Mental health support for people who are severely affected by acne is recommended in the first guidance from NICE on managing acne vulgaris.

Acne is a common skin condition that affects 95 per cent of people in England at some point. While most individuals will experience some acne in their teens and early 20s, around thre per cent of the population have acne past the age of 35.

Though the type and severity of acne can vary, evidence suggests that any form of acne can cause a person to experience psychological distress. In some cases this can be a part of, or contribute to, a mental health disorder, says NICE in its first guideline to address acne vulgaris, published on June 25. 

The new guideline (NG198) offers skin care advice and recommendations on pharmacological and photodynamic therapies. As a first line treatment option it recommends a 12-week course of one of the following, depending on the individual case: 

• Fixed combination of topical adapalene with topical benzoyl peroxide for any acne severity
• Fixed combination of topical tretinoin with topical clindamycin for any acne severity
• Fixed combination of topical benzoyl peroxide with topical clindamycin for mild to moderate acne
• A fixed combination of topical adapalene with topical benzoyl peroxide, together with either oral lymecycline or oral doxycycline for moderate to severe acne
• Topical azelaic acid with either oral lymecycline or oral doxycycline for moderate to severe acne.

Topical benzoyl peroxide can be considered as monotherapy as an alternative treatment to these options if these treatments are contraindicated, or the patient wishes to avoid using a topical retinoid, or an antibiotic.

Oral isotretinoin should only be considered for people older than 12 years who have a severe form of acne that is resistant to adequate courses of standard therapy with systemic antibiotics and topical therapy.

Photodynamic therapy can be considered for people aged 18 and over with moderate to severe acne if other treatments are ineffective, not tolerated or contraindicated.

Dr Paul Chrisp, director of the Centre for Guidelines at NICE, said: “Acne affects most of us at some point in our lives, and while it is usually limited to a few facial spots in our teenage years, for some people it is more severe and can impact on their self-esteem and mental health. Not everyone with acne will experience high levels of psychological distress, but it’s important that we find ways to support those who do.

“With this new guideline it is our hope that people whose acne affects their everyday lives are offered the support they need to treat the condition, both physically and mentally.”