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Acne Dr Stephen Chadwick GPsWI. Acne Very common Very common Most teenagers will have some acne Most teenagers will have some acne Tends to resolve by.

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Presentation on theme: "Acne Dr Stephen Chadwick GPsWI. Acne Very common Very common Most teenagers will have some acne Most teenagers will have some acne Tends to resolve by."— Presentation transcript:

1 Acne Dr Stephen Chadwick GPsWI

2 Acne Very common Very common Most teenagers will have some acne Most teenagers will have some acne Tends to resolve by late teens or early twenties, but can persist Tends to resolve by late teens or early twenties, but can persist Late onset Late onset 10% will have acne in thirties 10% will have acne in thirties 6% in forties 6% in forties

3 Features Comedones (open and closed) Comedones (open and closed) Grease Grease Red papules and pustules Red papules and pustules Nodules and cysts Nodules and cysts Scarring Scarring Pain and tenderness Pain and tenderness Low self esteem and confidence Low self esteem and confidence

4 Cause Disorder of pilosebaceous follicle Disorder of pilosebaceous follicle Excess of oil Excess of oil Dead skin not shed properly and blocks the pores with blackheads Dead skin not shed properly and blocks the pores with blackheads Microcomedones and comedones Microcomedones and comedones Pockets of oil form ideal breeding ground for Propionibacterium acnes Pockets of oil form ideal breeding ground for Propionibacterium acnes Inflammation leads to red papules and pustules. Inflammation leads to red papules and pustules.

5 Assessment Previous treatments Previous treatments Compliance and side effects Compliance and side effects How bad does the patient feel it is ?/10 How bad does the patient feel it is ?/10 Objective assessment of severity Objective assessment of severity Mild/moderate/severe and face/chest/back Mild/moderate/severe and face/chest/back Comedones, papules and pustules Comedones, papules and pustules Nodules and cysts Nodules and cysts Scarring Scarring

6 Treatment Do not pick or squeeze Do not pick or squeeze Ask about inappropriate emollient use Ask about inappropriate emollient use Oil-free make-up, non-comedogenic Oil-free make-up, non-comedogenic Use mild soap or gentle cleanser Use mild soap or gentle cleanser Expect topical treatments to dry or irritate, and manage this Expect topical treatments to dry or irritate, and manage this At least 2 months to assess any treatment At least 2 months to assess any treatment

7 Comedonal

8 Comedonal Topical retinoid Topical retinoid E.g. Tretinoin 0.025% gel applied nocte, or Adapalene 0.1% gel/cream E.g. Tretinoin 0.025% gel applied nocte, or Adapalene 0.1% gel/cream Or Azelaic Acid Or Azelaic Acid E.g. Skinoren 20% cream E.g. Skinoren 20% cream

9 Mild papulo-pustular Topical Retinoid and Topical Antimicrobial Topical Retinoid and Topical Antimicrobial E.g.tretinoin gel nocte and antimicrobial marne (?BPO, or Duac), or possibly Epiduo gel (adapalene + BPO) E.g.tretinoin gel nocte and antimicrobial marne (?BPO, or Duac), or possibly Epiduo gel (adapalene + BPO) Or Azelaic Acid + Topical Antimicrobial Or Azelaic Acid + Topical Antimicrobial E.g. Zineryt lotion E.g. Zineryt lotion

10 Moderate Papulo-pustular Oral antibiotic + Topical Retinoid +/- BPO Oral antibiotic + Topical Retinoid +/- BPO E.g. Lymecycline od, or Erythromycin 500mg bd, + Tretinoin gel nocte +/- BPO marne E.g. Lymecycline od, or Erythromycin 500mg bd, + Tretinoin gel nocte +/- BPO marne Or Alt. oral antibiotic + alt. retinoid/azelaic acid +/- BPO Or Alt. oral antibiotic + alt. retinoid/azelaic acid +/- BPO E.g. Trimethoprim 300mg bd + adapalene +/- BPO E.g. Trimethoprim 300mg bd + adapalene +/- BPO Or Females, ? Add Dianette Or Females, ? Add Dianette

11 Nodulo-cystic Oral antibiotic + topical retinoid +/- BPO Oral antibiotic + topical retinoid +/- BPO ? High Dose, eg Lymecycline bd or Trimethoprim 300mg bd ? High Dose, eg Lymecycline bd or Trimethoprim 300mg bd Or Oral Isotretinoin Or Oral Isotretinoin Or Females, Dianette + topical retinoid +/- oral antibiotic Or Females, Dianette + topical retinoid +/- oral antibiotic

12 Severe, includes any scarring

13 Oral Isotretinoin Oral Isotretinoin Or High Dose Oral Antibiotic + Topical Retinoid + BPO Or High Dose Oral Antibiotic + Topical Retinoid + BPO Or Females, Dianette + topical retinoid +/- oral antibiotic Or Females, Dianette + topical retinoid +/- oral antibiotic

14 Maintenance Treatment Use Oral Antibiotics for 6-12 months minimum, continue topical retinoid (azelaic acid) long term Use Oral Antibiotics for 6-12 months minimum, continue topical retinoid (azelaic acid) long term For moderate-severe cases, ?topical retinoid +/- BPO long term For moderate-severe cases, ?topical retinoid +/- BPO long term

15 How to reduce referrals? Manage expectations, compliance and side effects Manage expectations, compliance and side effects Use PILs e.g. Use PILs e.g. Use more Topical Retinoids and combine them with Topical or Oral Antibiotics +/- BPO Use more Topical Retinoids and combine them with Topical or Oral Antibiotics +/- BPO

16 When to refer Refer early if scarring, or severe cases Refer early if scarring, or severe cases Mild-moderate cases not responding to standard treatments regimes Mild-moderate cases not responding to standard treatments regimes Females for ?Ro-accutane, discuss contraception prior to referral Females for ?Ro-accutane, discuss contraception prior to referral

17 Questions?


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