A-Z
Topics
Latest


Acne

About

What is covered

This NICE Pathway covers management of acne vulgaris in primary and specialist care. It includes recommendations on topical and oral treatments (including antibiotics and retinoids), treatment using physical modalities and management of acne-related scarring.
Throughout this NICE Pathway, 'acne' in recommendations refers to 'acne vulgaris' unless otherwise stated.

Updates

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Short Text

Everything NICE has said on acne in an interactive flowchart

What is covered

This NICE Pathway covers management of acne vulgaris in primary and specialist care. It includes recommendations on topical and oral treatments (including antibiotics and retinoids), treatment using physical modalities and management of acne-related scarring.
Throughout this NICE Pathway, 'acne' in recommendations refers to 'acne vulgaris' unless otherwise stated.

Sources

NICE guidance and other sources used to create this interactive flowchart.
Acne vulgaris: management (2021) NICE guideline NG198

Quality standards

Quality statements

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

NICE has produced resources to help implement its guidance on:

Information for the public

NICE has written information for the public on each of the following topics.

Pathway information

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Supporting information

Treatment choices for mild to moderate and moderate to severe acne vulgaris

Acne severity
Treatment
Advantages
Disadvantages
Any severity
Fixed combination of topical adapalene with topical benzoyl peroxide, applied once daily in the evening
  • Topical
  • Does not contain antibiotics
  • Not for use during pregnancy
  • Use with caution during breastfeedingWhen discussing treatment choices with a person with childbearing potential, cover that topical retinoids and oral tetracyclines are contraindicated during pregnancy and when planning a pregnancy, and that they will need to use effective contraception, or choose an alternative treatment to these options.
  • Can cause skin irritationTo reduce the risk of skin irritation associated with topical treatments, such as benzoyl peroxide or retinoids, start with alternate-day or short-contact application (for example washing off after an hour). If tolerated, progress to using a standard application., photosensitivity, and bleaching of hair and fabrics
Any severity
Fixed combination of topical tretinoin with topical clindamycin, applied once daily in the evening
  • Topical
  • Not for use during pregnancy or breastfeeding
  • Can cause skin irritation and photosensitivity
Mild to moderate
Fixed combination of topical benzoyl peroxide with topical clindamycin, applied once daily in the evening
  • Topical
  • Can be used with caution during pregnancy and breastfeeding
  • Can cause skin irritation, photosensitivity, and bleaching of hair and fabrics
Moderate to severe
Fixed combination of topical adapalene with topical benzoyl peroxide, applied once daily in the evening, plus either oral lymecycline or oral doxycycline taken once daily
  • Oral component may be effective in treating affected areas that are difficult to reach with topical treatment (such as the back)
  • Treatment with adequate courses of standard therapy with systemic antibiotics and topical therapy is a Medicines and Healthcare products Regulatory Agency (MHRA) requirement for subsequent oral isotretinoin, See the MHRA guidance on isotretinoin for severe acne: uses and effects.
  • Not for use in pregnancy, during breastfeeding, or under the age of 12
  • Topical adapalene and topical benzoyl peroxide can cause skin irritation, photosensitivity, and bleaching of hair and fabrics
  • Oral antibiotics may cause systemic side effects and antimicrobial resistance
  • Oral tetracyclines can cause photosensitivity
Moderate to severe
Topical azelaic acid applied twice daily, plus either oral lymecycline or oral doxycycline taken once daily
  • Oral component may be effective in treating affected areas that are difficult to reach with topical treatment (such as the back)
  • Treatment with adequate courses of standard therapy with systemic antibiotics and topical therapy is an MHRA requirement for subsequent oral isotretinoin ,
  • Not for use in pregnancy, during breastfeeding, or under the age of 12
  • Oral antibiotics may cause systemic side effects and resistance
  • Oral tetracyclines can cause photosensitivity
Azelaic acid
Formulation with either of these 2 concentrations:
  • 15% azelaic acid
  • 20% azelaic acid
Consultant dermatologist-led team
This team may include associate specialists and healthcare professionals accredited for extended roles for dermatology under consultant supervision.
Fixed combination of topical adapalene with topical benzoyl peroxide
Formulation with either of these 2 concentrations:
  • 0.1% adapalene with 2.5% benzoyl peroxide
  • 0.3% adapalene with 2.5% benzoyl peroxide
Fixed combination of topical benzoyl peroxide with topical clindamycin
Formulation with either of these 2 concentrations:
  • 3% benzoyl peroxide with 1% clindamycin
  • 5% benzoyl peroxide with 1% clindamycin
Mild to moderate acne
Acne severity varies along a continuum. For mild to moderate acne, this includes people who have 1 or more of:
  • any number of non-inflammatory lesions (comedones)
  • up to 34 inflammatory lesions (with or without non-inflammatory lesions)
  • up to 2 nodules.
Mild to moderate acne
Acne severity varies along a continuum. For mild to moderate acne, this includes people who have 1 or more of:
  • any number of non-inflammatory lesions (comedones)
  • up to 34 inflammatory lesions (with or without non-inflammatory lesions)
  • up to 2 nodules.
Moderate to severe acne
Acne severity varies along a continuum. For moderate to severe acne this includes people who have either or both of:
  • 35 or more inflammatory lesions (with or without non-inflammatory lesions)
  • 3 or more nodules.
Moderate to severe acne
Acne severity varies along a continuum. For moderate to severe acne this includes people who have either or both of:
  • 35 or more inflammatory lesions (with or without non-inflammatory lesions)
  • 3 or more nodules.
Oral lymecycline or oral doxycycline
  • 408mg lymecycline daily
  • 100mg doxycycline daily
Topical azelaic acid
Formulation with either of these 2 concentrations:
  • 15% azelaic acid
  • 20% azelaic acid

Glossary

(‘acne’ in recommendations refers to ‘acne vulgaris’ unless otherwise stated)
(a severe form of nodulo-cystic acne with interconnecting sinuses and abscesses)
(acute significant worsening of acne)
(a very serious form of acne conglobata associated with systemic symptoms)
(0.1% adapalene)
(5% benzoyl peroxide)
(an ingredient that is likely to block skin pores)
(0.025% tretinoin with 1% clindamycin)
(a blend of synthetic surfactants that is formulated to have neutral to slightly acidic pH similar to the skin, it is widely available in both solid and liquid forms as a skin cleansing product)
(0.1% adapalene)
(5% benzoyl peroxide)

Paths in this pathway

Pathway created: June 2021 Last updated: June 2021

© NICE 2021. All rights reserved. Subject to Notice of rights.

Recently viewed