The Australasian College of Dermatologists
Recommendations from the Australasian College of Dermatologists on leg cellulitis, epidermal cysts, urticaria, distorted toenails & acne. The Australasian College of Dermatologists was established in 1966 as the medical college responsible for the training and professional development of medical practitioners in the speciality of dermatology.
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.
- 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.
- 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.
A long-standing College Fellow, in consultation with the Honorary Secretary has prepared 5 recommendations. All ACD members were invited to choose three out of the five recommendations. Following an NPS Representatives meeting, it was noted that five recommendations are needed. Therefore the remaining two recommendations were selected.
- 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.
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.