American Academy of Dermatology Issues Updated Guidelines for the Management of Acne


New topicals, systemic treatments, and best practices to help guide doctors treating patients with acne.

Acne is the most common skin condition in the United States, affecting nearly 50 million Americans each year, with symptoms usually beginning in puberty. Acne affects 85% of adolescents and can also often begin or continue in adulthood, especially in women. To help ensure that people with acne get the best possible treatment, the American Academy of Dermatology (AAD) has published updated guidelines of care for the management of acne in adults, adolescents, and children over the age of 9 in the Journal of the American Academy of Dermatology.

[[Watch Julie C. Harper, MD, explain how genetic studies of c. acnes could lead to an acne vaccine.]]

"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 board-certified dermatologist John S. Barbieri, MD, MBA, FAAD, 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."

Acne affects 85% of adolescents and can also often begin or continue in adulthood, especially in women.

Updates to the management of acne vulgaris provides 18 evidence-based recommendations for topical, systemic, and physical treatment methods, including newly approved therapeutic options, and 5 good practice statements.

Strong recommendations were made for the use of the following:

  • Topical benzoyl peroxide to reduce the amount of acne-causing bacteria on the skin.
  • Topical retinoids (e.g. adapalene, tretinoin, tazarotene, trifarotene) to help unclog pores and reduce inflammation.
  • Oral antibiotics, such as oral doxycycline, and topical antibiotics to reduce the amount of acne-causing bacteria on the skin and lessen inflammation.
  • Combinations of topical benzoyl peroxide, retinoids, or the above antibiotics

Employing best practices in guideline development, the multidisciplinary workgroup also issued 5 good practice statements:

  • When managing acne with topical medications, the guidelines recommend combining multiple different treatment types, as this can lead to better results.
  • The guidelines recommend limiting use of oral antibiotics when possible to reduce the development of antibiotic resistance and other antibiotic-associated complications.
  • It is recommended that topical and oral antibiotics are used simultaneously with benzoyl peroxide to prevent the development of antibiotic resistance.
  • For patients with larger acne bumps, the guidelines recommend injectable corticosteroids as a potential option for more rapid relief of inflammation and pain.
  • For patients with severe acne or for patients who have failed standard treatment with oral or topical therapy, the guidelines recommend isotretinoin.

[[Watch Guy Webster, MD, PhD, explain how he helps patients manage the potential side effects of isotretinoin.]]

Additionally, the guidelines provide conditional recommendations. Conditional recommendations apply to most patients, but the most appropriate action may differ depending on individual patient factors, including:

  • Topical clascoterone, which addresses hormonal causes of acne.
  • Topical salicylic acid to unclog pores and exfoliate the skin.
  • Topical azelaic acid to unclog pores, kill bacteria, and fade dark spots that may continue when an acne spot clears.
  • Oral minocycline or sarecycline to reduce the amount of acne-causing bacteria on the skin and lessen inflammation. 
  • Hormonal therapies such as combined oral contraceptives or spironolactone to address hormonal causes of acne.

Available evidence was insufficient to develop recommendations for procedures such as chemical peels, laser and light-based devices, microneedling, as well as for dietary changes, or alternative therapies such as vitamins or plant-based products. Additionally, a conditional recommendation against adding broadband light, intense pulsed light, to adapalene 0.3% gel.

"Board-certified dermatologists are on the forefront of new and exciting advances in the treatment of acne," said Dr. Barbieri. "We are able to offer our patients with acne more options than ever before as we work to address their concerns and determine the most effective treatment plan possible. Just as important, dermatologists must have access to all available therapeutic options."

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