BNF for Children 2011-2012

576 13.6.1 Topical preparations for acne BNFC 2011–201213 SkinAntibacterial resistance of Propionibacterium acnes isincreasing; there is cross-resistance between erythromycinand clindamycin. To avoid development of resistance:. when possible use non-antibiotic antimicrobials(such as benzoyl peroxide or azelaic acid);. avoid concomitant treatment with different oral andtopical antibacterials;. if a particular antibacterial is effective, use it forrepeat courses if needed (short intervening coursesof benzoyl peroxide or azelaic acid may eliminateany resistant propionibacteria);. do not continue treatment for longer than necessary(but treatment with a topical preparation should becontinued for at least 6 months).ANTIBACTERIALSCautions some manufacturers advise preparationscontaining alcohol are not suitable for use withbenzoyl peroxideIndication and doseAcne vulgaris for dose, see under preparationsDalacin T c (Pharmacia) ATopical solution, clindamycin 1% (as phosphate), inan aqueous alcoholic basis, net price (both withapplicator) 30 mL = £4.34, 50 mL = £7.23Excipients include propylene glycolDoseApply twice dailyLotion, clindamycin 1% (as phosphate) in an aqueousbasis, net price 30 mL = £5.08, 50 mL = £8.47Excipients include cetostearyl alcohol, hydroxybenzoates (parabens)DoseApply twice dailyStiemycin c (Stiefel) ASolution, erythromycin 2% in an alcoholic basis, netprice 50 mL = £7.69Excipients include propylene glycolDoseApply twice dailyZindaclin c (Crawford) AGel, clindamycin 1% (as phosphate), net price 30 g =£8.66Excipients include propylene glycolDoseChild 12–18 years apply once dailyZineryt c (Astellas) ATopical solution, powder for reconstitution, erythromycin40 mg, zinc acetate 12 mg/mL when reconstitutedwith solvent containing ethanol, net price perpack of powder and solvent to provide 30 mL = £7.71,90 mL = £16.68Excipients none as listed in section 13.1.3DoseApply twice dailyTopical retinoids and relatedpreparations for acneTopical tretinoin, its isomer isotretinoin, and adapalene(a retinoid-like drug), are useful for treating comedonesand inflammatory lesions in mild to moderateacne. Patients should be warned that some redness andskin peeling can occur initially but settles with time.Several months of treatment may be needed to achievean optimal response and the treatment should be continueduntil no new lesions develop.Tretinoin can be used under specialist supervision totreat infantile acne; adapalene can also be used. See alsoNeonatal and Infantile Acne, p. 574.Cautions Topical retinoids should be avoided in severeacne involving large areas. Contact with eyes, nostrils,mouth and mucous membranes, eczematous, broken orsunburned skin should be avoided. Topical retinoidsshould be used with caution on sensitive areas such asthe neck, and accumulation in angles of the nose shouldbe avoided. Exposure to UV light (including sunlight,solariums) should be avoided; if sun exposure is unavoidable,an appropriate sunscreen (section 13.8.1) orprotective clothing should be used. Use of retinoids withabrasive cleaners, comedogenic or astringent cosmeticsshould be avoided. Allow peeling (resulting from otherirritant treatments) to subside before using a topicalretinoid; alternating a preparation that causes peelingwith a topical retinoid may give rise to contactdermatitis (reduce frequency of retinoid application).Pregnancy Topical retinoids are contra-indicated inpregnancy; females of child-bearing age must use effectivecontraception (oral progestogen-only contraceptivesnot considered effective).Side-effects Local reactions include burning, erythema,stinging, pruritus, dry or peeling skin (discontinue ifsevere). Increased sensitivity to UVB light or sunlightoccurs. Temporary changes of skin pigmentation withtretinoin have been reported. Eye irritation and oedema,and blistering or crusting of skin have been reportedrarely.ADAPALENECautions see notes abovePregnancy see notes aboveBreast-feeding amount of drug in milk probably toosmall to be harmful; ensure infant does not come incontact with treated areasSide-effects see notes aboveLicensed use not licensed for use in infantile acneIndication and doseInfantile acneChild 1 month–2 years apply thinly once daily atnightMild to moderate acne vulgarisChild 12–18 years apply thinly once daily in theevening; reduce frequency or suspend treatment ifirritation occursDifferin c (Galderma) ACream, adapalene 0.1%, net price 45 g = £11.40.Label: 11Excipients include disodium edetate, hydroxybenzoates (parabens)Gel, adapalene 0.1%, net price 45 g = £11.40.Label: 11Excipients include disodium edetate, hydroxybenzoates (parabens),propylene glycol