American Academy of Dermatology publishes updated care guidelines for acne
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Key takeaways:
- The academy released strong recommendations for isotretinoin, doxycycline and other treatments.
- Clascoterone, sarecycline, minocycline, spironolactone and other therapies received conditional recommendations.
The American Academy of Dermatology has released new care guidelines for acne vulgaris, according to a press release.
Published in the Journal of the American Academy of Dermatology, these guidelines are an update to the AAD’s 2016 acne guidelines and include 18 recommendations for topical and systemic therapies and five good practice statements.
According to John Barbieri, MD, MBA, assistant professor at Harvard Medical School, director of the advanced acne therapeutics clinic at Brigham and Women’s Hospital, associate editor of JAMA Dermatology and co-chair of the AAD Acne Guidelines Work Group, the new guidelines provide important recommendations for novel acne treatments.
Two of the many recommendations worth highlighting include clascoterone and sarecycline therapy, according to Barbieri.
“Clascoterone is the first FDA-approved treatment that can address hormonal causes of acne in both men and women,” Barbieri told Healio. “Sarecycline is a narrow-spectrum tetracycline that might have some advantages over other tetracycline such as doxycycline and minocycline.”
“It will be important for dermatologists to have access to these valuable new treatments,” Barbieri adds.
New recommendations were also released regarding doxycycline and minocycline.
“Minocycline and doxycycline are currently prescribed in roughly equal proportions for the management of acne,” Barbieri explained. “However, while there is no evidence to suggest minocycline is more effective than doxycycline, it can be associated with rare but serious side effects.”
According to Barbieri, these serious adverse events may include vestibular dysfunction, autoimmune hepatitis, drug-induced lupus and drug reaction with eosinophilia and systemic symptoms. As a result, the academy released a strong recommendation in favor of doxycycline while releasing a conditional recommendation for minocycline.
“We should consider whether reducing use of minocycline might be beneficial to our overall care of patients with acne,” Barbieri added.
The authors also discussed that the use of trimethoprim-sulfamethoxazole, a systemic antibiotic, should be limited due to serious adverse events including Stevens-Johnson syndrome/toxic epidermal necrolysis and acute respiratory failure.
Oral isotretinoin received a strong recommendation for severe acne, acne causing psychosocial burden or scarring, or acne failing standard treatment with oral or topical therapy, whereas spironolactone received a conditional recommendation.
The authors have deemed that frequent laboratory monitoring for young, healthy patients on either isotretinoin or spironolactone is not a high-value practice.
“The updated guidelines provide specific recommendations about laboratory monitoring that can help clinicians and patients who are interested in less frequent monitoring feel more comfortable with these approaches,” Barbieri said.
According to Barbieri, there seems to be a common misconception that a “conditional recommendation” suggests a treatment is less valuable or should not be prescribed. However, the committee would like to make it clear that this is not the case.
“With the Grading of Recommendations Assessment, Development and Evaluation approach, it is expected that many recommendations will be conditional,” Barbieri said. “We think these are also good treatments and a conditional recommendation does not mean they should not be used. It is important that dermatologists have access to these important treatments as well.”
Reference:
- American Academy of Dermatology issues updated guidelines for the management of acne. https://www.aad.org/news/updated-guidelines-acne-management. Published Jan. 31, 2024. Accessed Feb. 6, 2024.
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