The Australasian College of Dermatologists
Recommendations from the Australasian College of Dermatologists on leg cellulitis, epidermal cysts, urticaria, distorted toenails & acne, advice on systemic non-sedating antihistamines and topical corticosteroids for skin conditions. The Australasian College of Dermatologists (ACD) is the sole medical college accredited by the Australian Medical Council for the training and continuing professional development of medical practitioners in the specialty of dermatology. As the national peak membership organisation, we represent over 550 dermatologist Fellows (FACD) and 100 trainees. We are the leading authority in Australia for dermatology, providing information, advocacy and advice to patients, communities, government and other stakeholders on skin health and dermatological practice.
5.
Monotherapy for acne with either topical or systemic antibiotics should be avoided.
In light of concerns about antibiotic resistance, the treatment of acne with topical or oral antibiotics should be in combination with agents such as benzoyl peroxide or retinoids and prolonged use should be avoided.
Supporting evidence
- Eady EA, Gloor M, Leyden JJ. Propionibacterium acnes resistance: A worldwide problem. Dermatology 2003;206 (1):54-6.
- Earnshaw S, Mendez A, Monnet DL, et al. Global collaboration to encourage prudent antibiotic use. The Lancet Infectious Diseases 2013;13(12):1003-4.
- Archer CB, Cohen SN, Baron SE and on behalf of British Association of Dermatologists and Royal College of General Practitioners. Guidance on the diagnosis and clinical management of acne. Clin Exp Dermatol 2012; 37(s1)1:1-6.
- Laxminarayan R, Duse A, Wattal C, et al. Antibiotic resistance—the need for global solutions. The Lancet Infectious Diseases 2013;13(12):1057-98.
- Adler BL, Kornmehl H, Armstrong AW. 2017. Antibiotic Resistance in Acne Treatment. JAMA Dermatol. 2017 Aug 1;153(8):810-811 (Fee for access)
- Kosmadaki M and Katsambas A. 2017. Topical Treatments for Acne. Clin Dermatol. 2017 Mar-Apr;35(2):173-178. (Fee for access)
- Barbieri JS, Spaccarelli N, Margolis DJ and James WD. 2019. Approaches to Limit Systemic Antibiotic Use in Acne: Systemic Alternatives, Emerging Topical Therapies, Dietary Modification, and Laser and Light-based Treatments. J Am Acad Dermatol. 2019 Feb;80(2):538-549. (Fee for access)
- Dreno B. 2016. Bacteriological Resistance in Acne: A Call to Action. Eur J Dermatol. 2016 Apr 1;26(2):127-32. (Fee for access)
- Farrah G and Tan E. 2016. The Use of Oral Antibiotics in Treating Acne Vulgaris: A New Approach Dermatol Ther. 2016 Sep;29(5):377-384. (Fee for access)
- Zaenglein A, Pathy AL, Schlosser BJ, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol 2015; http://dx.doi.org/10.1016/j.jaad.2015.12.037.
How this list was made
College’s Expert Advisory Committee, comprising seven longstanding Fellows considered four potential recommendations, together with supporting evidence, and agreed to proceed with three of them. The Committee then refined and finalised the recommendations. These were reviewed by the NPS Representatives Committee and finalised in response to the feedback received.
- 1 Do not assume that bilateral redness and swelling of both lower legs is due to infection unless there is clinical evidence of sepsis such as malaise, fever and neutrophilia, plus an expanding area of redness or swelling over a period of hours to days.
- 2 Do not routinely prescribe antibiotics for inflamed epidermoid cysts (formerly called sebaceous cysts) of the skin.
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3
Acute urticaria (i.e. of less than 6 weeks duration) does not routinely require investigation for an underlying cause. Where clinical history and examination suggest the possibility of a bacterial infection or food as a likely trigger, further testing may be warranted. If individual lesions (weals) persist for longer than 24 hours an alternative diagnosis may need to be considered.
- 4 Do not prescribe topical or systemic anti-fungal medication for patients with thickened, distorted toenails unless mycological confirmation of a dermatophyte infection has been obtained.
- 5 Monotherapy for acne with either topical or systemic antibiotics should be avoided.
- 6 Do not recommend that patients take systemic non-sedating antihistamine for itchy rashes, i.e. eczema, psoriasis. Non-sedating antihistamines can be prescribed for urticaria according to the ASCIA guidelines.
- 7 Do not routinely prescribe or recommend topical steroids Class II and above on the face including periorbital areas, or flexural areas of skin (axilla/groin and natal cleft).
- 8 Review your diagnosis and/or treatment/adherence if patient has not responded to adequate prescribed topical steroids after two weeks.