Acne guidelines adapted from pcds

DERMATOLOGY
Management of Acne
Acne guidelines adapted from Primary Care Dermatology Society Guidelines

All treatments should be used for 3 months before assessing response

Treatment of comedonal acne
o Normally a topical retinoid e.g. adapalene, isotretinoin or tretinoin.
o Treatments will normally dry the skin. Start 2-3 nights a week and gradually increase the frequency of applications. A non-oil based moisturiser can also be used o An alternative topical retinoid, azelaic acid or Benzoyl Peroxide Treatment of mild papular/pustular acne

 Use both a topical retinoid and a topical anti-microbial
 Topical anti-microbials include Duac ® Once Daily (clindamycin and 5%
benzoyl peroxide), Zineryt ® (erythromycin and zinc), Dalacin T ®
(clindamycin and 5% benzoyl peroxide)
o A separate retinoid and anti-microbial at opposite ends of the day
o Combined preparations e.g. Aknemycin ® Plus (tretinoin and
erythromycin), or Epiduo ® (2.5% Benzoyl Peroxide gel and
adapalene)
Treatment of moderate inflammatory acne

 Combine systemic antibiotics with topical agents
 First choice of antibiotic: tetracyclines .should be taken 60 minutes before or
after food. Tetracyclines are contra-indicated in pregnancy and in patients aged under 12 o Lymecycline 408mg OD
o Alternatives. Oxytetracycline 500mg BD is cheaper however in some
patients it may not be as effective as the other tetracyclines.
Doxycycline 100mg daily, can cause a photo sensitive eruption
o Minocycline is rarely used due to the increased risk of hepatotoxicity o Erythromycin 500mg BD
 Topical preparations to use
o Topical retinoids o Topical antimicrobials e.g. benzoyl peroxide o It is not advisable to prescribe oral and topical antibiotics of different Moderate-severe acne in a woman

 Consider adding in Dianette ® to the topical/systemic treatments
 Dianette may be of particular value in patients with significant
endocrinopathies such as polycystic ovarian syndrome  Once a sustained improvement (3 months) has been seen withdraw the Dianette. Patients may then be transferred to Yasmin
Referral Criteria
 Severe acne – refer early
 Moderate acne only partially responding to treatment and starting to scar
 Inadequate response to at least two systemic antibiotics PLUS topical
treatments, each given for a minimum of 3 months
 Patients with associated and severe psychological symptoms, regardless of  Patients 16 and over should be referred via CAS – patients under 16 should be referred directly to the acute specialist.
For patient information/leaflets – see PCDS

For further advice, patients can contact:
Acne Support Group
N.B.
For historical and educational reasons, medicines have been described using
brand names. Wherever possible, prescribers should ensure appropriate
consideration is given to generic preparations.

REFERENCES:

AUTHORS:
Coastal West Sussex Dermatology Task & Finish Group, Dr A Karim and Dr Justine Hextall, Consultant Dermatologists WSHT. OTHERS
INVOLVED: Western Sussex Hospitals NHS Trust LRMG Committee.

PUBLISHED:
06/11 REVIEW DUE: 06/13

Source: http://gp.westernsussexhospitals.nhs.uk/wp-content/uploads/gpsiteweb/Dermatology-Acne-guidelines-FINAL-06-13-AssetID=273726&type=full&servicetype=Attachment.pdf