13.6.1 Topical preparations for acne

Many of these products are cheap to buy and are readily available, along with advice, from pharmacies. Some self-care medicines are available in shops and supermarkets. Please click here for further information and a patient leaflet.

Benzoyl peroxide and azelaic acid

Benzoyl peroxide
  • Cream
  • Gel

Indications

Dose

  • Apply 1–2 times daily preferably after washing with soap and water, start treatment with lower-strength preparations.
  • If skin irritation occurs, reduce frequency or suspend use until irritation subsides and re-introduce at reduced frequency.

Notes

  1. Avoid excessive exposure to sunlight.
  2. May bleach fabrics and hair.
  3. At the time of writing (Summer 2016) there were supply issues with benzoyl peroxide products, speak to your local Medicines Optimisation Pharmacist or Technician for more information.
Duac Once Daily®
  • Gel benzoyl peroxide 5%, clindamycin 1% (£13.14 = 30g)

Indications

Dose

  • Apply once daily in the evening

Notes

  1. Treatment with Duac Once Daily Gel should not exceed more than 12 weeks of continuous use.
Azelaic acid
  • Gel 15% (£7.48 = 30g)
  • Cream 20% (£3.74 = 30g)

Indications

Dose

  • Apply twice daily. In cases of sensitive skin, once daily for first week (cream) or once daily until irritation ceases (gel)
  • Finacea® gel – discontinue if no improvement after 1 month for acne or 2 months for rosacea.

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).
  • To 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.
  • To avoid accumulation in the angles of the nose
  • Use with caution in sensitive areas such as the neck

Topical retinoids should not be used in pregnancy (teratogenic) and women of childbearing age must use adequate contraceptive precautions while using a retinoid (oral progestogen-only contraceptives not considered effective).

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.

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

Indications

Dose

  • Apply thinly once daily in the evening
Treclin®

(Tretinoin plus clindamycin)

  • Gel clindamycin 1% (as clindamycin phosphate), tretinoin 0.025% (£11.94 = 30g)

Indications

Dose

  • Apply once daily (thinly) at bedtime

Notes

  1. Treatment with Treclin should not exceed 12 weeks of continuous use without careful evaluation. It should be noted that therapeutic improvement may not be observed for several weeks after starting treatment.
  2. Treclin® gel is indicated for the topical treatment of acne vulgaris when comedones, papules and pustules are present in patients 12 years or older.
  3. The routine commissioning of Treclin® has been accepted in Devon for the treatment of moderate acne vulgaris in adults and children over 12 years and older for treatment courses of up to 12 weeks (see Commissioning Policy for more details).
Epiduo®

(Adapalene plus benzoyl peroxide)

  • Gel (£19.05 = 45g)

Indications

Dose

  • Apply thinly once daily in the evening

Notes

  1. May bleach clothing and hair
Isotrexin®
  • Gel (Isotretinoin plus erythromycin) (£7.47 = 30g)

Indications

Dose

  • Apply thinly 1-2 times daily.

Notes

  1. The efficacy and safety of Isotrexin® has not been studied beyond 12 weeks. The prescriber should evaluate the benefit of continuing treatment beyond 12 weeks of uninterrupted use, taking account of an increased risk of antimicrobial resistance.

 

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