Implementing the Acne Care Pathway Dr Art O’Hagan, Consultant Dermatologist

Skin disease in the UK Skin disease is most prevalent disease in under 16s (1 in 5 babies have eczema) and the second most common disease in adults Each year 24% of the population present to their GP with a skin problem. Skin cancer is the most common form of cancer in the UK and malignant melanoma incidence rates in Britain have more than quadrupled since the 1970s.

Rationalisation of Dermatology services in SHSCT

Rationale for care pathways Locally agreed clinical care pathways are essential to support equity of access to care, best clinical practice and optimum care outcomes. Agreed care pathways facilitate seamless care for people accessing services.

Acne referral data Jan 2012

Current Acne clinic in SHSCT Severe acne / acne fulminans triaged to Urgent consultant clinic Other cases generally triaged to Nurse led acne clinic (seen by experienced dermatology nurses) and other treatments recommended or counselled and worked up for Isotretinoin Seen at consultant clinic and isotretinoin initiated Nurse specialist clinic should be established soon

Summary of Recent audit of acne clinic in Craigavon Hospital 45% patients discharged from acne clinic 25% required Roaccutane immediately and referred to dermatology consultant 30% given treatment advice and review at nurse led clinic

Inflammatory acne

Comodomal acne

Commedomal acne

Moderate Acne – papules and pustules Moderate disease papules and pustules

Severe Acne – nodules and cysts Severe presentation with nodules and cysts

Need to examine patients as disease is not only confined to facial areas

Severe Acne (fulminans)

AS BEFORE

Acne: Excoriation (acne excoriee)

Summary of topical therapies for acne Benzoyl Peroxide Azelaic Acid Antibacterials Topical Retinoids Combinations Other agents Acnecide® gel £5.44 / 30g Finacea® Dalacin T® £ 5.08 / 30mls Differin® Gel £11.40 / 45g Epiduo® gel (adapalene 0.1%, benzoyl peroxide 2.5%) £ 17.91/ 45g Brasivol® (aluminium oxide 38.09% in fine particles) brevoxyl® cream £3.30 / 40g Skinoren® Zindaclin® £8.66 / 30g Isotrex® gel £5.94 / 30g Isotrexin® gel (isotretinoin 0.05%, erythromycin 2%) £7.49 / 30g Actinac® paste Panoxyl® gel/ cream £1.89/ 40g / lotion/ aquagel Zineryt® £7.71 / 30mls Retin A® cream£5.94 / 30g Aknemycin® gel (tretinoin 0.025%, erythromycin 4%) £7.05 / 30g Nicam® gel Stiemycin® £7.69 / 50mls Duac® gel (benzoyl peroxide 5%, clindamycin 1%) £9.95 / 25g Acnisal® lotion Quinoderm® (BPO 5%-10% potassium hydroxyquinoline sulphate 0.5% ) £1.30 / 25g

Oral Antibiotic therapy for acne Tetracyclines Alternative cyclines Macrolides Other Antibiotics Tetracycline doxycycline Erythromycin Trimethoprim Oxytetracycline Lymecycline Minocycline

www.carepathways4gp.org.uk