Acne

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Mild to moderate Acne

First-Line

12 weeks of either of these - applied once daily in the evening:

  • Duac
    • Benzoyl peroxide with Clindamycin (3% or 5% benzoyl peroxide with 1% clindamycin)
  • Epiduo gel
    • Adapalene (retinoid) with Benzoyl Peroxide (0.1% or 0.3% adapalene with 2.5% benzoyl peroxide)
    • Females of child-bearing age must use effective contraception (oral progestogen-only contraceptives not considered effective
  • Treclin gel
    • Tretinoin (retinoid) with Clindamycin (0.025% tretinoin with 1% clindamycin)
    • Females of child-bearing age must use effective contraception (oral progestogen-only contraceptives not considered effective)
Second-Line
  • Benzoyl Peroxid
    • If above contraindicated or the person wishes to avoid retinoid or antibiotic

Moderate to Severe Acne

First-Line

12 weeks of either of these - applied once daily in the evening:

  • Epiduo gel
    • Adapalene (retinoid) with Benzoyl Peroxide (0.1% or 0.3% adapalene with 2.5% benzoyl peroxide)
    • Females of child-bearing age must use effective contraception (oral progestogen-only contraceptives not considered effective
  • Treclin gel
    • Tretinoin (retinoid) with Clindamycin (0.025% tretinoin with 1% clindamycin)
    • Females of child-bearing age must use effective contraception (oral progestogen-only contraceptives not considered effective)
  • Epiduo & oral lymecycline 408 mg once daily
  • Epiduo & oral doxycycline 100 mg once daily
  • Topical azelaic acid (retinoid) (15% or 20%) applied twice daily & oral lymecycline 408 mg once daily
  • Topical azelaic acid (retinoid) (15% or 20%) applied twice daily & oral doxycycline 100 mg once daily
Second-line

Counselling 

  • Topical retinoids and oral tetracyclines are contraindicated during pregnancy and when planning a pregnancy - use effective contraception, or choose an alternative treatment to these options
  • Use non-alkaline (skin pH neutral or slightly acidic) synthetic detergent cleansing product twice daily on acne-prone skin
  • Avoid over-cleaning the skin (which may cause dryness and irritation)
  • Avoid oil-based comedogenic skin care products, make-up and sunscreens, and if make-up is used it should be removed at the end of the day.
  • Persistent picking or scratching of lesions can increase the risk of scarring.
  • Treatments may irritate the skin, especially at the start of treatment 

Isotretinoin (Roaccutane)

Must be under expert supervision and only prescribed for the treatment of severe forms of acne resistant to adequate courses of standard therapy with systemic antibacterials and topical therapy.

MHRA Alerts:

  • Loss of Libido
    • May cause sexual side-effects, including erectile dysfunction and decreased libido
  • Neuropsychiatric reactions
    • Monitor patients for signs of depression or suicidal ideation and refer for appropriate treatment
    • particular care is needed in those with a history of depression
    • encourage patient to report any changes in mood or behaviour
  • Pregnancy
    • Contra-indicated in pregnancy due to a high risk of serious congenital malformations
    • Females of childbearing age must be within Pregnancy Prevention Programme
      • Ensure that female patients have a PPP card
      • Exclude pregnancy a few days before treatment, every month during treatment & 1 month after stopping treatment
      • Use contraception for at least 1 month before starting treatment, during treatment, and for at least 1 month after stopping treatment
      • At least 1 highly effective method of contraception (i.e. a user-independent form such as an intra-uterine device or implant) or 2 complementary user-dependent forms of contraception (e.g. combined oral contraceptives and barrier method)
      • Oral progestogen-only contraceptives are not considered effective
      • Females should be advised to discontinue treatment and to seek prompt medical attention if they become pregnant during treatment or within 1 month of stopping treatment.
  • Avoid blood donation during treatment and for at least 1 month after treatment
  • Avoid wax epilation (risk of epidermal stripping), dermabrasion, and laser skin treatments (risk of scarring) during treatment and for at least 6 months after stopping
  • Avoid exposure to UV light (including sunlight) and use sunscreen and emollient (including lip balm) from the start of treatment
  • Monitoring: Lipids & LFTs before treatment, 1 month after starting and then every 3 months

Patient information 

British Association of Dermatologists

Acne - NHS

 

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