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Guidelines unanimously advise topical treatments as first-line, although differ in recommending either topical benzoyl peroxide or topical retinoid (mainly adapalene) alone or in combination. Guidance published by the National Institute for Health and Care Excellence advises counselling patients regarding avoidance of skin irritation when starting topical treatments and promoting adherence (treatments take 6\u20138 weeks to work). Oral antibiotics are currently overprescribed for acne but have a role when coprescribed with a non-antibiotic topical treatment. Hormonal treatments, such as the combined contraceptive pill, are also effective and there is growing evidence for the use of spironolactone for women with persistent acne. Recent guidance from the Medicines and Healthcare products Regulatory Agency regarding isotretinoin has implications for specialist prescribing and monitoring, and increasing public awareness of potential risks of mental health problems and sexual dysfunction. Although acne is associated with psychiatric disorder, the mental health effects of isotretinoin remain controversial.<\/jats:p>","DOI":"10.1136\/dtb.2023.000051","type":"journal-article","created":{"date-parts":[[2023,12,28]],"date-time":"2023-12-28T02:00:26Z","timestamp":1703728826000},"page":"6-10","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":23,"title":["Managing acne vulgaris: an update"],"prefix":"10.1136","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7264-5260","authenticated-orcid":false,"given":"Miriam","family":"Santer","sequence":"first","affiliation":[{"name":"Primary Care Research Centre, University of Southampton, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"Burden-Teh","sequence":"additional","affiliation":[{"name":"University of Nottingham, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Ravenscroft","sequence":"additional","affiliation":[{"name":"Dermatology, Queen's Medical Centre, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,12,27]]},"reference":[{"key":"2025082701374696000_62.1.6.1","doi-asserted-by":"publisher","DOI":"10.1038\/jid.2013.446"},{"key":"2025082701374696000_62.1.6.2","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/S0140-6736(11)60321-8","article-title":"Acne vulgaris","volume":"379","author":"Williams","year":"2012","journal-title":"The Lancet"},{"key":"2025082701374696000_62.1.6.3","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.12149"},{"key":"2025082701374696000_62.1.6.4","doi-asserted-by":"publisher","DOI":"10.1177\/1359105309342470"},{"key":"2025082701374696000_62.1.6.5","doi-asserted-by":"publisher","DOI":"10.3399\/BJGP.2021.0332"},{"key":"2025082701374696000_62.1.6.6","unstructured":"National Institute for Health and Care Excellence . 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