# Acne vulgaris (mild-to-moderate) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Spironolactone tablets US prescribing information, sections 2.3 and 3 (DailyMed SetID c23b6b9b-aec3-48a8-a518-76e4097f6479, Sun Pharmaceutical Industries): "Hypertension: Initiate treatment at 25 to 100 mg daily in either single or divided doses" and "Tablets: 25 mg, 50 mg, and 100 mg". The 25 to 100 mg range and the divided-dose option are the label's; the label carries no acne indication, so the acne use is off-label. · ADAPALENE US prescribing information, Dosage and Administration (DailyMed SetID 330bc2b3-e064-4189-9c47-9c5a50aa4dde) · Acnecide 5% w/w Gel SmPC section 4.2 (eMC product 2225) · CLINDAMYCIN PHOSPHATE US prescribing information, Dosage and Administration (DailyMed SetID 96434354-a646-4869-92a2-4052d3f7a4aa) · NICE Guideline NG198 (2021), recommendation 1.5.1 · NICE Guideline NG198 (2021), recommendation 1.5.12; NICE Guideline NG198 Acne vulgaris: management (2023 update), recommendation on treatments not to use (NCBI Bookshelf niceng198guid) · Skinoren 20% Cream SmPC sections 4.1 and 4.2 (eMC product 285) · UK eMC Doxycycline 100mg Capsules SmPC (or DailyMed Doxycycline 100mg Capsule Package Insert) · eMC SmPC, Roaccutane 10 mg soft capsules (Neon Healthcare), sections 4.1 and 4.2 - Verified date: 2026-08 ## Verified against - Spironolactone tablets US prescribing information, sections 2.3 and 3 (DailyMed SetID c23b6b9b-aec3-48a8-a518-76e4097f6479, Sun Pharmaceutical Industries): "Hypertension: Initiate treatment at 25 to 100 mg daily in either single or divided doses" and "Tablets: 25 mg, 50 mg, and 100 mg". The 25 to 100 mg range and the divided-dose option are the label's; the label carries no acne indication, so the acne use is off-label. - ADAPALENE US prescribing information, Dosage and Administration (DailyMed SetID 330bc2b3-e064-4189-9c47-9c5a50aa4dde) - Acnecide 5% w/w Gel SmPC section 4.2 (eMC product 2225) - CLINDAMYCIN PHOSPHATE US prescribing information, Dosage and Administration (DailyMed SetID 96434354-a646-4869-92a2-4052d3f7a4aa) - NICE Guideline NG198 (2021), recommendation 1.5.1 - Skinoren 20% Cream SmPC sections 4.1 and 4.2 (eMC product 285) - UK eMC Doxycycline 100mg Capsules SmPC (or DailyMed Doxycycline 100mg Capsule Package Insert) - eMC SmPC, Roaccutane 10 mg soft capsules (Neon Healthcare), sections 4.1 and 4.2 - Acne Vulgaris - disease-level clinical article (acne-vulgaris-clinical.txt) ## Treatment metadata - Adapalene — topical - Benzoyl peroxide — topical - Azelaic acid — topical - Referral & safety-netting (no drug therapy) - Clindamycin — topical - Isotretinoin — 20 mg — oral.solid - Doxycycline — 100 mg — oral.solid - Spironolactone — oral.solid ## Complete treatment card ```text ACNE VULGARIS (MILD-TO-MODERATE) Sources: Spironolactone tablets US prescribing information, sections 2.3 and 3 (DailyMed SetID c23b6b9b-aec3-48a8-a518-76e4097f6479, Sun Pharmaceutical Industries): "Hypertension: Initiate treatment at 25 to 100 mg daily in either single or divided doses" and "Tablets: 25 mg, 50 mg, and 100 mg". The 25 to 100 mg range and the divided-dose option are the label's; the label carries no acne indication, so the acne use is off-label. · ADAPALENE US prescribing information, Dosage and Administration (DailyMed SetID 330bc2b3-e064-4189-9c47-9c5a50aa4dde) · Acnecide 5% w/w Gel SmPC section 4.2 (eMC product 2225) · CLINDAMYCIN PHOSPHATE US prescribing information, Dosage and Administration (DailyMed SetID 