Guidelines of care for the management of acne vulgaris

[madman]

Background

Acne vulgaris commonly affects adults, adolescents, and preadolescents aged 9 years or older.


Objective

The objective of this study was to provide evidence-based recommendations for themanagement of acne.


Methods

A working group conducted a systematic review and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of evidence and formulating and grading recommendations.


Results

This guideline presents 18 evidence-based recommendations and 5 good practice statements. Strong recommendations are made for benzoyl peroxide, topical retinoids, topical antibiotics, and oral doxycycline. Oral isotretinoin is strongly recommended for acne that is severe, causing psychosocial burden or scarring, or failing standard oral or topical therapy. Conditional recommendations are made for topical clascoterone, salicylic acid, and azelaic acid, as well as for oral minocycline, sarecycline, combined oral contraceptive pills, and spironolactone. Combining topical therapies with multiple mechanisms of action, limiting systemic antibiotic use, combining systemic antibiotics with topical therapies, and adding intralesional corticosteroid injections for larger acne lesions are recommended as good practice statements.


Limitations

Analysis is based on the best available evidence at the time of the systematic review.


Conclusions

These guidelines provide evidence-based recommendations for the management of acne vulgaris. ( J Am Acad Dermatol Redirecting.)




ACNE GRADING AND CLASSIFICATION


MICROBIOLOGICAL AND ENDOCRINE TESTING


ACNE MANAGEMENT


TOPICAL THERAPIES
Topical retinoids
Benzoyl peroxide
Topical antibiotics
Fixed-dose topical combinations
Clascoterone
Salicylic acid
Azelaic acid
Considerations in Topical Therapies


SYSTEMIC ANTIBIOTICS
Doxycycline
Minocycline
Sarecycline
Considerations in Systemic Antibiotics


HORMONAL AGENTS
Combined oral contraceptives
Spironolactone
Intralesional corticosteroid
Considerations in hormonal agents


ISOTRETINOIN


PHYSICAL MODALITIES


COMPLEMENTARY/ALTERNATIVE THERAPIES


DIET


GAPS IN RESEARCH AND STUDY LIMITATIONS




SUMMARY

Analysis of the evidence from this systematic review based on 9 clinical questions resulted in 18 evidence-based recommendations and 5 good practice statements for the treatment of acne. Strong recommendations are made for benzoyl peroxide, topical retinoids, and topical antibiotics, as well as for oral doxycycline. Oral isotretinoin is strongly recommended for acne that is severe, causing psychosocial burden or scarring, or failing standard oral or topical therapy. Conditional recommendations are made for topical clascoterone, salicylic acid, azelaic acid, as well as for oral minocycline,sarecycline, COC pills, and spironolactone. Combining topical therapies with multiple mechanisms of action, limiting systemic antibiotic use, combining systemic antibiotics with topical therapies, and adding intralesional corticosteroid injections for larger acne lesions are recommended as good practice statements (Table III).

 

[madman]

Table I. Clinical questions and scope

 

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Table II. Strength of recommendation and certainty of evidence

 

[madman]

Fig 1. Management of acne vulgaris.

 

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Table III. Recommendation for the management of acne vulgaris in adults, adolescents, and preadolescents(>9 years)

 

[madman]

Table IV. Summary of contraindications to combined oral contraceptive use based on the US Medical Eligibility Criteria for Contraceptive Use*

 

[madman]

CAPSULE SUMMARY

*The American Academy of Dermatology’s 2016 guidelines for themanagement of acne vulgaris are updated with a systematic review, which resulted in 18 evidence-based recommendations and 5 good practice statements.

*Strong recommendations are made for topical benzoyl peroxide, retinoids, and/or antibiotics and their fixed-dose combinations, and for oral doxycycline. Oral isotretinoin is strongly recommended for severe acne, acne-causing psychosocial burden or scarring, or acne failing standard treatment with oral or topical therapy.

*Conditional recommendations are made for the use of topical clascoterone, salicylic acid, azelaic acid, oral minocycline, sarecycline, combined oral contraceptives, and spironolactone.

*Using topical therapies combining multiple mechanisms of action, limiting systemic antibiotic use, combining systemic antibiotics with benzoyl peroxide and other topical therapies, and adjuvant intralesional corticosteroid injections are recommended as good clinical practices.