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Acne vulgaris: Topical: Apply once daily to affected areas after skin has been cleaned and dried Dosing: Pediatric Children ≥9 years and Adolescents: Refer to adult dosing. Dosing: Geriatric Refer to adult dosing. Dosage Forms: U.S. Excipient information presented when available (limited, particularly for generics); consult specific product labeling. Gel, topical: Epiduo®: Adapalene 0.1% and benzoyl peroxide 2.5% (45 g) Generic Equivalent Available: U.S. No Administration Apply a pea-sized amount for each area of the face (eg, forehead, chin, each cheek). Skin should be clean and dry before applying. For external use only; avoid applying to eyes and mucous membranes. Use Topical treatment of acne vulgaris Adverse Reactions Significant 1% to 10%: Dermatologic: Dry skin (<1% to 10%), scaling (<1% to 9%), erythema (1% to 8%), burning (1% to 7%), stinging (1% to 7%), contact dermatitis (3%), skin irritation (1%) Postmarketing and/or case reports: Blistering, conjunctivitis, eczema, eyelid edema, facial swelling, pain, photosensitivity, pruritus, rash, skin discoloration Contraindications There are no contraindications listed in the manufacturer's labeling. Warnings/Precautions

Concerns related to adverse effects: • Bleaching effects: May bleach hair or colored fabric. • Photosensitivity: Use is associated with increased susceptibility/sensitivity to UV light; avoid sunlamps or excessive sunlight exposure. Daily sunscreen use and other protective measures are recommended. • Skin irritation: Certain cutaneous signs and symptoms (eg, erythema, dryness, scaling, burning/stinging) may occur during treatment; these are most likely to occur during the first 4 weeks and usually lessen with continued use. Use of moisturizer, decreased use, or discontinuation may be recommended.

Other warnings/precautions: • Appropriate use: For external use only; avoid contact with abraded skin, mucous membranes, and eyes. Metabolism/Transport Effects None known. Drug Interactions (For additional information: Launch Lexi-Interact™ Drug Interactions Program ) Contraceptives (Progestins): Retinoic Acid Derivatives may diminish the therapeutic effect of Contraceptives (Progestins). Retinoic Acid Derivatives may decrease the serum concentration of Contraceptives (Progestins). Management: Two forms of effective contraception should be used in patients receiving retinoic acid derivatives. Particularly, microdosed progesterone-only preparations may be inadequately effective. Risk D: Consider therapy modification Multivitamins/Minerals (with ADEK, Folate, Iron): May enhance the adverse/toxic effect of Retinoic Acid Derivatives. Risk X: Avoid combination Multivitamins/Minerals (with ADEK, Folate, Iron): May enhance the adverse/toxic effect of Retinoid-like Compounds. Risk X: Avoid combination Porfimer: Photosensitizing Agents may enhance the photosensitizing effect of Porfimer. Risk C: Monitor therapy Vitamin A: May enhance the adverse/toxic effect of Retinoid-like Compounds. Risk D: Consider therapy modification Pregnancy Risk Factor C ( show table ) Pregnancy Implications There are no well-controlled studies in pregnant women. Use only if benefit outweighs the potential risk to fetus. Lactation Excretion in breast milk unknown/use caution Pricing: U.S. (Medi-Span®)

Gel (Epiduo External) 0.1-2.5% (45 g): $307.86 International Brand Names Epiduo (AR, AU, BE, BR, CH, CO, DE, DK, FI, FR, GB, HK, IE, IT, KP, MY, NO, NZ, PH, PL, PT, SE, SG, TH) Mechanism of Action Benzoyl peroxide releases free-radical oxygen which oxidizes bacterial proteins in the sebaceous follicles decreasing the number of anaerobic bacteria and decreasing irritating-type free fatty acids. Adapalene is a retinoid-like compound which is a modulator of cellular differentiation, keratinization, and inflammatory processes, all of which represent important features in the pathology of acne vulgaris. Pharmacodynamics/Kinetics Absorption: Via the skin Metabolism: Benzoyl peroxide: Converted to benzoic acid in skin Excretion: Adapalene: Primarily through bile; Benzoyl peroxide: Urine Use of UpToDate is subject to the Subscription and License Agreement . Topic 9009 Version 32.0 © 2013 UpToDate, Inc. All rights reserved. | Subscription and License Agreement | Release: 21.3 - C21.34 Licensed to: Morehouse School of Medicine | Support Tag: [1104-200.215.4.194-84581B2B62-S473950.14]