Acne Vulgaris

Acne Vulgaris

CKS Acne Vulgaris

Avoid concomitant use or oral and topical antibiotics.

Co-prescription of a topical retinoid or benzyl peroxide (BPO) with oral antibiotics reduces the risk of antimicrobial resistance.

Topical antibiotics alone (e.g. clindamycin) should not be used.

Resistance to P.acnes to erythromycin is much more common than with tetracyclines so  avoid unless tetracycline contra-indicated (e.g. children < 12 years or pregnancy).

Comedonal Acne - responds best to topical retinoids (e.g. Adapalene) or retinoids plus benzoxyl peroxide (BPO) (e.g. Epiduo)

Adapalene - Apply thinly OD

Epiduo - Apply thinly OD

Topical BPO + Clindamycin (Duac) - Apply thinly OD

Duration: 6-8 weeks

Reduce frequency if topical irritation occurs

Inflammatory Acne: Mild to moderate papulopustular disease may respond to topical therapy (see above). Add oral antibiotics if unresponsive to topical therapy.

2nd line:

Lymecycline 408mg OD

or

Doxycyline 100mg OD

6- 12 weeks

Severe nodulocystic disease: Start oral antibiotics (see above) and refer to dermatology.

Continue antibiotics until clinic review - if no response after 12 weeks, consider switching to alternative tetracycline or erythromycin