Red flags and when to refer

If a person with acne presents with the following symptoms, they should be referred to a GP:

• Psychological distress. Acne can impact a person’s mental health and lead to long-term physical and emotional damage. If the person is becoming socially withdrawn or shows signs of depression, then prompt onward referral to a GP is warranted
• Signs of bacterial infection
• Widespread acne, cysts or nodules
• Significant pain and discomfort
• Sudden worsening of acne
• Over-the-counter treatments aren’t working after six to eight weeks
• The acne is leaving scars or dark patches (hyperpigmentation, a particular issue with skin of colour)
• Urgent referral is required if you suspect acne fulminans³ (see the online version of this feature to find out more).