Guidelines of care for the management of acne vulgaris
Clinical Summary
View sourceWhat was studied
An evidence-based clinical guideline for acne vulgaris, developed via systematic review using GRADE, covering management in preadolescents (≥9 years), adolescents, and adults.
Key findings
The guideline issues 18 recommendations and 5 good practice statements: strong recommendations for benzoyl peroxide, topical retinoids, topical antibiotics, and oral doxycycline; strong for oral isotretinoin in severe, scarring/psychosocial burden, or refractory acne; conditional for topical clascoterone, salicylic acid, and azelaic acid, and for oral minocycline, sarecycline, combined oral contraceptives, and spironolactone; good practice to combine topical agents with different mechanisms, limit systemic antibiotic use, pair systemic antibiotics with topicals, and add intralesional corticosteroids for larger lesions.
Clinical implications
Use benzoyl peroxide and a topical retinoid (± topical antibiotic) as core therapy; add oral doxycycline when needed, and reserve isotretinoin for severe, scarring/psychosocial burden, or refractory cases. Consider clascoterone, salicylic or azelaic acid, minocycline or sarecycline, combined oral contraceptives, or spironolactone as conditionally recommended options; combine topicals, minimize systemic antibiotic exposure, and use intralesional corticosteroids for large lesions.
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