It is Thursday morning, you have had your morning quota of coffee, you are logged on and ready to see what the day has in store for you. You have a quick scan through your list, seeing many friendly familiar names on there, when one booking note for Winnie catches your eye: “wishes to discuss acne…”
An initial sigh of relief, but you have this niggling feeling that something has changed in the world of dermatology, a quick search of the latest 2021 NICE guidelines confirms this is indeed the case. Time to run through these changes before ringing Winnie!
Acne is of course incredibly common, with 80% of the population experiencing acne at some point between the ages of 11-30. Although often trivialised as a minor condition, it is a serious one for all our patients that have it. It is crucial therefore to take even mild to moderate acne seriously, and to offer our patients the best evidence-based treatments ASAP as delays or ineffective management can lead to lifelong physical and emotional scars.
So, what treatment do NICE say we should offer Winnie first line? Based on a new review of the evidence, they now recommend we prescribe one of the following five first-line treatments over a 12-week course and then review. They all have similar clinical and cost effectiveness. The fixed combination topical therapies are also more effective compared with topical monotherapies.
For acne of any severity, we can consider prescribing a 12-week course of either:
Topical adapalene combined with topical benzoyl peroxide (Epiduo), or
- Topical clindamycin combined with topical tretinoin (Treclin)
If Winnie has mild to moderate acne an additional alternative includes a 12-week course of:
Topical benzoyl peroxide combined with topical clindamycin (Duac)
If Winnie has moderate to severe acne, additional alternatives include prescribing a 12-week course of one of the following treatment options:
Topical adapalene combined with topical benzoyl peroxide (Epiduo) and oral lymecycline
- Topical adapalene combined with topical benzoyl peroxide (Epiduo) and oral doxycycline
- Topical azelaic acid and oral lymecycline
- Topical azelaic acid and oral doxycycline
Even if you say so yourself, you are incredibly proud of your efficient review of the latest NICE guidelines, even if this did require sacrificing your second cup of coffee to achieve this(!), you are now fully prepared for your consultation with Winnie. You dial the number provided…straight to voicemail!
Tune in to our FREE, interactive one-hour dermatology webinar on Tuesday 8th February at 8pm, or watch on demand, where we will discuss how to manage Winnie’s acne in more detail, including how we classify severity, maintenance therapies, reviews and referral criteria along with other common dermatology conditions seen in primary care. I look forward to seeing you then!