[6 min read] How to manage acne patients in primary care

Acne is one of the most common chronic dermatological disorders. It affects around 15 per cent of adolescents and adults older than 12. So, it is not a surprise that primary care practitioners are often in the position to diagnose and treat acne.

For further information on this topic, you may be interested to learn more about the HealthCert Professional Diploma program in General Dermatology.

Acne is not a serious threat to physical health. However, its effect on physical appearance and mental health is the cause of concern. Symptoms of acne, such as pustules, papules, nodules, and deep scars are unattractive and may affect patients’ self-esteem and lead to anxiety and depression.

Although acne will clear up spontaneously in most people in their early twenties, the skin disorder often requires treatment. Early effective treatment is invaluable, and that’s where primary care plays an important role.

What is acne?

Acne is an inflammatory condition that affects sebaceous glands in the skin. The overproduction of sebum clogs-up hair follicles, creating a friendly environment for bacteria to breed and cause infections. The result of that process is visible on patients’ skin as different manifestations of acne. These include:

  • Comedones (small dark or white bumps),
  • Papules (small raised lesions with different color or texture than the surrounding skin),
  • Pustules (puss-filled, blister-like lesions), and
  • Nodules/cysts (hard, deep-lying lumps)

Acne is not an infectious disease. Despite a common belief, a poor diet is not one of the causes, and aggressive hygiene (over-washing) can only worsen the problem.

Diagnosing acne

Acne is relatively easy to diagnose with a visual check-up of a patient in a primary care setting. However, basic training in general dermatology is valuable to accurately determine the severity of acne and the effectiveness of the treatment.

If there are any diagnostic uncertainties, it is essential to refer to a secondary care specialist. The same applies to patients with severe acne and those with inadequate response to at least three months of comprehensive treatment (antibiotics + topicals.)

Severe psychological distress due to acne also requires a specialist’s attention.

How to treat acne

The first and second-line treatments differ according to the type of acne. Here we have four categories:

  1. Acne with open comedones (blackheads)
  2. Mild papular/pustular acne
  3. Severe inflammatory acne (numerous pustules, some nodules)
  4. Severe nodular acne

*for patients with severe nodular/cystic acne, a referral to secondary care specialist is often necessary.

A primary care provider should provide sufficient information to patients about self-care. These are the most important tips:

  • Wash the acne-affected area no more than two times a day gently with lukewarm water.
  • Do not pick or squeeze acne.
  • Use minimal makeup and other cosmetics.
  • For dry skin, use only water-based and fragrance-free emollients.
  • Do not use any oily skincare products.

– Dr Rosmy De Barros

Read another article like this one: How to manage skin rashes in primary care


References:

  • Samuels DV, Rosenthal R, Lin R, Chaudhari S, Natsuaki MN. Acne vulgaris and risk of depression and anxiety: A meta-analytic review. J Am Acad Dermatol. 2020;83(2):532-541. doi:10.1016/j.jaad.2020.02.040
  • Dréno B. What is new in the pathophysiology of acne, an overview. J Eur Acad Dermatol Venereol. 2017;31 Suppl 5:8-12. doi:10.1111/jdv.14374
  • Stangeland KZ, Huldt-Nystrøm T, Li X, Danielsen K. Behandling av akne [Treatment of acne] [published correction appears in Tidsskr Nor Laegeforen. 2019 Sep 17;139(14):]. Tidsskr Nor Laegeforen. 2019;139(12):10.4045/tidsskr.18.0946. Published 2019 Sep 9. doi:10.4045/tidsskr.18.0946
  • Conforti C, Giuffrida R, Fadda S, et al. Topical dermocosmetics and acne vulgaris. Dermatol Ther. 2021;34(1):e14436. doi:10.1111/dth.14436

3 comments on “[6 min read] How to manage acne patients in primary care

    1. the ideations usually happens in patients with uncontrolled depression prescribed roaccutane in combination with antidepressants that arent titrated to a good dosing

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