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
Severe Acne – nodules and cysts
Severe Acne (fulminans)
Acne: Excoriation (acne excoriee)
Summary of topical therapies for acneBenzoyl 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 TrimethoprimOxytetracycline
Lymecycline
Minocycline