Acne Prescribing
A guide to prescribing acne treatment in primary care.
Mild acne –Benzoyl peroxide 2.5 % or 5 % once or twice a day
Benzoyl peroxide – cheapest option- works quickly and can be as effective as topicl retinoids branded examples include Acnecide gel 5 %
Azelaic acid 20 % BD
Topical erythromycin 2-4 % bd or clindamycin 1 % BD
Topical retinoid
Tretinoin 0.01 % or 0.025 % once or twice a day
Adapalene 0.1 % nocte
Isotretnoin 0.05 % BD
Topical retinoids – warn that it may irritate the skin -can be started slowly for eg once or twice a week and then increased gradually to every day.
You cal also advie to consider ↑ ing the application time gradually for e.g start with 15-30 mins and increase gradually to overnight.
Mild to moderate acne-Use of combination
treatment for e.g Benzoyl peroxode + an antibiotic like erythromycin or clindamycin
Benzoyl peroxide + clindamycin ( Duac® )
Benzoyl peroxide + a topical retinoid for e.g adapalene 0.1 % ( Epiduo® gel )
Topical retinoid + a topical antibiotic for e.g
Tretnoin 0.025 % + clindamycin 1 %
( Treclin® )
. Topical erythromycin
( Zineryt® ) ↑ ing resistance )
Consider using topical antibiotic in combination with BPO or a retinoid rather than in isolation
Severe acne –More extensive lesions or unresponsive to topical therapy or truncal disease where topical application is difficult
Systemic treatment + topical retinoid / BPO
Discontinue topical antibiotic
Oral antibiotic for atleast 3 months choose from the following commonly used preparations
○ Doxycyline 50-100 mg od
○ Lymecylcine 409 mg od
○ Oxytetracycline 500 mg bd
○ Erythromycin 500 mg bd
In female patient an OCP can be used in combination with topical treatment or systemic antibiotics
Dianette® is licensed for severe acne but increases the risk of VTE- the risk is 1.5 to 2 times higher than for COCs with levonorgestrel and may be similar to the risk with contraceptives containing gestodene , desogestrel or drospirenone. Yasmin is also considered to be a good choice but POPs worsen acne.
Topical retinoids and tetracyclines including oral formulations are contra-indicated in pregnancy. Females of child bearing age must use effective contraception ( oral progestogen-only contraceptives not considred effective ) BNF
References
- Swindon CCG & Wiltshire Acne Prescribing Guidelines
- Clinical Management in Primary Care Cambridgeshire and Peterborough Clinical Commissioning Group
- Acne Pathway Coventry and Rugby Clinical Commissioning Group
