First acne guideline published by NICE

The new guideline is the first by NICE to address acne vulgaris, and offers recommendations on pharmacological and photodynamic therapies.

Though the type and severity of acne can vary, evidence suggests that any form of acne can cause a person to experience psychological distress. | GETTY IMAGES
Though the type and severity of acne can vary, evidence suggests that any form of acne can cause a person to experience psychological distress. | GETTY IMAGES

In its new guidance, NICE says people with acne should be offered a 12-week course of one of the following first-line treatment options:

  • A fixed combination of topical adapalene with topical benzoyl peroxide (for any acne severity)
  • A fixed combination of topical tretinoin with topical clindamycin (for any acne severity)
  • A fixed combination of topical benzoyl peroxide with topical clindamycin (for mild to moderate acne)
  • A fixed combination of topical adapalene with topical benzoyl peroxide, together with either oral lymecycline or oral doxycycline (for moderate to severe acne)
  • Topical azelaic acid with either oral lymecycline or oral doxycycline (for moderate to severe acne).

Topical benzoyl peroxide monotherapy can be considered as an alternative if the above treatments are contraindicated or the patient wishes to avoid using a topical retinoid or an antibiotic, NICE says. Antibiotics, whether topical or oral, should not be used alone to treat acne.

For people with moderate to severe acne who cannot tolerate or have contraindications to oral lymecycline or oral doxycycline, these medicines can be replaced in the above combination regimens with trimethoprim or an oral macrolide (eg, erythromycin).

To reduce the risk of skin irritation associated with topical treatments, such as benzoyl peroxide or retinoids, NICE recommends starting with alternate-day or short-contact application (for example washing off after an hour). If this is tolerated, treatment can be progressed to standard application.

If a person receiving treatment for acne requires hormonal contraception, NICE says clinicians should consider prescribing the combined oral contraceptive pill in preference to the progestogen-only pill.

Evidence-based guidance

For people aged 18 and over with moderate to severe acne, photodynamic therapy is recommended as an option if other treatments are ineffective, not tolerated or contraindicated.

NICE also provides guidance on reviewing first-line acne treatment at 12 weeks, oral isotretinoin treatment for severe acne, treatment of acne associated with polycystic ovary syndrome, maintenance acne treatment, and management of acne relapse.

In addition, the guideline emphasise the importance of supporting the mental health of patients experiencing significant psychological distress as a result of acne. NICE advises clinicians to consider referral to mental health services where appropriate, especially for those with a current or past history of severe depression or anxiety, body dysmorphic disorder, suicidal ideation and self-harm.

Professor Nick Levell, Chair of the British Association of Dermatologists' Therapy & Guidelines Sub-Committee, said: 'It is great that NICE has chosen to work with the British Association of Dermatologists which has co-badged these evidence-based guidelines to help people who are suffering with acne.

'We all hope that this will improve care for adults and children, help reduce resistance to antibiotics, highlight areas where further research is needed and provide guidance to all those involved in looking after people with this distressing condition.'

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