American Academy of Dermatology presents new acne treatment guidelines
12 Feb 2024 --- The American Academy of Dermatology (AAD) releases updated guidelines for managing acne vulgaris, intending to ensure that patients receive the best possible treatment that are applicable to children over nine, adolescents and adults.
“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,” says board-certified dermatologist John S. Barbieri, co-chair of the AAD’s Acne Guideline Workgroup.
“This update provides evidence-based recommendations for dermatologists and other clinicians caring for patients with acne.” The updated recommendations are published in the Journal of the American Academy of Dermatology.
The organization flags that acne affects nearly 50 million US citizens annually, especially teens experiencing puberty.
Favored treatments
Together with five “good practice” suggestions, the updated guidelines contain 18 evidence-based recommendations for topical, systemic and physical treatment approaches.
AAD strongly recommends topical benzoyl peroxide, topical retinoids, oral antibiotics, and combinations.AAD strongly recommends topical benzoyl peroxide, topical retinoids, oral antibiotics and combinations.
Topical benzoyl peroxide reduces the number of acne-causing bacteria on the skin. Meanwhile, topical retinoids, such as adapalene, tretinoin, tazarotene and trifarotene, unclog pores and reduce inflammation, according to AAD. Antibiotic oral doxycycline and topical antibiotics also reduce acne-causing bacteria and inflammation.
Conditional recommendations
AAD presents conditional recommendations covering various treatments, such as topical clascoterone, salicylic acid, azelaic acid and hormonal therapies. They are recommended for most patients, with individual factors determining the most appropriate action.
According to the organization, topical clascoterone addresses the hormonal causes of acne, salicylic acid unclogs pores and exfoliates the skin and azelaic acid unclogs pores, kills bacteria and fades dark acne spots. Also, oral minocycline or sarecycline are said to reduce the amount of acne-causing bacteria on the skin and reduce inflammation.
AAD suggests another treatment for hormonal acne — combined oral contraceptives or spironolactone.
Best practices
The guidelines emphasize using multiple treatment types to achieve better results and limiting the use of oral antibiotics to prevent antibiotic resistance.
To stop antibiotic resistance from forming, benzoyl peroxide should be used in conjunction with topical and oral antibiotics, according to AAD.
The guidelines suggest injectable corticosteroids as a possible option for faster pain and inflammation relief for patients with larger acne bumps. It also recommends isotretinoin for patients who have severe acne or who have not responded to standard oral or topical therapy.
Although AAD lists several treatments, it recognizes that there is not enough evidence to support procedures like chemical peels, light- and laser-based devices, microneedling, dietary modifications or alternative therapies.
Moreover, the conditional recommendation from AAD suggests against mixing broadband light or intense pulsed light with 0.3% adapalene gel.
Edited by Venya Patel
