Acne is a common skin condition that affects millions of people worldwide. In an effort to provide the most up-to-date and effective treatment options for acne, a panel of experts recently drafted an update to the American Academy of Dermatology (AAD) clinical guidelines. These guidelines offer strong recommendations for various treatment approaches, as well as good practice statements to ensure optimal management of acne.
The expert panel made 18 treatment recommendations, categorized as strong or conditional, along with five good practice statements. Among the strong recommendations were antibiotics, benzoyl peroxide, topical retinoids, and oral isotretinoin. These treatments have shown significant efficacy in managing and treating acne. Additionally, the use of fixed-dose topical antibiotics, topical benzoyl peroxide, and topical retinoids were highly recommended by the panel for their effectiveness in addressing acne symptoms.
The updated guidelines highlight the importance of utilizing multimodal therapy in managing acne with topical medications. This approach combines multiple mechanisms of action, resulting in comprehensive treatment and improved outcomes. The guidelines also shine a light on new acne treatments, such as clascoterone and sarecycline, which have shown promise in addressing hormonal causes of acne in both men and women. Payers need to provide coverage for these treatments to ensure patient access.
The AAD’s clinical guidelines have shifted from the Strength of Recommendation Taxonomy (SORT) approach to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. This change aligns the guidelines with international standards, making them more relevant and reliable. The grading system helps clinicians determine the optimal course of action for their patients, considering both benefits and risks.
In addition to the strong recommendations, the expert panel also provided conditional recommendations for various treatment options. The topical agents clascoterone, salicylic acid, and azelaic acid were conditionally recommended, supported by high-level evidence. The use of systemic antibiotics minocycline and sarecycline also received conditional recommendations. The panel advised considering doxycycline over azithromycin due to limited evidence supporting the effectiveness of minocycline in managing acne. Safety concerns associated with minocycline were also emphasized.
For hormonal treatments, the panel conditionally recommended oral contraceptives and spironolactone. Monitoring potassium levels for spironolactone is optional, but it may be useful for patients with risk factors for hyperkalemia. In cases of severe acne, the panel recommended daily isotretinoin dosing over intermittent dosing. The choice between standard isotretinoin or lidose-isotretinoin was also emphasized. The panel advised against adding pneumatic broadband light to adapalene gel and cautioned against the use of trimethoprim-sulfamethoxazole due to severe adverse reactions.
With the release of the updated AAD clinical guidelines, healthcare professionals now have access to comprehensive recommendations for the treatment of acne. Through strong and conditional recommendations, along with good practice statements, the guidelines offer valuable insights into the most effective and safe treatment options available. Clinicians should carefully consider these recommendations to provide optimal care and improve outcomes for patients with acne.
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