Clinical management
Spironolactone effective for persistent acne in women
A randomised controlled trial recruited adult women in the UK with facial acne for at least 6 months felt to warrant oral antibiotics.
Spironolactone improved acne compared to placebo with a greater difference at 6 than 3 months.
Consider spironolactone (off-licence) alongside topical acne treatment as an alternative to long-term oral antibiotics in women (should not be prescribed for men with acne as it can reduce testosterone levels, causing potential gynaecomastia/ loss of sexual function).
Offer contraceptive counselling (although spironolactone is cautioned against in pregnancy, it is less teratogenic than oral tetracyclines).
Baseline bloods to check renal function/ potassium are advised to exclude renal impairment- consider ongoing monitoring in women >45/ with relevant comorbidities.
Initiate spironolactone at 50mg, increasing to 100 mg after 1-2 weeks if tolerated.
WiseGP Actions:
Share this GEM with your practice team and at medication reviews consider offering women with persistent acne spironolactone (off licence) with topical treatment, rather than repeated courses of oral antibiotics.
To help reduce antibiotic prescribing, could this form the basis of a quality improvement project for your PCN clinical pharmacist or GP registrar?
Read more about the evidence informing this GEM using the links below.
https://www.bmj.com/content/381/bmj-2022-074349
https://www.bmj.com/content/381/bmj.p1114
No difference in effectiveness of different emollients for childhood eczema
A trial involving 77 GP practices in England, randomly assigned 550 eligible children with eczema to one of four different treatment groups (lotion, cream, gel, ointment)
At 16-week follow-up there was no difference in eczema severity between groups
Stinging was less common with ointments compared to other emollients
WiseGP Actions:
Consider offering parents small samples of different emollients to trial, to find one they prefer and are more likely to use effectively in the future
Have a look at our GEM on eczema self-management and consider signposting parents for support with emollient use to eczema care online.
Read more here:
https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(22)00146-8/fulltext
Improving eczema self-management
Researchers worked with GPs, specialist nurses, dermatologists and people with eczema to create a website to support parents of children with eczema and young people to manage their eczema. The website is interactive and includes videos, stories and advice from others with eczema.
Access to the website supported self-management of eczema and led to less severe eczema symptoms.
WiseGP actions:
Could sharing the Eczema Care Online website with your patients reduce their requirement to consult with eczema symptoms?
Perhaps you could feature a link on your practice website or set up an AccuRx text message to send to parents of children with eczema or young people presenting with eczema symptoms?
https://www.eczemacareonline.org.uk/en?language_set=1
Read more about the evidence informing this GEM here: https://www.bmj.com/content/379/bmj-2022-072007
