Acne Vulgaris Management in Primary Care
Acne Vulgaris
Management in primary care
Why treat
•
Massive psychosocial impact
•
Leaves life long scarring
•
Effective treatments
Severity
Mild Moderate Severe
Mild acne
Mild comedonal
mild acne
•
Over the counter products to treat and
prevent recurrence
•
Use oil free products eg make up
•
Advise low glycaemic index, Zinc and less dairy
•
Avoid picking/ squeezing (acne excoriee)
Consider predominant lesions
•
Inflammatory – benzoyl peroxide (2.5-5%)
•
Comedonal – retinoid gel/cream
Tips
1.
Needs 2-3 months to show improvement
2.
If irritation reduce dose, frequency of
application, change formulation
Moderate acne
Moderate acne
•
Use combination products (minimum 2-3/12)
epiduo (BPO + retinoid)
Duac ( AB +BPO)
treclin (AB + retinoid )
Zineryt (AB plus zinc)
–
in pregnancy
For women (especially PCOS) consider dianette
(can be used for 3-4 cycles after acne clears)
•
Progress to oral antibiotics
•
First choice doxycycline and lymecycline
•
Always use a non-AB topical
•
Use for 3 months only then continue topical
•
2
nd
line trimethoprim 300mg bd
•
Erythromycin 500mg bd for pregnant women
and children
When to refer
When referring
•
Make sure women are on two forms
contraception if sexually active
•
Arrange bloods to be done 2 weeks prior to
appointment (FBC UE LFT and lipids)
ECZEMA
•
Currently around 6 million in UK
(underestimate)
•
Increasing 1in 5 children
•
27 million + prescriptions a year
eczema
•
A massive impact on QOL
•
90% itch or pain
•
70% sleeplessness and fatigue
•
74% stress was a trigger
–
vicious cycle
•
Social embarrassment and bullying
•
Investing time with patient at the start has
massive impact on patient self management
and reducing GP attendances
A problem with barrier of skin
treatment
•
Moisturisers and soap substitutes work at this
level so should always be used even between
flares
•
Avoid triggers (from history)
•
Steroids are required when the eczema flares
steroids
•
Try to remember one from each group
•
Potent – mometasone / Betnovate
•
Moderate - eumovate
•
Mild - hydrocortisone 1%
•
Creams / ointments ?
Fear of steroids
•
Widespread sub- optimal management of
eczema in primary care due to unfounded
fears
•
Need to educate both practitioners (esp
pharmacists) and patients
•
HC1% does not cause atrophy but should be
avoided on eyelids where absorption can
occur
Flare require potent steroids
see hand outs
i finger tip = 2 palms
Eyelids
•
Consider tacrolimus ointment (protopic 0.1%
and 0.03%) and pimecrolimus cream ( elidel )
once flare is under control with steroid
•
Should be applied bd for one month then od
for one month and try tailing off. Consider
twice weekly long term as well
•
No long term adverse effects seen
Triggers and irritants
•
Avoid extreme temperature changes
•
Irritant clothing – wear cotton
•
Perfumes, soaps, skin irritants etc
•
Animal dander, pollen, dust mite etc – triggers
vary
•
Pollution
•
Stress
Recurrent infections
•
Takes wet swabs (skin and nose)
•
Use dermol as soap during infections only
•
Oral antibiotics may help but often not
required if eczema is treated adequately
When to refer
•
Routine referral
–
Diagnosis uncertain
–
Eczema is associated with severe recurrent
infections
–
Contact allergic eczema suspected
–
Causing serious social or psychological problems
for child or carers
–
Eczema not controlled to the satisfaction of carers
or child
Case scenario
Case scenario
Rapid development of
numerous monomorphic,
punched-out erosions with
haemorrhagic crusting ±
vesicles
Eczema Herpeticum
Eczema Herpeticum
Widespread herpes simplex infection on a
background of eczema
Refer to secondary care urgently
This detailed presentation covers the management of acne vulgaris in primary care, emphasizing the importance of treatment due to its massive psychosocial impact and potential for long-lasting scarring. It categorizes acne severity into mild, moderate, and severe, providing specific recommendations and treatment options for each category. From over-the-counter products for mild acne to combination therapies and oral antibiotics for moderate cases, the presentation also includes guidance on when to refer patients to specialists for further management.
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Presentation Transcript
Acne Vulgaris Management in primary care
Why treat Massive psychosocial impact Leaves life long scarring Effective treatments
Severity Mild Moderate Severe
mild acne Over the counter products to treat and prevent recurrence Use oil free products eg make up Advise low glycaemic index, Zinc and less dairy Avoid picking/ squeezing (acne excoriee)
Consider predominant lesions Inflammatory benzoyl peroxide (2.5-5%) Comedonal retinoid gel/cream Tips 1. Needs 2-3 months to show improvement 2. If irritation reduce dose, frequency of application, change formulation
Moderate acne Use combination products (minimum 2-3/12) epiduo (BPO + retinoid) Duac ( AB +BPO) treclin (AB + retinoid ) Zineryt (AB plus zinc) in pregnancy For women (especially PCOS) consider dianette (can be used for 3-4 cycles after acne clears)
Progress to oral antibiotics First choice doxycycline and lymecycline Always use a non-AB topical Use for 3 months only then continue topical 2ndline trimethoprim 300mg bd Erythromycin 500mg bd for pregnant women and children
When referring Make sure women are on two forms contraception if sexually active Arrange bloods to be done 2 weeks prior to appointment (FBC UE LFT and lipids)
ECZEMA Currently around 6 million in UK (underestimate) Increasing 1in 5 children 27 million + prescriptions a year
eczema A massive impact on QOL 90% itch or pain 70% sleeplessness and fatigue 74% stress was a trigger vicious cycle Social embarrassment and bullying
Investing time with patient at the start has massive impact on patient self management and reducing GP attendances
treatment Moisturisers and soap substitutes work at this level so should always be used even between flares Avoid triggers (from history) Steroids are required when the eczema flares
steroids Try to remember one from each group Potent mometasone / Betnovate Moderate - eumovate Mild - hydrocortisone 1% Creams / ointments ?
Fear of steroids Widespread sub- optimal management of eczema in primary care due to unfounded fears Need to educate both practitioners (esp pharmacists) and patients HC1% does not cause atrophy but should be avoided on eyelids where absorption can occur
Flare require potent steroids see hand outs i finger tip = 2 palms
Eyelids Consider tacrolimus ointment (protopic 0.1% and 0.03%) and pimecrolimus cream ( elidel ) once flare is under control with steroid Should be applied bd for one month then od for one month and try tailing off. Consider twice weekly long term as well No long term adverse effects seen
Triggers and irritants Avoid extreme temperature changes Irritant clothing wear cotton Perfumes, soaps, skin irritants etc Animal dander, pollen, dust mite etc triggers vary Pollution Stress
Recurrent infections Takes wet swabs (skin and nose) Use dermol as soap during infections only Oral antibiotics may help but often not required if eczema is treated adequately
When to refer Routine referral Diagnosis uncertain Eczema is associated with severe recurrent infections Contact allergic eczema suspected Causing serious social or psychological problems for child or carers Eczema not controlled to the satisfaction of carers or child
Case scenario Rapid development of numerous monomorphic, punched-out erosions with haemorrhagic crusting vesicles
Eczema Herpeticum Widespread herpes simplex infection on a background of eczema Refer to secondary care urgently
