BNF for Children 2011-2012

BNFC 2011–2012 13.6.1 Topical preparations for acne 577With benzoyl peroxideEpiduo c (Galderma) AGel, adapalene 0.1%, benzoyl peroxide 2.5%, net price45 g = £17.91. Label: 11Excipients include disodium edetate, polysorbate 80, propylene glycolDoseAcne vulgarisChild 12–18 years apply thinly once daily in the evening;reduce frequency or suspend treatment if irritationoccursNote May bleach clothing and hairISOTRETINOINNote Isotretinoin is an isomer of tretinoinImportant For prescribing information on isotretinoin whengiven by mouth, see p. 579Cautions (topical application only) see notes above;also personal or familial history of non-melanomaskin cancerContra-indications (topical application only) rosacea;perioral dermatitisPregnancy (topical application only) see notes aboveBreast-feeding avoidSide-effects (topical application only) see notesaboveIndication and doseAcne vulgarisApply thinly 1–2 times dailyIsotrex c (Stiefel) AGel, isotretinoin 0.05%, net price 30 g = £5.94.Label: 11Excipients include butylated hydroxytolueneWith antibacterialIsotrexin c (Stiefel) AGel, isotretinoin 0.05%, erythromycin 2% in ethanolicbasis, net price 30 g = £7.47. Label: 11Excipients include butylated hydroxytolueneTRETINOINNote Tretinoin is the acid form of vitamin ACautions see notes aboveContra-indications personal or familial history ofnon-melanoma skin cancer; rosacea; perioraldermatitisPregnancy see notes aboveBreast-feeding amount of drug in milk after topicalapplication probably too small to be harmful; ensureinfant does not come into contact with treated areasSide-effects see notes aboveLicensed use Retin-A c not licensed for use ininfantile acneIndication and doseSee under preparationsMalignant disease section 8.1.5Retin-A c (Janssen) AGel, tretinoin 0.01%, net price 60 g = £5.28; 0.025%,60 g = £5.28. Label: 11Excipients include butylated hydroxytolueneDoseInfantile acneApply 0.01% gel thinly 1–2 times daily; increase to0.025% gel if necessaryAcne vulgaris, particularly that associated with oilyskinApply thinly 1–2 times dailyWith antibacterialAknemycin Plus c (Almirall) ASolution, tretinoin 0.025%, erythromycin 4% in analcoholic basis, net price 25 mL = £7.05. Label: 11Excipients none as listed in section 13.1.3DoseAcne (all forms), particularly that associated with oilyskinApply thinly 1–2 times dailyOther topical preparations for acneSalicylic acid is available in various preparations forsale direct to the public for the treatment of mild acne.Other products are more suitable for acne; salicylic acidis used mainly for its keratolytic effect.A topical preparation of nicotinamide is available forinflammatory acne.NICOTINAMIDECautions avoid contact with eyes and mucous membranes(including nose and mouth); reduce frequencyof application if excessive dryness, irritation or peelingSide-effects dryness of skin; also pruritus, erythema,burning and irritationLicensed use licensed for use in children (age rangenot specified by manufacturer)Indication and doseInflammatory acne vulgaris see under preparationsbelowNicam c (Dermal)Gel, nicotinamide 4%, net price 60 g = £7.10Excipients none as listed in section 13.1.3DoseApply twice daily; reduce to once daily or on alternatedays if irritation occursSALICYLIC ACID UCautions risk of significant systemic absorption inneonates; avoid contact with mouth, eyes, mucousmembranes; systemic effects after excessive useSalicylate toxicity Salicylate toxicity can occur particularlyif applied on large areas of skin or on neonatal skinSide-effects local irritationLicensed use licensed for use in children (age rangenot specified by manufacturer)Indication and doseAcne vulgaris see under preparationPsoriasis section 13.5.2Warts and calluses section 13.7Fungal nail infections section 13.10.213 Skin