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

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

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 .
  • Mandatory Referral: Refer patients if there is diagnostic uncertainty about their acne, or if they have acne conglobata or nodulo-cystic acne .
  • 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 ,.
    • Moderate to severe acne which has not responded to previous treatment that includes an oral antibiotic ,.
    • Acne that is leading to scarring ,.
    • Acne with persistent pigmentary changes ,.
    • Acne of any severity, or acne-related scarring, that is causing or contributing to persistent psychological distress or a mental health disorder ,. 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 ,.
  • 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) ,.
    • 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) .
    • 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 .
    • 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 .

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