Acne Vulgaris

Virtually every adolescent has a few "spots", however, about 15% of the adolescent population have sufficient problems to seek treatment. In most patients, but not all, the acne clears up by the late teens or early 20s. More severe acne tends to last longer. A group of patients have persistent acne lasting up to the age of 30 to 40 years, and sometimes beyond. Patients with persistent acne often have a family history of persistent acne.

Acne is not infectious and, to date, there is no clear-cut evidence to implicate diet. Acne may scar - most of the time this is preventable by using the correct treatment given in a timely fashion.

Mild to moderate acne should be managed in primary care

  • Several different agents may need to be tried alone or in combination
  • Do not use combinations of agents with similar properties or actions e.g. topical plus systemic antibiotics]
  • Inform patient that response is usually slow and allow at least 4 months before deeming a treatment unsuccessful

Advice on assessment including pictures is available at the Primary Care Dermatology website, please follow the link below. Drug choices should follow Joint Formulary guidance, chapter 13.

Primary Care Dermatology – Acne Vulgaris

Referral Criteria

Who to refer

  • Severe acne - refer early
  • Moderate acne only partially responding to treatment ( i.e. more than 6 months) and starting to scar
  • Inadequate response to at least two systemic antibiotics PLUS topical treatments, each given for a minimum of three months

Please include in the referral letter:

a. Details of previous treatment including dose and duration of treatment

b. In females details of contraception.

  • Treatment options in Secondary Care include:
    • Oral isotretinoin (see below)
    • High dose oral antibiotics such as lymecycline 408 mg BD or trimethoprim 300 mg BD
    • Co-cyprindiol with additional cyproterone acetate (50-100 mg/10 days)
    • Short courses of oral corticosteroids may be required

Referral

Referral criteria

The main reason for referring a patient with acne is for isotretinoin treatment.Females of child bearing age should preferably be established on contraception prior to treatment with isotretinoin.

  • Who to refer
  • Severe acne - refer early
  • Moderate acne only partially responding to treatment ( i.e. more than 6 months) and starting to scar
  • Inadequate response to at least two systemic antibiotics PLUS topical treatments, each given for a minimum of three months
  • Mild to moderate acne in patients who have an extreme psychological reaction to their acne and have failed to respond to prolonged courses ( i.e. more than 6 months) of systemic antibiotic treatment and topical treatment

Please include in the referral letter:

a. Details of previous treatment including dose and duration of treatment

b. In females details of contraception.

  • Treatment options in Secondary Care include:
    • Oral isotretinoin
    • High dose oral antibiotics such as lymecycline 408 mg BD or trimethoprim 300 mg BD
    • Co-cyprindiol with additional cyproterone acetate (50-100 mg/10 days)
    • Short courses of oral corticosteroids may be required

Referral instructions

e-Referral Service selection

  • Specialty: Dermatology
  • Clinic Type: Psoriasis
  • Service: DRSS-Eastern-Dermatology-Devon CCG- 15N

Referral forms

DRSS Referral forms

Supporting Information

Evidence

Guidelines adapted from Primary Care Dermatology Guidelines

Pathway Group

This guideline has been signed off by the Eastern Locality on behalf of NEW Devon CCG.

Publication date: 30 January 2017

 

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