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BNSSG Adult Joint Formulary

13.7 Rosacea and acne

Last edited: 13-03-2024

13.7.1 Acne

First line drugs Second line drugs Specialist drugs Secondary care drugs

 Refer to BNSSG Antimicrobial Stewardship Guidelines for treatment of acne


Recommended: (TLS Green)

Co-cyprindiol (Dianette®)



Recommended: (TLS Green)

Azelaic acid cream 20% (Skinoren®)



Recommended: (TLS Green)

Benzoyl peroxide / Azelaic acid

Benzoyl peroxide 5% gel/cream

Benzoyl peroxide 5% / Clindamycin 1% gel (Duac Once Daily®)


Retinoid and Related Drugs

Topical retinoids are contraindicated in pregnancy. Women of childbearing age should take adequate contraceptive precautions.

Recommended: (TLS Green)

Adapalene cream/gel 0.1% (Differin®(TLS Green)

Adapalene / Benzoyl peroxide gel (Epiduo®(TLS Green)

Tretinoin 0.025% / Clindamycin 1% Gel (TLS Green)

Trifarotene cream 50micrograms/g (Aklief®) (TLS Green)

Isotretinoin capsules – Restricted to dermatology specialist teams only (TLS Red)

  • 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
  • Please see new safety measures from the MHRA published in the October 2023 Drug Safety Update, where the MHRA have strengthened the safe use of isotretinoin through the introduction of additional oversight of the initiation of isotretinoin in patients under 18 years and through improved assessment and monitoring of mental health and sexual function issues. All patients must be counselled about the benefits and risks of treatment before isotretinoin is prescribed, including possible mental health and sexual function side effects. Referrers (usually the GP) are asked to provide information about isotretinoin to the patient and provide counselling (where possible) regarding the benefits and risks of isotretinoin treatment.
  • Please see updated Isotretinoin Patient Information Leaflet from British Association of Dermatology if aged 18 or over: British Association of Dermatologists ( 
  • New isotretinoin regulatory risk minimisation materials for all patients can be found here: Acknowledgement of Risk Form, Patient Reminder Card, Pharmacist Check List


13.7.2 Rosacea

Recommended: (TLS green)

Metronidazole 0.75% cream/gel

Alternatives (TLS blue):

Ivermectin cream

  • For moderate to severe erythematotelanectatic, popular, pustular rosacea


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