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Acne Vulgaris

  

Acne vulgaris (or simply acne)


Indications for referral
  • Severe acne with scarring
  • Moderate, but treatment – resistant, acne
  • Consideration of isotretinoin treatment

Ensure female patients are aware of teratogenicity and have effective contraception where appropriate

Initial Primary Care Management

Please see below for a table of GP management advice for Acne vulgaris:

Mild

Non inflammatory

comedones

Single topical treatment for at least 2–3/12

  • Benzoyl peroxide   2.5% or 5% OD-BD*
  • Azelaic acid 20%   BD*
  • Topical erythromycin 2-4%bd or clindamycin   1% BD
  • Topical retinoid: Tretinoin 0.01% or 0.025% OD-BD
  • Adapalene   0.1% nocte
  • Isotretinoin 0.05% OD-BD
Moderate and localised

Inflammatory papules / pustules +/-   comedones

Two separate topical treatments:

  • Benzoyl peroxide + erythromycin or clindamycin
  • Benzoyl peroxide + topical retinoid
  • Topical retinoid + topical antibiotic
Moderate and extensive or   difficult to reach Oral treatment (if topical not tolerated or extensive disease)

Oral antibiotics for at least 3 months

  • Oxytetracycline   500mg BD 
  • Erythromycin   500mg BD 
  • Lymecycline 408mg   OD
  • Doxycycline   50-100mg OD
  • Minocycline   Modified Release 100mg OD

Others:

Combined oral contraceptive pill in females (Dianette or Yasmin)

Severe

Nodules, cysts and inflammatory   papules

  • Combined oral  antibiotics and non-antibiotic topical   treatment
  • Combined oral contraceptive pill in females (Dianette or Yasmin)
Is this Acne fulminans?Inflammatory with malaise / pyrexia

No

Is there scarring (www.dermnet.com/Acne-Scar – follow link) or failure to respond to oral/topical over 6/12 (3/12 if severe)
Yes If Isotretinoin a possibility: check FBC, LFTs, lipids, & give contraceptive advice
Refer Urgently Refer to Dermatology
References/Sources

Cambridge University Hospitals NHS Foundation Trust Acne Referral Guidelines August 2010

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