BNF for Children 2011-2012

BNFC 2011–2012 13.6.1 Topical preparations for acne 575Benzoyl peroxide and azelaic acidBenzoyl peroxide is effective in mild to moderate acne.Both comedones and inflamed lesions respond well tobenzoyl peroxide. The lower concentrations seem to beas effective as higher concentrations in reducing inflammation.It is usual to start with a lower strength and toincrease the concentration of benzoyl peroxide gradually.Adverse effects include local skin irritation, particularlywhen therapy is initiated, but the scaling andredness often subside with a reduction in benzoyl peroxideconcentration, frequency, and area of application.If the acne does not respond after 2 months then use of atopical antibacterial should be considered.Azelaic acid has antimicrobial and anticomedonalproperties. It may be used as an alternative to benzoylperoxide or to a topical retinoid for treating mild tomoderate comedonal acne, particularly of the face;azelaic acid is less likely to cause local irritation thanbenzoyl peroxide.BENZOYL PEROXIDECautions avoid contact with eyes, mouth, and mucousmembranes; may bleach fabrics and hair; avoidexcessive exposure to sunlightSide-effects skin irritation (reduce frequency or suspenduse until irritation subsides and re-introduce atreduced frequency)Licensed use Quinoderm c is licensed for use inchildren; all other preparations, not licensed for usein treatment of infantile acneIndication and doseAcne vulgarisChild 12–18 years apply 1–2 times daily preferablyafter washing with soap and water, starttreatment with lower-strength preparationsNote May bleach clothingInfantile acneChild 1 month–2 years apply 1–2 times daily;start treatment with lower-strength preparationsAcnecide c (Galderma)Gel, benzoyl peroxide 5% in an aqueous gel basis, netprice 60 g = £10.88Excipients include propylene glycolWith antimicrobialsDuac c Once Daily (GSK) AGel, benzoyl peroxide 5%, clindamycin 1% (as phosphate)in an aqueous basis, net price 25 g = £9.95, 50 g= £19.90Excipients include disodium edetateDoseAcne vulgarisChild 12–18 years apply once daily in the eveningQuinoderm c (Ferndale)Cream, benzoyl peroxide 5%, potassium hydroxyquinolinesulphate 0.5%, in an astringent vanishingcreambasis, net price 50 g = £2.21Excipients include cetostearyl alcohol, edetic acid (EDTA)Cream, benzoyl peroxide 10%, potassium hydroxyquinolinesulphate 0.5%, in an astringent vanishingcreambasis, net price 25 g = £1.30, 50 g = £2.49Excipients include cetostearyl alcohol, edetic acid (EDTA)DoseAcne vulgaris, acneform eruptions, folliculitisApply 2–3 times dailyAZELAIC ACIDCautions avoid contact with eyes, mouth, and mucousmembranesSide-effects local irritation (reduce frequency or discontinuetemporarily); less commonly skin discoloration;very rarely photosensitisationIndication and doseSee under preparationsFinacea c (Meda) AGel, azelaic acid 15%, net price 30 g = £7.48Excipients include disodium edetate, polysorbate 80, propylene glycolDoseFacial acne vulgarisChild 12–18 years apply twice daily; discontinue if noimprovement after 1 monthSkinoren c (Bayer Schering) ACream, azelaic acid 20%, net price 30 g = £3.74Excipients include propylene glycolDoseAcne vulgarisApply twice daily (sensitive skin, once daily for firstweek). Extended treatment may be required but manufactureradvises period of treatment should not exceed 6months13 SkinBrevoxyl c (GSK)Cream, benzoyl peroxide 4% in an aqueous basis, netprice 40 g = £3.30Excipients include cetyl alcohol, fragrance, stearyl alcoholPanOxyl c (Stiefel)Aquagel (= aqueous gel), benzoyl peroxide 2.5%, netprice 40 g = £1.76; 5%, 40 g = £1.92; 10%, 40 g = £2.13Excipients include propylene glycolCream, benzoyl peroxide 5% in a non-greasy basis,net price 40 g = £1.89Excipients include isopropyl palmitate, propylene glycolGel, benzoyl peroxide 5% in an aqueous alcoholicbasis, net price 40 g = £1.51; 10%, 40 g = £1.69Excipients include fragranceWash, benzoyl peroxide 10% in a detergent basis, netprice 150 mL = £4.00Excipients include imidureaTopical antibacterials for acneIn the treatment of mild to moderate inflammatoryacne, topical antibacterials may be no more effectivethan topical benzoyl peroxide or tretinoin. Topical antibacterialsare probably best reserved for children whowish to avoid oral antibacterials or who cannot toleratethem.Topical preparations of erythromycin and clindamycinmay be used to treat inflamed lesions in mildto moderate acne when topical benzoyl peroxide ortretinoin is ineffective or poorly tolerated. Topical benzoylperoxide, azelaic acid, or retinoids used in combinationwith an antibacterial (topical or systemic) may bemore effective than an antibacterial used alone. Topicalantibacterials can produce mild irritation of the skin,and on rare occasions cause sensitisation.