To reduce the risk of skin irritation associated with topical treatments, start with alternate-day or short-contact application (for example washing off after an hour). If tolerated, progress to using a standard application.

Benzoyl peroxide

Benzoyl peroxide plus clindamycin

• Benzoyl peroxide 3% / clindamycin 1% gel (£13.14 = 30g)
• Benzoyl peroxide 5% / clindamycin 1% gel (£10.15 = 30g, £16.41 = 60g)

Indications

• Initial treatment for mild to moderate acne (for 12 weeks).

Dose

• Applied once daily in the evening.

Notes

1. Hands should be washed after application.
2. Avoid deliberate or prolonged exposure to sunlight.
3. May bleach hair or coloured fabrics. Avoid contact with hair, fabrics, furniture, or carpeting.

Benzoyl peroxide

• Gel 5% (£5.44 = 30g, £10.68 = 60g)

Indications

• Initial treatment for acne (for 12 weeks).
• Maintenance treatment for acne.

Dose

• Applied once or twice daily in the evening.

Notes

1. Hands should be washed after application.
2. Avoid deliberate or prolonged exposure to sunlight.
3. May bleach hair or coloured fabrics. Avoid contact with hair, fabrics, furniture, or carpeting.
4. Alternative option where first-line treatments of acne are contraindicated, or not suitable (see acne guidance).

Azelaic acid

Azelaic acid

• Cream 20% (£4.49 = 30g)
• Gel 15% (£7.48 = 30g)

Indications

• Mild papulopustular rosacea (gel 15%).
• Initial treatment for moderate to severe acne in combination with oral lymecycline or doxycycline (for 12 weeks).
• Maintenance treatment of acne (monotherapy) (second line) (see note 3).

Dose

• Apply twice daily.

Notes

1. Hands should be washed after application.
2. Discontinue gel if no improvement after one month for acne, or two months for rosacea.
3. Alternative maintenance option where Epiduo is contraindicated or not suitable (see acne guidance).

Topical retinoids and related preparations for acne

Patients should be advised:

• Redness and skin peeling may occur initially, but usually settles with time
• Exposure to UV light (including sunlight, solariums) should be avoided; if sun exposure is unavoidable, an appropriate sunscreen or protective clothing should be used (even on a bright but cloudy day).
• Allow peeling (e.g. from benzoyl peroxide) to subside before using a topical retinoid
• Alternating a preparation that causes peeling with a topical retinoid may give rise to contact dermatitis (reduce frequency of retinoid application)
• Use of retinoids with abrasive cleaners, comedogenic or astringent cosmetics should be avoided.
• Avoid accumulation in the angles of the nose
• Use with caution in sensitive areas such as the neck

MHRA Drug Safety Update (June 2019): Teratogenic risk and risk of neuropsychiatric reactions with topical retinoids

• Systemic exposure is thought to be negligible following application of topical retinoids (topical adapalene, alitretinoin, isotretinoin, tazarotene, and tretinoin) during pregnancy.
• However, since risk cannot be excluded, use of topical retinoids is contraindicated during pregnancy as a precaution.
• Women and girls should be advised not to use topical retinoids if they are planning a pregnancy and to use effective contraception to minimise the risk of accidental exposure in pregnancy if they are of childbearing potential.
• For topical retinoids (adapalene, alitretinoin, isotretinoin, tazarotene, and tretinoin), the review concluded that data show systemic exposure is negligible following topical application and is unlikely to be associated with an increased risk of neuropsychiatric disorders (see EMA Public Assessment Report)
• See also resources for: contraception for drugs with teratogenic potential, and prescribing in pregnancy and lactation

Topical retinoids should be avoided in severe acne involving large areas.

Several months of treatment may be needed to achieve an optimal response and the treatment should be continued until no new lesions develop.

Epiduo

(Adapalene plus benzoyl peroxide)

• Adapalene 0.1% / benzoyl peroxide 2.5% gel (£20.85 = 45g)
• Adapalene 0.3% / benzoyl peroxide 2.5% gel (£20.85 = 45g)

Indications

• Initial treatment for acne (as monotherapy or in combination with oral lymecycline or doxycycline) (for 12 weeks).
• Maintenance treatment for acne (as monotherapy).

Dose

• Applied once daily in the evening.

Notes

1. Hands should be washed after application.
2. Avoid deliberate or prolonged exposure to sunlight.
3. May bleach hair or coloured fabrics. Avoid contact with hair, fabrics, furniture, or carpeting.

Treclin

(Clindamycin plus tretinoin)

• Clindamycin 1% / tretinoin 0.025% gel (£11.94 = 30g)

Indications

• Initial treatment for acne (for 12 weeks).

Dose

• Applied once daily in the evening.

Notes

1. Hands should be washed after application.
2. Avoid deliberate or prolonged exposure to sunlight.
3. May bleach hair or coloured fabrics. Avoid contact with hair, fabrics, furniture, or carpeting.

Adapalene

• Cream 0.1% (£16.43 = 45g)
• Gel 0.1% (£16.43 = 45g)

Indications

• Maintenance treatment of acne.

Dose

• Applied once daily in the evening.

Notes

1. Hands should be washed after application.
2. Avoid deliberate or prolonged exposure to sunlight.
3. May bleach hair or coloured fabrics. Avoid contact with hair, fabrics, furniture, or carpeting.
4. Alternative maintenance option where Epiduo is contraindicated or not suitable (see acne guidance).

Trifarotene

• Cream 50 micrograms/g (£27.75 = 75g)

Indications

• Maintenance treatment of acne.

Dose

• Applied once daily in the evening.

Notes

1. Hands should be washed after application.
2. Avoid deliberate or prolonged exposure to sunlight.
3. May bleach hair or coloured fabrics. Avoid contact with hair, fabrics, furniture, or carpeting.
4. Alternative maintenance option where Epiduo is contraindicated or not suitable (see acne guidance).