Acne Treatment Guidelines

Legal and professional obligations

Pharmacists play a critical role in ensuring high-quality care for patients with allergic rhinitis. This includes adhering to relevant standards, codes, and guidelines while prioritising patient safety and well-being. Pharmacists must respect patient privacy, maintain confidentiality, and document all interactions, such as treatment recommendations, advice provided, referrals made, and follow-up actions. Accurate documentation supports continuity of care and professional accountability.

Clinical features

Acne is a chronic disorder affecting hair follicles and sebaceous glands.

Types of acne

Non-inflammatory acne

Comedones (hair follicles blocked with skin debris and oil) can be open (blackheads) and/or closed (whiteheads)

Inflammatory

Papules (raised, solid lesions ≤1 cm in diameter)

Pustules (white or yellow lesions filled with neutrophils containing pus)

Nodules (raised, solid lesions >1 cm in diameter that reach into deeper layers of the skin)

Cysts (firm lesions containing fluid or semi-fluid material)

Resolving lesions

Macules (patches of skin that are altered in colour but are usually not raised) and scars.

Classification of acne

Severity	Typical Presention
Mild	Mainly comedones; a few papules and pustules. Lesions are confined to forehead, nose, and chin. No scarring. Total lesion count <30.
Moderate	Numerous comedones, papules, and pustules; some nodules. Lesions affect extensive areas of the face and sometimes the trunk. Mild scarring may be present. Total lesion count 30–125.

Severe	Nodules and cysts; numerous papules and pustules. Lesions are widespread. Extensive scarring. Total lesion count >125.

Gathering patient information

When consulting patients, it is essential to assess their symptoms and medical history.

Key questions to ask include:

What symptoms are present?
How long have the symptoms been occurring?
Have there been any triggers or aggravating factors?
Is there a family history of acne or scarring?
Has the patient used any treatments before? If so, what was the response?
Does the patient take any medications that may contribute to acne? (e.g., corticosteroids, androgens, lithium)
Is there a history of androgen excess symptoms?
Does the patient have any underlying medical conditions? (e.g., PCOS)
What is the impact of acne on the patient’s emotional and social well- being?
Is the patient pregnant or breastfeeding?

The need to refer

Refer to a medical practitioner if:

Child is ≤6 years old
Unclear diagnosis
Acne is unresponsive to appropriate treatment
Moderate or severe acne
Signs of androgen excess (hirsutism, menstrual irregularities)
Acne caused/aggravated by medication
Significant emotional or social impacts
Scarring or family history of severe scarring

Treatment

Severity	First-line treatment	Alternative/ adjunct Treatments	Escalation options
Mild	OTC topical products (benzoyl peroxide, salicylic acid, azelaic acid, niacinamide)	OTC Topical retinoids (adapalene) for 6 weeks	If unresponsive consider combination therapy (benzoyl peroxide + adapalene) or if inflammation present (benzoyl peroxide + clindamycin)
Moderate	Oral antibiotics if no inflammation (doxycycline, minocycline, erythromycin) + topical therapy	Antiandrogen therapy for females (COCP, spironolactone)	If no response, switch antibiotics or consider isotretinoin
Severe	Oral isotretinoin	Combination therapy: oral antibiotics + topical therapy	Monitor for side effects, consider long-term dermatological care

Prevention

Minimising aggravating factors is essential in managing acne effectively. Patients should identify and avoid medicines that can exacerbate acne, such as corticosteroids, lithium, and certain oral contraceptives. Exposure to occupational and lifestyle factors like industrial oils, halogens, cosmetics, and humid environments should also be minimised when possible. While dietary factors have not been definitively proven to cause acne, patients who notice a link between certain foods and acne flare-ups may consider adjusting their diet accordingly. Additionally, systemic drugs or topical products, including skincare, cosmetics, and sunscreens, should be assessed as potential contributors to acne, and their use should be adjusted if necessary. For female patients who develop acne while on a combined oral contraceptive pill (COCP), switching to a formulation containing a progestogen with antiandrogenic properties, such as cyproterone, dienogest, or drospirenone, may be beneficial. Given that acne can have significant emotional and social impacts, healthcare providers should assess the patient’s psychological well-being and provide referrals to counsellors or psychologists if necessary

Proper skin care is an important preventive measure. Patients should wash affected areas no more than twice daily with a gentle, non-soap cleanser and warm (not hot) water, avoiding harsh scrubbing, exfoliants, astringents, and face masks, as these can irritate the skin and worsen acne. Picking, squeezing, or touching pimples should be discouraged to prevent infection and scarring. The use of water-based or oil-free, non-comedogenic cosmetics and sunscreens is recommended, and a light, oil-free, non- comedogenic moisturiser should be applied in the evening, particularly if the skin is dry or irritated. Patients using photosensitising acne treatments, such as adapalene, should avoid excessive sun exposure and use a broad- spectrum sunscreen with SPF 30 or higher daily. Occupational and environmental factors should also be considered when advising patients on acne prevention. Individuals working in high-humidity environments or exposed to steam, such as chefs, baristas, or those using saunas, should take extra precautions with their skincare routine. Additionally, those in contact with comedogenic substances, such as industrial oils or certain cosmetics, should use protective measures to reduce skin exposure. By adopting these preventive strategies, patients can help reduce the frequency and severity of acne flare-ups while improving overall skin health.

Source

Acne Treatment Guidelines. Australian Pharmaceutical Formulary and Handbook. Canberra: Pharmaceutical Society of Australia. 2024.

Acne. Therapeutic Guidelines. 2022.

Course Content

Treatment guidelines for acne

Evaluation

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Legals

Treatment guidelines for acne