Therapeutic AreaFormulary ChoicesCost for 28
(unless otherwise stated)
Rationale for decision / comments
Treatment of comedonal acne
First-line: Topical retnoids
1st optionDifferin®Cream: £16.43 (45g)
Gel: £16.43 (45g)
Adapalene 0.1%
Mild to moderate acne vulgaris where comedones, papules and pustules predominate.
Once daily.
2nd optionIsotrex®
Gel: £5.94 (30g)
Isotretinoin 0.05%
Mild to moderate inflammatory and non-inflammatory acne vulgaris.
Once or twice daily.

Six to eight weeks of treatment may be required before therapeutic effect is observed
Second line: Topical Retinoid with Benzoyl peroxideEpiduo®Gel: £19.05 (45g)Adapalene 0.1%, Benzoyl peroxide 2.5% gel
Cutaneous treatment of Acne vulgaris when comedones, papules and pustules are present
Once daily.
Third line: Azelaic acid
1st optionSkinoren®Cream: £3.74 (30g)Azelaic acid 20%
Topical treatment of acne vulgaris
Twice daily.
2nd optionFinacea®Gel: £7.48 (30g)Azelaic acid 15%
For the relief of mild to moderate papular-pustular acne of the facial area.
For the topical treatment of papulopustular rosacea.
Twice daily.
Treatment of mild papular / pustular acne
First line: Combination of two of: Clindamycin / topical retinoid / benzoyl peroxide
1st option - Topical Retinoid with Benzoyl peroxideEpiduo®Gel: £19.05 (45g)Adapalene 0.1%, Benzoyl peroxide 2.5% gel
Cutaneous treatment of Acne vulgaris when comedones, papules and pustules are present.
Once daily.
2nd options - Clindamycin with Topical retinoidTreclin®Gel: £11.94 (30g)Tretinoin 0.025%, Clindamycin 1%
Topical treatment of acne vulgaris when comedones, papules and pustules are present in patients 12 years or older.
Once daily.

Recommended course of up to 12 weeks.
Duac Once Daily®1%/3% Gel: £13.14 (30g)
£26.28 (60g)
1%/5% Gel: £13.14 (30g)
£26.28 (60g)
Benzoyl peroxide 3%, Clindamycin 1% gel

Benzoyl peroxide 5%, Clindamycin 1% gel
Topical treatment of mild to moderate acne vulgaris, particularly inflammatory lesions, in adults and adolescents aged 12 years and above
Once daily.

Recommended course of up to 12 weeks
Second line: Erythromycin / topical retinoidIsotrexin®Gel: £7.47 (30g)Isotretinoin 0.05%, Erythromycin 2%
Treatment of moderate acne.
Once or twice daily.

Recommended course of up to 12 weeks
Aknemycin Plus®Solution: £7.05 (25ml)Tretinoin 0.025%, Erythromycin 4%
All forms of acne, both non-inflammatory forms with comedones and inflammatory forms with papules and pustules particularly those associated with a very oily skin.
Once or twice daily.

Recommended course of 9 to 12 weeks
Treatment of moderate-severe acne in pregnancy
First line - Benzoyl peroxide
1st optionPanoxyl®5% Gel: £1.89 (40g)
10% Gel: £1.99 (40g)
2.5% Aquagel: £1.76 (40g)
5% Aquagel: £1.92 (40g)
10% Aquagel: £2.13 (40g)
5% Cream: £1.89 (40g)
10% Wash: £4.00 (150ml)
Benzoyl Peroxide
Mild to moderate inflammatory acne vulgaris
PanOxyl 10 Aquagel: once daily.
2nd optionsQuinoderm®Cream 5%/0.5%:
£2.43 (50g)
Cream 10%/0.5%:
£1.58 (25g)
£2.55 (50g)
Benzoyl peroxide, potassium hydroxyquinoline sulfate.
Acne vulgaris, acneform eruptions, folliculitis.
Two or three times daily.
Brevoxyl®Cream: £4.13 (50g)Benzoyl peroxide 4%
Moderate acne vulgaris
Once or twice daily.
Acnecide®Gel: £5.44 (30g)
£10.68 (60g)
Wash gel: £5.44 (50g)
Benzoyl peroxide 5%
Gel: once or twice daily.
Wash: twice daily.
Second-line: topical erythromycinZinerytLotion: £7.71 (30ml)
£16.68 (90ml)
Erythromycin 40mg/ml / Zinc acetate 12mg/ml
Twice daily for 10-12 weeks.
13.6.3: Rosacea
First line: Topical Metronidazole or Azelaic Acid
1st – option Topical MetronidazoleRozex®Cream: £6.60 (30g)
£9.88 (40g)
Gel: £6.60 (30g)
£9.88 (40g)
Inflammatory papules, pustules and erythema of rosacea
Metronidazole 0.75% w/w, Propylene glycol 30 mg/g
Propyl parahydroxybenzoate (E216) 0.2 mg/g
Methyl parahydroxybenzoate (E218) 0.8 mg/g
Twice daily for up 3-4 months.
Acea®
Gel: £9.95 (40g)Metronidazole 0.75%
Acute inflammatory exacerbations of rosacea
Twice daily for 8 weeks.
Rosiced®Cream: £7.50 (30g)inflammatory papulo-pustules rosacea
metronidazole 0.75%
Twice daily for 6-12 weeks.
2nd option: Topical Azelaic acidFinacea®Gel: £7.48 (30g)Azelaic acid 15%
For the relief of mild to moderate papular-pustular acne of the facial area.
For the topical treatment of papulopustular rosacea.
Twice daily.
Second line: Topical IvermectinSoolantra®Cream: £18.29 (30g)One gram of cream contains 10 mg of Ivermectin
Licensed for the treatment of the inflammatory lesions of rosacea. NICE guidance due in December 15empag. More costly than topical metronidazole (roughly £14) but it may stop a cohort of patients progressing to oral antibiotics.
It has good evidence and, unlike other products, it is a parasiticidal and is thought to target mites that are associated with rosacea.
Apply once daily for up to 4 months. Discontinue if no improvement after 3 months
Third line: Topical BrimonidineMirvaso®
see MHRA alert
Gel: £33.69 (30g)One gram of gel contains 3.3 mg of brimonidine, equivalent to 5 mg of brimonidine tartrate.
Facial erythema of rosacea in adult patients provided that patients have tried all other alternatives and that redness is a significant problem.

AWMSG Clinical expert summary 27/08/15: It was highlighted by experts that the effect of topical brimonidine on erythema is short lasting. They felt that it should not be used daily since it has an extreme pallor effect and an extreme rebound reaction after 12 hours; generally patients would be advised to limit its use to special occasions where pallor is required temporarily. One exception however, might be when the patient’s occupation involves facing the public on a daily basis; then a regular treatment may be necessary.
MHRA ALERT
Brimonidine gel (Mirvaso): risk of systemic cardiovascular effects; not to be applied to damaged skin
Systemic cardiovascular effects including bradycardia, hypotension, and dizziness have been reported after application.
Link to MHRA alert