SOURCE: Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol 2016:74:945-973.
There are updated guidelines on the management of acne in adolescents and adults from the American Academy of Dermatology. A multidisciplinary team, which included representatives from dermatology, primary care, pediatrics, and an acne patient participant, generated the guidelines. While it’s not possible to adequately summarize this lengthy document in a few words, several noteworthy principles merit sharing with all primary care clinicians who address acne in their practices.
For mild acne, recommended first-line treatments include benzoyl peroxide, topical retinoids, and topical antibiotics (clindamycin preferred), with topical dapsone considered an alternative. Topicals may be used as monotherapy, dual, or even triple combination, except for topical antibiotics, which are not recommended as monotherapy due to emergence of bacterial resistance. For moderate acne, monotherapy is not considered first line; rather, dual or even triple combination topicals (benzoyl peroxide, antibiotics, retinoids), oral antibiotics plus dual/triple topicals, or (for women) oral contraceptives and spironolactone are options. Although not a usual treatment, isotretinoin becomes a consideration when moderate-to-severe acne has not responded to first-line treatments. Systemic antibiotics (e.g., doxycycline, TMP/SMX, azithromycin, cephalexin) are useful in moderate-to-severe acne, and are recommended to be used in combination with benzoyl peroxide and topical retinoids (but not in combination with topical antibiotics). Tetracycline is the preferred antibiotic class. The new guidelines provide a useful template on which to plan management of acne at all levels of severity.