Mild to Moderate Acne
Patients with mild to moderate acne can usually be managed in Primary Care. Prolonged treatment may be required with regular review to encourage patient compliance.
Topical Treatment for 3 months then review
- Retinoids: Adapalene, Isotretinoin, Tretinoin
- Topical antibiotic combined with benzoyl peroxide, retinoids or zinc to reduce antimicrobial resistance
Assess response to oral antibiotics at three months. If poor response, change to alternative oral antibiotic but continue for six months minimum.
Under 12 years old:
- Erythromycin or Clarithromycin bd
12 years and over:
- Lymecycline 408mg
- Doxcycline 100mg od
- Erythromycin or Clarithromycin 500 mg bd
- Minocycline may have additional side effects so is not a preferred second line treatment
Consider additional anti-androgen treatment e.g. Cyproterone and ethinyloestradiol combination or the combined oral contraceptive
Severe cystic acne with scarring
Commence systemic antibiotic therapy and refer immediately for consideration of systemic isotretinoin, indicating the reasons justifying an urgent referral.