Acne vulgaris is an inflammatory condition of the skin, where patients may present with
pimples, or even pustules, nodules and cysts, some of which may result in scarring. It can be an extremely distressing condition to experience, and the psychological response does not always correlate with the severity patients present with.
Most commonly, acne affects the face, back and chest, and whilst it is commonly thought to be confined to adolescence, it can carry well over into adulthood. The aims of treatment include the minimisation of lesions, and to prevent recurrence.
Another form of acne is known as rosacea, which can present in flushing, erythema and the patient may report a burning sensation on the affected areas.
Differential diagnosis
It can be difficult to differentiate between acne vulgaris and rosacea, particularly if the case is milder. But that’s where we’re here to help. See the table below which outlines the
difference between the two types of disease:
Acne vulgaris
Comedones present
Back and chest affected
Typically presents in teenagers and young adults
Redness usually presents only affected area.
Rosacea
Comedones usually not present
Usually occurs only on the face
Not restricted to younger people
Redness is widespread along the around the pimple
Common hurdles for the primary care healthcare professional
Despite its prevalence, acne and rosacea do bring a fair number of problems which need to be addressed by us in primary healthcare.
Something many of us will have seen in the community is a patient who may present with a mild form of acne, but the effect on their self-esteem and confidence is profound. Here, it’s important to show empathy, compassion and employ your signposting superpowers. Is there a scheme in the local area which requires a GP referral? Somewhere they can talk
through their issues? Do they need referral to the local mental health service?
Another situation you will inevitably see is relapse. Not every treatment works for as long as the patient expected it to, and this can further exacerbate their distress. If you’re
prescribing for the patient, try and classify their condition as best you can, and supplement your prescription with a consultation full of understanding and empathy.
Due to the fact that both forms of acne can impact so negatively on the quality of life of a
patient, once treatment is initiated, they are anxious for results to manifest soon.
However, you as their healthcare provider must manage expectations and advise them on the time it will take to see results. This will reduce the risk of treatment failure, and increase the quality of life of the patient.
Have you experienced any difficulties in your practice that we haven’t mentioned? Tell us in the comments below!
Medicines management of acne
Despite the pathophysiology of both types of acne being quite different, both topical and
oral antibiotics play a huge part. Tetracyline and erythromycin have an overlap in the roles they play in the management of both types of acne.
Can you identify five side effects of both antibiotics?
Oral contraceptives also play a part in acne that has not responded to other interventions.
Like other interventions, they can have significant effects, but carry the risks of some serious side effects, and may need to be stopped if some of them occur.
Can you identify three situations that require immediate discontinuation of oral
contraceptives?
Have you signed up to our Dermatology Masterclass yet?
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Minor surgery and peri-operative management
Practice of suturing techniques
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