How can I effectively manage a patient with acne who has not responded to topical treatments?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 14 August 2025Updated: 14 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

For patients with acne who have not responded to topical treatments, consider referring them to a consultant dermatologist-led team or a nationally accredited GP with an Extended Role (GPwER) working within a pathway, especially if they have moderate to severe acne that has not responded to two completed courses of treatment .

If the acne is severe and resistant to standard therapy, consider oral isotretinoin after assessing the patient's suitability, following the MHRA guidance on safety measures .

In cases of refractory acne, review treatment options and consider another 12-week course of an appropriate treatment, or refer to specialist care if there is no response .

Additionally, discuss the possibility of maintenance therapy after initial response, which may include topical retinoids or combinations, to prevent relapse .

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