96434354-a646-4869-92a2-4052d3f7a4aa) · NICE Guideline NG198 (2021), recommendation 1.5.1 · NICE Guideline NG198 (2021), recommendation 1.5.12; NICE Guideline NG198 Acne vulgaris: management (2023 update), recommendation on treatments not to use (NCBI Bookshelf niceng198guid) · Skinoren 20% Cream SmPC sections 4.1 and 4.2 (eMC product 285) · UK eMC Doxycycline 100mg Capsules SmPC (or DailyMed Doxycycline 100mg Capsule Package Insert) · eMC SmPC, Roaccutane 10 mg soft capsules (Neon Healthcare), sections 4.1 and 4.2 Review status: REVIEWED against Spironolactone tablets US prescribing information, sections 2.3 and 3 (DailyMed SetID c23b6b9b-aec3-48a8-a518-76e4097f6479, Sun Pharmaceutical Industries): "Hypertension: Initiate treatment at 25 to 100 mg daily in either single or divided doses" and "Tablets: 25 mg, 50 mg, and 100 mg". The 25 to 100 mg range and the divided-dose option are the label's; the label carries no acne indication, so the acne use is off-label., ADAPALENE US prescribing information, Dosage and Administration (DailyMed SetID 330bc2b3-e064-4189-9c47-9c5a50aa4dde), Acnecide 5% w/w Gel SmPC section 4.2 (eMC product 2225), CLINDAMYCIN PHOSPHATE US prescribing information, Dosage and Administration (DailyMed SetID 96434354-a646-4869-92a2-4052d3f7a4aa), NICE Guideline NG198 (2021), recommendation 1.5.1, Skinoren 20% Cream SmPC sections 4.1 and 4.2 (eMC product 285), UK eMC Doxycycline 100mg Capsules SmPC (or DailyMed Doxycycline 100mg Capsule Package Insert), eMC SmPC, Roaccutane 10 mg soft capsules (Neon Healthcare), sections 4.1 and 4.2, Acne Vulgaris - disease-level clinical article (acne-vulgaris- clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - Ask about age of onset, family history, medication use, and menstrual pattern, since flares often track the cycle - Systemic symptoms like fever, muscle aches, and joint pain matter, especially in severe disease [fever · joint pain · muscle pain] - Signs of virilization, excess hair growth, male-pattern balding, voice deepening, or genital enlargement, should be asked about in young patients and females [excess hair · hair loss · virilisation] - Adult women often flare on the lower face and neck in sync with their menstrual cycle SIGNS - what you find (9) - Lesions progress from comedones, to small red papules, to pustules, to coalescing nodules or cysts as severity rises [acne · cyst · papules · pustules] - Closed comedones appear as smooth, dome-shaped, skin-colored to whitish or grayish bumps [acne] - Lesions confined to the forehead, nose, and chin are typical in young teens, spreading to inflammatory lesions as it progresses - Healed lesions can leave boxcar, ice-pick, or rolling depressed scars, or raised keloidal scars [scarring] - Hyperandrogenism can accompany acne, with excess hair growth, darkened skin folds, irregular periods, and weight gain [abnormal uterine bleeding · acne · excess hair · irregular periods · weight gain] - Darker-skinned patients are more prone to dark marks left behind after lesions heal - Uniform lesions all in the same stage point instead to drug-induced acne or pityrosporum folliculitis [acne] - Acne conglobata is a severe nodulocystic variant in young men, with interconnecting comedones, cysts, nodules, and deep abscesses, usually without systemic symptoms [acne · cyst] - Acne fulminans is an acute, painful, ulcerating and bleeding form that can come with fever and joint pain [acne · bleeding · fever · joint pain] TESTS (4) - Diagnosis relies on physical exam - labs or biopsy are not usually needed - A history of hirsutism or irregular periods in a woman warrants checking testosterone, LH, FSH, and DHEA levels - Sudden severe, treatment-resistant acne should prompt a workup for an ovarian or adrenal tumor causing hyperandrogenism - Acne fulminans workup adds cholesterol, triglycerides, a pregnancy test, and joint x-rays when indicated IF NOT THIS - what else fits (9) - Rosacea lacks comedones and has visible blood vessels, unlike acne - Perioral dermatitis clusters red bumps around the mouth but spares the lip border, unlike acne - Demodex folliculitis causes papules and pustules and is suspected when acne or rosacea treatment fails - Facial angiofibromas in tuberous sclerosis look like pink or red bumps on a child's cheeks and nose - Pseudofolliculitis barbae causes inflamed bumps and scarring in the beard area of people with tightly curled hair - Nevus comedonicus is a cluster of comedones present from birth or early childhood - Sebaceous hyperplasia shows as small yellowish bumps with a central dimple on the forehead and cheeks - Benign adnexal tumors present as flesh-colored bumps on the face - Favre-Racouchot syndrome, from sun damage in older adults, produces comedones on the upper outer cheeks Source StatPearls "Acne Vulgaris" - disease-level clinical article Status traced to the source above !! MULTI-DRUG REGIMEN - all 2 drugs are given TOGETHER. Not a choice between them. !! the regimen: Benzoyl peroxide + Clindamycin Rx: Topical | Main treatment | Oral retinoid | Oral antibiotic TOPICAL - choose one 1. ADAPALENE [1st line] Adult Apply 0.1% gel or cream thin layer once daily to clean skin at bedtime Peds Children >12 years: apply thin layer once daily at bedtime Choice Alternatives. NG198 names topical adapalene among its first-line options; 8 Egyptian products from 12 EGP. The entry also carries benzoyl peroxide with clindamycin as a fixed pair. Source ADAPALENE US prescribing information, Dosage and Administration (DailyMed SetID 330bc2b3-e064-4189-9c47-9c5a50aa4dde) Why First-line topical retinoid targeting comedones and inflammation Caution Local irritation, erythema, and peeling are common during the first 2-4 weeks. Apply sunscreen during day (increases photosensitivity). If pregnant or breast-feeding, ask a doctor before use. Egypt ADANOID 0.1% TOP. GEL 30 GM GLOBAL NAPI P... 12.00 EGP ACNE-JED 0.1% TOPICAL GEL 15 GM JEDCO INT. CO... 16.00 EGP PAL-MASH 0.1% TOPICAL CREAM 30 GM MEDIZEN PHARMACEUTICAL INDUSTRIES > MA... 16.50 EGP ADAGEL 0.1% TOPICAL GEL. 30 GM EGPI > TAG PH... 34.00 EGP ADAPALENE 0.1% GEL 30 GM BORG 34.00 EGP MARPALENE 0.1% TOPICAL CREAM 30 GM MARCYRL PHARMACEUTICAL INDUSTRIES (MPI) 34.00 EGP RANDAPALENE 0.1% GEL 30 GM GLOBAL NAPI P... 38.00 EGP AKNAPALEN 1% TOPICAL GEL 25 GM EGPI 34.00 EGP 2. BENZOYL PEROXIDE [1 of 2 - GIVE ALL TOGETHER] Adult Apply 5% gel once or twice daily after washing Peds Children >12 years: apply 2.5-5% gel once or twice daily Source Acnecide 5% w/w Gel SmPC section 4.2 (eMC product 2225) Why Topical antimicrobial with comedolytic action and no bacterial resistance Caution Bleaches hair, clothing, and bed linen on contact. Start with 2.5% or 5% strength to minimize skin irritation. Avoid contact with eyes, lips, and mucous membranes. 5% is the only strength on the Egyptian register - Akneroxid-5 and Panoxyl 5%. No Egyptian pharmacy stocks a 2.5% single-agent gel. Start on alternate days if the skin is irritable; 5% is not gentler than 2.5% and bleaches fabric. Egypt AKNEROXID-5 5% GEL 20 GM MUP > HERMAL-... 