Evidence-Based Guidelines for Managing Acne: Updates from AAD

The updated 2024 guidelines from the American Academy of Dermatology (AAD) aim to provide clinicians with evidence-based strategies for effective management of acne. They outline 18 recommendations and five good practice statements, reflecting advancements since the prior 2016 guidelines. Here’s a brief overview of the guidelines.

Scope and Pathogenesis

Acne is derived from a complex interplay of factors, including follicular hyperkeratinization, microbial colonization (primarily Cutibacterium acnes), sebum production, and inflammatory pathways. It manifests as comedones, papules, pustules, or nodules, which can lead to erythema, hyperpigmentation, or scarring.

Psychological impacts such as depression, anxiety, and reduced quality of life underscore the need for tailored therapeutic interventions.

Recommendations Overview

The guidelines endorse topical therapies as foundational acne treatments and recommend:

• Benzoyl peroxide (BP) and retinoids like tretinoin, adapalene, tazarotene, and trifarotene because of their comedolytic and anti-inflammatory properties. Fixed-dose combinations of BP with topical retinoids or antibiotics are particularly effective.
• Conditional use of agents like clascoterone, salicylic acid, and azelaic acid, which target specific aspects of acne pathogenesis.

Systemic antibiotic recommendations include:

• Oral doxycycline for moderate-to-severe cases.
• Minocycline and sarecycline for conditional use due to their side effect profiles and cost considerations.
• Limiting the duration of systemic antibiotic use to prevent resistance.

In addition to indicating that regular potassium monitoring is generally unnecessary for individuals on hormone therapy, the guidelines suggest:

• Conditional use of combined oral contraceptives for females, leveraging their anti-androgenic effects.
• Conditional use of spironolactone, particularly for patients with hormonally driven acne.

Considerations for oral isotretinoin include:

• Use for severe or refractory acne only.
• Emphasis on pregnancy prevention and monitoring of lipid levels and liver function during treatment.

In terms of adjunctive and alternative therapies, the guidelines recommend:

• Intralesional corticosteroids for severe inflammatory lesions.
• Conditional use of physical modalities like chemical peels and light therapy.

These updated guidelines provide a robust framework for managing acne. They also emphasize shared decision-making to ensure treatments align with patient preferences, costs, and individual clinical scenarios.

By integrating evidence-based strategies with patient-centered care, dermatologists can effectively address the physical and psychosocial burdens of acne.

Reference:

Reynolds RV, Yeung H, Cheng CE, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2024;90(5):1006.e1-1006.e30. doi:10.1016/j.jaad.2023.12.017