Acne Vulgaris
Acne Vulgaris
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ICD 10 code: L70.0-5/L70.8-9
DESCRIPTION
- Acne is an inflammatory condition of the hair follicle
- It is caused by hormones and sebum gland keratinisation, leading to follicular plugging producing comedomes and proliferation of Propioni bacterium acnes
- Distributed on face, chest and back
- Occurs more commonly in adolescence, but may also occur in adulthood
- May also occur as a result of the inappropriate use of topical steroids or as a side effect of medicine e.g. Isoniazid
Mild acne:
- Predominantly consists of non-inflammatory comedones
Moderate acne:
- Consists of a mixture of non-inflammatory comedones and inflammatory papules and pustules
Severe acne:
- It is characterised by the presence of the widespread nodules and cysts, as well as a preponderance of inflammatory papules and pustules
GENERAL MEASURES
- Do not squeeze lesions
- Avoid greasy or oily cosmetics and hair grooming products that block the hair follicle openings
- Discourage excessive facial washing
MEDICINE TREATMENT
Mild inflammatory acne:
- Benzoyl peroxide 5%, gel, apply in the morning to affected areas as tolerated
- Wash off in the evening
- If ineffective and tolerated, increase application to 12 hourly
- Avoid contact with eyes, mouth, angles of the nose and mucous membranes
LoE:IVb2
Moderate inflammatory acne:
- Benzoyl peroxide 5%, gel, apply in the morning to affected areas as tolerated
- Wash off in the evening
- If ineffective and tolerated, increase application to 12 hourly
- Avoid contact with eyes, mouth, angles of the nose and mucous membranes
LoE:IVb3
AND
- Doxycycline, oral, 100 mg daily for 3 months
- Review patient after 3 months of treatment
- It should be taken with meals
- Do not take it together with iron preparations and antacids
LoE:IVb4
Note:
Doxycycline should always be used with a topical agent and should not be used as monotherapy.
For non-inflammatory acne:
Topical retinoids
- Main therapeutic objective is to control comedone formation
- Introduce topical retinoids gradually as a night-time application to limit skin irritant effects, as they are not photo-stable and degrade when exposed to sunlight (e.g. start twice a week and titrate up)
| CAUTION Do not use if pregnant or planning pregnancy Limit exposure to sunlight. If sunburn occurs, discontinue therapy until the skin has recovered. LoE:IIIa5 |
- Tretinoin, topical, apply at night to affected areas for at least 6 weeks
- Review patient after 6 weeks’ treatment
- Minimise exposure to sunlight. If sunburn occurs, discontinue therapy until the skin has recovered
- Acne may worsen during the first few weeks
- Apply about a pea-sized amount to entire face. Avoid contact with eyes and area around mouth and nose
REFERRAL
- All severe cases
- Poor response to treatment
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.0_07 November 2024
Chapter 5: Skin Conditions_5.3 Acne Vulgaris