4.25 EGP PANOXYL 5% GEL 40 GM GLOBAL NAPI P... 8.50 EGP 3. AZELAIC ACID [1st line] Adult Apply 20% cream thinly twice daily, morning and evening, to clean dry skin; about 2.5 cm of cream covers the whole face Peds 12 to 18 years: The adult application, with no dose adjustment. (No dose adjustment for adolescents aged 12 to 18. Safety and efficacy have not been established under 12 years.) Source Skinoren 20% Cream SmPC sections 4.1 and 4.2 (eMC product 285) Why NG198 names topical azelaic acid as one of the five first-line options. It matters in Egypt because it does not bleach clothing the way benzoyl peroxide does, it is far less irritating than a retinoid, and it fades the post-inflammatory pigmentation that darker skin is left with - which is often what the patient actually minds. Caution Patients with sensitive skin should use it once daily in the evening for the first week, then move to twice daily. Burning, stinging and itching in the first 2-4 weeks are expected and settle; warn the patient or they will stop. Improvement takes about 4 weeks to become apparent and the course is 12 weeks - the commonest failure is stopping at 3 weeks. The label says caution should be exercised when prescribing azelaic acid to pregnant women. Unlike the retinoids it is not contraindicated, which makes it the practical choice in a pregnant patient with acne. Keep it away from eyes, mouth and other mucous membranes. Per NG198 it is used with an oral antibiotic for moderate to severe acne, not as a standalone for that severity. Egypt AZECLEAR 20% CREAM 30 GM BIOPHARM EGYP... 21.60 EGP EZALIC 20% CREAM 30 GM MULTI-APEX 26.40 EGP SKINOREN 20% CREAM 30 GM INTENDIS MANU... 35.50 EGP AZADERM 20% CREAM 30 GM MUP 87.00 EGP 4. CLINDAMYCIN [2 of 2 - GIVE ALL TOGETHER] Adult Apply 1% solution or gel thin layer BID (always combine with BPO or retinoid) Peds Children >12 years: apply 1% gel BID for max 12 weeks Source CLINDAMYCIN PHOSPHATE US prescribing information, Dosage and Administration (DailyMed SetID 96434354-a646-4869-92a2-4052d3f7a4aa) Why Topical antibiotic for inflammatory acne; must combine to prevent resistance Caution Do NOT use as monotherapy (high risk of bacterial resistance). Always co-prescribe with benzoyl peroxide. Discontinue if severe diarrhea develops. Egypt CLINDACINE RAMEDA 1% TOPICAL GEL 20 GM RAMEDA 7.00 EGP CLINOCID 1% TOPICAL CREAM 30 GM CID 7.00 EGP CLINDASOL 1% TOPICAL GEL 20 GM AMRIYA > EURO... 26.00 EGP MAIN TREATMENT 5. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Acne Vulgaris - disease-level clinical article (acne-vulgaris-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Dermatologist referral is recommended for severe acne. RED FLAG - Acne fulminans (systemic symptoms - fever, bone pain, ulcerating/hemorrhagic lesions) requires urgent lab workup, not seen among app treatments/cautions 6. SPIRONOLACTONE [add-on - not a substitute] Adult Start at 25 or 50 mg daily. The dose may then be raised to a ceiling of 100 mg per day, taken all at once or split across 2 doses. Peds No paediatric dose is stated in the sources held for this drug. Source Spironolactone tablets US prescribing information, sections 2.3 and 3 (DailyMed SetID c23b6b9b-aec3-48a8-a518-76e4097f6479, Sun Pharmaceutical Industries): "Hypertension: Initiate treatment at 25 to 100 mg daily in either single or divided doses" and "Tablets: 25 mg, 50 mg, and 100 mg". The 25 to 100 mg range and the divided-dose option are the label's; the label carries no acne indication, so the acne use is off-label. Why Oral anti-androgen therapy reducing sebum secretion by blocking androgen receptors for female patients with moderate-to-severe acne. Caution Adverse effects include hyperkalemia, breast tenderness, menstrual irregularities, orthostatic hypotension, and headache. Contraindicated in pregnancy due to risk of feminization of male fetus. Egypt SPIRONOLACTONE (DELTA) 25MG 10 TAB. GLOBAL NAPI PHARMACEUTIC... 