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

2. 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.

3. Rationalisation of Dermatology services in SHSCT

5. 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.

6. Acne referral data Jan 2012

7. 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

8. 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

9. Inflammatory acne

10. Comodomal acne

11. Commedomal acne

12. Moderate Acne – papules and pustules
Moderate disease papules and pustules

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

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

15. Severe Acne (fulminans)

16. AS BEFORE

17. Acne: Excoriation (acne excoriee)

18. 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

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