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BNSSG Paediatric Joint Formulary

13.7 Rosacea and Acne

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Last edited: 16-08-2024

First line drugs

Second line drugs

Specialist drugs

Secondary care drugs

13.7 Rosacea and Acne

Refer to BNSSG Antimicrobial Stewardship Guidelines for treatment of acne

Anti-androgens

Co-cyprindiol (Dianette^®) (TLS Green)

Anticomedonals

Azelaic acid cream 20% (Skinoren^®) (TLS Green)

Peroxides

Benzoyl peroxide / Azelaic acid (TLS Green)

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

Benzoyl peroxide 5% gel/cream (TLS Green)

Retinoid and related drugs

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

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

Adapalene 0.1% / Benzoyl peroxide 2.5% gel (Epiduo^®) (TLS Green)

Isotretinoin gel (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.

The referrer (usually the GP) is to provide information about isotretinoin to the patient and provide counselling (where possible) regarding the benefits and risks of isotretinoin treatment:

Isotetnoin - British Association of Dermatologists (bad.org.uk) if aged 18 or over.

Isotretinoin guide for young people – Medicines For Children - if aged under 18.
New isotretinoin regulatory risk minimisation materials for all patients can be found here: Acknowledgement of Risk Form, Patient Reminder Card, Pharmacist Check List.

Aldosterone Antagonists

Spironolactone (oral) (TLS Amber Specialist Initiated)

For treatment of acne vulgaris in female patients

13.7 Rosacea and Acne

13.7 Rosacea and Acne

Anti-androgens

Co-cyprindiol (Dianette®) (TLS Green)

Anticomedonals

Azelaic acid cream 20% (Skinoren®) (TLS Green)

Peroxides

Benzoyl peroxide / Azelaic acid (TLS Green)

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

Benzoyl peroxide 5% gel/cream (TLS Green)

Retinoid and related drugs

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

Adapalene 0.1% / Benzoyl peroxide 2.5% gel (Epiduo®) (TLS Green)

Isotretinoin gel (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)

Aldosterone Antagonists

Spironolactone (oral) (TLS Amber Specialist Initiated)

Co-cyprindiol (Dianette^®) (TLS Green)

Azelaic acid cream 20% (Skinoren^®) (TLS Green)

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

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

Adapalene 0.1% / Benzoyl peroxide 2.5% gel (Epiduo^®) (TLS Green)

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