Research Summary

AAD Updates Care Guidelines for Management of Acne Vulgaris

Anthony Calabro, MA

The American Academy of Dermatology (AAD) recently updated its 2016 guidelines for the management of acne vulgaris in adults, adolescents, and children aged 9 years and older.

The newly updated guidelines, written by the AAD’s Acne Guideline Workgroup, provide 18 evidence-based recommendations for managing acne vulgaris as well as five good practice statements. The recommendations ranged from strong to conditional, with strong recommendations indicating that the benefits of a treatment clearly outweigh the risks. Conditional recommendations were made for those treatments where the benefits balanced with the risks of use. Although conditional recommendations for treatment would apply to most patients, some patients may warrant a different option depending on certain factors.

The workgroup focused on FDA-approved acne treatments and those commonly used in the United States. Medication-induced acne, infantile to mid-childhood acne, and acne-induced hyperpigmentation and scarring were considered beyond the scope of the updated guidelines.

“We examined evidence based on a systematic review of the literature on acne grading and classification, laboratory testing, and treatment using topical therapies, systemic antibiotics, hormonal agents, oral isotretinoin, physical modalities, complementary and alternative medicine, and dietary and environmental interventions,” the workgroup wrote.

Of the workgroup's evidence-based recommendations, they strongly recommended the use of topical benzoyl peroxide, retinoids, and/or antibiotics and their fixed-dose combinations, and oral doxycycline.

The workgroup’s five good practice statements included recommending:

  • Multimodal therapy for managing acne with topical medications.
  • Limiting the use of systemic antibiotics to reduce antibiotic resistance and other antibiotic-associated complications.
  • Using systemic antibiotics concurrently with benzoyl peroxide and other topical therapy.
  • Using intralesional corticosteroid injections as adjuvant therapy for those with large acne papules or nodules.
  • Using isotretinoin for patients with severe acne or those who previously used standard oral or topical therapies with no improvement.

The workgroup noted some limitations, including excluding studies published in other languages in their systematic review. Additionally, the review included only randomized clinical trials, which may have excluded studies with longer-term follow-up data.

 

Reference:
Reynolds RV, Yeung H, Cheng CE, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. Published online January 30, 2024. Accessed February 8, 2024. doi:10.1016/j.jaad.2023.12.017