13.7 Rosacea and acne
| First line drugs | Second line drugs | Specialist drugs | Secondary care drugs |
Traffic light status (TLS) explained:
- Green: Routine prescribing within licensed indication
- Amber 1: specialist recommendation followed by GP initiation and continuation
- Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
- Amber 3: specialist initiation and stabilisation followed by GP continuation
- Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
- Red: Hospital or specialist prescribing only
13.7.1 Acne
Peroxides
Benzoyl peroxide
- Gel (topical) 2.5%, 5%, 10%
Duac® Once Daily
- Gel benzoyl peroxide 5%, clindamycin 1%
Notes:
- To be used second-line after Epiduo
Anticomedonals
Azelaic acid (Amber 2)
- Gel 15%
- Cream 20%
Anti-infectives
Erythromycin with zinc acetate
- Zineryt® Topical solution
Anti-inflammatories
Ivermectin (Amber 2)
- Cream, 10mg/g
Anti-androgens
Co-cyprindiol
- Tablets
Notes:
- See current BNF for cautions and further information before initiating co-cyprindiol
Retinoid and related drugs
Topical retinoids are contra-indicated in pregnancy. Women of childbearing age should take adequate contraceptive precautions.
Epiduo®
- Adapalene 0.1% & benzoyl peroxide 2.5%
Notes:
- First-line
Adapalene
- Differin®Cream (topical) 0.1%
- Differin®Gel (topical) 0.1%
Isotretinoin (Amber 2)
- Gel (Topical) 0.05%
Isotretinoin
- Capsules 5mg, 20mg
Notes:
- MHRA/CHM Advice: Isotretinoin (Roaccutane) - rare reports of erectile dysfunction and decreased libido (October 2017)
- MHRA Drug Safety Update: Isotretinoin - risk of serious skin reactions (September 2010)
- Isotretinoin is teratogenic and must not be given to women of child-bearing age unless they practice effective contraception (oral progestogen-only contraceptives not considered effective) and then only after detailed assessment and explanation by the physician. Women must also be registered with a pregnancy prevention programme.
- Pregnancy must be excluded before starting isotretinoin (perform pregnancy test 2–3 days before expected menstruation, start treatment on day 2 or 3 of menstrual cycle) — women must practice effective contraception at least 1 month before, during, and for at least 1 month after treatment
- Prescribed in accordance to the following Isotretinoin (Alliance) Pregnancy Prevention Programme:
Isotrexin® (Amber 2)
- Gel, isotretinoin 0.05%, erythromycin 2%
Treclin® (Amber 2)
- Gel clindamycin 1%, tretinoin 0.025%
Antibiotic choice
Tetracyclines
Lymecycline (Amber 2)
- capsules 408mg
Note:
- A good first line antibiotic as compliance is good (it can be taken with food) and bacterial resistance is less than with first generation tetracyclines
Doxycycline (Amber 2)
- capsules 50mg, 100mg
Minocycline (Amber 2)
- rarely used
Macrolides
- Erythromycin
- Clarithromycin
Trimethoprim
- There are concerns of bacterial resistance, so this treatment may best be reserved for young children who do not tolerate macrolides
Others
Dianette (Amber 2)
- Tablets
Fludroxycortide 4 micrograms per square centimetre Tape (Haelan® Tape)
Traffic light status (TLS) explained:
- Green: Routine prescribing within licensed indication
- Amber 1: specialist recommendation followed by GP initiation and continuation
- Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
- Amber 3: specialist initiation and stabilisation followed by GP continuation
- Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
- Red: Hospital or specialist prescribing only
Last updated by: Dupe Fagbenro on 05-12-2018 12:41
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BNF
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NICE
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Summary of product characteristics
