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AAD Releases Updated Guidelines for the Management of Acne Vulgaris

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Article

The guidelines update the American Academy of Dermatology’s 2016 recommendations for acne management in adults, adolescents, and children aged 9 and older.

frank29052515/AdobeStock

frank29052515/AdobeStock

New guidelines for the management of patients with acne vulgaris were recently published in the Journal of the American Academy of Dermatology (JAAD). The guidelines update and replace the 2016 guidelines of care for acne management in adults, adolescents, and children aged 9 and older.1

The American Academy of Dermatology (AAD)’s Acne Guideline Workgroup examined evidence “based on a systematic review of the literature on acne grading and classification, laboratory testing, and treatment using topical therapies, systemic antibiotics, hormonal agents, oral isotretinoin, physical modalities, complementary and alternative medicine, and dietary and environmental interventions,” the group wrote.

The resulting guidelines focus on acne treatments that are available, approved by the US Food and Drug Administration (FDA), and commonly used in the US. Acneiform eruptions and medication-induced acne are not addressed.

The workgroup, which included 9 board-certified dermatologists (including 1 methodologist and 1 measure representative and medical writer), 3 board-certified pediatric dermatologists, 1 staff liaison, and 1 patient representative, developed 18 evidence-based recommendations and 5 good practice statements.

The group reserved strong recommendations for those treatments with benefits that clearly outweigh risks and burden. Conditional recommendations were made in the case of treatments with benefits closely balanced with risks and burden. A conditional recommendation implies the group believes most people would want the recommended course of action.

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.

The group made conditional recommendations for the use of topicalclascoterone, salicylic acid, azelaic acid, oral minocycline, sarecycline, combined oral contraceptives, and spironolactone.

Good clinical practice recommendations include:

  • Using topical therapies combining multiple mechanisms of action
  • Limiting systemic antibiotic use
  • Combining systemic antibiotics with benzoyl peroxide and other topical therapies
  • Utilizing adjuvant intralesional corticosteroid injections

Available evidence was insufficient to develop recommendations for procedures such as chemical peels, laser and light-based devices, microneedling, dietary changes, or alternative therapies such as vitamins or plant-based products, the AAD reported. The workgroup also made a conditional recommendation against adding broadband light to adapalene 0.3% gel.

“These guidelines provide important updates to the 2016 AAD acne guidelines, including discussion of new topical medications, which are directly applied to the skin, and systemic treatments, which are taken by mouth,” said John S. Barbieri, MD, MBA, FAAD, co-chair of the AAD’s Acne Guideline Workgroup, in a press release.2

“This update provides evidence-based recommendations for dermatologists and other clinicians caring for patients with acne.”

References

  1. Reynolds RV, Yeung H, Cheng CE, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. January 30, 2024.DOI:https://doi.org/10.1016/j.jaad.2023.12.017
  2. American Academy of Dermatology issues updated guidelines for the management of acne. News release. The American Academy of Dermatology. January 31, 2024. Accessed February 1, 2024. https://www.aad.org/news/updated-guidelines-acne-management
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