A recent article published in The BMJ summarized NICE guidance for the management of acne vulgaris. The recommendations were:

• For mild to moderate acne, first-line treatment options include – fixed combination oftopical adapalene with topical benzoyl peroxide; topical tretinoin with topical clindamycin; or topical benzoyl peroxide with topical clindamycin.
• For moderate to severe acne, first- line treatment options include:

o    Fixed combination of topical adapalene with topical benzoyl peroxide or topical tretinoin with topical clindamycin

o    Fixed combination of topical adapalene with topical benzoyl peroxide, plus either oral lymecycline or oral doxycycline

o    Topical azelaic acid plus either oral lymecycline or oral doxycycline

o    Topical or oral antibiotics should not be used as monotherapy or in combination with each other

• Review treatment response at 12 weeks. Antibiotics (topical or oral), when indicated, should only be continued for more than six months in exceptional circumstances.
• If moderate-to-severe acne has failed to respond to a 12-week course of treatment that includes an oral antibiotic or if mild-to-moderate acne has failed to respond adequately to two different 12-week courses of treatment, referral to a dermatologist is warranted.

Source: The BMJ. 2021;374:n1800. doi: 10.1136/bmj.n1800