Acne is one of the most prevalent skin conditions treated by dermatologists.  It is characterized as a chronic, inflammatory disease that can significantly impact the lives of patients. In January 2024, the American Academy of Dermatology (AAD) released Guidelines of Care for the Management of Acne Vulgaris to offer standardized, evidence-based recommendations for the treatment of acne.

Despite these comprehensive guidelines, the Centers for Disease Control and Prevention (CDC) has noted that dermatologists prescribe more oral antibiotics per clinician than any other specialty, with the majority of these prescriptions being for the treatment of acne. The guidelines recommend systemic antibiotic use be the “shortest duration possible,” ideally no more than 3-4 months, and should be used in conjunction with benzoyl peroxide and other topical treatments. In more severe cases, Accutane may be prescribed. Prolonged use of antibiotics raises significant concerns regarding antibiotic resistance.

In a recent study published in JAMA Dermatology, the researchers explored the reasons behind dermatologists’ frequent and long-term antibiotic prescriptions. Through the use of online surveys and interviews, the researchers found:

“Five salient themes were to be affecting long-term antibiotic prescriptions: perceived lack of evidence to justify change in dermatologic practice, difficulty navigating patient demands and satisfaction, discomfort with discussing contraception, iPLEDGE-related barriers, and the absence of an effective system to measure progress on antibiotic stewardship”.

The study uncovered an intriguing finding: clinicians possess knowledge of antibiotic guidelines, yet they may exhibit reluctance in discontinuing effective medications. The researchers underscore the significance of taking these factors into account when crafting forthcoming outpatient antibiotic stewardship initiatives. This pivotal study prompts curiosity regarding the potential impact on the next guideline revision and the subsequent enhancement of adherence to recommended time limits. Below are the relevant guidelines:

That concludes our Guidelines Spotlight on the Management of Acne Vulgaris. Sign up for alerts and stay informed on the latest published guidelines and articles.

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