Treatment in Primary Care

Treatment may typically include:

	topical antimicrobials (benzoyl peroxide)			topical keratolytics (salicylic acid)
	topical antibiotics			oral antibiotics
	topical retinoids			In women: oral anti-androgens
	comedolytics (azelaic acid)

 

• Some topical treatments can be prescribed as combination products. Selection of treatment will depend on the type and severity of the acne (see British National Formulary, Section 13.6).
• Patients with nodulocystic acne are at high risk of scarring and should be referred immediately. Treatment should be started while awaiting the hospital appointment.
• In those with less severe forms of acne, the treatment alternatives should be tried for 2-3 months, then reviewed to assess whether they are having an effect.
• Treatment should be changed if the patient and doctor feel that the response is inadequate.
• Outcomes are likely to be improved if the patient and healthcare professional decide on treatment in partnership, with help and advice that promote self-management

 

Secondary Care

Are in a position to:

• confirm or establish the diagnosis
• provide, in conjunction with other health care professionals, advice on the condition and its treatment, together with social and psychological support
• manage patients whose acne is resistant to, or intolerant of, treatments in primary care
• manage patients whose acne is particularly severe or who are at risk of, or are, developing scarring despite treatment
• assess the need for, and possibly provide, physical treatments
• manage the treatment of patients who require oral isotretinoin

 

Referral Advice

Most patients with acne can be managed in primary care. They should, however, be referred to a specialist service if they:

	have a severe variant of acne such as fulminating acne or acne with systemic symptoms (acne fulminans)
	have severe or painful deep nodules or cysts (nodulocystic acne) and could benefit from oral isotretinoin
	have severe social or psychological problems, including a morbid fear of deformity (dysmorphophobia)
	are at risk of, or are developing, scarring despite primary care therapies
	have moderate acne that has failed to respond to treatment which has included two courses of oral antibiotics, each lasting three months. Failure is probably best based upon a subjective assessment by the patient .
	Are suspected of having an underlying endocrinological cause for the acne (such as polycystic ovary syndrome) that needs assessment

 

Immediate

Urgent

Soon

Routine

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