NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Prescribing
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13 Skin

13.6 Acne and rosacea

13.6.1 Topical preparations for acne and rosacea

Preferred list
CLINDAMYCIN AND BENZOYL PEROXIDE (DUAC) (GEL)

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/128158.htm#_128158

ERYTHROMYCIN AND ZINC ACETATE (ZINERYT) (topical solution)

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/19925.htm#_19925

Total Formulary
ADAPALENE AND BENZOYL PEROXIDE (EPIDUO) (topical gel)

Restrictions: Restricted to the treatment of mild to moderate facial acne when monotherapy with benzoyl peroxide or adapalene is not considered appropriate.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/PHP7829-epiduo.htm?q=epiduo&t=search&ss=text&p=1#PHP7829-epiduo

AZELAIC ACID (Skinoren) (20% cream)

Prescribing Notes:

The 20% cream (Skinoren®) is used in the management of acne vulgaris.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/19890.htm

CLINDAMYCIN (DALACIN T)

Prescribing Notes:

Available as a 1% topical solution or lotion

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/19921.htm

IVERMECTIN (cream)

Restrictions: Restricted to the treatment of moderate to severe inflammatory lesions of rosacea where other topical treatments are unsuitable or ineffective.

13.6.2 Oral preparations for acne

Preferred list
CO-CYPRINDIOL

Prescribing Notes:

Brands include Dianette®. Contains a mixture of cyproterone acetate and ethinylestradiol in a 2000:35 part ratio. CSM advice (see BNF for full advice): Prescribers are reminded that the risk of venous thromboembolism is higher in women taking co-cyprindiol than those taking a low-dose combined oral contraceptive. It is licensed for severe acne and moderately severe hirsutism and should not be used solely for contraception though it is occasionally used as a contraceptive (unlicensed indication) when acne is present. It is contraindicated in those with a personal or close family history of venous thromboembolism.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/6044.htm

Total Formulary
DOXYCYCLINE

Prescribing Notes:

Suitable for prescribing in patients with renal impairment and would be the preferred tetracycline choice for systemic treatment of acne in these patients (see BNF).

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3816.htm

MINOCYCLINE

Restrictions: Minocycline is reserved for patients who have failed on other tetracyclines.

Prescribing Notes:

Suitable for prescribing in patients with renal impairment (see BNF).

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3823.htm

ISOTRETINOIN

Restrictions: Restricted to use in hospitals, under specialist dermatological supervision.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/6048.htm

13.6.3 Topical preparations for rosacea

Preferred list
METRONIDAZOLE (ROZEX) (0.75% CREAM, GEL)

Prescribing Notes:

Used in the treatment of rosacea (not acne)

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/26703.htm

Total Formulary
AZELAIC ACID (FINACEA) (15% gel)

Prescribing Notes:

The 15% gel (Finacea®) preparation is for use in the treatment of rosacea. 

BNF Link: https://www.medicinescomplete.com/mc/bnf/current/PHP7806-azelaic-acid.htm

BRIMONIDINE (MIRVASO) (gel)

Restrictions: Restricted to use in patients with moderate to severe persistent facial erythema associated with rosacea.

Prescribing Notes:

It should be noted that this only provides symptomatic treatment for the erythema component and does not treat the rosacea directly.

BNF Link: https://www.medicinescomplete.com/mc/bnf/current/PHP34613-brimonidine-tartrate.htm