Microsoft word - acne laminate.doc

Suggestions for treatment
Treatment Options1
Acne Severity
Mild to moderate

2nd line options
• Topical retinoid + BP2 • Topical antibiotic3,4 + BP • Topical antibiotic3,4 + Moderate to severe
3rd line options
*Severe presentations (e.g. nodulocystic acne or acne fulminans) may require initiation of therapy with 3rd line
Combined oral contraceptives
Spironolactone or low dose6,8
oral isotretinoin
1 – Wait 8 to 12 weeks before changing from one therapy to another. 2 – It is reasonable to consider topical retinoids with BP as second line therapy, especially if the goal is to minimize antibiotic use. Evidence for the effect of benzoyl peroxide plus a topical retinoid versus either agent alone is inconsistent. (There is consistent evidence that topical clindamycin + BP is superior to BP alone). 3 – Do not switch from one topical antibiotic to another. Change to oral agent if antibiotic treatment desired
4 – Long term therapy with topical or oral antibiotics is not recommended due to concerns of developing
resistance. • Topical or oral antibiotics are used only to gain a measure of control over inflammatory lesions and should be stopped when there is no further inflammation.
• Response to topical or oral antibiotics usually occurs within 3 months. Once patients respond (no further inflammation) consider “stepping down” to benzoyl peroxide or a topical retinoid to maintain
response.
5 – The addition of benzoyl peroxide may address resistance concerns and may lead to better outcomes. Separate the application of benzoyl peroxide products from other topical products by applying one in the morning and the other in the evening. 6 – When starting oral isotretinoin discontinue other therapies. 7 – 1st line in women also wanting birth control or add on treatment to 1st and 2nd line therapies in women
with no contraindications. Some suggest use ahead of oral antibiotics. 8 – Expert opinion suggests 20 mg oral isotretinoin daily X 6 months as treatment option for adult onset acne. Wholesale costs of acne therapies, not including dispensing fee - June 2008
Preparations
Concentration
Pack size
Cost / g or ml
Benzoyl Peroxide
Water based gel
Alcohol based gel
Acetone based gel
Retinoids
Cream
Solution
1 - costs of different concentrations are the same for each preparation Combination BP/topical antibiotic preparations
Clindoxyl (BP 5%/Clin 1%) is given a 4 month expiry date after dispensing.
Stored at room temperature by the patient.
BenzaClin (BP 5%/Clin 1%) is given a 3 month expiry date after dispensing.
Stored at room temperature by the patient.

Benzamymcin (BP 5%/Ery 3%) is given a 3 month expiry date after dispensing.
Requires refrigeration by the patient.
Topical antibiotics
Preparations
Concentration
Pack size
Cost / g or ml
Clindamycin
Erythromycin
Combination products
BP + clindamycin
BP + erythro
Tretinoin + erythro
Oral antibiotics

Strength
Cost / unit
90 day cost
Tetracyclines
Erythromycins
Combined oral contraceptives
Trade name
Contents
Cost / month
Oral isotretinoin
Cost: 5 mos for
Trade name
60 kg person
Then alternate 40 mg on day 1 and 80 mg on day 2 for 4 months 40 mg once daily for 1 month Then 60 mg once daily (40 mg plus 2 x 10 mg) for 4 months 40 mg once daily for 1 month Then alternate 40 mg on day 1 and 80 mg on day 2 for 4 months 40 mg once daily for 1 month Then 60 mg once daily (40 mg plus 2 x 10 mg) for 4 months Dalhousie Academic Detailing Service. Source McKesson Canada Maritimes, Wholesale Distributor. June 2008

Source: http://cme.medicine.dal.ca/files/Acne_Tx_costs.pdf