Newest Guidelines for the Treatment of Acne

Neil H. Shear, MD, FRCPC, FACP,

Professor and Chief of Dermatology, Professor of Medicine, Pediatrics and Pharmacology, University of Toronto Faculty of Medicine; Head of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON.

CLINICAL TOOLS

Abstract: This article summarizes key statements from the 2009 Global Alliance to Improve Outcomes in Acne Group's therapeutic guidelines, published as a supplement in the Journal of the American Academy of Dermatology (JAAD). It offers an algorithm for acne treatment, as well as addresses important statements from the committee on acne pathophysiology, epidemiology, and the latest research findings, as they pertain to the guidelines.
Key Words: acne, treatment guidelines, adherence, antibiotic resistance, maintenance.
Dermatologists should be actively contributing to educating other clinicians that acne is a chronic disease.
Despite many extensive educational programs, the committee sees an ongoing need to urgently reduce the use of antimicrobial therapies, especially as single agents.
A combination of a topical retinoid plus an antimicrobial agent is first-line therapy for most patients with acne (a finding based on clinical trials with over 16,000 total subject participants in studies of Level I evidence quality), as it targets multiple pathogenic features and both inflammatory and noninflammatory acne lesions.
The Global Alliance 2009 update affirms that topical retinoids should be fundamentally a core component of an acne therapy regimen for stages I to III. The committee's consensus is that early and appropriate treatment, continued for as long as necessary, is the best approach to mitigating scarring for acne patients.
Implement strategies to improve adherence to therapy (e.g., medication reminders, self-monitoring with diaries, support groups, telephone follow-up) to ensure success.
Treat acne as quickly and as efficiently as possible to achieve the best therapeutic outcomes, and to improve patient satisfaction, limit treatment expenses, and mitigate scarring.
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