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 To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?'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
How should I treat severe acne?
- In severe acne, there are nodules and cysts (nodulocystic acne), as well as a preponderance of inflammatory papules and pustules. There is a high risk of scarring (or scarring may already be evident), and there is likely to be considerable psychosocial morbidity.
- Refer all people with severe acne for specialist assessment and treatment (for example with oral isotretinoin), and consider prescribing an oral antibiotic in combination with a topical drug whilst waiting for an appointment.
- Oral tetracycline, oxytetracycline, doxycycline, or lymecycline are first-line options. Erythromycin is an alternative if tetracyclines are poorly tolerated or contraindicated (such as in pregnancy). Minocycline is not recommended.
- Benzoyl peroxide or a topical retinoid are recommended as adjunctive treatment for most people. Azelaic acid is an alternative, but avoid the use of topical antibiotics with oral antibiotics.
- Consider prescribing a combined oral contraceptive in women who require contraception. Standard combined oral contraceptives or co-cyprindiol (Dianette®) are options.
© NHS Institute for Innovation and Improvement