dr art ohagan, consultant dermatologist. skin disease is most prevalent disease in under 16s (1 in 5...

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IMPLEMENTING THE ACNE CARE PATHWAY Dr Art O’Hagan, Consultant Dermatologist

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Page 1: Dr Art OHagan, Consultant Dermatologist. Skin disease is most prevalent disease in under 16s (1 in 5 babies have eczema) and the second most common disease

IMPLEMENTING THE ACNE CARE PATHWAY

Dr Art O’Hagan, Consultant Dermatologist

Page 2: Dr Art OHagan, Consultant Dermatologist. Skin disease is most prevalent disease in under 16s (1 in 5 babies have eczema) and the second most common disease

Skin disease in the UK

Skin disease is most prevalent disease in under 16s (1 in 5 babies have eczema) and the second most common disease in adults

Each year 24% of the population present to their GP with a skin problem.

Skin cancer is the most common form of cancer in the UK and malignant melanoma incidence rates in Britain have more than quadrupled since the 1970s.

Page 3: Dr Art OHagan, Consultant Dermatologist. Skin disease is most prevalent disease in under 16s (1 in 5 babies have eczema) and the second most common disease

Rationalisation of Dermatology services in SHSCT

Page 4: Dr Art OHagan, Consultant Dermatologist. Skin disease is most prevalent disease in under 16s (1 in 5 babies have eczema) and the second most common disease

Page 5: Dr Art OHagan, Consultant Dermatologist. Skin disease is most prevalent disease in under 16s (1 in 5 babies have eczema) and the second most common disease

Rationale for care pathways

Locally agreed clinical care pathways are essential to support equity of access to care, best clinical practice and optimum care outcomes. Agreed care pathways facilitate seamless care for people accessing services.

Page 6: Dr Art OHagan, Consultant Dermatologist. Skin disease is most prevalent disease in under 16s (1 in 5 babies have eczema) and the second most common disease

Acne referral data Jan 2012

Page 7: Dr Art OHagan, Consultant Dermatologist. Skin disease is most prevalent disease in under 16s (1 in 5 babies have eczema) and the second most common disease

Current Acne clinic in SHSCT

Severe acne / acne fulminans triaged to Urgent consultant clinic

Other cases generally triaged to Nurse led acne clinic (seen by experienced dermatology nurses) and other treatments recommended or counselled and worked up for Isotretinoin

Seen at consultant clinic and isotretinoin initiated

Nurse specialist clinic should be established soon

Page 8: Dr Art OHagan, Consultant Dermatologist. Skin disease is most prevalent disease in under 16s (1 in 5 babies have eczema) and the second most common disease

Summary of Recent audit of acne clinic in Craigavon Hospital

• 45% patients discharged from acne clinic• 25% required Roaccutane immediately

and referred to dermatology consultant• 30% given treatment advice and review

at nurse led clinic

Page 9: Dr Art OHagan, Consultant Dermatologist. Skin disease is most prevalent disease in under 16s (1 in 5 babies have eczema) and the second most common disease

Inflammatory acne

Page 10: Dr Art OHagan, Consultant Dermatologist. Skin disease is most prevalent disease in under 16s (1 in 5 babies have eczema) and the second most common disease

Comodomal acne

Page 11: Dr Art OHagan, Consultant Dermatologist. Skin disease is most prevalent disease in under 16s (1 in 5 babies have eczema) and the second most common disease

Commedomal acne

Page 12: Dr Art OHagan, Consultant Dermatologist. Skin disease is most prevalent disease in under 16s (1 in 5 babies have eczema) and the second most common disease

Moderate Acne – papules and pustules

Page 13: Dr Art OHagan, Consultant Dermatologist. Skin disease is most prevalent disease in under 16s (1 in 5 babies have eczema) and the second most common disease

Severe Acne – nodules and cysts

Page 14: Dr Art OHagan, Consultant Dermatologist. Skin disease is most prevalent disease in under 16s (1 in 5 babies have eczema) and the second most common disease

Page 15: Dr Art OHagan, Consultant Dermatologist. Skin disease is most prevalent disease in under 16s (1 in 5 babies have eczema) and the second most common disease

Severe Acne (fulminans)

Page 16: Dr Art OHagan, Consultant Dermatologist. Skin disease is most prevalent disease in under 16s (1 in 5 babies have eczema) and the second most common disease

Page 17: Dr Art OHagan, Consultant Dermatologist. Skin disease is most prevalent disease in under 16s (1 in 5 babies have eczema) and the second most common disease

Acne: Excoriation (acne excoriee)

Page 18: Dr Art OHagan, Consultant Dermatologist. Skin disease is most prevalent disease in under 16s (1 in 5 babies have eczema) and the second most common disease

Summary of topical therapies for acneBenzoyl Peroxide

Azelaic Acid Antibacterials Topical Retinoids

Combinations Other agents

Acnecide® gel£5.44 / 30g

Finacea® Dalacin T® £ 5.08 / 30mls

Differin® Gel £11.40 / 45g

Epiduo® gel (adapalene 0.1%, benzoyl peroxide 2.5%) £ 17.91/ 45g

Brasivol® (aluminium oxide 38.09% in fine particles)

brevoxyl® cream£3.30 / 40g

Skinoren® Zindaclin® £8.66 / 30g

Isotrex® gel £5.94 / 30g

Isotrexin® gel (isotretinoin 0.05%, erythromycin 2%) £7.49 / 30g

Actinac® paste

Panoxyl® gel/ cream £1.89/ 40g / lotion/ aquagel

Zineryt® £7.71 / 30mls

Retin A® cream£5.94 / 30g

Aknemycin® gel (tretinoin 0.025%, erythromycin 4%) £7.05 / 30g

Nicam® gel

Stiemycin® £7.69 / 50mls

Duac® gel (benzoyl peroxide 5%, clindamycin 1%) £9.95 / 25g

Acnisal® lotion

Quinoderm® (BPO 5%-10% potassium hydroxyquinoline sulphate 0.5% ) £1.30 / 25g

Page 19: Dr Art OHagan, Consultant Dermatologist. Skin disease is most prevalent disease in under 16s (1 in 5 babies have eczema) and the second most common disease

Oral Antibiotic therapy for acne

Tetracyclines Alternative cyclines

Macrolides Other Antibiotics

Tetracycline doxycycline Erythromycin Trimethoprim

Oxytetracycline

Lymecycline

Minocycline

Page 20: Dr Art OHagan, Consultant Dermatologist. Skin disease is most prevalent disease in under 16s (1 in 5 babies have eczema) and the second most common disease

www.carepathways4gp.org.uk

http://www.carepathways4gp.org.uk/

Page 21: Dr Art OHagan, Consultant Dermatologist. Skin disease is most prevalent disease in under 16s (1 in 5 babies have eczema) and the second most common disease

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