GPs’ perspectives on acne management in primary care: a qualitative interview study

BACKGROUND: Acne is a common skin condition, affecting most adolescents at some point. While guidelines recommend topical treatments first-line, long courses of oral antibiotics are commonly prescribed. AIM: To explore GPs’ perspectives on managing acne. DESIGN AND SETTING: Qualitative interview study with GPs in South West England. METHOD: GPs were invited to participate via existing email lists used by GP educators to disseminate information. Purposive sampling was used to recruit a range of participants by sex, number of years in practice, and whether their practice was rural or urban. Semi-structured telephone interviews followed an interview guide and were audiorecorded and transcribed. Data were explored using inductive thematic analysis facilitated by NVivo software (version 11). RESULTS: A total of 102 GPs were invited, of whom 20 participated. Analysis revealed uncertainties regarding topical treatments, particularly around available products, challenges regarding side effects, and acceptability of topical treatments. GPs generally either perceived topical treatments to be less effective than oral antibiotics or perceived pressure from patients to prescribe oral antibiotics due to patients’ views of topical treatments being ineffective. GPs described a familiarity with prescribing oral antibiotics and expressed little concern about antimicrobial stewardship in the context of acne. Some seemed unaware of guidance suggesting that antibiotic use in acne should not exceed 3 months, while others spoke about avoiding difficult conversations with patients regarding discontinuation of antibiotics. CONCLUSION: GPs expressed uncertainty about the use of topical treatments for acne and either felt that treatments were of low effectiveness or perceived pressure from patients to prescribe oral antibiotics.