When is it appropriate to refer a patient with acne vulgaris to a dermatologist?

It is appropriate to refer a patient with acne vulgaris to a dermatologist or a nationally accredited GP with an Extended Role (GPwER) working within a consultant dermatologist-agreed pathway in several situations:

• Urgent Referral: Patients with acne fulminans should be urgently referred on the same day to the on-call hospital dermatology team for assessment within 24 hours ².
• Mandatory Referral: Refer patients if there is diagnostic uncertainty about their acne, or if they have acne conglobata or nodulo-cystic acne ².
• Consider Referral for Treatment Failure or Specific Concerns: Consider referral if the patient has:
  • Mild to moderate acne that has not responded to two completed courses of treatment ¹,².
  • Moderate to severe acne which has not responded to previous treatment that includes an oral antibiotic ¹,².
  • Acne that is leading to scarring ¹,².
  • Acne with persistent pigmentary changes ¹,².
  • Acne of any severity, or acne-related scarring, that is causing or contributing to persistent psychological distress or a mental health disorder ¹,². This includes considering referral to mental health services if there is significant psychological distress, suicidal ideation, self-harm, severe depressive or anxiety disorder, or body dysmorphic disorder ¹,².
• Other Specific Referral Considerations:
  • If a medical disorder or medication (including self-administered anabolic steroids) is likely to be contributing to the person's acne, consider condition-specific management or referral to an appropriate specialist (e.g., a reproductive endocrinologist) ¹,².
  • For people with skin of colour (SOC), early and more aggressive treatment, including early referral for consideration of oral isotretinoin treatment, may be needed due to increased risk of post-inflammatory hyperpigmentation (PIH) ¹.
  • If acne relapses after a second course of oral isotretinoin (prescribed under specialist care) and is currently moderate to severe, further care should be decided by the consultant dermatologist-led team, and re-referral should be offered if the patient is no longer under their care ¹.
  • If a person's acne-related scarring is severe and persists a year after their acne has cleared, refer them to a consultant dermatologist-led team with expertise in scarring management ².