acne management in primary care
DESCRIPTION
A short guide to management of acne from a primary care perspectiveTRANSCRIPT
Managing Acne in Primary Care
Nicholas Ashley
Objectives
• Classifying acne by severity
• Topical Management
• Systemic Management
• When referral is needed
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?
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
What conservative measures can be suggested?...
Conservative
• Empathy and Counselling
• Dietary advice
• Face washing (twice a day maximum)
• Sunlight
What topical treatments can be suggested?...
Topical Therapies• Benzoyl Peroxide
2.5% strength
• Antibiotics
Clindamycin/Erythro/Doxy
• Topical retinoids
Antiinflammatory
Ensure NO PREGNANCYDon’t use on same area as
Benzoyl Peroxide
What systemic treatments can be suggested?...
Systemic Therapies
• Antibiotics
Doxycycline (not in young – teeth S/E)
Erythromycin
(Not in combo with topical Abx)
• OCP
• Retinoids
(Double contraception)
Secondary Care ONLY
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.
Specialty CareReferral
• 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.
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
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
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