3.00 EGP (0.30/unit) EPILACTONE 25MG 10 TAB. EIPICO 4.00 EGP (0.40/unit) SPIRONOLACTONE (DELTA) 50MG 10 TAB. GLOBAL NAPI PHARMACEUTIC... 4.50 EGP (0.45/unit) SPIRONOLACTONE (DELTA) 100MG 20 TAB. GLOBAL NAPI PHARMACEUTI... 16.80 EGP (0.84/unit) POTASAVE 100 MG 20 TAB ALFACURE PHAR... 21.00 EGP (1.05/unit) POTASPIRONO 25 MG 20 TAB. UNIPHARMA 36.00 EGP (1.80/unit) POTASPIRONO 100 MG 20 TAB. UNIPHARMA 90.00 EGP (4.50/unit) SPECTONE 100 MG 20 TABS. KAHIRA 90.00 EGP (4.50/unit) ORAL RETINOID 7. ISOTRETINOIN [alternative] Adult 0.5 mg/kg daily initially, adjusted within the range 0.5-1.0 mg/kg/day to a cumulative total of 120-150 mg/kg x 16-24 weeks typically achieves remission; there is no substantial additional benefit beyond a cumulative 150 mg/kg Peds Must not be used for prepubertal acne and is not recommended under 12 years. In an adolescent 12 years and over the adult mg/kg regimen applies, under dermatology supervision. The mg/kg fields are left null because the paediatric dose is not a separate figure - it is the same 0.5-1.0 mg/kg/day, which is captured in the adult dose. Source eMC SmPC, Roaccutane 10 mg soft capsules (Neon Healthcare), sections 4.1 and 4.2 Why 20 live products, oral and topical. The only acne condition in the dataset, and a search for isotretinoin currently returns nothing at all even though it is the single most consequential acne drug a GP will encounter on a patient's prescription. Caution THIS CONDITION IS MILD-TO-MODERATE ACNE AND ORAL ISOTRETINOIN IS NOT FOR THAT. The licensed indication is severe nodular or conglobate acne, or acne at risk of permanent scarring, that has resisted adequate courses of systemic antibacterial plus topical therapy. Must be prescribed only by, or under the supervision of, a physician experienced in systemic retinoid therapy. PREGNANCY PREVENTION PROGRAMME is mandatory for any woman able to become pregnant: highly effective contraception from one month before, throughout, and one month after treatment, with monthly pregnancy testing. Depression, anxiety, aggression, mood change, psychotic symptoms and suicide have been reported - assess mental health before starting and at every review, and ask the family. Check serum lipids and liver enzymes at baseline, at one month, then quarterly; stop for uncontrolled hypertriglyceridaemia or pancreatitis symptoms. Do not co-prescribe a tetracycline - benign intracranial hypertension. That rules out the doxycycline commonly used in acne. Do not donate blood during treatment or for one month afterwards. Topical isotretinoin and tretinoin products share the generic name but are an entirely different treatment with none of these requirements. Egypt ROACCUTREX 20 MG 30 CAPS. MEDIZEN PHARM... 161.00 EGP (5.37/unit) ISO-ACNETIN 20 MG 30 CAPS SIGMA > GLOBE... 300.00 EGP (10.00/unit) ACNELOFIX 20 MG 20 CAPS. MELANO PHARMA 270.00 EGP (13.50/unit) ROACCUTANE 20 MG 30 CAPS. F.HOFFMAN LA ... 