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
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34 inflammatory lesions (with or without non-inflammatory lesions); up to 2 nodules.
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First line
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| 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
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GREEN Tretinoin and clindamycin 0.025%/1% gel (Treclin®)
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| 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
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(oral or topical):
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| GREEN Benzoyl peroxide 5% gel (Acnecide®) |
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Moderate to severe acne:
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This includes people who have either or both of the following: 35 or more inflammatory lesions (with or without non-inflammatory
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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)
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GREEN Adapalene 0.3%/Benzoyl Peroxide 2.5% gel (Epiduo®Gel)
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| GREEN Tretinoin and clindamycin 0.025%/1% gel (Treclin®)
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Alternative if treatment options above are contraindicated or the person wishes to avoid using a topical retinoid or
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| 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)
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GREEN Doxycycline capsules 100 mg (dose: 100 mg daily)
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Less preferred antibiotics options:
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| 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
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| 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
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| 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
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| 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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