Print Print
CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Acne vulgaris - Management
Basis for recommendation

Recommendations for treatment are based on international guidelines [ICSI, 2006; Strauss et al, 2007] and narrative reviews [Webster, 2002; James, 2005; Ravenscroft, 2005; Zaenglein and Thiboutot, 2006; Acne Working Group, 2008], and reflect published data from randomized controlled trials (RCTs) where available, and otherwise, expert opinion.

Topical retinoids

  • Topical retinoids normalize follicular keratinization, promote drainage of comedones, and inhibit new comedone formation. They have been used historically mainly to treat comedones, but they are also effective at treating inflammatory lesions (if used in the longer term) by inhibiting microcomedone formation [Thiboutot, 2000; Wolf, 2002]. This is supported by good evidence from placebo-controlled trials [Purdy and DeBerker, 2008].

Topical benzoyl peroxide

  • Benzoyl peroxide is a potent bactericide and significantly reduces the population of Propionibacterium acnes in the sebaceous follicle [Thiboutot, 2000]. There is good evidence from placebo-controlled trials that benzoyl peroxide reduces both inflammatory and non-inflammatory lesions [Purdy and DeBerker, 2008].

Topical antibiotics

  • Topical antibiotics reduce colonization of sebaceous follicles by P. acnes and may also have an anti-inflammatory effect. Most evidence from placebo-controlled trials has addressed the effectiveness of topical antibiotics at reducing inflammatory acne lesions, and most experts believe they are of limited use for the treatment of mild acne [Dreno, 2004; ICSI, 2006].

Azelaic acid

  • Azelaic acid is a second-line option that should be considered for mild acne if other treatments are unsuitable [Acne Working Group, 2008]. There is a lack of trial evidence to support the use of azelaic acid in comparison with data available for other topical treatments, and the clinical effect of azelaic acid has been reported to be disappointing by some experts [Brown and Shalita, 1998; James, 2005].

Combined oral contraceptives (COCs)

  • COCs are recommended as a first-line adjunctive treatment for women who have acne [ICSI, 2006; Strauss et al, 2007]. There is good evidence from placebo-controlled trials that COCs are effective in reducing lesion count, acne severity, and the woman's perception of the condition [Arowojolu et al, 2007].

© NHS Institute for Innovation and Improvement