Management for acne

Acne can affect individuals for variable periods and while it always affects the face, it can also affect the back and, less commonly, the upper chest.

Comedones (blackheads and whiteheads) are always present but there may also be inflammatory lesions – papules (small red bumps that may feel sore) and pustules (pus-filled spots). There may be larger nodules or cysts that are often painful. When acne lesions heal, they can leave scars or hyperpigmented patches.

Prompt, effective treatment of acne is important to:

• Minimise the risk of long-term scarring
• Reduce the psychological impact.

Effective acne management comprises pharmacological treatments together with supporting advice and guidance. Young people with acne can experience hurtful comments and bullying and are bombarded with messages about acne that can be confusing. In practice, patients seek treatment when there are obvious inflammatory lesions (i.e. mild-moderate acne).

Where OTC treatment has already been tried for an appropriate length of time or acne severity makes prescription treatment appropriate, NICE guidance recommends first-line treatment with a fixed combination of adapalene with benzoyl peroxide (BPO) or tretinoin with clindamycin or clindamycin with BPO, as these are more effective than the single agents. They also have the advantage of being easier to apply than two separate products and may be less irritant, because lower concentrations of each agent are used (than when a product is used alone).

The final choice depends on whether the patient is pregnant (or likely to be) and the degree of irritation experienced with the same ingredients in the past, in addition to patient preference. At present, choice may also depend on availability of appropriate PGDs. Private PGDs are in use as well as NHS PGDs.