Offer people with acne a 12-week course of 1 of the following according to severity:
Any Severity
Mild to moderate acne
Moderate to severe acne
Prescribing Notes
- For full prescribing information refer to NICE NG198.
- Treatment courses should be of 12 weeks duration (positive effects can take 6 to 8 weeks to become noticeable).
- Do not prescribe a combination of a topical antibiotic and an oral antibiotic.
- Do not use monotherapy to treat acne.
- Topical benzoyl peroxide monotherapy should only be considered as an alternative treatment if the above treatments are contraindicated, or the patient wishes to avoid using a topical retinoid, or an antibiotic (topical or oral).
- Topical treatment should be applied sparingly to all the affected areas, not just the spots.
- To reduce the risk of skin irritation associated with topical treatments start with alternate-day or short-contact application (for example washing off after an hour). If tolerated, progress to using a standard application.
- Exposure to sunlight or UV radiation should be avoided or minimized during treatment.
In those with childbearing potential:
- Topical retinoids and oral tetracyclines are contraindicated during pregnancy and when planning a pregnancy, an effective contraception must be used or an alternative treatment chosen.
- If a person being treated for acne wishes to use hormonal contraception, consider a combined oral contraceptive pill in preference to the progestogen-only pill. See 7.3.1 for COC choices.
Review first-line treatment at 12 weeks and
- in people whose treatment includes an oral antibiotic:
- if their acne has completely cleared consider stopping the antibiotic but continuing the topical treatment
- if their acne has improved but not completely cleared, consider continuing the oral antibiotic, alongside the topical treatment, for up to 12 more weeks
- if acne fails to respond adequately consider referral to a consultant dermatologist-led team.
- in people whose treatment does not include an oral antibiotic:
-
- if their acne has completely cleared consider stopping treatment. If required, an appropriate maintenance treatment is a fixed combination of topical adapalene and topical benzoyl peroxide
- if the acne fails to respond adequately:
- mild to moderate: offer a different option from the choices above. If this also fails consider referral to a consultant dermatologist-led team.
- moderate to severe: offer a different option which includes an oral antibiotic from the choices above.
- Only continue treatment that includes an antibiotic (topical or oral) for more than 6 months in exceptional circumstances. Review at 3 monthly intervals, and stop the antibiotic as soon as possible
Oral retinoids
- Oral isotretinoin should only be used for severe forms of acne resistant to adequate courses of standard therapy with systemic antibacterials and topical therapy – see MHRA alert
- Oral isotretinoin is a RED list medication and is only prescribable by a specialist dermatology team in secondary care