DERMATOLOGY Management of Acne Acne guidelines adapted from Primary Care Dermatology Society Guidelines
All treatments should be used for 3 months before assessing response
Treatment of comedonal acne
o Normally a topical retinoid e.g. adapalene, isotretinoin or tretinoin.
o Treatments will normally dry the skin. Start 2-3 nights a week and
gradually increase the frequency of applications. A non-oil based moisturiser can also be used
o An alternative topical retinoid, azelaic acid or Benzoyl Peroxide
Treatment of mild papular/pustular acne
Use both a topical retinoid and a topical anti-microbial Topical anti-microbials include Duac ® Once Daily (clindamycin and 5%
benzoyl peroxide), Zineryt ® (erythromycin and zinc), Dalacin T ® (clindamycin and 5% benzoyl peroxide)
o A separate retinoid and anti-microbial at opposite ends of the day o Combined preparations e.g. Aknemycin ® Plus (tretinoin and
erythromycin), or Epiduo ® (2.5% Benzoyl Peroxide gel and adapalene) Treatment of moderate inflammatory acne Combine systemic antibiotics with topical agents First choice of antibiotic: tetracyclines .should be taken 60 minutes before or
after food. Tetracyclines are contra-indicated in pregnancy and in patients aged under 12
o Lymecycline 408mg OD o Alternatives. Oxytetracycline 500mg BD is cheaper however in some
patients it may not be as effective as the other tetracyclines. Doxycycline 100mg daily, can cause a photo sensitive eruption
o Minocycline is rarely used due to the increased risk of hepatotoxicity
o Erythromycin 500mg BD
Topical preparations to use
o Topical retinoids o Topical antimicrobials e.g. benzoyl peroxide o It is not advisable to prescribe oral and topical antibiotics of different
Moderate-severe acne in a woman
Consider adding in Dianette ® to the topical/systemic treatments Dianette may be of particular value in patients with significant
endocrinopathies such as polycystic ovarian syndrome
Once a sustained improvement (3 months) has been seen withdraw the
Dianette. Patients may then be transferred to Yasmin Referral Criteria
Severe acne – refer early Moderate acne only partially responding to treatment and starting to scar Inadequate response to at least two systemic antibiotics PLUS topical
treatments, each given for a minimum of 3 months
Patients with associated and severe psychological symptoms, regardless of
Patients 16 and over should be referred via CAS – patients under 16 should
be referred directly to the acute specialist.
For patient information/leaflets – see PCDS
For further advice, patients can contact: Acne Support Group N.B. For historical and educational reasons, medicines have been described using brand names. Wherever possible, prescribers should ensure appropriate consideration is given to generic preparations. REFERENCES: AUTHORS:
Coastal West Sussex Dermatology Task & Finish Group, Dr A Karim and Dr Justine Hextall, Consultant Dermatologists WSHT.
OTHERS INVOLVED: Western Sussex Hospitals NHS Trust LRMG Committee. PUBLISHED: 06/11 REVIEW DUE: 06/13
Guidelines Treatment of chronic bacterial prostatitis 1Urologic Clinic, Justus-Liebig-University Gießen, Gießen, Germany2Department of Urology, University of Washington, Seattle, United States of America This manuscript was published originally in: Naber KG Schaeffer AJ, Heyns CF, Matsumoto T, Shoskes DA, Bjerklund Johansen TE (eds): Urogenital Infections. European Association of Urology -
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DERMATOLOGY