Intended for healthcare professionals

Practice Guidelines

Management of acne vulgaris: summary of NICE guidance

BMJ 2021; 374 doi: (Published 20 September 2021) Cite this as: BMJ 2021;374:n1800
  1. Jingyuan Xu, clinical fellow and dermatology registrar12,
  2. Ifigeneia Mavranezouli, senior health economist13,
  3. Laura Kuznetsov, systematic reviewer1,
  4. M Stephen Murphy, clinical advisor1,
  5. Eugene Healy, topic advisor and professor and honorary consultant dermatologist45
  6. on behalf of the Guideline Committee
    1. 1National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, UK
    2. 2University of Manchester, Manchester, UK
    3. 3Research Department of Clinical, Educational & Health Psychology, University College London, London, UK
    4. 4University of Southampton, Southampton, UK
    5. 5University Hospital Southampton NHS Foundation Trust, Southampton, UK
    1. Correspondence to: J Xu j.xu{at}

    What you need to know

    • For mild to moderate acne, first-line treatment options include a fixed combination of (a) topical adapalene with topical benzoyl peroxide, (b) topical tretinoin with topical clindamycin, or (c) topical benzoyl peroxide with topical clindamycin

    • For moderate to severe acne, first- line treatment options include (a) and (b) of those above, and:

      • a fixed combination of topical adapalene with topical benzoyl peroxide, plus either oral lymecycline or oral doxycycline

      • topical azelaic acid plus either oral lymecycline or oral doxycycline

    • Topical or oral antibiotics should not be used as monotherapy or in combination with each other

    • Review treatment response at 12 weeks; options that include an antibiotic (topical or oral) should be continued for more than 6 months only in exceptional circumstances

    • Consider referral to a consultant dermatologist-led team if moderate to severe acne has failed to respond to a 12-week course of treatment that includes an oral antibiotic or if mild to moderate acne has failed to respond adequately to two different 12-week courses of treatment

    Acne vulgaris is the eighth most common disease globally, resulting in >70 000 patients being referred for specialist care in the UK each year.12 While acne vulgaris most often affects adolescents, it is not uncommon in adults and can occur in children. The clinical features vary depending on its severity and its associated psychological impact. Acne vulgaris may persist and lead to pigmentary changes and permanent scarring. This article summarises the guideline from the National Institute for Health and Care Excellence (NICE) on the management of acne vulgaris.3 This guidance was developed with the aim to improve the management of acne vulgaris and reduce sequelae, with a clear framework of referral to more specialised services as appropriate. Throughout the summary and guideline, “acne” refers to acne vulgaris unless otherwise stated.

    How the guideline fits in practice

    • First-line treatment options …

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