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

1. Swindon CCG & Wiltshire Acne Prescribing Guidelines
2. Clinical Management in Primary Care Cambridgeshire and Peterborough Clinical Commissioning Group
3. Acne Pathway Coventry and Rugby Clinical Commissioning Group