13.6.1. Topical preparations for acne

Benzoyl Peroxide

ChoiceDrugDosage
1st choice

Benzoyl peroxide 5% gel (Acnecide®)

Benzoyl peroxide 5% wash (Acnecide®)

Dose: Apply once or twice a day


Dose: Apply twice a day

Topical antibacterials for acne

ChoiceDrugDosage
1st choice

Clindamycin 1% /benzoyl peroxide 5%; Clindamycin 1%/ benzoyl peroxide 3% - (Duac®) gel

Dose: Apply once daily in the evening

Topical retinoids and related preparations

ChoiceDrugDosage
1st choiceAdapalene 0.1% cream and gel (Differin®)Dose: Apply thinly once daily in the evening

Or

Isotretinoin 0.05% gel (Isotrex®)Dose:
Apply thinly 1-2 times daily
Or
Adapalene 0.1%, benzoyl peroxide 2.5% (Epiduo®) gel Dose:
Apply thinly once daily in the evening

Prescribing Notes

Topical agents

  • Topical treatment should be applied sparingly to all the affected areas, not just the spots.
  • Gradual dosing can be considered to improve tolerability of topical agents e.g. use twice a week or every other day for the first few weeks before moving to daily use.

Benzoyl peroxide

  • Topical treatment takes at least 30 days to become effective and should be reviewed after 2 months.
  • In mild to moderate acne comedones and inflamed lesions respond well to benzoyl peroxide.
  • Benzoyl peroxide (or other abrasive cleansers) may cause peeling which should be given time to subside before using a topical retinoid.
  • The use of topical benzoyl peroxide should be considered when prescribing an oral antibiotic for acne in order to help reduce the development of resistance.

Topical retinoids

  • Topical retinoids are recommended for comedonal acne, they may initially cause redness of the skin.
  • Treatment is often limited by skin irritation.  Starting with ‘short contact use’ (apply for 20-30 minutes then wash off) and building up if tolerated can help reduce irritation.
  • Exposure to sunlight of areas treated with retinoids should be avoided or minimized. Topical retinoids are best applied at night.
  • Adapalene is less irritant than other topical retinoids.
  • Topical retinoids are contraindicated in pregnancy.
  • Benzoyl peroxide inactivates topical retinoid when used concurrently. Therefore apply individual products 12 hours apart. A combined proprietary product (Epiduo®) is also available.

Topical antibacterials for acne 

  • Topical antibacterials are as effective as oral antibiotics but encourage resistance and are more expensive.
  • Avoid concomitant treatment with different oral and topical antibacterials to reduce the likelihood of development of bacterial resistance.
  • The combination product Duac® gel is recommended because comcomitant use of benzoyl peroxide and an antibacterial is more effective than either component alone and decreases the risk of resistance.
  • Do not continue treatment with a topical antibacterial for longer than necessary, where possible treatment should be limited to 12 weeks duration.