Acne vulgaris (mild-to-moderate)

Apply 0.1% gel or cream thin layer once daily to clean skin at bedtime

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.

ADAPALENE US prescribing information, Dosage and Administration (DailyMed SetID 330bc2b3-e064-4189-9c47-9c5a50aa4dde)

First-line topical retinoid targeting comedones and inflammation

Apply 5% gel once or twice daily after washing

Acnecide 5% w/w Gel SmPC section 4.2 (eMC product 2225)

Topical antimicrobial with comedolytic action and no bacterial resistance

Apply 20% cream thinly twice daily, morning and evening, to clean dry skin; about 2.5 cm of cream covers the whole face

(No dose adjustment for adolescents aged 12 to 18. Safety and efficacy have not been established under 12 years.)

Skinoren 20% Cream SmPC sections 4.1 and 4.2 (eMC product 285)

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.

Apply 1% solution or gel thin layer BID (always combine with BPO or retinoid)

CLINDAMYCIN PHOSPHATE US prescribing information, Dosage and Administration (DailyMed SetID 96434354-a646-4869-92a2-4052d3f7a4aa)

Topical antibiotic for inflammatory acne; must combine to prevent resistance

Acne Vulgaris - disease-level clinical article (acne-vulgaris-clinical.txt)

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

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.

No paediatric dose is stated in the sources held for this drug.

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.

Oral anti-androgen therapy reducing sebum secretion by blocking androgen receptors for female patients with moderate-to-severe acne.

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

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.

eMC SmPC, Roaccutane 10 mg soft capsules (Neon Healthcare), sections 4.1 and 4.2

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.

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

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.

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.

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.