The management of acne vulgaris in primary care: a cohort study of consulting and prescribing patterns using CPRD

Background: Effective management of acne vulgaris in primary care involves support (usually provided over a number of consultations) and prescribing effective treatments. However, consulting and prescribing patterns for acne in primary care are not well described.Objective: To describe the rate of primary care consultations and follow-up consultations; prescribing patterns, including overall use of acne related medications (ARM) and initial and follow-up prescribing, for acne vulgaris in the UK.Methods: UK primary care acne consultations and prescriptions for ARMs were identified in the Clinical Practice Research Datalink (CPRD). Annual consultation rates (between 2004 and 2013) by age and gender, new consultations and consultations in the subsequent year; prescribing trends, prescribing during a new consultation and over the subsequent 90 days and year were calculated, using number of registered patients as the denominator.Results: 65.9% of patients who had a new acne consultation had no further acne consultations in the subsequent year. 26.6%, 25.2%, 23.5% and 2.8% of patients were prescribed no ARM, an oral antibiotic, a topical antibiotic, or an oral plus topical antibiotic respectively during a new acne consultation. 59.9% and 38.5% of patients prescribed an ARM received no further ARM prescriptions in the following 90 days and one year respectively, despite most prescriptions being for 2 months or less. Prescribing rates for lymecycline and topical combined clindamycin/benzoyl peroxide increased substantially between 2004 and 2013. There were no important changes in consultation rates between 2004 and 2013.Conclusion: These data suggest that patients with acne are receiving sub-optimal initial choice of ARMs, longitudinal care and prescribing.