TRIP

At which level of severity of acne (mild/moderate/severe) is a topical retinoid recommended? Can we prescribe this in primary care?

TRIP Answers, 2006

At which level of severity of acne (mild/moderate/severe) is a topical retinoid recommended? Can we prescribe this in primary care?
At which level of severity of acne (mild/moderate/severe) is a topical retinoid recommended? Can we prescribe this in primary care?
o Topical retinoids are the treatment of choice for comedonal acne; they have an anti-inflammatory effect as well as decreasing inflammatory lesions indirectly by preventing comedone formation [Thiboutot, 2000; Wolf, 2002].
•  “Prescribe topical drugs in the initial treatment of moderate acne, but focus more on the management of inflammatory lesions.
The treatment options outlined in the management of mild acne may be sufficient for people with moderate acne, but there is evidence that combining different topical treatments is a more effective approach [Gollnick et al, 2003; ICSI, 2003]:
The drugs should be applied several hours apart, which decreases the incidence of local skin irritation [Thiboutot, 2000].
o A topical retinoid combined with a topical antibiotic is another option, which has the advantage of being effective in treating both comedones and inflammatory lesions.
o We could find no information on when it may be appropriate to combine azelaic acid with another topical treatment…”
In addition, the guideline contains a section on medicines management focusing on how topical drugs be used and gives detailed prescribing information.
The NLH Q & A Service recommends reading the whole of the guideline to gain an overview of the management of acne in primary care.
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