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NICE acne guidance suggests treatment and lifestyle advice amid recognition of mental health impact


By Rebecca Jenkins
Freelance jounalist

25 Jun 2021

People who are severely affected by their acne may need mental health support, according to new NICE guidance released today (June 25).

In its first guidelines on managing acne, NICE concluded that although the type and severity of acne can vary, evidence suggested that any form of the condition can cause a person to experience psychological distress.

Healthcare professionals should consider referral to mental health services where appropriate, especially for those with a current or past history of severe depression or anxiety, body dysmorphic disorder, suicidal ideation and self-harm.

Dr Paul Chrisp, director of the Centre for Guidelines at NICE, said: ‘Acne affects most of us at some point in our lives, and while it is usually limited to a few facial spots in our teenage years, for some people it is more severe and can impact on their self-esteem and mental health.’

The guidance, developed in partnership with the British Association of Dermatologists, offered recommendations on pharmacological and photodynamic therapy, which should help most people with the condition.

Patients should be offered one of five first-line treatments for 12 weeks, to allow optimum efficacy, before being reviewed. Professionals should emphasise the importance of completing the course as it could take six to eight weeks to see positive effects.

The five recommended first-line treatments are:

  • a fixed combination of topical adapalene with topical benzoyl peroxide for any acne severity
  • a fixed combination of topical tretinoin with topical clindamycin for any acne severity
  • a fixed combination of topical benzoyl peroxide with topical clindamycin for mild to moderate acne
  • a fixed combination of topical adapalene with topical benzoyl peroxide, together with either oral lymecycline or oral doxycycline for moderate to severe acne
  • topical azelaic acid with either oral lymecycline or oral doxycycline for moderate to severe acne.

Topical benzyl peroxide could be considered as monotherapy if the other treatments were contraindicated, or the patient wanted to avoid using a topical retinoid or a topical or oral antibiotic.

To avoid skin irritation and improve adherence with topical therapies like benzoyl peroxide and retinoids, an initial alternate-day or short-contact application (for example washing off after an hour) could be trialled.

Clinicians were also reminded to discuss with patients that topical retinoids and oral tetracyclines are contraindicated during pregnancy and when planning a pregnancy.

In addition to treatment, the guidance also offered general lifestyle advice for managing acne, recommending that professionals advise people with acne:

  • to avoid oil-based and comedogenic make-up products, and to remove make-up at the end of the day.
  • that persistent picking or scratching of acne lesions can increase the risk of scarring.
  • that there was not enough evidence to support a particular diet to treat acne, but to see Public Health England’s Eatwell Guide for general dietary advice.

Considering the clinical evidence and concerns about antibiotic stewardship, the committee decided not to recommend oral antibiotics or topical antibiotics as monotherapy and agreed that, in addition, combined topical and oral antibiotics should not be used.

Treatment options that included an antibiotic (topical or oral) should be continued for more than six months only in exceptional circumstances. Reviews should occur at three‑monthly intervals and the antibiotic stopped as soon as possible.


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