Management of Acne Vulgaris
Publication Date: January 31, 2024
Last Updated: April 10, 2024
Topical Agents
When managing acne with topical medications, we recommend multimodal therapy combining multiple mechanisms of action. (U, CC)
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For patients with acne, we recommend benzoyl peroxide. (S, M )
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For patients with acne, we recommend topical retinoids. (S, M )
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For patients with acne, we recommend topical antibiotics. (S, M )
Remark: Topical antibiotic monotherapy is not recommended.
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For patients with acne, we conditionally recommend clascoterone. (C, H )
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For patients with acne, we conditionally recommend salicylic acid. (C, L )
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For patients with acne, we conditionally recommend azelaic acid. (C, M )
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For patients with acne, we recommend fixed dose combination topical antibiotic with benzoyl peroxide. (S, M )
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For patients with acne, we recommend fixed dose combination topical retinoid with topical antibiotic. (S, M )
Remark: Concomitant use of benzoyl peroxide is recommended to prevent the development of antibiotic resistance.
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For patients with acne, we recommend fixed dose combination topical retinoid with benzoyl peroxide. (S, M )
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Systemic antibiotics
For patients with acne, we recommend doxycycline. (S, M )
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For patients with acne, we conditionally recommend minocycline. (C, M )
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For patients with acne, we conditionally recommend sarecycline. (C, H )
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For patients with acne, we conditionally recommend doxycycline over azithromycin. (C, L )
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For patients with acne, we recommend limiting use of systemic antibiotics when possible to reduce the development of antibiotic resistance and other antibiotic associated complications. (U, CC)
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It is recommended that systemic antibiotics are used concomitantly with benzoyl peroxide and other topical therapy. (U, CC)
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Hormonal agents
For patients with acne, we conditionally recommend combined oral contraceptive pills. (C, M )
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For patients with acne, we conditionally recommend spironolactone. (C, M )
Remark: Potassium monitoring is not needed in healthy patients. However, consider potassium testing for those with risk factors for hyperkalemia (e.g., older age, medical comorbidities, medications).
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For patients with larger acne papules or nodules, we recommend intralesional corticosteroid injections as an adjuvant therapy. (U, CC)
Remark: Intralesional corticosteroid injections should be used judiciously for patients who are at risk of acne scarring and/or for rapid improvement in inflammation and pain. Using a lower concentration and volume of corticosteroid can minimize the risks of local corticosteroid adverse events.
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Isotretinoin
For patients with severe acne or for patients who have failed standard treatment with oral or topical therapy, we recommend isotretinoin. (U, CC)
Remark: Acne patients with psychosocial burden or scarring should be considered as having severe acne and to be candidates for isotretinoin. For patients undergoing treatment with isotretinoin, monitoring of LFTs and lipids should be considered, but CBC monitoring is not needed in healthy patients. Population-based studies have not identified increased risk of neuropsychiatric conditions or inflammatory bowel disease in acne patients undergoing treatment with isotretinoin. For persons of childbearing potential, pregnancy prevention is mandatory.
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For patients with severe acne, we conditionally recommend traditional daily dosing of isotretinoin over intermittent dosing of isotretinoin. (C, L )
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For patients prescribed isotretinoin, we conditionally recommend either standard isotretinoin or lidose-isotretinoin. (C, H )
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Physical modalities
For patients with acne, we conditionally recommend against adding pneumatic broadband light to adapalene 0.3% gel. (C, L )
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Algorithm
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Title
Management of Acne Vulgaris
Authoring Organization
American Academy of Dermatology
Publication Month/Year
January 31, 2024
Last Updated Month/Year
February 1, 2024
External Publication Status
Published
Country of Publication
US
Document Objectives
The objective of this study was to provide evidence-based recommendations for the management of acne. This guideline presents 18 evidence-based recommendations and 5 good practice statements. Strong recommendations are made for benzoyl peroxide, topical retinoids, topical antibiotics, and oral doxycycline. Oral isotretinoin is strongly recommended for acne that is severe, causing psychosocial burden or scarring, or failing standard oral or topical therapy. Conditional recommendations are made for topical clascoterone, salicylic acid, and azelaic acid, as well as for oral minocycline, sarecycline, combined oral contraceptive pills, and spironolactone. Combining topical therapies with multiple mechanisms of action, limiting systemic antibiotic use, combining systemic antibiotics with topical therapies, and adding intralesional corticosteroid injections for larger acne lesions are recommended as good practice statements.
Target Patient Population
Patients with acne vulgaris
Target Provider Population
Dermatologists and other clinicians caring for patients with acne vulgaris
Inclusion Criteria
Male, Female, Adolescent, Adult, Child
Health Care Settings
Ambulatory, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Treatment, Management
Diseases/Conditions (MeSH)
D013256 - Steroids, D013754 - Tetracyclines, D000152 - Acne Vulgaris, D000287 - Administration, Topical
Keywords
acne, acne vulgaris, acne management, topical antibiotics, antibiotics
Source Citation
Rachel V. Reynolds, Howa Yeung, Carol E. Cheng, Fran Cook-Bolden, Seemal R. Desai, Kelly Druby, Esther E. Freeman, Jonette E. Keri, Linda F. Stein Gold, Jerry K.L. Tan, Megha M. Tollefson, Jonathan S. Weiss, Peggy A. Wu, Andrea L. Zaenglein, Jung Min Han, John S. Barbieri, Guidelines of care for the management of acne vulgaris, Journal of the American Academy of Dermatology, 2024, ISSN 0190-9622, https://doi.org/10.1016/j.jaad.2023.12.017.
Methodology
Number of Source Documents
312
Literature Search Start Date
May 1, 2021
Literature Search End Date
November 1, 2022