Mild to moderate acne: |
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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. |
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First line |
GREEN Adapalene 0.1%/Benzoyl Peroxide 2.5% (Epiduo®Gel) |
GREEN Adapalene 0.3%/Benzoyl Peroxide 2.5% (Epiduo®Gel) |
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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): |
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GREEN Benzoyl peroxide 5% gel (Acnecide®) |
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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. |
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First line |
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Consider monotherapy with one of the following products: |
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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. |
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Topical product options (for use in combination therapy): |
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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®) |
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Oral antibiotic options (for use in combination therapy): |
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Preferred antibiotics options: |
GREEN Lymecycline capsules 408 mg (dose: 408 mg daily) |
GREEN Doxycycline capsules 100 mg (dose: 100 mg daily) |
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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) |
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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): |
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RED Isotretinoin capsules 5 mg,10 mg, 20 mg* |
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*Prescribed by or under the supervision of a Consultant Dermatologist |
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Hormonal acne treatment for female patients: |
GREEN Co-cyprindiol tablets (cyproterone 2mg & ethinylestradiol 35 micrograms)* |
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*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. |
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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®) |
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13.6.2 Preparations for rosacea |
GREEN Metronidazole 0.75% cream (Rosex®) |
GREEN Ivermectin 1% cream (Soolantra®) |
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