatment options on the formulary, but are not included in the 

NICE Guidance 198 treatment recommendations:

GREEN      Clindamycin 1% aqueous lotion (Dalacin T®) 

GREEN      Erythromycin 40mg & zinc acetate topical solution 12mg/ml(Zineryt®)


13.6.2 Preparations for rosacea

GREEN      Metronidazole 0.75% cream (Rosex®)
GREEN      Ivermectin 1% cream (Soolantra®) 
 All material in this section is aimed at health care professionals, but is information currently held in the public domain, members of the
 public seeking advice on medicine-related matters are advised to speak with their GP, pharmacist, nurse or contact NHS111 Service 
 Email: info.elmmb@nhs.net
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