533.00 EGP (17.77/unit) ISOTRETINOIN 20MG 10 SOFT GELATIN CAPS. RANBAXY 124.00 EGP ISOTRETAM 20 MG 20 S.G. CAPS. MEDIZEN 212.00 EGP NETLOOK 20MG 20 SOFT GELATIN CAPS. MEDIZEN PHARMACEUTICAL INDUSTRIES > A... 274.00 EGP ISOTRETINOIN 20MG 30 SOFT GELATIN CAPS. SUN PHARMA EGYPT LIMITED > RANBAXY 372.00 EGP ORAL ANTIBIOTIC - give alongside 8. DOXYCYCLINE [add-on - not a substitute] Adult 100 mg once daily with food or fluid x 12 weeks, reviewed at 12 weeks; a further 12 weeks only if the acne has improved but not cleared Peds No paediatric acne dose is stated in the sources held for this drug. Doxycycline must not be given under 8 years: the eMC Doxycycline 100mg Capsules SmPC section 4.2 states it "should not be used in children aged younger than 8 years due to the risk of teeth discolouration". The 50 mg acne figure in that label is an adult and adolescent indication, not a child dose. Source NICE Guideline NG198 Acne vulgaris: management, "Terms used in this guideline", entry "Oral lymecycline or oral doxycycline": "Formulation of either: 408 mg lymecycline daily / 100 mg doxycycline daily." The UK eMC Doxycycline 100mg Capsules SmPC section 4.2 states a lower figure for the same indication - "50 mg daily with food or fluid for 6 to 12 weeks" - and the DailyMed doxycycline capsule label states no acne dose at all, only that in severe acne doxycycline "may be useful adjunctive therapy". Under the tier list in docs/SOURCES.md a tier-1 guideline outranks a tier-2 product label for a dose, so NG198 leads and the label figure is recorded here. Why Lymecycline is the other tetracycline NG198 names and it is not marketed in Egypt; doxycycline is, in 12 products. Moderate-to-severe acne needs an oral antibiotic on top of the topicals and this condition had none between topical clindamycin and oral isotretinoin - a jump from a topical to a pregnancy-category-X specialist drug with nothing in between. Caution NICE NG198 rules out three things in acne: do not give a topical antibiotic on its own, do not give an oral antibiotic on its own, and do not pair a topical antibiotic with an oral one. So this is given alongside a topical retinoid with benzoyl peroxide, or alongside azelaic acid - never by itself, and never together with the topical clindamycin listed here. NEVER alone, and never with the topical clindamycin in this condition. NG198 1.5.11 forbids oral antibiotic monotherapy and forbids combining a topical antibiotic with an oral one. Contraindicated in pregnancy and when planning a pregnancy - discuss contraception before writing it. Do not co-prescribe with oral isotretinoin - the combination causes benign intracranial hypertension. Swallow upright with a full glass of water and not at bedtime, or the capsule ulcerates the oesophagus. Photosensitivity is a real problem in Egyptian sun over a 12-week course; advise sunscreen and cover. Review at 12 weeks. If the acne has completely cleared, stop the antibiotic and continue the topical. NG198 keeps its doses in the glossary and table 1 rather than in a numbered recommendation. 1.5.12 is the one that carries the 12-week review given here. Egypt FARCODOXIN 100MG 10 CAPS. PHARCO 11.00 EGP (1.10/unit) DOXY M.R.100 MG 10 CAPS. ADWIA 12.00 EGP (1.20/unit) GRANUDOXY 100MG 10 F.C. TAB. GLOBAL NAPI P... 12.00 EGP (1.20/unit) DOXYDOX 100 MG 10 CAPS. EIPICO 23.00 EGP (2.30/unit) DOXYMYCIN 100 MG 10 CAPS. EL NILE. 30.00 EGP (3.00/unit) TABOCINE 100MG 10 CAPS. TABUK PHARMAC... 46.00 EGP (4.60/unit) VIBRAMYCIN 100MG 10 CAPS. PFIZER 65.00 EGP (6.50/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)