Combination therapy is the way forward for treating moderate-to-mild acne, according to new guidelines from The American Academy of Dermatology.

For example, antibiotics should be used with topical acne therapy, and patients should continue using topical treatments to manage their condition. Once a course of antibiotics is complete,  Additionally, some female patients may see their acne improve with the use of oral contraceptives, which can be combined with other treatments.

The new guidelines appear online in the Journal of the American Academy of Dermatology.

For severe acne or moderate acne that does not respond to other therapy, the guidelines call for oral isotretinoin. Because this medication carries a high risk of birth defects, females must take careful steps to prevent pregnancy while on isotretinoin, and all patients who take the drug must enroll in the federal iPledge program. While some studies have suggested a connection between oral isotretinoin and inflammatory bowel disease or depressive symptoms, the evidence is not conclusive; however, patients should be aware of these risks and carefully follow their doctor’s treatment advice.

There is not enough evidence to recommend other acne treatments  including laser treatments or chemical peels and alternative therapies like tea tree oil.

Some research suggests that dairy products, particularly skim milk, and diets with a high glycemic index, such as those high in sugar and carbohydrates, may be linked to acne,  but there is not enough data to recommend dietary changes for acne patients.

"The updated guidelines published by the AAD reflect the newest data we have in treating acne,” says Joshua Zeichner, MD assistant professor of dermatology and Director of Cosmetic & Clinical Research at Mt Sinai Medical Center in New York City. “In addition to the topical and oral therapies previously addressed, the current guidelines also give guidance on laser and light treatments as well as diet,” says Dr. Zeichner, also a member of the Practical Dermatology advisory board and host of Dermtube journal club.

“The better we understand acne and its optimal treatment strategies the better recommendations we can make for our patients, which ultimately translates to better clinical outcomes.”