Patient information is available from the British Association of Dermatologists
Treatment should be considered in terms of the severity of the condition. Acne can be mild, moderate or severe (2).
Goals of managing acne vulgaris include clearing or reducing the skin lesions, preventing scarring and managing psychological distress. Reassure the patients that acne is very common and it can be effectively treated, although there might be an initial deterioration in the condition during the treatment, before improvement. Advice on good skin care must be provided (2).
Topical corticosteroids should NOT be used.
Topical retinoids should be avoided in pregnant or breast feeding women (2). If topical therapy is re quired in pregnancy then topical benzoyl peroxide and topical erythromycin are usually considered safe in pregnancy (3).
When prescribing the medications, gels can be considered for oily skin, creams for dry skin and lotions when there are large areas of skin to be treated (2).
During treatment with prescribed medications, patients should use bland facial washes and moisturizers (3).
The CKS (2) defines management in terms of mild, moderate and severe acne.
NICE suggest (4):
Treatment choices for mild to moderate and moderate to severe acne vulgaris
Acne severity | Treatment | Advantages | Disadvantages |
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Any severity | Fixed combination of topical adapalene with topical benzoyl peroxide, applied once daily in the evening |
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Any severity | Fixed combination of topical tretinoin with topical clindamycin, applied once daily in the evening |
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Fixed combination of topical benzoyl peroxide with topical clindamycin, applied once daily in the evening |
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Fixed combination of topical adapalene with topical benzoyl peroxide, applied once daily in the evening, plus either oral lymecycline or oral doxycycline taken once daily |
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Moderate to severe | Topical azelaic acid applied twice daily, plus either oral lymecycline or oral doxycycline taken once daily |
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Effects of the different agents used to treat acne (5)
Topical retinoids: Comedolytic and sometimes anti-inflammatory
Antibiotics: Antimicrobial and anti-inflammatory
Benzoyl peroxide: Antimicrobial plus weakly anti-inflammatory and comedolytic
Hormonal agents: Sebosuppressive
Oral retinoids: Comedolytic, sebosuppressive, antimicrobial, and anti-inflammatory
Reference:
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