Managing Acne in Primary Care
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A short guide to management of acne from a primary care perspective
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Managing Acne in Primary Care
- 1. Managing Acne in Primary Care Nicholas Ashley
- 2. Objectives • Classifying acne by severity • Topical Management • Systemic Management • When referral is needed
- 3. Questions • Name some dermatological findings present on the skin of an acne sufferer • Name some different treatments available • At what point should a dermatology referral be considered?
- 4. Severity • Mild Comedones -Open/Closed (Black/White heads) No inflammation (erythema) • Moderate >Blackheads and Whiteheads Papules and Pustules Inflammation (erythema) • Severe Nodules and Cysts Severe inflammation Scarring
- 5. What conservative measures can be suggested?...
- 6. Conservative • Empathy and Counselling • Dietary advice • Face washing (twice a day maximum) • Sunlight What topical treatments can be suggested?...
- 7. Topical Therapies • Benzoyl Peroxide 2.5% strength • Antibiotics Clindamycin/Erythro/Doxy • Topical retinoids Antiinflammatory Ensure NO PREGNANCY Don’t use on same area as Benzoyl Peroxide What systemic treatments can be suggested?...
- 8. Systemic Therapies • Antibiotics Doxycycline (not in young – teeth S/E) Erythromycin (Not in combo with topical Abx) • OCP • Retinoids (Double contraception) Secondary Care ONLY
- 9. Treating Scarring • OTC topical treatments • Laser Treatment • Dermabrasion Outpatient procedure. Abrasive substances blown onto the face and then vacuumed off. Limited role in treating acne scarring • Chemical peels • Subcision Used to treat depressed acne scars. Uses a needle to breakdown subcuticular fibrotic strands, thus releasing the skin from the underlying connective tissue.
- 10. Specialty Care Referral • People who have a severe variant of acne including acne fulminans or Gram-negative folliculitis should be referred urgently to be seen within two weeks. • People who have severe acne such as painful, deep nodules or cysts (nodulocystic acne), or other people who could benefit from oral isotretinoin, should be referred as 'soon'. • Milder cases with possible scarring or failure to get an adequate response require 'routine' referral.
- 11. Practical Prescribing • Case vignette: Moderate acne non responsive to following regime o PANOXYL Wash o DUAC Daily (Benzoyl peroxide and Clindamycin) OD o Isotrex 0.05% gel applied topically OD/BD o Isotrex gel + Oral Erythromycin 250mg BD longterm (2 months) Will need to strongly consider secondary care referral
- 12. Conclusion • Assess Severity • Ask “does this need secondary referral?” • Start at the appropriate level of treatment and escalate as necessary Topical or Systemic • Always assess need for counselling/support
- 13. Answers • Name some dermatological findings of an acne sufferer Comedones (open/closed) Papules Nodules Scarring Pustules Cysts • Name some different treatments available Antibiotic (cream/tablet) Retinoids (cream/tablet) Benzyl Peroxide • At what point should a dermatology referral be considered? Severe acne Scarring potential Refractory to treatment
Editor's Notes
- Comedones: skin-coloured, small bumps (open/black or closed/white) which are blocked sebaceous ducts that have subsequently enlarged Papules – up to 1cm “bump” not fluid filled Vesicles ->bullae – small or large and fluid (non pus) filled Pustules – filled with pust
- Wash face with soap and water twice a day. Dietary advice (low glycaemic load and low dairy). sunlight