ACNE Causes: puberty (testosterone increase), consider hyperandrogenism if irregular periods/hirsuitism Goals/outcome measures, Reduce or clear lesions, Prevent scarring, Relieve psychological distress Non-Inflammatory lesions Whiteheads (closed comedones-small raised white bumps Blackheads (open comedones-small raised bumps with dark centre Inflammatory lesions Papules-small round or oval raised elevations of skin Pustules-resemble papules, but have central pocket of pus Nodules-poorly defined swellings, usually red/tender Consider oral contraception in women for all grades of acne (standard or co-cyprindiol) Single topical treatment for at least 8/52-3/12 benzoyl peroxide 2.5% of 5% Azelaic acid (Cambs 1st line) Tretinoin 0.01% or 0.025% (Cambs 1st line) Topical antibiotic erythromycin (cambs 2nd line) Adapalene (cambs 2nd line) Mild non-inflammatory comedones Combined topical Benzoyl peroxide + erythromycin/clindamycin Benzoyl peroxide+topical retinoid Topical retinoid +topical antibiotic Moderate inflammatory papules and pustules +/-Comedones oral treatment (if topical not tolerated or extensive disease) Oral antibiotics for at least 3 months (1st line oxytetracycline, erythromycin 2nd line lymecycline) Severe Nodules and cysts and inflammatory papules NO Combined oral antibiotics and non-antibiotic topical treatment Is there scarring? Or Failure to respond to oral/topical over 6 months (3/12 if severe) If isotretinoin a possibility Check LFT, FBC, lipids,and give contraceptive advice References CKS Map of Medicine Refer Dermatology Refer (Soon) Is this Acne fulminansinflammatory with malaise/pyrexia YES Urgent referral Cambridgeshire PCT formulary drugs for acne June 2010 1st line cost 2nd line topical Benzoyl peroxide cream Azelaic acid £1.89/40g £3.74/30g Erythromycin 4% gel Clindamycin solution 1% Topical retinoids tretinoin £5.39/60g adapalene £11.40/45g Oral preparations Oxytetracyline 500mg bd Tetracycline 500mg bd Erythromycin 500mg bd Co-cyprindiol (women) £1.42/28 tabs 250mg £9.10 /28 tabs 250mg £1.97/28 tabs 250mg £2.92/21 tabs lymecycline £7.77 (28 tabs) cost