GP appt tomorrow with teen DD. What do we ask for next for her acne?

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Saw GP 2 months ago and DD was prescribed mercilon contraceptive pill for both her heavy periods and her acne. Also got given Duac gel.

DD also uses Purefide daily cleanser.

Periods have improved but acne hasn't.

We're back for review tomorrow. Will obvs follow GP's lead but just wondering what she might prescribe next for DD for the acne? Or if anyone has any tips based on their own teens experiences?

Thanks.

This is a good guide. https://www.pcds.org.uk/clinical-guidance/acne-vulgaris
Oral antibiotics maybe - if scarring then referral for Roaccutane.

We were given a few prescriptions by the GP but none worked.

Saw a dermatologist privately and he prescribed treclin gel , Lymecycline antibiotics for 6 months and changed the pill that the GP had prescribed for her acne as he said it was the wrong one. She is now on dretin ( also known as Yasmin) and he described it as the skin friendly contraceptive pill.

Her skin was clear within three months of this regime and the treclin gel is now helping to reduce the signs of scarring.

I’d request a referral to a dermatologist in this situation. I personally wouldn’t want a GP trying anything stronger than the strongest Duac without a specialist consultant involved.

Also should add that she finished her course of Lymecycline in April this year and the acne hasn't returned.

If your area is anything like our's the waiting list for a dermatologist appt on the NHS is long. We were referred in August 2022 and the appointment we were offered was for January 2024.

Even the wait for a private appointment was three months but it was worth every penny. The consultant wrote to our GP who then prescribed everything the dermatologist had recommended.

We ended private with our ds, immediately on to Roaccutane.

My DS is badly scarred from the acne and the private dermatologist was raging that the NHS had neglected him.

He was monitored for his mental health but has come out fine.

Dermatology referral would probably re rejected if we hadn't tried anything stronger than Duac in primary care! Do you have any idea what a tiny proportion of acne gets referred?

Thanks all.
Thats a really useful and interesting link @mycoffeecup

She doesn't meet the referral criteria for NHS derm referral here. In our area mild-moderate acne is managed in primary care. It's only severe nodular cystic acne that you can refer to derm for (I work in primary care so have just double checked).

I was thinking that lymecycline might be the next thing offered.

We are open to looking at private if needs be but want to see what else the GP can suggest first as we're not rich and private is very expensive (£220 for initial appt plus £150 for follow up + presumably prescription costs as well). She has no scarring and is not hugely bothered by it although of course she'd be happier without it.

Thanks again and will report back after the appt.

Oral antibiotics next and continue with topical agents of which there are more. If she gets severe scarring that pushes her up the waiting list for consideration of roaccutane but she doesn't otherwise currently fulfill the criteria.

Ask for Lymecycline its particularly good for acne with acnecide as a topical adjunct

If that doesn't work you'll need to see a dermatologist to get Roaccutane prescribed which gets rid of acne permanently. Ignore any negative stories you read about it. It's a miracle drug and works spectacularly well

Following as I have a DS in the same position. His acne isn't massively bad and it does seem to flare up then calm down (can't find a cause or link) but it's getting him down. We've tried all the usual off the shelf products.
I'm reluctant to try roaccutane as he has quite delicate mental health. When I was a teenager none of the prescription gels and creams from the doctor did anything.
I did do a search on here the other day and someone recommended a product called Thyme Out, it has good reviews, has anyone else tried this? I don't want to waste money if he needs medication but also I'd rather explore all options

My DD acne cleared with lymecycline in 3 months. She now on the pill to keep it at bay but is really using it for contraception tbh.

I needed Roaccutane 30 years ago. It was an absolute godsend for me and got rid of my acne permanently and mine was horrendous and very mentally debilitating. It changed my life. So I will always sing its praises.

Lymecycline should have been the first thing you were offered

It's so frustrating how many GPS just don't understand acne

It's also frustrating how people want to steer clear of Roaccutane

It's an amazing drug which pretty much guarantees to get rid of your acne

Acne can make you feel very depressed so not giving it to your DC because they're MH is shot to shit from the acne is counterproductive

@Blossomandbee get your poor DS some Roaccutane to clear his acne once and for all

Stop reading up about it in the internet like the bloody MMR and autism

Your doing your child a huge disservice

@HappiDaze don't you dare speak to me like that! You've no idea anything about my son, his history, what I've read or anything!

Well no how would I

This is an online forum where we can only go by what people choose to post

If you're going to get offended then don't post on forums that you are 'reluctant' to help your own DC.

Was lucky, got ds into consultant within a couple of months and he was given Roaccutane.

I think most on the shelf products are a complete waste of money and often these one size fits all skin care products can be too harsh and end up aggravating acne.

I would take your DS to the GP. A prescription is going to cost less per month and have more likelihood of helping his acne. The various topical creams and antibiotics are much more advanced and effective compared to when you were a teen and it is not likely he would need Roaccutane to clear it up.

Dad was prescribed the pill for 6 months, then lymecycline for 6 months, then erythromycin for 3 months. Nothing helped so she went on roaccutane. Acne gone within 2 weeks. Was only on it for 4 months and all done with no recurrence.
DS has just done the lymecycline and erythromycin. They didn’t help so started on roaccutane this week-can already see a difference.

DD not dad!

Obviously without seeing how bad your DDs acne is none of us can say what she should be offered next but if it helps, this is the guidance that a GP ought to be following
https://cks.nice.org.uk/topics/acne-vulgaris/management/primary-care-management/
Not written for patients but fairly easy to follow

No you don't, exactly. Which is evident in your waffling about the internet, MMR vaccine and autism. None of which were even mentioned in my post.

@MoxieFox yes I agree. I've been very careful with what I've bought him to try I know some are very harsh.
I will take him to the GP and see what they say.

Well we're out of the appt.

GP has advised Epiduo as the next step before trying oral antibs so we have a script for Epiduo and a tel call in 4 weeks to see how DD is getting on.

If no improvement then we move to the lymecycline.

She did mention roaccutane as a last resort but she was generally quite negative in how she talked about it focusing on the risks rather than it's efficacy.

Will see how we go with the epiduo. DD is happy to try it and as I've said before, she is not unduly bothered by her skin so I don't feel like, at this point, we need to rush the process/make demands other than what the GP is suggesting.

Thanks for all the valuable input 💐

@Blossomandbee Thyme Out didn't do anything for me but I think they do a trial/travel size that night be worth a go?

(As an aside, it's not a crime to be wary of a high-strength drug that has been in the news in recent years for its possible association with adverse effects on delicate teenage brains. A lot of people have great results on it but that doesn't mean you can't ask questions/carefully consider, with your HCP, whether that's the best option for your kid, and no-one on here should try to make you feel like shit for doing that. My own laywoman's opinion is that in the vast majority of cases, roaccutane is worth it, but obviously that's not a decision I would try and make for your child.)

I always think it's a good idea to start with a fairly gentle salicylic acid cleanser (Cerave and Garnier Pure Sensitive are my preferred ones), Effaclar Duo+ (niacinamide can be very effective) and topical benzoyl peroxide gel (Purifide) on mild acne. For anything worse than that I'd go straight to the GP but you do usually need to give any new regime a good few weeks, sometimes even months, to see a difference, which is so frustrating for teenagers.