New NICE guidance on acne vulgaris: implications for first-line management in primary care

Acne Vulgaris: Management , published on 25 June 2021, is a National Institute for Health and Care Excellence (NICE) guideline for patients with acne, their families and carers, their healthcare professionals, and commissioners.1 It does not consider neonatal acne. This article highlights parts of the guideline that cover skin care advice and first-line medication options in the management of acne. The guideline also covers further areas such as ‘Referral to specialist care’, ‘Oral isotretinoin’, Physical treatment’, ‘Relapse’, Maintenance treatment’, and ‘Management of acne-related scarring’, which will not be covered in this article. Acne vulgaris is one of the commonest inflammatory skin conditions, reported to create 3.5 million general practice consultations per year in the UK.2 It usually affects adolescents and young adults, and can last for several years. Acne vulgaris most commonly affects the face but chest, back, and shoulders may be involved. Lesions are a combination of non-inflammatory (comedones) and inflammatory lesions (papules, pustules, cysts, nodules), often leading to scarring. The committee agreed to grade acne vulgaris into ‘Mild to Moderate’ or ‘Moderate to Severe’ in order to conduct separate network meta-analysis, while accepting that acne lies along a continuum. This is easily accomplished in busy clinics and provides a baseline for assessing treatment response. Mild-to-moderate acne vulgaris includes patients who have one or more of