General Notes: Acne

Step 1

  • Benzoyl peroxide gel

Step 2

  • Zineryt® solution

or

  • Benzoyl peroxide with clindamycin gel

or

  • a retinoid gel/cream (Treclin® gel, adapalene gel/cream, Epiduo® gel)

Step 3

  • Oral antibiotic treatment

Step 4

  • Oral retinoid treatment

Further information, including presentation, management and referral criteria available at The Dermatology Patient Pathways - Acne.

Benzoyl Peroxide

Preferred list (P)

BENZOYL PEROXIDE gel

Topical Antibacterial Preparations

Preferred list (P)

ERYTHROMYCIN WITH ZINC ACETATE (Zineryt® lotion)

Topical Retinoids and Related Preparations

Total list (T)

TRETINOIN WITH CLINDAMYCIN gel (Treclin®)

  • Tretinoin 0.025% with clindamycin 1%
  • Contains an antimicrobial.

ADAPALENE 0.1% gel/cream

ADAPALENE WITH BENZOYL PEROXIDE gel (Epiduo®)

  • Adapalene 0.1% with benzoyl peroxide 2.5%
  • SMC restriction: for use in mild to moderate facial acne when monotherapy with benzoyl peroxide or adapalene is inappropriate.

Prescribing Notes:

  • Risk of irritation with topical retinoids – build up frequency and duration of application over 2 – 3 weeks.
  • Following application of topical retinoids, evidence suggests that systemic exposure is thought to be negligible. However, since risk cannot be excluded, their use is contraindicated during pregnancy as a precaution.
  • Any recommendation for a topical retinoid issued to a patient of childbearing potential will require clearly documented discussion around the need for effective contraception. (oral progestogen-only contraceptives are not considered effective)
  • Women and girls should be advised not to use topical retinoids if planning a pregnancy and to use effective contraception to minimise risk of accidental foetal exposure.
  • If the patient wishes to proceed without effective contraception, all clinicians involved in direct clinical care must be in agreement. The patient must be aware of and understand the possible risks and consequences of declining contraception.
  • All topical treatment should be reviewed after 3 months.  

Oral Antibiotics

Preferred list (P)

OXYTETRACYCLINE

  • Avoid in renal disease.

DOXYCYCLINE immediate release capsules

  • Note: 40mg modified release capsules are not licensed in acne

Total list (T)

LYMECYCLINE

  • Avoid in renal disease.

ERYTHROMYCIN

  • Alternative if tetracyclines are poorly tolerated or contraindicated (such as in pregnancy).

Specialist initiation (S1)

TRIMETHOPRIM

  • Indication - acne resistant to other antibacterials.

MINOCYCLINE

  • Not a preferred second line treatment due to incidence of side effects.

Prescribing Notes:

  • Oral antibiotics should be limited to the shortest possible period, and discontinued when further improvement of acne is unlikely.

Hormonal Treatment

Total list (T)

CO-CYPRINDIOL

  • Indication - moderate to severe acne related to androgen-sensitivity (with or without seborrhoea) in women of reproductive age.

NHSL Joint Adult Formulary Key

To indicate the category of a formulary medicine, updated sections adopt the following key:

Preferred list (P): First-line formulary choices.

Total list (T): Alternative choices when preferred list options not effective/not tolerated, or not indicated.

Specialist initiation (S1): Specialist initiation, or on the advice of a Consultant or Specialist Practitioner in this therapeutic area. Continuation in primary care is acceptable.

Specialist use only (S2): Supply via hospital, Homecare Service or a hospital based prescription (HBP) for dispensing by community pharmacy. Not prescribed in primary care setting.

Editorial Information

Last reviewed: 31/01/2022

Next review date: 31/01/2025

Author(s): NHSL.

Version: Please refer to the introduction section for an explanation of the review dates above.

Approved By: ADTC

Reviewer name(s): ADTC.