Acne vulgaris

See prescribing notes for additional guidance.

Alternative monotherapy if first line options are contraindicated, or person wishes to avoid using a topical retinoid or antibiotic.

Alternative monotherapy if other options are contraindicated.

Alternative for patients with contraindications to other options or who wish to avoid topical retinoids.

Topical adapalene with benzoyl peroxide, plus an oral antibiotic (see below).

Oral doxycycline is the preferred antibiotic. Lymecycline should only be used if there are issues with doxycycline (e.g. photosensitivity). Erythromycin can be used if contraindications/intolerances to tetracyclines.

Topical azelaic acid, plus an oral antibiotic (see below).

Oral doxycycline is the preferred antibiotic. Lymecycline should only be used if there are issues with doxycycline (e.g. photosensitivity). Erythromycin can be used if contraindications/intolerances to tetracyclines.

For females in the treatment of moderate to severe acne, vulgaris if the chosen first-line treatment is not effective, consider adding co-cyprindiol or an alternative combined oral contraceptive pill.

Spironolactone can be considered in moderate to severe acne vulgaris in women who have failed to respond/not tolerate one topical and one systemic agent as above. It can be used as monotherapy or in addition to the options above.

Consider in people older than 12 years who have a severe form of acne vulgaris that is resistant to adequate courses of standard therapy with systemic antibiotics and topical therapy.

Combination product for the treatment of mild acne vulgaris that is mostly inflammatory in nature. Adapalene + Benzoyl peroxide gel is licensed for children aged 9 years and over.

Used in combination for the treatment of mild acne that is mostly inflammatory in nature.

Alternative monotherapy if first and second-line options are contraindicated, or person wishes to avoid using a topical retinoid or antibiotic.

Alternative for patients with contraindications to other options or who wish to avoid topical retinoids.

Topical adapalene with benzoyl peroxide, plus an oral antibiotic.

Adapalene + Benzoyl peroxide gel is licensed for children aged 9 years and over.

Erythromycin or trimethoprim. Note that liquid formulations are less cost-effective than tablets.

Specialist recommendation when adapalene 0.1%/benzoyl peroxide 2.5% gel not suitable. May be less irritating.

Erythromycin or trimethoprim. Note that liquid formulations are less cost-effective than tablets.

Consider in children under 12 years who have a severe form of acne vulgaris that is resistant to adequate courses of standard therapy with systemic antibiotics and topical therapy.